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Advanced Neurology Stroke care in sub-Sahara Africa

in 2014, significantly enhancing the educational 4.5. Availability of stroke diagnostic studies and
and leadership skills of multidisciplinary stroke care treatment options in SSA
teams at KBTH, including nurses, physicians, and The availability and accessibility of stroke diagnostic
physiotherapists. The stroke unit initially focused on examinations and treatments in SSA exhibit significant
education in four key areas: manual handling and variability, contingent upon health-care levels:
positioning, continence, swallowing and nutrition,
and communication post-stroke, eventually leading (i) Laboratory tests: Basic serum examinations, including
to substantial improvements in stroke outcomes complete blood count, lipid profile, blood glucose,
in Ghana. 62,63 Other established stroke units in the hemoglobin A1c, renal function, HIV testing, syphilis
region can be found in South Africa. The stroke unit serology, and C-reactive protein, are readily available
at Groote Schuur Hospital in Cape Town is another at most LLHCs and all HHCCs, obtainable for patients
key example of organized and specialized stroke care upon admission and during follow-up. However,
at a large public hospital in SSA. Encouragingly, the advanced serum testing, such as antiphospholipid
number of these specialized stroke units is increasing autoantibodies and genetic thrombophilia, may not
across Africa, including at both public and private be readily available, including at HHCCs. 68
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hospitals, providing hope for stroke patients in the (ii) Head-and-neck imaging examinations: Computed
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region. Notably, some hospitals in SSA that lacks a tomography (CT) scans are available in all HHCCs
resolute stroke unit have ingeniously created minimal in SSA, although imaging services may not be
setting stroke units, which are 3 – 5 bed acute stroke available 24 h a day. 67,68 Key factors affecting the
units located within a neurology ward and equipped continuous availability of CT scan imaging include
with tools for frequent monitoring of vital signs. the lack of radiology technologists and radiologists
Patients in these minimal setting units are evaluated during after-hours, as well as breakdowns of CT scan
more frequently by a resolute multidisciplinary stroke machines with delayed repairs. Consequently, many
team, leading to improved stroke outcomes in the patients may not receive hyperacute head imaging at
setting of minimal resources. 66 presentation, although nearly all can access imaging
Of note, while organized stroke care in SSA faces within 24 – 72 h thereafter. In most cases, patients are
significant challenges, there are ongoing efforts to improve required to pay for CT scans, further limiting access.
access and quality of care across the continent. The Magnetic resonance imaging (MRI) of the brain is
disparities in resource availability, personnel training, and not ubiquitously available and often comes at a cost,
technology underscore the need for continued investment even in public hospitals. Frequently, patients may be
and collaboration to enhance stroke care in this region. referred to private imaging facilities outside of public
hospitals for MRI brain imaging. With regard to
4.4. Trained personnel for stroke care in SSA vascular imaging, carotid Doppler ultrasound scans
The availability of trained personnel for the provision are available, although CT angiography and magnetic
of specialized and comprehensive stroke care in SSA is resonance angiography are seldom performed. 69
limited, exhibiting significant variability across the region. (iii) Cardiac workup: Electrocardiogram testing, for
This deficiency primarily stems from socioeconomic screening of cardiac rhythm abnormalities or signs
challenges and a paucity of training opportunities within of cardiac ischemia, is often available at little to no
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the region. According to a large survey, nearly all SSA cost, often within 24 h of presentation. Transthoracic
countries, with the exceptions of South Africa, Ethiopia, echocardiography for evaluating proximal sources
Cameroon, and Nigeria, fall into two categories: those of emboli is commonly available at most HHCCs.
with 10 – 30 neurologists per country (level C-1) or 1 – However, the availability of Holter monitors
9 neurologists per country (level C-2). Furthermore, and implantable loop recorders for continuous
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several countries were found to entirely lack a neurologist cardiac rhythm monitoring is either nonexistent or
(level D category). These statistics encompass vascular prohibitively costly.
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neurologists, a subset of neurologists who are scarcer. In
general, neurologists tend to practice at HHCCs. Other 4.6. Availability of stroke therapeutics in SSA
essential members of multidisciplinary stroke care teams Stroke therapeutics in the region fall into two categories:
at HHCCs comprise neurosurgeons, physiotherapists, (i) Stroke pharmacotherapeutics: Thrombolytics are
radiologists, medical social workers, and nutritionists. mostly unavailable except at large tertiary hospitals,
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However, occupational and speech therapists are notably especially those with stroke units. According
scarce resources in this context. to a survey, thrombolysis was available in only

Volume 3 Issue 2 (2024) 8 doi: 10.36922/an.2804