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Pillay SC, Redant R, Umuneza N, Hoosen A, Breytenbach F, Haffejee S, Matsena-Zingoni Z, Sekome K. Factors affecting length of hospital stay in stroke survivors in South Africa: A call for a stroke unit. Afr J Disabil 2022; 11:1065. [PMID: 36567925 PMCID: PMC9772707 DOI: 10.4102/ajod.v11i0.1065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/04/2022] [Indexed: 12/23/2022] Open
Abstract
Background Stroke in Africa is a growing and neglected crisis with the incidence more than doubling in low- to middle-income countries in the last four decades. Despite this growing threat, implementation of stroke models of care in hospitals is lacking. Stroke units as a model of care have been shown to decrease mortality, reduce length of hospital stay (LOS) and improve outcomes in stroke survivors. Objectives To determine the profile of stroke survivors and identify factors contributing to LOS at Chris Hani Baragwanath Academic Hospital (CHBAH) in South Africa to support stroke unit implementation. Method This study involved a retrospective record review of stroke survivors admitted to CHBAH between September 2018 and May 2019. Factors associated with LOS were determined using linear regression models; univariate and multiple regression models were fitted. Results A total of 567 participants' data were included. Overall, 51.85% of the participants required services from all rehabilitation disciplines. The median LOS was 9 days (interquartile ranges [IQR]: 5-11 days) with each discipline providing an average of six sessions. Participants who were referred to the rehabilitation team 3 days after admission to hospital stayed 6 days longer compared with those participants who were referred earlier (p < 0.001). Conclusion Delayed referral to the rehabilitation team resulted in increased LOS. This study supports the need for dedicated stroke units to decrease hospital LOS and improve patients' outcomes by ensuring early, well-coordinated rehabilitation intervention and discharge planning. Contribution The study highlights the urgency for re-evaluation of stroke care infrastructure within Gauteng to streamline and provide accessible stroke models of care.
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Affiliation(s)
- Stephanie C. Pillay
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Roxann Redant
- Department of Occupational Therapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nadia Umuneza
- Department of Physiotherapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Azra Hoosen
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Fiona Breytenbach
- Department of Occupational Therapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Sameera Haffejee
- Department of Physiotherapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Kganetso Sekome
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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Mark O'Meara R, Ganas U, Hendrikse C. Access to acute stroke care: A retrospective descriptive analysis of stroke patients' journey to a district hospital. Afr J Emerg Med 2022; 12:366-372. [PMID: 36032786 PMCID: PMC9399483 DOI: 10.1016/j.afjem.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/22/2022] [Accepted: 07/24/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction The burden of stroke in Africa has increased in the last two decades, with the population undergoing a rapid epidemiological transition, with a rise in the incidence of stroke risk factors together with the gradual aging of the population. Evidence-based guidelines for acute stroke care are often not feasible in resource challenged settings but even when resources are available, considerable delays to definitive care exists. This study aims to describe the factors that influence time from symptom onset to hospital arrival in patients that present to a district level hospital Emergency Centre with confirmed ischaemic strokes. Methods A descriptive analysis was performed using a retrospective folder and database review. All adult patients with a confirmed ischaemic stroke, on Computed Tomography (CT) scan, presenting to Mitchells Plain Hospital Emergency Centre during the study period of 12 months (1st of January 2019 to 31st of December 2019), were eligible for inclusion. Data were collected from existing electronic patient databases and the time from onset of symptoms to hospital arrival was extracted from the clinical notes. Results A total of 730 (2%) patients presented with a diagnosis of stroke, of which 381 (52%) were included (CT confirmed ischaemic strokes). Only 48 (13%) presented within 4.5 h of symptom onset and the median time from onset of symptoms to presentation to the hospital was 24 h (IQR 12-72 h). The majority of patients (31%) arrived via a primary public emergency medical service (EMS) call, while 29% presented directly to the hospital as self-referrals with private transport. Primary public EMS calls had the shortest call-to-hospital-arrival time (1 hour and 31 minutes), even though the median time from symptom onset to hospital arrival was still 16 h. Conclusion The median time from symptom onset to hospital arrival for patients with stroke symptoms is much longer than what evidence-based guidelines suggest. The chain of survival for emergency stroke care is only as strong as its weakest link and the data from this study suggest that improvement campaigns should target stroke education and access to care.
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Affiliation(s)
- Ryan Mark O'Meara
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Ushira Ganas
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Clint Hendrikse
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Okekunle A, Asowata O, Akinpeloye O, Olahan R, Ayodele A, Olaleye B, Akanni O, Akpa O. Community-based Investigation of the Risk Factors for Cardiovascular Diseases in Ibadan and suburbs (COMBAT-CVDs): Design and Methods. AFRICAN JOURNAL OF BIOMEDICAL RESEARCH : AJBR 2022; 25:265-271. [PMID: 35812130 PMCID: PMC9265233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Africa is gradually becoming the epicentre for the burden of cardiovascular diseases (CVDs) worldwide, and community-based data alluding to the pattern and dynamics of escalating epidemiological thresholds of CVDs among indigenous Africans are limited. This manuscript focuses on the design and methods of Community-based Investigation of the Risk Factors for Cardiovascular Diseases in Ibadan and suburbs (COMBAT-CVDs), an ongoing community-based door-to-door study assessing the profile, burden and dynamics of CVDs risk factors among residents of Ibadan and suburbs. COMBAT-CVDs is a cohort of community-dwelling indigenous Africans, males and females, ≥18years from ten communities in Ibadan, Nigeria. The recruitment of participants for the first wave (W0) started in 2020, covering; questionnaire administration and physical examination. The World Health Organization's STEPS Instrument for Chronic Disease Risk Factor Surveillance was used for data collection. Data were collected on sociodemographic, socioeconomic and lifestyle-related characteristics, history of CVDs, stress, depression and sleep quality. Also, anthropometric and blood pressure measures were conducted by trained personnel using standard operating procedures and instruments. Data collection for the second wave is underway, and the collection of blood and other biological samples for genetic epidemiology is planned, subject to availability of funds. For the W0 recruitment, a total of 3638 community-dwelling adults (males - 54.6% and females - 45.4%) participated with a ≥99.7% response rate. The COMBAT-CVDs will likely provide novel data, insightful characterization of CVDs risk factors and evidence for context-specific and culturally relevant interventions for the community-based prevention and management of CVDs among Africans in this setting.
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Affiliation(s)
- A.P. Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- The Postgraduate College, University of Ibadan, Ibadan, 200284, Nigeria
| | - O.J. Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O.J. Akinpeloye
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - R. Olahan
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A.E. Ayodele
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - B.J. Olaleye
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O.O. Akanni
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Public Health, Lead City University, Ibadan, Nigeria
| | - O.M. Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- The Postgraduate College, University of Ibadan, Ibadan, 200284, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, 200284 Ibadan, Nigeria
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