Surviving a stroke in South Africa: outcomes of home-based care in a low-resource rural setting

Figuring it out by yourself: Perceptions of home-based care of stroke survivors, family caregivers and community health workers in a low-resourced setting, South Africa

“…This study was part of a larger mixed-methods study with the overall aim of developing a home-based stroke rehabilitation programme in the Cape Winelands district of the Western Cape, SA. The situational analysis informing the design and development of the training programme included a concurrent quantitative study reporting on the outcomes of the current HCBC in the district 44 as well as this qualitative study.…”

“…At the time of the study, the rural Cape Winelands district (population of 866 000) recorded more than 600 stroke-related admissions annually in its six public-sector acute hospitals. After an average length of stay of 5 days, 44 most stroke survivors were discharged home to untrained family caregivers. There was a lack of clinical practice guidelines and pathways.…”

Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review

“…Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa (SA) [1][2][3][4] ; an estimated 75 000 strokes occur each year in SA, with a projected burden of disease of 564 000 disability-adjusted life years. 5 The burden of stroke in rural areas of SA is also on the increase with an estimated 33 500 strokes occurring in 2011 in these areas alone.…”

“…7 Increased (1) prevalence of cardiovascular risk factors (such as hypertension, obesity, diabetes mellitus), (2) unchecked industrialisation and (3) urbanisation, contribute to this epidemiological transition of stroke in many low-income and middle-income countries, 8 including SA. 1 Cardiovascular diseases, including stroke, was previously set to surpass infectious diseases as the major cause of morbidity and mortality in sub-Saharan Africa 9 with the burden of these non-communicable diseases increasing in this region of Africa. 10 In the last decade, a growing body of evidence shows an association with non-communicable diseases and infectious diseases: for example, diabetes mellitus, chronic respiratory conditions and chronic kidney disease have been linked to increased tuberculosis (TB) morbidity and mortality and vice versa.…”

“… 21 In SA, stroke care occurs across a range of settings, from tertiary hospitals to remote community primary healthcare facilities; care for people with stroke can be provided individually or in a group setting, at home, in a community environment or a specialist centre. 1 While public health policy in SA ascribes to primary healthcare and a decentralised approach, many stroke care and rehabilitation services remain centralised at district and specialist rehabilitation hospitals, 22 which reinforces the inequality experienced by rural communities in terms of healthcare access. 5 Although home-based care services are available in certain communities, poor referral to and articulation with these services and other healthcare levels, often result in poor service delivery.…”