Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania.
Int J Qual Health Care
; 31(5): 385-392, 2019 Jun 01.
Article
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| MEDLINE
| ID: mdl-30165650
ABSTRACT
OBJECTIVE:
Given the high post-stroke mortality and disability and paucity of data on the quality of stroke care in Sub-Saharan Africa, we sought to characterize the implementation of stroke-focused treatments and 90-day outcomes of neuroimaging-confirmed stroke patients at the largest referral hospital in Tanzania.DESIGN:
Prospective cohort study.SETTING:
Muhimbili National Hospital (MNH) in Dar es Salaam, July 2016-March 2017.PARTICIPANTS:
Adults with new-onset stroke (<14 days), confirmed by head CT, admitted to MNH. MAIN OUTCOMESMEASURES:
Modified Rankin scale (mRS) and vital status.RESULTS:
Of 149 subjects (mean age 57; 48% female; median NIH stroke scale (NIHSS) 19; 46% ischemic stroke; 54% hemorrhagic), implementation of treatments included dysphagia screening (80%), deep venous thrombosis prophylaxis (0%), aspirin (83%), antihypertensives (89%) and statins (95%). There was limited ability to detect atrial fibrillation and carotid artery disease and no acute thrombolysis or thrombectomy. Of ischemic subjects, 19% died and 56% had severe disability (mRS 4-5) at discharge; 49% died by 90 days. Of hemorrhagic subjects, 33% died and 49% had severe disability at discharge; 50% died by 90 days. In a multivariable model, higher NIHSS score but not dysphagia, unconsciousness, or patient age was predictive of death by 90 days.CONCLUSIONS:
The 90-day mortality of stroke presenting at MNH is 50%, much higher than in higher income settings. Although severe stroke presentations are a major factor, efforts to improve the quality of care and prevent complications of stroke are urgently needed. Acute stroke interventions with low number needed to treat represent challenging long-term goals.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Accidente Cerebrovascular
Tipo de estudio:
Etiology_studies
/
Incidence_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Africa
Idioma:
En
Revista:
Int J Qual Health Care
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2019
Tipo del documento:
Article
País de afiliación:
Estados Unidos