Stroke Care Services in Africa: A Systematic Review

2018 ◽  
Vol 1 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Rufus O. Akinyemi ◽  
Olaleye A. Adeniji
Keyword(s):  
Large Scale ◽  
Systems Of Care ◽  
Care Delivery ◽  
Stroke Care ◽  
Developed Countries ◽  
High Morbidity ◽  
New Paradigm ◽  
African Countries ◽  
Care Services ◽  
Stroke Services

Background: Stroke is the second leading cause of death and adult-onset disability globally. Although its incidence is reducing in developed countries, low- and middle-income countries, especially African countries, are witnessing an increase in cases of stroke, leading to high morbidity and mortality. Evidently, a new paradigm is needed on the continent to tackle this growing burden of stroke in its preventative and treatment aspects. Aims and Objectives: The aim of this study was to determine the scope of stroke care services, where they exist, and their relationship with currently existing health systems. Methods: A detailed literature search was undertaken referring to PubMed and Google Scholar for articles from January 1960 to March 2018, using a range of search terms. Of 93 publications, 45 papers were shortlisted, and 21 reviewed articles on existing stroke services were included. Results: The literature on models of stroke services in Africa is sparse. We identified focused systems of care delivery in the hyperacute, acute, and rehabilitative phases of stroke in a few African countries. There is a continent-wide paucity of data on the organization of prehospital stroke services. Only 3 African countries (South Africa, Egypt, and Morocco) reported experiences on thrombolysis. Also, the uptake of dedicated stroke units appears limited across the continent. Encouragingly, there are large-scale secondary prevention models on the continent, mostly within the context of experimental research projects, albeit with promising results. We found only 1 article on the interventional aspects of stroke care in our review, and this was a single-center report. Conclusions: The literature on the organization of stroke services is sparse in Africa. Dedicated action at policy, population, community, and hospital-based levels is urgently needed toward the organization of stroke services to tame the burgeoning burden of stroke on the African continent.

Stroke services in Africa: What is there and what is needed

2022 ◽  
pp. 174749302110664
Author(s):  
Tamer Roushdy ◽  
Hany Aref ◽  
Selma Kesraoui ◽  
Michael Temgoua ◽  
Kiatoko Ponte Nono ◽  
...  
Keyword(s):  
Online Survey ◽  
A Priori ◽  
Stroke Care ◽  
Diagnostic Tools ◽  
African Countries ◽  
Related Services ◽  
The Past ◽  
Care Services ◽  
Stroke Services ◽  
Corrective Procedures

Background: Over the past few years, the incidence and prevalence of stroke has been rising in most African countries and has been reported as one of the leading causes of morbidity and mortality. To study this problem, we need to realize the quality and availability of stroke care services as a priori to improve them. Methods and Results: In this study, we investigated the availability of different stroke-related services in 17 countries from different African regions. An online survey was conducted and fulfilled by stroke specialists and included primary prevention, acute management, diagnostic tools, medications, postdischarge services, and stroke registries. The results showed that although medications for secondary prevention are available, yet many other services are lacking in various countries. Conclusion: This study displays the deficient aspects of stroke services in African countries as a preliminary step toward active corrective procedures for the improvement of stroke-related health services.

Tribal Health Care Services—Anecdotal Evidence of ‘Health Trap’ in Selected Areas: A Case Study

2012 ◽  
Vol 14 (1) ◽  
pp. 51-65
Author(s):  
N. Rajagopal
Keyword(s):  
Human Capital ◽  
Low Income ◽  
Health Care Services ◽  
Developed Countries ◽  
The State ◽  
New Paradigm ◽  
Capital Theory ◽  
Care Services ◽  
Development Paradigm

Kerala has been a destination for many economists from all around the world for its ‘unique model of development’. The basic sustainable indicators of human capital attainment of Kerala, despite its low income, are probably an exception in the human capital theory. Professor Amartya Sen, on many occasions, cited a ‘new paradigm of social development’ in the state. Many world bodies like UNDP, WHO, UNICEF, etc. have acknowledged this at different times. The development paradigm of Kerala had been a source of inspiration for the preparation of the Human Development Index (HDI) in 1990. The strong record of basic health has made the state comparable with developed countries.

scholarly journals Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

2017 ◽  
Vol 49 (1-2) ◽  
pp. 45-61 ◽  
Author(s):  
Jeyaraj Durai Pandian ◽  
Akanksha G. William ◽  
Mahesh P. Kate ◽  
Bo Norrving ◽  
George A. Mensah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care Services ◽  
Cost Effective ◽  
Stroke Care ◽  
Evidence Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
Stroke Services ◽  
Low And Middle Income

Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.

scholarly journals Architecturalising Aged Care Delivery for Urban Dwelling Elderly

2021 ◽  
Author(s):  
Emma Leech
Keyword(s):  
Urban Environment ◽  
Urban Space ◽  
Systems Of Care ◽  
Care Delivery ◽  
Care Facility ◽  
Aged Care ◽  
Future Design ◽  
Care Services ◽  
Retirement Village ◽  
Typology Of Care

<p>The world’s demographics are drastically changing, with people living longer and are healthier as they age (WHO, 2018). By 2050 the world’s population over </p> 65 years old will be 17% almost double 8.5% in 2015 (Cire, 2016). Architecture for aged care, evolved out of necessity to separate sick aging people to reduce their chance of mortality and exposure to disease. The typology of care has taken on a more homelike approach over the last 60 years as research suggests that better health outcomes and better quality of life can be observed through the familiar vernacular of home (de Veer and Kerkstra, 2001). In many cultures the retirement village is the epitome of this home-like approach. This thesis argues that the lack of integration between this typology and the surrounding neighborhoods both suburban and urban, create social and physical separation between elderly and their communities. <p>This research explores how architecture can deliver aged care services to make ageing at home in an urban environment more accessible within the context of a central Tokyo intersection. Using the underlying weaknesses of current systems of care delivery identified through the literature review this research begins the conversation on how architecture can frame the facilitation of care and the possibilities for future design responses. Through the design process, combating segregation of elderly individuals while balancing their privacy needs and independence has determined the ideas behind design experimentation and creation. </p> <p>The outcome of this research is an understanding of architectures role within aged care. The support from the environment is not only vital physically but can significantly contribute to wellness. As well as this the research reinforces the scope of alternative solutions possible when working with an established rich urban environment inherently more focused on connection. A significant move into an urban space will result in a care environment that is connected with its surroundings instead of designed in isolation. Application of this research to current aged care facility environments could create a first step of developing greater scope of connection between a facility space and a community model of care. </p>

scholarly journals The Adaptation and Validation of the Satisfaction with Stroke Care Questionnaire (Homesat) (SASC10-MyTM) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community.

2020 ◽  
Author(s):  
Aznida Firzah Abdul Aziz ◽  
Chai-Eng Tan ◽  
Mohd Fairuz Ali ◽  
Syed Mohamed Aljunid
Keyword(s):  
Social Support ◽  
Factor Analysis ◽  
Support Services ◽  
Care Delivery ◽  
Stroke Care ◽  
Healthcare Services ◽  
Post Stroke ◽  
Care Services ◽  
Social Support Services ◽  
Discharge Transition

Abstract Background Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region. Methods The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My TM ). The SASC10-My TM was then tested on 175 post-stroke patients who were recruited at ten public primary care health centres across Peninsular Malaysia, in a trial-within a trial study. Results One item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My TM had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My TM was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My TM score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge. Conclusions The SASC10-My TM questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes.

scholarly journals The Adaptation and Validation of the Satisfaction with Stroke Care Questionnaire (Homesat) (SASC10-MyTM) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community.

2020 ◽  
Author(s):  
Aznida Firzah Abdul Aziz ◽  
Chai-Eng Tan ◽  
Mohd Fairuz Ali ◽  
Syed Mohamed Aljunid
Keyword(s):  
Social Support ◽  
Factor Analysis ◽  
Support Services ◽  
Care Delivery ◽  
Stroke Care ◽  
Healthcare Services ◽  
Post Stroke ◽  
Care Services ◽  
Social Support Services ◽  
Discharge Transition

Abstract Background Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region.Methods The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My TM ). The SASC10-My TM was then tested on 175 post-stroke patients who were recruited at ten public primary care health centres across Peninsular Malaysia, in a trial-within a trial study.Results One item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My TM had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My TM was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My TM score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge.Conclusions The SASC10-My TM questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes.Trial registration: No.: ACTRN12616001322426 (Registration Date: 21st September 2016

scholarly journals Architecturalising Aged Care Delivery for Urban Dwelling Elderly

2021 ◽  
Author(s):  
Emma Leech
Keyword(s):  
Urban Environment ◽  
Urban Space ◽  
Systems Of Care ◽  
Care Delivery ◽  
Care Facility ◽  
Aged Care ◽  
Future Design ◽  
Care Services ◽  
Retirement Village ◽  
Typology Of Care

<p>The world’s demographics are drastically changing, with people living longer and are healthier as they age (WHO, 2018). By 2050 the world’s population over </p> 65 years old will be 17% almost double 8.5% in 2015 (Cire, 2016). Architecture for aged care, evolved out of necessity to separate sick aging people to reduce their chance of mortality and exposure to disease. The typology of care has taken on a more homelike approach over the last 60 years as research suggests that better health outcomes and better quality of life can be observed through the familiar vernacular of home (de Veer and Kerkstra, 2001). In many cultures the retirement village is the epitome of this home-like approach. This thesis argues that the lack of integration between this typology and the surrounding neighborhoods both suburban and urban, create social and physical separation between elderly and their communities. <p>This research explores how architecture can deliver aged care services to make ageing at home in an urban environment more accessible within the context of a central Tokyo intersection. Using the underlying weaknesses of current systems of care delivery identified through the literature review this research begins the conversation on how architecture can frame the facilitation of care and the possibilities for future design responses. Through the design process, combating segregation of elderly individuals while balancing their privacy needs and independence has determined the ideas behind design experimentation and creation. </p> <p>The outcome of this research is an understanding of architectures role within aged care. The support from the environment is not only vital physically but can significantly contribute to wellness. As well as this the research reinforces the scope of alternative solutions possible when working with an established rich urban environment inherently more focused on connection. A significant move into an urban space will result in a care environment that is connected with its surroundings instead of designed in isolation. Application of this research to current aged care facility environments could create a first step of developing greater scope of connection between a facility space and a community model of care. </p>

Abstract 3030: Meta-analysis of Cost Effectiveness of Different Stroke Unit Subtypes

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Minal Jain ◽  
Anunaya Jain ◽  
Abhijit R Kanthala ◽  
Babak S Jahromi
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Systems Of Care ◽  
Surrogate Marker ◽  
Cost Effective ◽  
Stroke Care ◽  
Developed Countries ◽  
Direct Care ◽  
Early Supported Discharge ◽  
Acute Rehabilitation

Aim: To perform a systematic review and metanalysis, comparing outcome and cost of stroke care in a stroke unit (SU) versus conventional care (CC). Secondary aim was to compare cost effectiveness of different SU subtypes. Methods: Pubmed search was performed for “Stroke Unit” among all English language articles from 01/01/1996 to 01/01/2011. Only articles from developed countries, reporting the length of stay (LOS) and/or cost and outcomes for ischemic stroke were included. Studies wherein data was collected before 01/01/1996, articles only on rehabilitation units, and all systematic reviews were excluded. LOS was taken as a surrogate marker of stroke care cost in studies wherein direct care costs were not reported. Non-QALY outcomes were converted to QALYs using reported logistic regressions. Ratios less than $50,000/QALY were considered cost effective while greater than $100,000 /QALY were considered non-cost effective. All cost were reported in 2010 US$. Result: A total of 5,537 articles in Pubmed were studied, of which 19 studies met the inclusion criteria. LOS for patients managed at SU ranged from 9.2-32.3 days versus 8-35.3 days for CC units and average incremental QALYs between them were 0.09. The average incremental cost/QALY was $41,204.37. The average cost/QALY for different types of SU were $19,428.64 for Acute only SU (A SU), $44,228.81 for Acute+Rehabilitation SU (A+R SU), $29,145.93 for Acute+Rehabilitation+Early Supported Discharge (A+R+ESD) SU and $20,460.56 for SU with Continuous monitoring (SU CM). In comparison to an A SU, SU CM and A+R+ESD SU were cost effective alternatives (ICER SU CM estimated at $25,120.89, ICER A+R+ESD SU estimated at $24,574.59). Conclusion: Stroke Units are cost effective when compared to the conventional systems of care. Acute + rehab SU with early supported discharge appears to be the most cost effective model amongst different subtypes of SU.

scholarly journals Implementation of large-scale health information systems

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ricardo Luz ◽  
Clarissa Carneiro Mussi ◽  
Ademar Dutra ◽  
Leonardo Correa Chaves
Keyword(s):  
Information Systems ◽  
Health Information ◽  
Large Scale ◽  
Care Delivery ◽  
Health Information Systems ◽  
Developed Countries ◽  
Systematic Analysis ◽  
Content Type ◽  
Expected Benefits ◽  
The Government

PurposeThe study aims to analyze the previous literature on government initiatives to implement health information systems (HISs).Design/methodology/approachProknow-C (Knowledge Development Process-Constructivist) was used in the selection of the literature and in the bibliometric and systematic analysis.FindingsThe research identified a portfolio composed of 33 articles aligned with the research theme and with scientific recognition, as well as periodicals, authors, papers and keywords that stood out the most. Amongst the government initiatives in the 24 identified countries, England has been the most studied nation, and there is a certain prominence of research arising from developed countries. Electronic health records (EHRs) have been the most explored technology. Efficiency and safety of health care delivery, integration of information and among health organizations, cost reduction and economicity are the most expected benefits from government programs. The difficulties found are related to the broader context in which the system is inserted, to the management of the program, to technology itself and to individuals. The most emphasized difficulties identified in most countries were previous context marked by a lack of standardization/interoperability, acceptance of providers and users and project financing. The findings of the present article provide a theoretical framework for future studies, in addition to yielding a replicable process for future use.Originality/valueThis research may be considered original as it analyzes – through a constructivism-structured process (Proknow-C) – the phenomenon under investigation by gathering bibliometric and systematic review data concomitantly. The countries and technologies reported emerge from the process itself.

scholarly journals A New Model for Efficient, Need-Driven Progress in Generating Primary Biodiversity Information Resources

2019 ◽  
Vol 3 ◽  
Author(s):  
Alex Asase ◽  
Moses Sainge ◽  
Raoufou Radji ◽  
Omokafe Ugbogu ◽  
Andrew Townsend Peterson
Keyword(s):  
Large Scale ◽  
Historical Context ◽  
Cost Effective ◽  
West African ◽  
Information Resources ◽  
Data Capture ◽  
Traditional Model ◽  
New Paradigm ◽  
African Countries ◽  
Biodiversity Information

The field of biodiversity informatics has developed rapidly in recent years with broad availability of large-scale information resources. However, online biodiversity information are biased (Boakes et al. 2010, Stropp et al. 2016) as a result of the relatively slow capture and digitization of existing data resources. The West African Plants (WAP) initiative approach to data capture is a prototype of a novel solution to the challenge of the traditional model, in which the institutional “owner” of the specimens is responsible for digital capture of associated data. The WAP Initiative is a consortium of West African researchers in botany, in coordination with six institutions across Europe and North America; its goal is to digitize and mobilize available, high-quality, primary biodiversity occurrence data resources for West African plant diversity (http://jrsbiodiversity.org/grants/university-of-ghana-herbaria/). Here, we developed customized workflows for data capture in formats directly and permanently useful to the “owner” herbarium, and digitized significant new biodiversity records adding to the information available for the plants of the region. Data records were captured strictly in accordance with DarwinCore standards, achieved either by (a) capturing data records from existing images (e.g., images supplied by Naturalis Bodiversity Centre), or (b) capturing data from images taken quickly and efficiently by project personnel in West African Herbaria. Digitization of images and data began in 2015 in West African partner institutions, and by middle of 2018 resulted in 190,953 records of species in 1965 genera and 331 families from 16 West African countries (Fig. 1). Our approach is cost-effective, allows development of information resources even for regions in which political situations make it impossible, and it provides a historical context against which to compare newer data as the latter become available (Peterson et al. 2016). Further measures of success of the initiative will center on whether the institutions “owning” the specimens follow through and put the new data records online. Already, several project institutions have put initial project data online as part of their GBIF data contributions, but—of course—success would consist of all project-generated data being completely available online. Note that this model is the reverse of the traditional model, in which the institutions holding the specimens create the information resources that are used by the rest of the world. This new paradigm in specimen digitization has considerable promise to accelerate and improve the process of generating biodiversity information, and can be replicated and applied in many biodiversity-rich, information-poor regions to remedy the oft-cited massive gaps in information availability.

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