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Towards best practice in acute stroke care in Ghana: a survey of hospital services

Baatiema, L; Otim, M; Mnatzaganian, G; Aikins, AD-G; Coombes, J; Somerset, S; (2017) Towards best practice in acute stroke care in Ghana: a survey of hospital services. BMC Health Services Research , 17 (1) , Article 108. 10.1186/s12913-017-2061-2. Green open access

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Abstract

BACKGROUND: Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice. METHODS: A multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards. RESULTS: Availability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care. CONCLUSION: This study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana.

Type: Article
Title: Towards best practice in acute stroke care in Ghana: a survey of hospital services
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s12913-017-2061-2
Publisher version: https://doi.org/10.1186/s12913-017-2061-2
Language: English
Additional information: © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
Keywords: Stroke, Hospital services, Organised care, Evidence-based care, Health policy, Ghana
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > UCL SLASH
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > SHS Faculty Office
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > SHS Faculty Office > UCL Institute for Advanced Studies
URI: https://discovery.ucl.ac.uk/id/eprint/10078613
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