Interventions for acute stroke management in Africa : A systematic review of the evidence

Journal article


Baatiema, Leonard, Chan, Carina K. Y., Sav, Adem and Somerset, Shawn. (2017). Interventions for acute stroke management in Africa : A systematic review of the evidence. Systematic Reviews. 6(1), p. Article 213. https://doi.org/10.1186/s13643-017-0594-4
AuthorsBaatiema, Leonard, Chan, Carina K. Y., Sav, Adem and Somerset, Shawn
Abstract

Background
The past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. Nonetheless, the evidence-to-practice gap in acute stroke care remains variable with slow and inconsistent uptake in low-middle income countries (LMICs). This review aims to identify and compare evidence-based acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence, and length of hospital stay across Africa.

Methods
This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. An electronic search was conducted in six databases comprising MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Academic Search Complete and Cochrane Library for experimental and non-experimental studies. Eligible studies were abstracted into evidence tables and their methodological quality appraised using the Joanna Briggs Institute checklist. Data were analysed and presented narratively with reference to observed differences in patient outcomes, reporting p values and confidence intervals for any possible relationship.

Results
Initially, 1896 articles were identified and 37 fully screened. Four non-experimental studies (three cohort and one case series studies) were included in the final review. One study focused on the clinical efficacy of a stroke unit whilst the remaining three reported on thrombolytic therapy. The results demonstrated a reduction in patient deaths attributed to stroke unit care and thrombolytic therapy. Thrombolytic therapy was also associated with reductions in symptomatic intracerebral haemorrhage (SICH). However, the limited eligible studies and methodological limitations compromised definitive conclusions on the extent of and level of efficacy of evidence-based acute stroke care interventions across Africa.

Conclusion
Evidence from this review confirms the widespread assertion of low applicability and uptake of evidence-based acute stroke care in LMICs. Despite the limited eligible studies, the overall positive patient outcomes following such interventions demonstrate the applicability and value of evidence-based acute stroke care interventions in Africa. Health policy attention is thus required to ensure widespread applicability of such interventions for improved patients’ outcomes. The review findings also emphasises the need for further research to unravel the reasons for low uptake.

Systematic review registration
PROSPERO CRD42016051566

Keywordsstroke; organised care; stroke service; Africa; evidence-based practice; implementation
Year2017
JournalSystematic Reviews
Journal citation6 (1), p. Article 213
PublisherBMC
ISSN2046-4053
Digital Object Identifier (DOI)https://doi.org/10.1186/s13643-017-0594-4
Scopus EID2-s2.0-85050639662
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-12
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online24 Oct 2017
Publication process dates
Accepted02 Oct 2017
Deposited07 Sep 2021
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https://acuresearchbank.acu.edu.au/item/8wvq5/interventions-for-acute-stroke-management-in-africa-a-systematic-review-of-the-evidence

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Ramadas, Amutha, Quek, Kia, Chan, Carina and Oldenburg, Brian. (2011). Web-based interventions for the prevention and management of Type 2 diabetes mellitus :A systematic review of recent evidence. International Journal of Medical Informatics. 80(6), pp. 389 - 405. https://doi.org/10.1016/j.ijmedinf.2011.02.002
Weaknesses in using quasi-quantitative food-frequency questionnaire data to link habitual intake of flavonoids to hypertension incidence
Somerset, Shawn. (2011). Weaknesses in using quasi-quantitative food-frequency questionnaire data to link habitual intake of flavonoids to hypertension incidence. American Journal of Clinical Nutrition. 93(5), pp. 1153 - 1154. https://doi.org/10.3945/ajcn.111.012856
Behavioral interventions for prevention and management of chronic disease
Oldenburg, Brian, Absetz, Pilvikki and Chan, Carina Ka Yee. (2010). Behavioral interventions for prevention and management of chronic disease. In Handbook of Behavioral Medicine: Methods and Applications pp. 969 - 988 Springer. https://doi.org/10.1007/978-0-387-09488-5_62
Perfectionism and eating disturbances in Korean immigrants : Moderating effects of acculturation and ethnic identity
Chan, Carina, Ku, Youngeun and Owens, Richard. (2010). Perfectionism and eating disturbances in Korean immigrants : Moderating effects of acculturation and ethnic identity. Asian Journal of Social Psychology. 13(4), pp. 293 - 302. https://doi.org/10.1111/j.1467-839x.2010.01326.x
Perfectionism and eating disturbances in Korean immigrants : Moderating effects of acculturation and ethnic identity
Chan, Carina, Ku, Youngeun and Owens, Richard. (2010). Perfectionism and eating disturbances in Korean immigrants : Moderating effects of acculturation and ethnic identity. Asian Journal of Social Psychology. 13(4), pp. 293 - 302. https://doi.org/10.1111/j.1467-839x.2010.01326.x
Food acquisition habits in a group of African refugees recently settled in Australia
Pereira, Carolina, Larder, Nicolette and Somerset, Shawn. (2010). Food acquisition habits in a group of African refugees recently settled in Australia. Health & Place: an international journal. 16(5), pp. 934 - 941. https://doi.org/10.1016/j.healthplace.2010.05.007
Reporting of dietary control frameworks in studies on simvastatin efficacy
Somerset, Shawn. (2010). Reporting of dietary control frameworks in studies on simvastatin efficacy. Clinical Nutrition. 29(3), pp. 352 - 357. https://doi.org/10.1016/j.clnu.2009.10.005
Experiences of Australian Muslim men in the workplace: A field study of employment choices and consequences
Sav, Adem, Sebar, Bernadette and Harris, Neil. (2010). Experiences of Australian Muslim men in the workplace: A field study of employment choices and consequences. Journal of Muslim Minority Affairs. 30(3), pp. 409 - 423. https://doi.org/10.1080/13602004.2010.515825
Nutrition education: towards a whole-school approach
Rowe, Fiona, Stewart, Don and Somerset, Shawn. (2010). Nutrition education: towards a whole-school approach. Health Education. 110(3), pp. 197 - 208. https://doi.org/10.1108/09654281011038868
Development of an interactive nutrition education website for patients with type 2 diabetes mellitus
Ramadas, Amutha, Quek, Kia Fatt, Chan, Carina Ka Yee, Hussain, Zanariah and Oldenburg, Brian. (2009). Development of an interactive nutrition education website for patients with type 2 diabetes mellitus. International Congress of Nutrition: 17th Congress, Vienna, August 2001. Switzerland: Karger. pp. 435 - 436
Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit: A 12-month intervention trial
Somerset, Shawn and Markwell, Katherine. (2009). Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit: A 12-month intervention trial. Public Health Nutrition. 12(2), pp. 214 - 221. https://doi.org/10.1017/S1368980008003327
Variations in prevalence and conduct of school food gardens in tropical and subtropical regions of north-eastern Australia
Somerset, Shawn and Bossard, Antoine. (2009). Variations in prevalence and conduct of school food gardens in tropical and subtropical regions of north-eastern Australia. Public Health Nutrition. 12(9), pp. 1485 - 1493. https://doi.org/10.1017/S1368980008004552
The voices of muslim men: The experiences of Australian muslim men in the workplace
Sav, Adem, Sebar, Bernadette and Harris, Neil. (2009). The voices of muslim men: The experiences of Australian muslim men in the workplace. 8th Industrial and Organisational Psychological Conference. Australia: Griffith University. pp. 1 - 1
Australian muslim men coping with conflict and achieving balance: Positive look at a negative issue
Sav, Adem, Harris, Neil, Sebar, Bernadette, Abdalla, Mohamad and Stewart, Donald. (2009). Australian muslim men coping with conflict and achieving balance: Positive look at a negative issue. Work Stress and Health Conference: Global Concersn and Approaches. United States of America: American Psychological Association. pp. 1 - 1
Work-life conflict among Australian muslim men and women in South-East Queensland
Sav, Adem, Sebar, Bernadette, Abdalla, Mohamad and Stewart, Donald. (2009). Work-life conflict among Australian muslim men and women in South-East Queensland. Work Stress and Health Conference: Global Concerns and Approaches. United States of America: American Psychological Association. pp. 1 - 1
Broadening the scope of work-life balance: Experiences of Australian Muslims
Sav, Adem, Harris, Neil, Sebar, Bernadette, Stewart, Donald and Abdalla, Mohamad. (2009). Broadening the scope of work-life balance: Experiences of Australian Muslims. 8th Industrial and Organisational Psychology Conference: Meeting the future: Promoting sustainable organisational growth. Australia: Australian Psychological Society. pp. 117 - 122
Designing health communications: Harnessing the power of affect, imagery, and self-regulation
Cameron, Linda D. and Chan, Carina. (2008). Designing health communications: Harnessing the power of affect, imagery, and self-regulation. Social and Personality Psychology Compass. 2(1), pp. 262 - 282. https://doi.org/10.1111/j.1751-9004.2007.0057.x
Dietary flavonoid sources in Australian adults
Somerset, Shawn and Johannot, Lidwine. (2008). Dietary flavonoid sources in Australian adults. Nutrition and Cancer. 60(4), pp. 442 - 449. https://doi.org/10.1080/01635580802143836