Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries

A Systematic Review

Akanksha G. William, Mahesh P. Kate, Bo Norrving, George A. Mensah, Stephen Davis, Gregory A. Roth, Amanda G. Thrift, Andre P. Kengne, Brett M. Kissela, Chuanhua Yu, Daniel Kim, David Rojas-Rueda, David L. Tirschwell, Foad Abd-Allah, Fortuné Gankpé, Gabrielle Deveber, Graeme J. Hankey, Jost B. Jonas, Kevin N. Sheth, Klara Dokova & 18 others Man Mohan Mehndiratta, Johanna M. Geleijnse, Maurice Giroud, Yannick Bejot, Ralph Sacco, Ramesh Sahathevan, Randah R. Hamadeh, Richard Gillum, Ronny Westerman, Rufus Olusola Akinyemi, Suzanne Barker-Collo, Thomas Truelsen, Valeria Caso, Vasanthan Rajagopalan, Narayanaswamy Venketasubramanian, Vasiliy V. Vlassovi, Jeyaraj Durai Pandian, Valery L. Feigin

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 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.

Original languageEnglish
Pages (from-to)45-61
Number of pages17
JournalNeuroepidemiology
Volume49
Issue number1-2
DOIs
Publication statusPublished - 1 Oct 2017
Externally publishedYes

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Stroke
Allied Health Personnel
Ambulances
Private Sector
Telemedicine
Primary Prevention
Secondary Prevention
PubMed
Caregivers
Health Services
Publications
Nurses
Economics
Delivery of Health Care
Costs and Cost Analysis
Research
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Epidemiology
  • Clinical Neurology

Cite this

William, A. G., Kate, M. P., Norrving, B., Mensah, G. A., Davis, S., Roth, G. A., ... Feigin, V. L. (2017). Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review. Neuroepidemiology, 49(1-2), 45-61. https://doi.org/10.1159/000479518

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries : A Systematic Review. / William, Akanksha G.; Kate, Mahesh P.; Norrving, Bo; Mensah, George A.; Davis, Stephen; Roth, Gregory A.; Thrift, Amanda G.; Kengne, Andre P.; Kissela, Brett M.; Yu, Chuanhua; Kim, Daniel; Rojas-Rueda, David; Tirschwell, David L.; Abd-Allah, Foad; Gankpé, Fortuné; Deveber, Gabrielle; Hankey, Graeme J.; Jonas, Jost B.; Sheth, Kevin N.; Dokova, Klara; Mehndiratta, Man Mohan; Geleijnse, Johanna M.; Giroud, Maurice; Bejot, Yannick; Sacco, Ralph; Sahathevan, Ramesh; Hamadeh, Randah R.; Gillum, Richard; Westerman, Ronny; Akinyemi, Rufus Olusola; Barker-Collo, Suzanne; Truelsen, Thomas; Caso, Valeria; Rajagopalan, Vasanthan; Venketasubramanian, Narayanaswamy; Vlassovi, Vasiliy V.; Pandian, Jeyaraj Durai; Feigin, Valery L.

In: Neuroepidemiology, Vol. 49, No. 1-2, 01.10.2017, p. 45-61.

Research output: Contribution to journalArticle

William, AG, Kate, MP, Norrving, B, Mensah, GA, Davis, S, Roth, GA, Thrift, AG, Kengne, AP, Kissela, BM, Yu, C, Kim, D, Rojas-Rueda, D, Tirschwell, DL, Abd-Allah, F, Gankpé, F, Deveber, G, Hankey, GJ, Jonas, JB, Sheth, KN, Dokova, K, Mehndiratta, MM, Geleijnse, JM, Giroud, M, Bejot, Y, Sacco, R, Sahathevan, R, Hamadeh, RR, Gillum, R, Westerman, R, Akinyemi, RO, Barker-Collo, S, Truelsen, T, Caso, V, Rajagopalan, V, Venketasubramanian, N, Vlassovi, VV, Pandian, JD & Feigin, VL 2017, 'Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review', Neuroepidemiology, vol. 49, no. 1-2, pp. 45-61. https://doi.org/10.1159/000479518
William, Akanksha G. ; Kate, Mahesh P. ; Norrving, Bo ; Mensah, George A. ; Davis, Stephen ; Roth, Gregory A. ; Thrift, Amanda G. ; Kengne, Andre P. ; Kissela, Brett M. ; Yu, Chuanhua ; Kim, Daniel ; Rojas-Rueda, David ; Tirschwell, David L. ; Abd-Allah, Foad ; Gankpé, Fortuné ; Deveber, Gabrielle ; Hankey, Graeme J. ; Jonas, Jost B. ; Sheth, Kevin N. ; Dokova, Klara ; Mehndiratta, Man Mohan ; Geleijnse, Johanna M. ; Giroud, Maurice ; Bejot, Yannick ; Sacco, Ralph ; Sahathevan, Ramesh ; Hamadeh, Randah R. ; Gillum, Richard ; Westerman, Ronny ; Akinyemi, Rufus Olusola ; Barker-Collo, Suzanne ; Truelsen, Thomas ; Caso, Valeria ; Rajagopalan, Vasanthan ; Venketasubramanian, Narayanaswamy ; Vlassovi, Vasiliy V. ; Pandian, Jeyaraj Durai ; Feigin, Valery L. / Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries : A Systematic Review. In: Neuroepidemiology. 2017 ; Vol. 49, No. 1-2. pp. 45-61.
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AU - William, Akanksha G.

AU - Kate, Mahesh P.

AU - Norrving, Bo

AU - Mensah, George A.

AU - Davis, Stephen

AU - Roth, Gregory A.

AU - Thrift, Amanda G.

AU - Kengne, Andre P.

AU - Kissela, Brett M.

AU - Yu, Chuanhua

AU - Kim, Daniel

AU - Rojas-Rueda, David

AU - Tirschwell, David L.

AU - Abd-Allah, Foad

AU - Gankpé, Fortuné

AU - Deveber, Gabrielle

AU - Hankey, Graeme J.

AU - Jonas, Jost B.

AU - Sheth, Kevin N.

AU - Dokova, Klara

AU - Mehndiratta, Man Mohan

AU - Geleijnse, Johanna M.

AU - Giroud, Maurice

AU - Bejot, Yannick

AU - Sacco, Ralph

AU - Sahathevan, Ramesh

AU - Hamadeh, Randah R.

AU - Gillum, Richard

AU - Westerman, Ronny

AU - Akinyemi, Rufus Olusola

AU - Barker-Collo, Suzanne

AU - Truelsen, Thomas

AU - Caso, Valeria

AU - Rajagopalan, Vasanthan

AU - Venketasubramanian, Narayanaswamy

AU - Vlassovi, Vasiliy V.

AU - Pandian, Jeyaraj Durai

AU - Feigin, Valery L.

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