Evolving concepts of stroke and stroke management in South Africa: Quo vadis?

Taylor, Allan; Ntusi, Ntobeko

doi:10.7196/samj.2019.v109i2.00009

Cited by 17 publications

(18 citation statements)

References 12 publications

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“…Communicable diseases like tuberculosis (ranked highest) and HIV/AIDS ranked in fifth place. Taylor & Ntusi [9] reported on the 2010 SA National Burden of Disease Study which positioned cerebrovascular accident (CVA)/stroke as the ninth most important cause of disability in SA.…”

Section: Introductionmentioning

confidence: 99%

Sustainable workforce: South African Audiologists and Speech Therapists

et al. 2020

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Background: Audiologists and Speech Therapists play a vital role in addressing sustainable development goals by supporting people who are marginalised due to communication challenges. The global burden of disease and poor social living conditions impact negatively on the development of healthy communication, therefore requiring the services of Audiologist and Speech therapists. Against this background, we examined the demographic profile and the supply, need and shortfall of Audiologists and Speech Therapists in South Africa. Methods: The data set was drawn from the Health Professions Council of South Africa (HPCSA) registers (for 2002-2017) for the speech, language and hearing professions. This demographic profile of the professions was created based on the category of health personnel; category of practice, geographical location, population group (race) and sex. The annual supply was estimated from the HPCSA database while the service-target approach was used to estimate need. Additional need based on National Health Insurance Bill was also included. Supply-need gaps were forecast according to three scenarios, which varied according to the future intensity of policy intervention to increase occupancy of training places: 'best guess' (no intervention), 'optimistic' (feasible intervention), and 'aspirational' (significant intervention) scenarios up to 2030. Results: Most (i.e. 1548, 47.4%) of the professionals are registered as Audiologists and Speech Therapists, followed by 33.5% registered as Speech Therapists and 19.1% registered as Audiologists. Around 88.5% professionals registered as Audiologists and Speech Therapists are practising independently, and 42.6% are practising in the Gauteng province. The profession is comprised majorly of women (94.6%), and in terms of the population groups (race), they are mainly classified as white (59.7%). In 2017, in best guess scenario, there is a supply-need gap of around 2800 professionals. In the absence of any intervention to increase supply capacity, this shortfall will remain same by the year 2030. By contrast, in aspirational scenario, i.e. supply is increased by 300%, the forecasted shortfall for 2030 reduces to 2300 from 2800 professionals. Conclusions: It is clear that without significant interventions, South Africa is likely to have a critical shortfall of Audiologists and Speech Therapists in 2030. Policy-makers will have to carefully examine issues surrounding the current framework regulating training of these and associated professionals, in order to respond adequately to future requirements.

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Section: Introductionmentioning

confidence: 99%

Sustainable workforce: South African Audiologists and Speech Therapists

et al. 2020

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“…Once a patient has had a stroke, dedicated stroke units have been shown to improve outcomes. 7 Intravenous thrombolytic reperfusion therapy is available in South Africa if a patient presents within 4.5 hours from symptom onset. 7 Rehabilitation therapy has been shown to produce outcomes equal to that of reperfusion at 6 months post stroke.…”

Section: Introductionmentioning

confidence: 99%

“…7 Intravenous thrombolytic reperfusion therapy is available in South Africa if a patient presents within 4.5 hours from symptom onset. 7 Rehabilitation therapy has been shown to produce outcomes equal to that of reperfusion at 6 months post stroke. South Africa has a limited number of allied health professionals to provide rehabilitation services, making reperfusion a more attractive option in the South African context.…”

Section: Introductionmentioning

confidence: 99%

“…Endovascular techniques have been performed in South Africa, but this is limited to neurointerventional centres and a highly specific patient population. 7 By 2030, there will be an estimated 20 million deaths per year because of stroke. Developing countries have limited epidemiological data yet 80% of global stroke burden occurs in these Background: Stroke is the second leading cause of death worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Acute stroke in the emergency department: A chart review at KwaZulu-Natal hospital

Feris

Naicker

2020

South African Family Practice

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This study was a retrospective chart review of all patients with a clinical diagnosis of stroke presenting to an ED of a regional hospital in rural KwaZulu-Natal from November 2018 to November 2019.Results: A total of 362 patient charts were screened, and 136 of the charts met the inclusion criteria for the study. Seventy per cent of the patients had pre-existing hypertension, only one patient was not on treatment and two patients were not on secondary prevention. In human immunodeficiency virus-positive patients (20.5%; n = 28), 17 patients were under 50 years old. The most common finding on computer tomography was ischemic strokes (74%, n = 100). Thrombolysis was given to five patients included in the study. The overall in-hospital mortality rate was 4.06%. Conclusion:This study adds to the limited data about stroke in South Africa. Our population represents a unique blend of infectious and lifestyle disease. More research in this setting is recommended to develop local guidelines on emergency stroke care.

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“…Low CD4 counts and high opportunistic infection rates are commonly seen in South Africa due to late initiation of ART, as only 85% of those living with HIV know their status and of these only 71% are receiving ART (Huerga et al, 2018). While South African research is predicting a marked reduction in new HIV infections over the next 30 years, particularly in the 15-49 years age groups (Taylor and Ntusi, 2019), those living with HIV and receiving ART remain at risk of stroke. It is estimated that in the age group 50 years and older the prevalence of stroke will increase from 9% to 17% due to increased life expectancy associated with the introduction of ART (Atadzhanov et al, 2012).…”

Section: Literature Reviewmentioning

confidence: 99%

The effect of HIV status on post-stroke outcomes in personal activities of daily living

Augustyn

Witt

Franzsen

2020

British Journal of Occupational Therapy

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Introduction This study explored the impact of HIV on the functional recovery of personal activities of daily living of stroke survivors. This assisted in identifying possible implications for the rehabilitation of stroke survivors who are also HIV-positive. Method A quantitative, descriptive, longitudinal comparative research design was used to determine the change in personal activities of daily living scores of HIV-negative and HIV-positive stroke survivors from admission to 1 month after discharge. Data were collected at a rehabilitation unit using the South African Database Functional Measure. Results There was no difference in the rate and nature of functional recovery of personal activities of daily living between the two groups between admission and discharge. A difference was noticed during the period from admission to 1 month after discharge, during which the HIV-negative group continued to show improvement, while the HIV-positive group showed little improvement or a decline in personal activities of daily living scores. Conclusions While the rate and nature of functional recovery related to personal activities of daily living for HIV-positive and HIV-negative stroke survivors is similar during inpatient care, discharge planning for the HIV-positive group needs to consider the decline in personal activities of daily living functioning post discharge. Regular follow-ups and the inclusion of the stroke survivors in an outpatient treatment programme is recommended.

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Evolving concepts of stroke and stroke management in South Africa: Quo vadis?

Cited by 17 publications

References 12 publications

Sustainable workforce: South African Audiologists and Speech Therapists

Sustainable workforce: South African Audiologists and Speech Therapists

Acute stroke in the emergency department: A chart review at KwaZulu-Natal hospital

The effect of HIV status on post-stroke outcomes in personal activities of daily living

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