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Advanced Neurology Stroke care in sub-Sahara Africa

Table 2. Levels of health‑care services for stroke in sub‑Saharan Africa
General hierarchical organization of health‑care facilities World Stroke Organization’s levels for health‑care service provision in stroke
Lower-level health-care center (LHCC): Community-level • Nursing and physician access: Availability of nurses but with limited access to
health centers, district hospitals, private center clinics, and physicians
small private hospitals • Diagnostics and hospital care: No access to stroke diagnostic services or hospital care
• Preventative advice: Limited access to basic lifestyle preventative advice
• Local community care: Care provided in local communities without coordination across
defined geographic regions
Higher-level health-care center (HHCC): Regional referral • Nursing and physician access: Availability of nurses and physicians, though they may
hospitals, national referral hospitals, and large urban private not specialize in stroke
hospitals • Basic diagnostics: Access to basic diagnostic services such as laboratory tests, ECG, CT
scans, and ultrasound
• Acute thrombolysis: Provision of acute thrombolysis using tPA
• Interdisciplinary care: Elements of stroke unit care with interdisciplinary team.
• Rehabilitation services: Access to rehabilitation services
• Prevention therapies: Availability of stroke prevention therapies such as aspirin, lifestyle
change recommendations, and blood pressure management
• Limited coordinated care: Some level of coordinated stroke care across distant
geographic regions
Abbreviations: CT: Computed tomography; ECG: Electrocardiogram; tPA: Tissue plasminogen activator.

Thrombolytics are administered to eligible ischemic stroke also receive training here. Supervising physicians,
patients, if available. Following initial treatment and either neurologists or internists with experience in
stabilization in the emergency room, patients are admitted managing complex neurological conditions, lead
to one of three types of wards for further stroke care: daily rounds and patient management, often while
(i) Internal medicine ward: This is the most common educating students. Nurses and nursing managers
destination for stroke patients. Managed by medical with specialty training in the care of patients with
officers under the supervision of internists, with or complicated neurological disorders are also part of the
without subspecialty training in neurology, these team.
wards cater to all adult patients with various medical (iii) Formal stroke unit: These specialized units are rare in
or non-surgical conditions. Nurses, with varying SSA and are typically found in large academic centers
patient-to-nurse ratios across the continent, provide in the western and southern parts of SSA. They
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daily care and prescribed treatments. 55,56 Despite high provide multidisciplinary and coordinated stroke care
patient volumes and diverse medical conditions, the with timely access to key diagnostic and therapeutic
staff here is adept at managing acute stroke cases. options. These units are classified at the level of
Patients receive daily ward rounds, medication Essential and Advanced Stroke Care Services by the
administration, and completion of stroke workup. World Stroke Organization’s roadmap for quality
Specialty stroke care, such as dysphagia assessment, stroke care (Table 2). A nationwide survey from
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nutrition, and physical therapy, is variably available. Nigeria found that 5 out of 58 hospitals surveyed had a
Most general medical units can provide minimal to stroke unit, with the number of dedicated stroke beds
essential stroke care services as outlined in the World ranging between 10 and 27 beds. Such stroke units
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Stroke Organization roadmap guideline for stroke are often established through collaborative efforts
care. 54 between hospitals in SSA and those in developed
(ii) Neurology unit: Formal neurology units are less countries. Notable examples include the Malawi
common and are usually found in larger national stroke unit at Queen Elizabeth National Hospital in
referral hospitals across SSA. 57-59 These units admit Blantyre and the stroke unit at Korle Bu Teaching
patients with various neurological conditions, with a Hospital (KBTH) in Accra, which were set up by the
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sizable proportion being stroke patients. More than Wessex-Stroke Partnership (WGSP). Established in
50% of admissions in these units are stroke related, 2009, the WGSP is a collaboration between Wessex
effectively functioning as de facto stroke units. Bed (United Kingdom) and KBTH in Accra, aiming to
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capacity typically ranges from 10 to 30, with some improve stroke outcomes in Ghana using culturally
overflow capacity. The units are staffed by junior and feasible and sustainable methods adapted from stroke
senior doctors with an interest in neurology, and treatment practices in the United Kingdom. WGSP
postgraduates in internal medicine and neurology opened the first resolute stroke unit in West Africa

Volume 3 Issue 2 (2024) 7 doi: 10.36922/an.2804