Quality of stroke guidelines in low- and middle-income countries: a systematic review

Abstract

Objective To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. Methods We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. Findings We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. Conclusion Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.

Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review

“…A limited number of the CPGs ( 75 , 77 , 80 , 81 , 83 , 84 , 86 ) in this scoping review were developed in middle-income countries while none were from a low-income country, consistent with findings from a previous review ( 120 ). This suggests a limitation in the use or implementation of CGPs in the continuum of stroke care in low and middle-income countries (LMIC) ( 38 ).…”

Inpatient Management of Acute Stroke of Unknown Type in Resource-Limited Settings

“…As a result, many LMICs lack comprehensive, context-appropriate guidelines for stroke care. 15 Here, we review best practices for managing stroke of unknown type (SOUT) in resource-limited settings based on existing literature from HICs and author experience in LMICs-contexts that would be classified as having "minimal" capacity per the World Stroke Organization. 16 We focus specifically on strategies for blood pressure (BP) management and use of antiplatelet therapy (APT) when no CT scanner is available to differentiate between acute IS and ICH.…”

Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings

“…Only 23% of LICs have guidelines for managing neurologic disorders, 6 and widespread resource gaps limit the applicability of standardized guidelines from HICs in LMIC contexts. 8,18 The growing mismatch between the global neurologic disease burden and the global capacity to provide inpatient neurology services requires coordinated efforts in multiple domains to strengthen systems of inpatient neurology care worldwide. These include neurology workforce development, context-appropriate management protocol development, deliberate resource utilization, mobile and telehealth modalities for care delivery and medical education, and advocacy efforts to coordinate local, national, and global capacity-building activities.…”