Towards best practice in acute stroke care in Ghana: a survey of hospital services.
Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice.



A multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards.



Availability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care.



This study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana.
Regional Institute for Population Studies, University of Ghana, P.O Box LG96, Legon, Accra, Ghana. leonard.baatiema@acu.edu.au.|School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia. leonard.baatiema@acu.edu.au.
Leonard
L
Baatiema
College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
Michael
M
Otim
College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia.
George
G
Mnatzaganian
Regional Institute for Population Studies, University of Ghana, P.O Box LG96, Legon, Accra, Ghana.
Ama De-Graft
AD
Aikins
School of Pharmacy, University of Queensland, Brisbane, Australia.
Judith
J
Coombes
School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
Shawn
S
Somerset
D000208:Acute Disease; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005869:Ghana; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards; D006280:Health Workforce; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data; D008297:Male; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000592:standards; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D001241:Aspirin
Evidence-based care; Ghana; Health policy; Hospital services; Organised care; Stroke