Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania

International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care
Robert W RegenhardtKigocha Okeng'o

Abstract

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. Prospective cohort study. Muhimbili National Hospital (MNH) in Dar es Salaam, July 2016-March 2017. Adults with new-onset stroke (<14 days), confirmed by head CT, admitted to MNH. Modified Rankin scale (mRS) and vital status. 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 p...Continue Reading

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Citations

Jan 14, 2020·Restorative Neurology and Neuroscience·Robert W RegenhardtDavid J Lin
Nov 29, 2020·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Neal M NolanAman B Patel
Feb 6, 2021·AJNR. American Journal of Neuroradiology·A T YuT M Leslie-Mazwi
Jan 2, 2021·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Robert W RegenhardtNatalia S Rost
Feb 12, 2021·PloS One·Kezia Kodawa TessuaSarah Shali Matuja
Feb 18, 2021·Journal of Neurointerventional Surgery·Robert W RegenhardtThabele M Leslie-Mazwi
Jul 31, 2021·Journal of Neurointerventional Surgery·Robert W RegenhardtThabele M Leslie-Mazwi

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