Stroke care in Africa: A systematic review of the literature

Urimubenshi, Gerard; Cadilhac, Dominique A.; Kagwiza, Jeanne; Wu, Olívia; Langhorne, Peter

doi:10.1177/1747493018772747

Cited by 54 publications

(66 citation statements)

References 53 publications

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“…Regarding The average prehospital delay for patients with IS in Morocco has ranged between 26 to 61.9 hours, which far exceeds the therapeutic window recommended by randomized clinical trials [65].This finding is in accordance with the median admission time (31 hours) mentioned in a review of literature on the African continent [66]. In addition, it joins the average consultation time mentioned in a prospective cross-sectional study conducted at the University Hospital Center of Brazzaville in the Republic of Congo, where they have reported a period of 28.2 hours [67].…”

Section: The Percentage Of Patients With Thrombolyzed Ischemic Strokesupporting

confidence: 78%

“…This could also be explained by the fact that most of the patients arrived at the emergency rooms using personal or common means of transportation (taxi, personal car), and only a minority used ambulance services (3.5%) [24]. From same perspective, a recent review demonstrated that low awareness of the signs and symptoms of stroke, the shortage of medical transportation, health care staff and stroke management units, as well as the economic cost of the access to brain imaging facilities and thrombolysis were reported as major obstacles to improve stroke care and stroke management in Africa [66].…”

Section: The Percentage Of Patients With Thrombolyzed Ischemic Strokementioning

confidence: 99%

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Ischemic stroke in Morocco: A systematic review

Kharbach

Obtel

Lahlou

et al. 2019

Preprint

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Background: The aim of this systematic review is to determine; the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco.Methods: The present work is a systematic review that was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analysis". We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the period between 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206). These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10172 in Acute Stroke Treatment, prehospital delay average and it’s influential factors, thrombolyzed patients proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco. Results: Twenty-nine (n = 29) studies were selected. The average age ranged from 49±15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by these studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 hours. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies have a reduced sample size, conducted in hospital environment, and no confidence interval was reported. Conclusions: Ischemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. Indicating, thus, the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco. Key words: Ischemic stroke, Trial of ORG classification 10172 in Acute Stroke Treatment classification, prehospital delay, thrombolysis, Morocco.

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Section: The Percentage Of Patients With Thrombolyzed Ischemic Strokesupporting

confidence: 78%

Section: The Percentage Of Patients With Thrombolyzed Ischemic Strokementioning

confidence: 99%

Ischemic stroke in Morocco: A systematic review

Kharbach

Obtel

Lahlou

et al. 2019

Preprint

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“…Consequently, insufficient knowledge of risk factors, warning signs, and urgent therapeutic approach options have been identified as a serious cause of increased mortality and morbidity due to stroke [ 7 ]. Similarly, this knowledge deficiency has been identified as one of the significant barriers to accessing quality health care for stroke in Africa, as well as a factor affecting pre-hospital time [ 8 9 ]. Several studies in various countries have all confirmed the persistence of a low level of knowledge among the general public about stroke, and more specifically about risk factors and warning signs [ 10 11 12 13 ].…”

Section: Introductionmentioning

confidence: 99%

Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco

Kharbach

Obtel

Achbani

et al. 2020

Annals of Global Health

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Background: Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients. Objective: The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco. Methods: This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke. Findings: A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4-13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI 95% : 1.08-3.44) primary education (OR 3.43; CI 95% : 1.63-7.21), rural residential (OR 1.67; CI 95% : 1.07-2.59), no history of stroke among respondents (OR 16.41; CI 95% : 4.37-61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI 95% : 2.81-6.96), were independently associated with a lower level of knowledge of stroke (Table 4). Conclusions: The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.

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“…Similar to other resource‐poor regions, recent research indicates access and delivery of quality and evidence‐based stroke care in Africa is limited and often poor . Studies in Ghana, Senegal and Congo further exemplify the limited nature of access to quality and evidence‐based stroke care in LMICs.…”

Section: Introductionmentioning

confidence: 95%

“…8 Similar to other resource-poor regions, recent research indicates access and delivery of quality and evidence-based stroke care in Africa is limited and often poor. 3,4,[8][9][10] Studies in Ghana, 5 Senegal 6 and Congo 7 further exemplify the limited nature of access to quality and evidence-based stroke care in LMICs. Efforts to improve uptake of better stroke care interventions to ensure optimal patient outcomes in resource-poor settings have been persistently hampered by a range of barriers such as lack of skilled health personnel, patients' lack of funds to meet health-care costs and inadequate health infrastructure.…”

Section: Introductionmentioning

confidence: 99%

Improving the quality of care for people who had a stroke in a low‐/middle‐income country: A qualitative analysis of health‐care professionals’ perspectives

Baatiema

Aikins

Abimbola

et al. 2020

Health Expectations

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Background and Objective Efforts to improve the adoption of evidence‐based interventions for optimal patient outcomes in low‐/middle‐income countries (LMICs) are persistently hampered by a plethora of barriers. Yet, little is known about strategies to address such barriers to improve quality stroke care. This study seeks to explore health professionals’ views on strategies to improve quality stroke care for people who had a stroke in a LMIC. Methods A qualitative interview study design was adopted. A semi‐structured interview guide was used to conduct in‐depth interviews among forty stroke care providers in major referral centres in Ghana. Participants were from nursing, medical, specialist and allied health professional groups. A purposive sample was recruited to share their views on practical strategies to improve quality stroke care in clinical settings. A thematic analysis approach was utilized to inductively analyse the data. Results A number of overarching themes of strategies to improve quality stroke care were identified: computerization and digitization of medical practice, allocation of adequate resources, increase the human resource capacity to deliver stroke care, development of clinical guideline/treatment protocols, institutionalization of multidisciplinary care and professional development opportunities. These strategies were however differentially prioritized among different categories of stroke care providers. Conclusion Closing the gap between existing knowledge on how to improve quality of stroke care in LMICs has the potential to be successful if unique and context‐specific measures from the views of stroke care providers are considered in developing quality improvement strategies and health systems and policy reforms. However, for optimal outcomes, further research into the effectiveness and feasibility of the proposed strategies by stroke care providers is needed.

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Stroke care in Africa: A systematic review of the literature

Cited by 54 publications

References 53 publications

Ischemic stroke in Morocco: A systematic review

Ischemic stroke in Morocco: A systematic review

Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco

Improving the quality of care for people who had a stroke in a low‐/middle‐income country: A qualitative analysis of health‐care professionals’ perspectives

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