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

Pandian, Jeyaraj Durai; William, Akanksha G.; Kate, Mahesh P.; Norrving, Bo LU ; Mensah, George A; Davis, Stephen; Roth, Gregory A; Thrift, Amanda G; Kengne, Andre P. and Kissela, Brett M., et al. (2017) In Neuroepidemiology 49. p.45-61
Abstract

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... (More)

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.

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publication status
published
subject
keywords
Low and Middle Income Countries (LMICs), Pre-hospital stroke transport, Strategies, Stroke services , Stroke units
in
Neuroepidemiology
volume
49
pages
17 pages
publisher
Karger
external identifiers
  • scopus:85028301222
  • wos:000412968900007
ISSN
0251-5350
DOI
10.1159/000479518
language
English
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yes
id
9b013945-6dc6-4ce1-9775-6e2ea4bbc785
date added to LUP
2017-10-06 11:23:17
date last changed
2018-04-07 03:00:14
@article{9b013945-6dc6-4ce1-9775-6e2ea4bbc785,
  abstract     = {<p>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.</p>},
  author       = {Pandian, Jeyaraj Durai and William, Akanksha G. and Kate, Mahesh P. and Norrving, Bo and Mensah, George A and Davis, Stephen and Roth, Gregory A and Thrift, Amanda G and Kengne, Andre P. and Kissela, Brett M. and Yu, Chuanhua and Kim, Daniel and Rojas-Rueda, David and Tirschwell, David L. and Abd-Allah, Foad and Gankpé, Fortuné and deVeber, Gabrielle and Hankey, Graeme J. and Jonas, Jost B. and Sheth, Kevin N. and Dokova, Klara and Mehndiratta, Man Mohan and Geleijnse, Johanna M. and Giroud, Maurice and Bejot, Yannick and Sacco, Ralph L and Sahathevan, Ramesh and Hamadeh, Randah R. and Gillum, Richard F and Westerman, Ronny and Akinyemi, Rufus Olusola and Barker-Collo, Suzanne and Truelsen, Thomas and Caso, Valeria and Rajagopalan, Vasanthan and Venketasubramanian, Narayanaswamy and Vlassovi, Vasiliy V. and Feigin, Valery L},
  issn         = {0251-5350},
  keyword      = {Low and Middle Income Countries (LMICs),Pre-hospital stroke transport,Strategies,Stroke services ,Stroke units},
  language     = {eng},
  month        = {08},
  pages        = {45--61},
  publisher    = {Karger},
  series       = {Neuroepidemiology},
  title        = {Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries : A Systematic Review},
  url          = {http://dx.doi.org/10.1159/000479518},
  volume       = {49},
  year         = {2017},
}