Improving Stroke Management through Specialized Stroke Units in Nigeria: A situational Review

Authors

  • Hope Ilanye Bell - Gam Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt
  • Authur Onwuchekwa Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt
  • Alagoma Murtala Iyagba Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt

DOI:

https://doi.org/10.60787/tnhj.v12i2.86

Keywords:

Sharing burden, Stroke unit, Nigeria

Abstract

Background: Stroke therapy is aimed at re-opening blocked arteries and increasing the survival of cells that are injured in addition to the early rehabilitation of the stroke patient. The establishment of stroke units has been found to improve the survival of patients and significantly reduce disability by rendering holistic care. Early intervention to rapidly restore and maintain blood supply to the ischemic area in the brain, minimize brain damage and hence impairment as well as disability and secondary complications which will reduce the risk of death is more likely achievable in specialized care settings. The objective of this review is to discuss the role and feasibility of implementing stroke care in specialized stroke units (SSUs).

Methods: Key literature detailing the care of stroke patients at the different tier of health institutions in Nigeria and abroad were reviewed using Medline and Google search utilizing the following keywords' Stroke unit; Management; Shared Burden and Nigeria. The difficulties associated with the provision of care for stroke patients in specialized stroke units were identified while the implications and suggestions for the development of such units in Nigeria are addressed.

Results: The care of stroke patients remains mainly uncoordinated and usually managed in the general medical wards with suboptimal management. Issues that may affect establishment of specialized Stroke Unit include lack of Neurologists, Geriatricians with special interest in stroke management, allied health professionals and Nurses trained in providing supportive care. The challenges of the start -up cost, and public education in seeking help early enough are also highlighted.

Conclusion: The evidence for the need for change from the usual care of stroke patient's in general medical wards to specialized stroke units is undisputable. Establishment of such units in Nigeria is desirable, urgent and feasible. The establishment of these SSUs can be started by having specific designated beds in a section of the medical wards with the care assigned to specially trained medical and allied health providers.

Downloads

Download data is not yet available.

References

Hatano S. Experience from a multicenter stroke register: a preliminary report. Bull World Health Organisation 1976;54:541-553

Sarti C, Bastenyte D, Cepaitis J,Tuomilehto J. International trends in mortality from stroke, 1968-1994. Stroke 2000;31:1588-1601

Strong K, Mathers C, Bonita R. Preventing stroke, saving lives around the world.

Lancet Neurol 2007,6;2:182-187

Foulkes MA, Wolfe PA, Price TR, Mohr JP, Hier DB. The stroke data bank: design, methods and baseline characteristics. Stroke 1998;19:547-554

Ogungbo BO, Ogun SA, Ushewokunze S, Mendilow AD,Walker R, Rodgers H. How can we improve the management of Stroke in Nigeria, Africa. Afr J Neurol Sc, 2005, 24;2:9-19

Osuntokun BO, Bademosi O, Akinkhugbe OO, Oyediran AB, Carlisle R. Incidence of Stroke in an African city:results from the Stroke Registry at Ibadan, Nigeria, 1973-1975

Danesi M, Okubadejo N, Ojini F. Incidence of Stroke in an urban mixed income community in Lagos, Nigeria. Neuroepidemiology 2007;28:216-223

Ogun SA, Adelowo OO,Familoni OB, Jaiyesimi AEA, Fakoya EAO.Pattern and outcome of Medical admissions at the Ogun State University Teaching Hospital,Sagamu:a three year review. Afr J Med 2000; 19:304-308

Odusote A. Management of Stroke. Nig Med Pract 1996, 32(5/6):54-62

Ojini F, Ogun SA, Danesi M. 30 days case fatality ofStroke at the Lagos University Teaching Hospital,Lagos, Nigeria. Nig Quart J Hosp Med 2004;14:64-66

Onwuchekwa AC, Asekomeh EG, Iyagba AM, Onung SO. Medical mortality in the Accident and Emergency Unit of the University of Port Harcourt Teaching Hospital. Nig J Med 2008, 17;2:184-187

Ogun SA, Oluwole O, Falade B, Ogunseyinde AO, Ojini FI, Odusote KA.Comparision Siriraj Stroke Score and the WHO criteria in the clinical classification of stroke subtypes. Afri J Med Sc 2002,3;1:3-6

Muir KW, Santosh C. Imaging of Acute ischaemic stroke and transient ischaemic attack. J Neurol Neurosurg Psychiatry 2005;76(suppl III):iii19-iii28

Van der Worp HB, van Gijn J. Acute Ischaemic Stroke. N Engl J Med 2007;357:572-579

Pandian JD, Padma V, Vijaya P, Sylaja PN, Murthy JMK. Stroke thrombolysis in developing countries. Int J Stroke 2007;2:17-26

Goldstein LB.Acute Ischaemic Stroke Treatment in 2007. Circulation 2007;116:1504-1514

Hacke W, Kaste UM, Olsen TS, Bogousslausky J,Orgogozo JM. Acute treatment of Ischaemic Stroke. Cerebrovasc Dis 2000;10(suppl3):22-33

Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous Intracerbral Haemorrhage. N Engl J Med 2001,344;19:1450-1460

Broderick J, Commoly S, Feldman E, Hanley D, Kase C, Krieger D, Mayberg M et al. Guidelines for the management of spontaneous intracerbral haemorrhage.

Stroke 2007;38:2001-2023

Williams UE. Neurological letter from Calabar, Nigeria. Pract Neurol2009;9:237-239

Owolabi MO, James HB, Ogunniyi A. Mapping Africa's way into prominence in the field of Neurology. Arch Neurol 2007;67:1696-1700

Smith SM, Albright S, O'Dowd T. Effectiveness ofshared care across the interface between primary and specialty care in chronic disease management. Cochrane Database of Systematic Reviews 2007,Issue 3.Art No:CD004910

Sulchi D,Evans A, Melbourn A,Kalra A. Does an integrated care pathway improve processes of care in stroke rehabilitation? A randomized controlled trial. Age and Ageing 2002; 31:175-179

Kumar S, Selim MH, Caplan LR. Medical Complications after Stroke. Lancet Neurol 2010, 9;1:105-118

Langhorne P. Organisation of Acute Sroke Care. British Med Bull 2000,56;2:436-443

Carraway WM. Stroke rehabilitation units:concepts, evaluation and unresolved issues. Stroke 1995;16:178-181

Stroke Unit Trialist Collaboration. Collaborative systematic review of the randomized trials of (organized stroke unit) care after stroke. British Med J 1997;314:1151-1159

Langhorne P, Williams BO, Gilchrist W, Howie K. Do stroke units save lives? Lancet 1993;342:395-8

Rodgers H, Dennis M, Cohen D, Rod I. British Association of Stroke Physicians:Benchmarking Survey of Stroke Services. Age and Ageing 2003;32:211-217

Langhorne P, Pollock A in conjunction with the Stroke Unit Trialist Collaborators. What are the components ofeffective stroke unit care? Age and Ageing 2002;31:365-371

Millikan CH. Stroke intensive care units: objectives and results. Stroke 1979,10;3:235-236

Pitner SE, Mance CJ. An Evaluation of Stroke Intensive Care: Results in a municipal Hospital.Stroke 1973, 4:737-741

Kjellstrom T, Norrving B, Shatchkute. Helsingborg 2006 Declaration on European Stroke Strategies. Cerebrovasc Dis 2007;23:229-241

Caplans LR. Stroke is best managed by Neurologists. Stroke 2003, 34:2763

Owolabi MO. Psychometric Properties of the HRQLISP-40: A Novel, Shortened Multiculturally Valid Holistic Stroke Measure. Neurorehabil Neural Repair 2010, 24:814-825

Cox AM McKevitt C, Rudi AG, Wolfe CD. Socioeconomic status and stroke. Lancet Neurol 2006;5:181-188The Nigerian Health Journal, Vol. 12, No 2, April — June, 2012Bell-Gam H.I, et al – Stroke Management in Nigeria

Downloads

Published

2015-12-09

How to Cite

Bell - Gam, H. I., Onwuchekwa, A., & Iyagba, A. M. (2015). Improving Stroke Management through Specialized Stroke Units in Nigeria: A situational Review. The Nigerian Health Journal, 12(2), 31. https://doi.org/10.60787/tnhj.v12i2.86
Abtract Views | PDF Download | EPUB Download: 919 / 254

Most read articles by the same author(s)

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.