Infrastructural and Knowledge Barriers to Accessing Acute Stroke Care at a Regional Tertiary Facility in Kenya

Mithi, Caroline; Shah, Jasmit; Mativo, Peter; Sokhi, Dilraj

doi:10.1177/25166085211018046

Cited by 4 publications

(7 citation statements)

References 33 publications

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“…In our study, the average of hospital arrival for the patients was 14 hours. This delay is almost similar in other African countries, for example, in the neighboring Kenya where patients present to the ER between 1 and 3 days from the onset [31] . Patients were signi cantly more likely to arrive at the hospital early if they lived in Mogadishu or its vicinity, similar to what has been found by Ashraf VV et al, where early emergency arrival was substantially related with living within 15 km of the hospital [2] .…”

Section: Discussionsupporting

confidence: 78%

“…In another study by Kocak et al [16] , 29.5% of patients came to the hospital in < 4 hours. As per study by Caroline Mithi et el, only 23.9% of patients with acute ischemic strokes arrived early to the hospital with in the therapeutic window [21] . In this study only 15% of the patient came within the therapeutic window and therefore majority of the patients missed the golden opportunity.…”

Section: Discussionmentioning

confidence: 95%

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Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross Sectional Study in Mogadishu Somalia

Hassan¹,

Yucel²

2022

Preprint

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Background and Objective: Intravenous thrombolysis (IVT) is now considered the best a standard treatment for acute ischemic stroke in eligible patients who present within 4.5 h of symptom onset. The low rates of thrombolysis for ischemic stroke in our country and other developing countries have been attributed to delays in arrivals to the hospital. This study aims to investigate the factors that influence the early hospital arrival of patients with acute ischemic stroke to the hospital in Mogadishu, Somalia. Methods: This is a cross-sectional study conducted in teaching hospital in Mogadishu, Somalia. Adult patients diagnosed with acute ischemic stroke admitted to the emergency department between June 2021 and May 2022 were included in the study. A questionnaire-based interview was administered to adult patients or patients’ relatives. Patients within the hospital while developing an ischemic stroke were excluded from the study. Patients' demographic characteristics, stroke risk factors, NIHSS Score, time to hospital arrival, factors influencing early hospital arrival including travel distance, ambulance availability, time of stroke onset, knowledge of stroke symptoms, and thrombolytic treatment were all assessed. Results: of the 212 patients in the study, 113(53.3%) of the subjects were male, while 99(46.7%) were female. The mean age of the patients was 62±10. The majority of the patients (153 (72%) were above 60 years of age. Hypertension was the most common risk factor among patients 121(57%), followed by diabetes mellitus (65(31%)) and hyperlipidemia 73(34%). MCA infarct was the most common arterial territory of infarction 117(55%). 140(66%) of the patients lived in the city, while 72(34%) lived outside of the city. 85(40%) of the patients were brought to the ER by ambulance, and only 32(15%) reached the hospital in less than 4 hours. The thrombolytic treatment rate was 1.4% of the cases in this study. 121(57%) had no idea about stroke symptoms, and only 34(16%) of the patients/relatives knew about thrombolytic treatment for acute stroke. In univariate and binary logistic regression analysis, delays in hospital arrivals were associated with travel distance of more than 10 km, transportation via non-ambulance means, living alone, lack of recognition of stroke symptoms, night time stroke onset, and lack of knowledge about thrombolytic treatment for acute stroke and non-hemiplegic presentation. Conclusion: This study demonstrates factors delaying early hospital arrivals of patients with ischemic stroke. Improving the modifiable factors through public education will prevent delays in early hospital arrival of the stroke patients and will improve early thrombolytic intervention and over all outcome of these patients.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 95%

Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross Sectional Study in Mogadishu Somalia

Hassan¹,

Yucel²

2022

Preprint

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“…As per a study by Caroline Mithi et al, only 23.9% of patients with acute ischemic strokes arrived early to the hospital within the therapeutic window. 21 In this study, only 15% of the patients came to the hospital within the therapeutic window, and therefore, the majority of the patients missed the golden opportunity.…”

mentioning

confidence: 78%

“…This delay is almost similar in other African countries, for example, in the neighboring Kenya where patients present to the emergency between 1 and 3 days from the onset. 21 Patients were significantly more likely to arrive at the hospital early if they lived in Mogadishu or its vicinity. This was similar to what has been found by Ashraf et al, where early emergency arrival was substantially related to living within 15 km of the hospital.…”

mentioning

confidence: 97%

Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross-Sectional Study at Teaching Hospital in Mogadishu Somalia

Hassan¹,

Yucel²

2022

JMDH

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Background and Purpose:The low rates of thrombolysis for ischemic stroke in our country and other developing countries can be attributed to delays in arrival at the hospital. This study aims to investigate the factors that influence the early hospital arrival of patients with acute ischemic stroke to the hospital in Mogadishu, Somalia. Methods: This is a cross-sectional study conducted at a teaching hospital in Mogadishu, Somalia. Adult patients with acute ischemic stroke admitted to the emergency department (ED) between June 2021 and May 2022 were included in the study. A questionnairebased interview was administered to adult patients or their relatives to assess the factors contributing to hospital delay. Results: Of the 212 patients in the study, 113 (53.3%) were male, while 99 (46.7%) were female. The mean age of the patients was 62 ±10. Hypertension was the most common risk factor among patients 121 (57%), followed by diabetes and hyperlipidemia. One hundred and forty (66%) patients lived in the city, while 72 (34%) lived outside of the city. About 53 (25%) of the patients were brought to the ED by ambulance, and only 32 (15%) reached the hospital in less than 4 hours. The majority of patients had no idea about stroke symptoms and thrombolytic treatment. In univariate and binary logistic regression analysis, delays in hospital arrivals were associated with a travel distance of more than 10 km, transportation via non-ambulance means, living alone, lack of recognition of stroke symptoms, night-time stroke onset, lack of knowledge about thrombolytic treatment, and non-hemiplegic presentation. Conclusion:This study demonstrates factors delaying early hospital arrivals of patients with ischemic stroke. Improving the modifiable factors through public education will prevent delays in the early hospital arrival of stroke patients and will improve early thrombolytic intervention and the overall outcome of these patients.

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“…A similar study also showed that one-sided limb weakness was mentioned correctly by most subjects. Although psychosocial stress was not listed as one of the direct risk factors of stroke, it was mentioned frequently by the subjects [35]. Albeit with costly campaigns, better awareness of stroke does not automatically improve onset-to-arrival time nor increase intravenous thrombolysis rate, and stroke information from the internet was negatively correlated with early arrival [35,36].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and reasons for delayed presentation in acute ischemic stroke: single-centered study in Indonesia

Yang,

Hartanto

2024

Egypt J Neurol Psychiatry Neurosurg

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Background Effective therapy for acute ischemic stroke relies on timely intervention. We aimed to evaluate the factors associated with the onset-to-arrival time and delayed hospital presentation in acute ischemic stroke patients. Subjects with acute ischemic stroke in Bethesda Hospital Yogyakarta, Indonesia from March to June, 2023 were prospectively recruited. A questionnaire was used to collect the information by direct interviews. Prespecified variables were included in univariate and multivariable analyses to identify the predictors of delayed hospital presentation of more than 4.5 h. Results Among a total of 175 patients, 64.6% of the patients arrived at the hospital more than 4.5 h after the stroke onset. Only 3 (1.7%) patients were eligible and received intravenous thrombolysis. In multivariable analysis, monthly income of more than IDR 550,000 (OR, 4.22; 95% CI 1.47–12.17; p = 0.007), wake-up stroke or unknown stroke onset (OR vs. known onset, 0.17; 95% CI 0.05–0.56; p = 0.004), distance from location of stroke onset more than 9.45 km (OR, 3.13; 95% CI 1.41–6.92; p = 0.005) and no history of coronary artery disease or heart failure (OR vs. present history, 0.12; 95% CI 0.04–0.37; p = 0.000) were related to delayed hospital presentation. The most frequently mentioned reasons for the delay were waiting for spontaneous improvement at home and unawareness of the stroke symptoms. Conclusions There is an enormous disparity in stroke services between developed and developing countries. This study highlighted the need to increase public stroke symptoms awareness.

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Infrastructural and Knowledge Barriers to Accessing Acute Stroke Care at a Regional Tertiary Facility in Kenya

Cited by 4 publications

References 33 publications

Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross Sectional Study in Mogadishu Somalia

Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross Sectional Study in Mogadishu Somalia

Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross-Sectional Study at Teaching Hospital in Mogadishu Somalia

Characteristics and reasons for delayed presentation in acute ischemic stroke: single-centered study in Indonesia

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