Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa – A survey based approach

Lin, Chen; Vakani, Ravi; Kussin, Peter S.; Guhwe, Mary; Farjat, Alfredo E.; Choudhury, Kingshuk Roy; Renner, David; Oduor, Chrispine; Graffagnino, Carmelo

doi:10.1016/j.jocn.2017.04.013

Cited by 7 publications

(9 citation statements)

References 3 publications

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“…Inpatient stroke centres in the United States and other high-resourced settings use protocols to reduce the risk of post stroke aspiration pneumonia, such as early swallow screening, nil per os (NPO), and Nasogastric tube (NGT) feeding in patients with prohibitive dysphagia, but resource-limited settings often lack adequate human resource for close nursing care and swallowing therapists to ensure safe nutrition after an acute neurologic insult that impairs mental status or oropharyngeal coordination (74,75). In sub-Saharan Africa, limited access to NGTs, parenteral feeding formulae, food texture change, difficulty to elevate the (head-of-bed) HOB in many hospitals, and vigorous oral feeding by bedside family caregivers may increase risk of aspiration.…”

Section: Discussionmentioning

confidence: 99%

Predictors of a 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal Observational Study

Chongolo

Alphonce

Mbelele

et al. 2023

Preprint

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BackgroundStroke is the leading cause of disability and the second most common cause of death after ischemic heart disease worldwide. A better understanding of the predictors of early post-stroke mortality provides opportunity for interventions that promote favourable post-stroke outcomes.ObjectiveThis study aimed to determine incidence and risk factors associated with 30-day mortality among adult patients admitted with first episode of stroke at referral hospitals in Dodoma.MethodsThe study employed a prospective longitudinal observational design. Adult patients with confirmed acute stroke by Computed Tomography scan or Magnetic Resonance Imaging, admitted to Dodoma Referral Hospitals were enrolled in the study. The National Institute of Health Stroke Scale was used to assess stroke severity at baseline. A comparison of risk factors, clinical profiles, and mortality was done using the Chi-square test. A binomial logistic regression model was used to determine the predictors of 30 days mortality in patients with stroke while 30-days probability of survival was estimated using Kaplan-Meier analysis.ResultsOut of 226 patients with first-ever stroke, 121(54%) were males and the population mean age was 63(15) years. 140(62%) had Ischaemic stroke subtype, and 154(68%) survived at 30 days of stroke after admission. Patient with history of smoking 2.4 [95% CI (1.0 - 5.6), p = 0.048], loss of consciousness 2.7 [95% CI (1.2 - 6.4; p = 0.019] and unequal pupil size 13.7 [95% CI (4.1 - 58.1, p < 0.001 were significantly more associated with mortality within 30-days. The median survival was 7 (3-9) days, whereas alcohol drinkers and those aged above 60 years had a shorter time to mortality compared to non-alcohol drinkers and those aged < 60 years.ConclusionThe study reveals high incidence of mortality within 30 days after the first episode of stroke, with the highest proportion die within seven days of being hospitalized. Advanced age of 60 years and above, smokers, alcoholic users, and severe stroke at admission warrant special attention. remains the most catastrophic and disabling conditions, with profound residual impairment and a high fatality rate, that puts a significant strain on community health expenditures as well as patients and their families (1–3). Globally, after ischemic heart disease, stroke is the second leading cause of mortality accounting for 11.8% of total deaths (4). Most of stroke related deaths occur in developing countries, accounting for about 87% of stroke deaths (5). Worldwide, one out of six persons will experience a stroke in their lifetime, with 5 to 10% of all stroke victims being under the age of 50 (6). In a 2004-2006 Tanzanian population-based study, the crude stroke incidence was 107.9 per 100,000 for urban and 94.5 per 100,000 for rural areas, and 315.9 and 108.6 per 100,000 for rural and urban respectively following age standardization (7); interestingly, the study highlighted higher incidence of stroke in urban Tanzania compared to developed countries(7).The most common conventional risk factors for stroke in Africa are hypertension, diabetes, smoking, a sedentary lifestyle, sickle cell disease, African race, an increasing in ageing population and alcohol abuse (8). Meanwhile, over 80% of published studies in Sub-Saharan Africa (SSA) identify hypertension as the most frequently identified risk factor (9). Both the rapid rise of hypertension and the poor control of blood pressure in Africa contribute to an increase in haemorrhagic stroke, which has a worse outcome than ischemic stroke (10,11).Thirty-day stroke mortality ranges between 3.1 to 9.7 % in high-income countries (12–14); however, it remains higher in Sub-Saharan Africa, ranging between 27 and 46% (7,15–17). Because of a lack of specialized facilities like stroke units, low- and middle-income countries have a greater stroke death rate than industrialized nations(18). Other predictors include premorbid conditions such as diabetes mellitus, advanced age, the severity of stroke on admission, haemorrhagic type of stroke, and infections (5,19,20). Two previous studies done in Tanzania reported a 33.3% and 61.3% in hospital stroke fatality rates, mortality rate was significantly higher in patients with septicaemia, age above 45 years, and aspiration pneumonia(21)Given the high global prevalence of stroke, there is limited information on the epidemiology, prevention, treatment, and outcome of stroke in African settings and other LMICs (3,22); therefore, limiting the baseline evidence for designing interventions to reduce this burden in developing countries (23). Consequently, the purpose of this study was to determine predictors of early mortality among adult patients admitted with first episode of stroke in referral hospitals in Dodoma.

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Section: Discussionmentioning

confidence: 99%

Predictors of a 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal Observational Study

Chongolo

Alphonce

Mbelele

et al. 2023

Preprint

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“…[5][6][7][8] Although inpatient stroke centers in the United States and other high-resourced settings commonly use protocols to minimize the risk of PSAP, such as early swallow screening, NPO, and NGT feeding in patients with prohibitive dysphagia, resource-limited settings often lack sufficient nursing care and swallowing therapists to ensure safe nutrition after an acute neurologic insult that impairs mental status or oropharyngeal coordination. 18,19 Additional factors in sub-Saharan Africa, including limited access to NGTs, enteral feeding formulas, and food texture modification, inability to elevate the HOB in many hospital settings, and aggressive oral feeding by bedside family caregivers, may further contribute to aspiration risk.…”

Section: Discussionmentioning

confidence: 99%

Aspiration Pneumonia in Adults Hospitalized With Stroke at a Large Academic Hospital in Zambia

et al. 2021

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Introduction:Preventing complications of stroke such as post-stroke aspiration pneumonia (PSAP) may improve stroke outcomes in resource-limited settings. We investigated the incidence and associated mortality of PSAP in Zambia.Methods:We conducted a prospective cohort study of adults with stroke at University Teaching Hospital (Lusaka, Zambia) between 12/2019-3/2020. NIH Stroke Scale, Glasgow Coma Scale, Modified Rankin Scale scores, and nine indicators of possible PSAP were collected serially over each participant’s admission. PSAP was defined as ≥4 indicators present, and possible PSAP as 2-3 present. T-tests and chi-square tests were used to compare clinical parameters across PSAP groups. Logistic regression was used to assess the relative effects of age, sex, PSAP status, and initial stroke severity on inpatient mortality.Results:We enrolled 125 participants. Mean age was 60±16 years, 61% were female, 55% of strokes were ischemic, and baseline NIH Stroke Scale was 19.7±8.7. Thirty-eight (30%) had PSAP, and 32 (26%) had possible PSAP. PSAP was associated with older age and more adverse stroke severity scores. Fifty-nine percent of participants with PSAP died, compared to 39% with possible PSAP and 8% with no PSAP. PSAP status independently predicted inpatient mortality after controlling for age, sex, and initial stroke severity. Swallow screening was not performed for any participant.Conclusion:PSAP is common and life-threatening in Zambia, especially among older participants with severe stroke presentations. PSAP was associated with significantly increased mortality independent of initial stroke severity, suggesting that interventions to mitigate PSAP may improve stroke outcomes in Zambia and other resource-limited settings.

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“…The phenomenon is universal; studies have explored ED personnel from diverse countries, including the U.S. [ 23 , 32 , 33 , 34 , 35 ], Great Britain [ 31 ], Scandinavia [ 21 , 25 ], India [ 30 ], Kenya [ 36 ], Saudi Arabia [ 27 , 28 ], and Australia [ 24 , 26 ]. These countries have different management approaches and various levels of stroke care.…”

Section: Introductionmentioning

confidence: 99%

Knowledge on Stroke Recognition and Management among Emergency Department Healthcare Professionals in the Republic of Cyprus

Rossis,

Michail,

Middleton

et al. 2023

Healthcare

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Stroke is a global leading cause of death and disability. Knowledge of related guidelines is crucial for emergency department (ED) staff, influencing early diagnosis and timely treatment. We investigated Greek Cypriot ED healthcare professionals’ (nurses and physicians) knowledge in recognizing and managing stroke. A descriptive cross-sectional study spanned November 2019 to April 2020, encompassing four private and seven public EDs in the Republic of Cyprus. The data were collected through a self-reported questionnaire developed by the research team, consisting of 37 questions. Eight questions focused on sociodemographic and employment characteristics, twenty-eight assessed knowledge in stroke recognition and management (each item was equally weighted without deliberate prioritization), and one question addressed self-assessment of knowledge in stroke care. A total of 255 nurses (response rate (RR): 74.1%) and 26 physicians (RR: 47.3%) completed the questionnaire. The average correct response rate was 12.9 out of 28 statements (SD: 4.2), with nurses and physicians scoring 12.6 (SD: 4.1) and 15.7 (SD: 4), respectively. Work experience significantly influenced stroke knowledge, with all groups demonstrating superiority over those with less than one year of experience. Participants with previous training scored an average of 1.45 additional correct answers while educational attainment did not significantly influence stroke knowledge. Investigating stroke knowledge among emergency department nurses and physicians in the Republic of Cyprus revealed significant deficits. This study stresses targeted interventions, including education, yearly examinations, workshops with hands-on training, and repeated training, to address these gaps and enhance the overall stroke care capabilities of the healthcare professionals.

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Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa – A survey based approach

Cited by 7 publications

References 3 publications

Predictors of a 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal Observational Study

Predictors of a 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal Observational Study

Aspiration Pneumonia in Adults Hospitalized With Stroke at a Large Academic Hospital in Zambia

Knowledge on Stroke Recognition and Management among Emergency Department Healthcare Professionals in the Republic of Cyprus

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