Stroke care in Africa: A systematic review of the literature
Gerard Urimubenshia b c d✉, Dominique Ann-Michele Cadilhace f, Jeanne Kagwizaa c, Olívia Wug h, Peter Langhorneb d
- a<!---->College of Medicine and Health Sciences, University of Rwanda<!---->, Kigali, Rwanda
- b<!---->Institute of Cardiovascular and Medical Sciences, University of Glasgow<!---->, Glasgow, UK
- cCollege of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- dInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- eStroke Division, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, Victoria, Australia
- fStroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Clayton, Australia
- gInstitute of Health and Wellbeing, <!---->University of Glasgow<!---->, Glasgow, UK
- hInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- ✉Corresponding author
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Abstract
Background Appropriate systems of stroke care are important to manage the increasing death and disability associated with stroke in Africa. Information on existing stroke services in African countries is limited. Aim To describe the status of stroke care in Africa. Summary of review We undertook a systematic search of the published literature to identify recent (1 January 2006-20 June 2017) publications that described stroke care in any African country. Our initial search yielded 838 potential papers, of which 38 publications were eligible representing 14/54 African countries. Across the publications included for our review, the proportion of stroke patients reported to arrive at hospital within 3 h from stroke onset varied between 10% and 43%. The median time interval between stroke onset and hospital admission was 31 h. Poor awareness of stroke signs and symptoms, shortages of medical transportation, health care personnel, and stroke units, and the high cost of brain imaging, thrombolysis, and outpatient physiotherapy rehabilitation services were reported as major barriers to providing best-practice stroke care in Africa. Conclusions This review provides an overview of stroke care in Africa, and highlights the paucity of available data. Stroke care in Africa usually fell below the recommended standards with variations across countries and settings. Combined efforts from policy makers and health care professionals in Africa are needed to improve, and ensure access, to organized stroke care in as many settings as possible. Mechanisms to routinely monitor usual care (i.e., registries or audits) are also needed to inform policy and practice.
TL;DRCombined efforts from policy makers and health care professionals in Africa are needed to improve, and ensure access, to organized stroke care in as many settings as possible. (Semantic Scholar)