Stroke care in Africa: A systematic review of the literature

With all these problems the only solution that will be tried is the 88% failure rate of tPa getting to full recovery. 
Rather than come up with solutions that address neurogenesis, neuroplasticity, or the 5 causes of the neuronal cascade of death.
http://journals.sagepub.com/doi/abs/10.1177/1747493018772747? 

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Gerard Urimubenshi¹²

Gerard Urimubenshi

1236381Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK2127745College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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, Dominique A Cadilhac³⁴

Dominique A Cadilhac

3Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Clayton, Australia4Stroke Division, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, Victoria, Australia
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, Jeanne N Kagwiza²

Jeanne N Kagwiza

2127745College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Olivia Wu⁵

Olivia Wu

5Institute of Health and Wellbeing, 3526University of Glasgow, Glasgow, UK
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, Peter Langhorne¹

Peter Langhorne

1236381Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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First Published April 17, 2018 Review Article

https://doi.org/10.1177/1747493018772747

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Article Information

Article first published online: April 17, 2018
Received: November 10, 2017; Accepted: February 11, 2018

https://doi.org/10.1177/1747493018772747

Gerard Urimubenshi^{1, 2}, Dominique A Cadilhac^{3, 4}, Jeanne N Kagwiza², Olivia Wu⁵, Peter Langhorne¹

¹236381Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

²127745College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

³Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Clayton, Australia

⁴Stroke Division, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, Victoria, Australia

⁵Institute of Health and Wellbeing, 3526University of Glasgow, Glasgow, UK

Corresponding Author: Gerard Urimubenshi, Glasgow Royal Infirmary, Level 2, New Lister Building, Glasgow G31 2ER, UK. Email: g.urimubenshi.1@research.gla.ac.uk

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Abstract

Background

Appropriate systems of stroke care are important to manage the increasing death and disability associated with stroke in Africa. Information on existing stroke services in African countries is limited.

Aim

To describe the status of stroke care in Africa.

Summary of review

We undertook a systematic search of the published literature to identify recent (1 January 2006–20 June 2017) publications that described stroke care in any African country. Our initial search yielded 838 potential papers, of which 38 publications were eligible representing 14/54 African countries. Across the publications included for our review, the proportion of stroke patients reported to arrive at hospital within 3 h from stroke onset varied between 10% and 43%. The median time interval between stroke onset and hospital admission was 31 h. Poor awareness of stroke signs and symptoms, shortages of medical transportation, health care personnel, and stroke units, and the high cost of brain imaging, thrombolysis, and outpatient physiotherapy rehabilitation services were reported as major barriers to providing best-practice stroke care in Africa.

Conclusions

This review provides an overview of stroke care in Africa, and highlights the paucity of available data. Stroke care in Africa usually fell below the recommended standards with variations across countries and settings. Combined efforts from policy makers and health care professionals in Africa are needed to improve, and ensure access, to organized stroke care in as many settings as possible. Mechanisms to routinely monitor usual care (i.e., registries or audits) are also needed to inform policy and practice.