article · The Lancet Global Health
This prospective cohort study, part of the Stroke Investigative Research and Educational Network (SIREN), examined patient-level and system-level factors contributing to early stroke fatality across 16 hospitals in Ghana and Nigeria. Researchers collected data on adult stroke patients, including demographic and clinical variables, alongside information on available stroke services and resources. Using a mixed-effect log-binomial model, the study identified several patient-level factors associated with increased fatality, such as higher National Institutes of Health Stroke Scale (NIHSS) scores, elevated intracranial pressure, and aspiration pneumonia. The findings suggest a need for interventions targeting aspiration pneumonia and policy changes to improve stroke unit access.
Understanding the specific factors that lead to early stroke fatality in Ghana and Nigeria is crucial for improving patient outcomes. This research highlights key areas, both clinical and systemic, where targeted interventions and policy changes can save lives and enhance the quality of stroke care in the region.
This early-stage research provides evidence to inform the development of clinical guidelines and training programmes for healthcare professionals focused on managing aspiration pneumonia in stroke patients. It also supports policy reforms aimed at improving access to and quality of stroke units within healthcare systems. The work identifies critical areas for intervention and improvement in healthcare delivery, rather than a direct product or service.
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BACKGROUND: Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria. METHODS: The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs. FINDINGS: , 1·48 (1·22-1·79); National Institutes of Health Stroke Scale (NIHSS) score, 1·20 (1·13-1·26) for each 5-unit rise; elevated intracranial pressure, 1·75 (1·31-2·33); and aspiration pneumonia, 1·79 (1·16-2·77). INTERPRETATION: Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted. FUNDING: US National Institutes of Health. TRANSLATIONS: For the Twi, Yoruba and Hausa translations of the abstract see Supplementary Materials section.
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DOI: 10.1016/s2214-109x(23)00038-4
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