Minimal Setting Stroke Unit in a Sub-Saharan African Public Hospital

Abstract

Introduction: Sub-Saharan Africa (SSA) has the highest stroke prevalence along with a case fatality that amounts to 40%. We aimed to assess the effect of a minimal setting stroke unit in SSA Public hospital on stroke mortality and main medical complications. Materials and Methods: The study was set in Conakry, Guinea, Ignace Deen public referral hospital. Clinical characteristics, hospital mortality and main medical stroke complications rates (pneumonia, urinary tract infections, sores and venous thromboembolism) of admitted stroke patients after the installation of a minimal stroke unit equipped with heart rate, blood pressure and blood oxygen saturation monitoring and portable oxygen concentrator (POST) were compared to a similar number of stroke patients admitted before the stroke unit creation (PRE). Results: PRE ( n = 318) and POST ( n = 361) stroke, patients were comparable in term of age (61 ± 14 vs. 60 ± 14.8 years, p = 0.24), sex (56 vs. 50% males, p = 0.09), High blood pressure rate (76.7 vs. 79%, p = 0.44), stroke subtype (ischemic in 72 vs. 78% of cases, p = 0.05) and NIHSS (11 ± 4 vs. 11 ± 4, p = 0.85). Diabetes was more frequent in the PRE group (19 vs. 9%, p < 0.001). Mortality was significantly lower in the POST group (7.2 vs. 22.3%, p < 0.0001) as well as medical complications (4.1 vs. 27.7%, p < 0.001) and lower pneumonia rate (3.3 vs. 14.5%, p < 0.001). Conclusions: Minimally equipped stroke units significantly reduce stroke mortality and main medical complications in SSA.

Protective effect of microRNA‑340‑5p against oxygen‑glucose deprivation/reperfusion in PC12 cells through targeting neuronal differentiation 4

“…The insufficient presence of oxygen and glucose for normal metabolism is the main cause of injury in stroke (30) and as the therapeutic window is limited, early recanalization has proved helpful in preventing ischemic neuronal loss (31). Thrombolytic therapies are commonly used for the treatment of ischemic stroke (32); however, the recovery of blood flow has been found to promote secondary injuries (33).…”

Stroke care and outcomes in the Department of Neurology in Parakou, Benin: Retrospective cohort study

“…Upon discharge, among the 349 survivors, 27.6% were independent (Rankin ≤2), 23 (6.5%) had RANKIN 0, 40 (11.4%) had RANKIN 1; 54 (15.4%) had RANKIN 3, 133 (38.2%) had RANKIN 4 and 62 (18.7%) had 5. The median RANKIN was 4 and the interquartile interval was [ [2] , [3] , [4] ].…”

“…Stroke mortality is also high in low income countries compared with those reported in western countries. Many studies have reported the in-hospital mortality of stroke in SSA with a range of 7.2%–45% [ [4] , [5] , [6] ]. We found an in-hospital case fatality of 16.8% in 85 cases [ 7 ].…”

Insights in the pathophysiology of haemorrhagic strokes in a sub‐Sahara African country, an epidemiological and MRI study

“…Considering those figures, SSA is facing a dramatic increase in stroke cases in the years to come with few healthcare means to deal with the coming epidemics, both in terms of technical facilities and in terms of trained health workers. Therefore, better understanding the specifics of stroke epidemics is needed to orient future public health policies in SSA for stroke prevention and treatment as pragmatic cost‐effective choices can impact positively stroke outcomes [5‐7].…”

“…Therefore, better understanding the specifics of stroke epidemics is needed to orient future public health policies in SSA for stroke prevention and treatment as pragmatic cost-effective choices can impact positively stroke outcomes. [5][6][7] Epidemiological reports suggest that stroke in SSA is characterized by higher proportion of intra-cerebral hemorrhagic stroke (ICH) than ischemic stroke (IS). The reasons for the over-representation of ICH are unknown but are reproductible in the few epidemiological studies realized in Gambia, Cameroon, Mozambique and Kenya.…”