Towards best practice in acute stroke care in Ghana: a survey of hospital services

Abstract

BackgroundStroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice.MethodsA multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards.ResultsAvailability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care.ConclusionThis study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2061-2) contains supplementary material, which is available to authorized users.

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

“…Within the context of stroke care, a paradoxical situation exists where delivery of quality and evidence‐based care for optimal patient outcomes is relatively limited and poor in LMICs compared to high‐income countries (HICs), although about 80% of the entire global burden of stroke is reported from LMICs . This burden has been largely attributed to the poor quality of care delivered in those settings and the low uptake of evidence‐based practice . Findings from the recent INTERSTROKE study further underscore the poor and limited access to optimal stroke care, leading to poor patient outcomes in LMICs …”

“…3 This burden has been largely attributed to the poor quality of care delivered in those settings and the low uptake of evidence-based practice. [4][5][6][7] Findings from the recent INTERSTROKE study further underscore the poor and limited access to optimal stroke care, leading to poor patient outcomes in LMICs. 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.…”

“…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.…”

Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access and Action

“…They lamented that this late presentation which is a common practice in the developing countries interfered with the acute management contributing immensely to the high mortality of stroke [51]. In Burkina Faso, the time between the onset of clinical signs and the first contact with a peripheral public health unit extended from 30 min to 24 h with an average of 6 h and 56 min [52] while 8.5% and 17% of the patients presented before 3 and 6 h, respectively at the emergency unit in another Nigeria centre [53]. This late presentation can be explained partly by poor knowledge as discussed above.…”

“…There are few other organs where this concept of time is critical. In SSA, persons with stroke do not present early to the healthcare facility [34,[51][52][53]. In Senegal, most of the patients were referred to a medical centre late.…”