Perceived barriers to acute stroke care in Kano, Nigeria: A focus group study and literature review of Sub-Saharan African stroke care barriers

Résumé fourni par la source

Background Globally, sub-Saharan Africa (SSA) has some of the highest stroke mortality rates. In Nigeria, for example, 1- and 3-year stroke death rates are estimated at 40% and 80%, respectively. Purpose To explore perceptions of acute stroke care barriers among healthcare professionals, patients, and caregivers in Kano, Nigeria, and to contextualize these findings within the literature from SSA. Methods We carried out focus groups to determine gaps in acute stroke treatment, management, prevention, and rehabilitation. The current study was carried out as part of a larger study to inform the low-resource stroke unit (LRSU) phase of the study. A moderator and translator attended each of 5 group sessions, and tailored, open-ended questions were answered by the participants. In addition, we carried out a literature search of barriers to acute stroke care in SSA. Results A convenience sample of 35 participants including 2 consulting neurologists of which 1 doubled as an administrator and 5 resident physicians, 7 nurses, 7 physiotherapists, 7 patients who had a stroke, and 6 caregivers, participated in focus group discussions. Five main overlapping themes regarding gaps in acute stroke care emerged: delays in access to care, significant resource limitations, financial and sociocultural barriers, gaps in rehabilitative services, and opportunities for system-wide improvements. Our main findings about barriers to stroke care share many similarities to other recent studies in SSA. Conclusion The findings support the prioritization of feasible, system-level strategies to improve stroke prevention, acute stroke treatment, and rehabilitation services in Kano and similar low-resource settings. LRSUs may provide a cost-effective pathway to help achieve this end.