Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa – A survey based approach. (August 2017)

• Record Type: Journal Article
• Authors: Lin, Chen; Vakani, Ravi; Kussin, Peter; Guhwe, Mary; Farjat, Alfredo E.; Choudhury, Kingshuk; Renner, David; Oduor, Chrispine; Graffagnino, Carmelo
• Is Part Of: Journal of clinical neuroscience. Volume 42(2017:Aug.)
• Page Start: 71
• Page End: 74
• Publication Date: 2017-08
• Subjects: Stroke -- Healthcare education -- Stroke education -- Sub-Saharan Africa -- Kenya -- Stroke management; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.04.013
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Understanding stroke management in sub-Saharan providers is critical. No clear majority on using a standardized scale for evaluation of stroke patients. VTE prophylaxis nor swallowing screening considered to be done a majority of time. Clinical experience impacted use of IV fluids and timing of antithrombotic therapy. Future efforts in education are needed to improve stroke care in sub-Saharan Africa. Abstract: There is no published literature regarding sub-Saharan health-care providers' understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimize patient outcomes. A cross-sectional survey of acute stroke diagnosis, hospital management, and secondary prevention questions was administered to health-care providers working in one large Kenyan acute referral hospital. Due to the prevalence of medical students (61.8%), an experienced-focused analysis contrasted students with more experienced providers. Providers ( n = 199) anonymously responded to the surveys. Among the acute diagnosis most respondents stated that stroke scales should always used (58.3% of respondents), 3 h was the time period for alteplase (t-PA) (53.8% of respondents), and CT scan should be always be obtained prior to administration of anticoagulant therapy (61.3% of respondents). Neither VTE prophylaxis nor dysphagia/swallowing screening were considered to be done a majority of time. Secondary prevention results were variable. The respondent's level of clinical experience made the most difference in correctly answering the most appropriate IV Fluid to use in stroke patients (adjusted p = 0.003) and the ideal initiation time for antithrombotic therapy (adjusted p = 0.0017). Healthcare providers demonstrated a wide variability in their responses. Future efforts to improve stroke care in sub-Saharan Africa should include education and process improvement initiatives to focus on more specific aspects of stroke management based on the results from this survey.