Interventions for acute stroke management in Africa: a systematic review of the evidence

Leonard Baatiema,Carina K Y Chan,Adem Sav,Shawn Somerset

doi:10.1186/s13643-017-0594-4

Leonard Baatiema, Carina K Y Chan + Show 2 more

Open Access

https://doi.org/10.1186/s13643-017-0594-4

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Abstract

BackgroundThe past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. Nonetheless, the evidence-to-practice gap in acute stroke care remains variable with slow and inconsistent uptake in low-middle income countries (LMICs). This review aims to identify and compare evidence-based acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence, and length of hospital stay across Africa.MethodsThis review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. An electronic search was conducted in six databases comprising MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Academic Search Complete and Cochrane Library for experimental and non-experimental studies. Eligible studies were abstracted into evidence tables and their methodological quality appraised using the Joanna Briggs Institute checklist. Data were analysed and presented narratively with reference to observed differences in patient outcomes, reporting p values and confidence intervals for any possible relationship.ResultsInitially, 1896 articles were identified and 37 fully screened. Four non-experimental studies (three cohort and one case series studies) were included in the final review. One study focused on the clinical efficacy of a stroke unit whilst the remaining three reported on thrombolytic therapy. The results demonstrated a reduction in patient deaths attributed to stroke unit care and thrombolytic therapy. Thrombolytic therapy was also associated with reductions in symptomatic intracerebral haemorrhage (SICH). However, the limited eligible studies and methodological limitations compromised definitive conclusions on the extent of and level of efficacy of evidence-based acute stroke care interventions across Africa.ConclusionEvidence from this review confirms the widespread assertion of low applicability and uptake of evidence-based acute stroke care in LMICs. Despite the limited eligible studies, the overall positive patient outcomes following such interventions demonstrate the applicability and value of evidence-based acute stroke care interventions in Africa. Health policy attention is thus required to ensure widespread applicability of such interventions for improved patients’ outcomes. The review findings also emphasises the need for further research to unravel the reasons for low uptake.Systematic review registrationPROSPERO CRD42016051566

Highlights

The past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide
This study aims to identify and compare four recommended acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence and length of hospital stay across hospital settings in Africa
A total number of 625 duplicates were removed. Another 1234 studies were removed after title and abstract screening for relevance

Summary

Introduction

The past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. In Africa, this burden is further accentuated by the increasing prevalence of hypertension [2,3,4,5] This notwithstanding, the nature of acute stroke care is often poor due to the fact that the application of evidence-based acute stroke care interventions for optimal patient outcomes in such countries remains inadequate [6,7,8,9]. In the context of Africa, there is low allocation to the national health budgets [10] Compounded to this is the fact that the African continent is currently facing an epidemiological transition, precipitated by rapid unplanned urbanisation, ageing population and increasing modifiable risk factors for non-communicable diseases [11]. This makes it extremely difficult for most healthcare systems to provide standardised care

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