Strategies to Improve Stroke Care Services on Low- and Middle-Income Countries: A Systematic Review

被引：75

作者：

Pandian, Jeyaraj Durai ^{[1
]}

William, Akanksha G. ^{[1
]}

Kate, Mahesh P. ^{[1
]}

Norrving, Bo ^{[2
,3
]}

Mensah, George A. ^{[4
,5
]}

Davis, Stephen ^{[6
,7
,8
]}

Roth, Gregory A. ^{[9
,10
]}

Thrift, Amanda G. ^{[12
]}

Kengne, Andre P. ^{[13
]}

Kissela, Brett M. ^{[14
]}

Yu, Chuanhua ^{[15
]}

Kim, Daniel ^{[16
]}

Rojas-Rueda, David ^{[17
]}

Tirschwell, David L. ^{[18
]}

Abd-Allah, Foad ^{[19
]}

Gankpe, Fortune ^{[20
]}

deVeber, Gabrielle ^{[21
]}

Hankey, Graeme J. ^{[22
]}

Jonas, Jost B. ^{[23
]}

Sheth, Kevin N. ^{[24
,25
]}

Dokova, Klara ^{[26
,27
]}

Mehndiratta, Man Mohan ^{[28
]}

Geleijnse, Johanna M. ^{[29
]}

Giroud, Maurice ^{[30
,31
]}

Bejot, Yannick ^{[30
,31
]}

Sacco, Ralph ^{[32
]}

Sahathevan, Ramesh ^{[33
]}

Hamadeh, Randah R. ^{[34
,35
]}

Gillum, Richard ^{[36
,37
]}

Westerman, Ronny ^{[38
]}

Akinyemi, Rufus Olusola ^{[39
]}

Barker-Collo, Suzanne ^{[40
]}

Truelsen, Thomas ^{[41
]}

Caso, Valeria ^{[42
]}

Rajagopalan, Vasanthan ^{[43
]}

Venketasubramanian, Narayanaswamy ^{[44
]}

Vlassovi, Vasiliy V. ^{[45
]}

Feigin, Valery L. ^{[11
]}

机构：

[1] Christian Med Coll & Hosp, Dept Neurol, Stroke Unit, Ludhiana, Punjab, India

[2] Lund Univ, Neurol, Dept Clin Sci Lund, Lund, Sweden

[3] Skane Univ Hosp, Dept Neurol & Rehabil Med, Lund, Sweden

[4] CTRIS, Bethesda, MD USA

[5] Div Cardiovasc Sci, Bethesda, MD USA

[6] Univ Melbourne, Melbourne Brain Ctr, Royal Melbourne Hosp, Parkville, Vic, Australia

[7] Univ Melbourne, Translat Neurosci, Parkville, Vic, Australia

[8] World Stroke Org, Parkville, Vic, Australia

[9] Univ Washington, Div Cardiol, Seattle, WA 98195 USA

[10] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA

[11] Auckland Univ Technol, Natl Inst Stroke & Appl Neurosci, Auckland, New Zealand

[12] Monash Univ, Monash Hlth, Sch Clin Sci, Stroke & Ageing Res STARC,Dept Med, Clayton, Vic, Australia

[13] South African Med Res Council, Noncommunicable Dis Res Unit, Francie van ZijI Dr, Cape Town, South Africa

[14] Univ Cincinnati, Neurosci Inst, Dept Neurol & Rehabil Med, Cincinnati, OH USA

[15] Wuhan Univ, Sch Publ Hlth, Wuhan, Hubei, Peoples R China

[16] Northeastern Univ, Dept Hlth Sci, Washington, DC USA

[17] IS Global, Ctr Res Environm Epidemiol, Barcelona, Spain

[18] Univ Washington, Sch Med, UW Med Comprehens Stroke Ctr, Seattle, WA USA

[19] Cairo Univ, Dept Neurol, Cairo, Egypt

[20] CHU Hassan II, Neurosurg Serv, Fes, Morocco

[21] Hosp Sick Children, Res Inst, Hosp Sick Children Senior Scientist, Childrens Stroke Program,Div Neurol, Toronto, ON, Canada

[22] Univ Western Australia, QEII Med Ctr, Perkins Inst Med Res, Med Sch, Perth, WA, Australia

[23] Heidelberg Univ, Med Fac Mannheim, Dept Ophthalmol, Mannheim, Germany

[24] Yale Sch Med, Neurosci Intens Care Unit, Dept Neurol, Div Neurocrit Care & Emergency, New Haven, CT USA

[25] Yale New Haven Hosp, New Haven, CT USA

[26] Med Univ Varna, Dept Social Med, Varna, Bulgaria

[27] Med Univ Varna, Hlth Care Org, Fac Publ Hlth, Varna, Bulgaria

[28] Janakpuri Super Special Hosp, New Delhi, India

[29] Wageningen Univ, Div Human Nutr, Wageningen, Netherlands

[30] Univ Hosp Dijon Burgundy, Dept Neurol, Dijon, France

[31] Dijon Stroke Registry, Pathophysiol & Epidemiol Cerebrocardiovasc Dis PE, Dijon, France

[32] Univ Miami, Miller Sch Med, Dept Neurol, Miami, FL 33136 USA

[33] Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Ballarat Hlth Serv, Melbourne, Vic, Australia

[34] Arabian Gulf Univ, Coll Med & Med Sci, Dept Family & Community Med, Manama, Bahrain

[35] Arabian Gulf Univ, Coll Med & Med Sci, Grad Studies & Res, Manama, Bahrain

[36] Howard Univ, Coll Med, Dept Internal Med, Washington, DC USA

[37] Howard Univ, Coll Med, Dept Community & Family Med, Washington, DC USA

[38] Fed Inst Populat Res Wiesbaden, Competence Ctr Mortal Follow Up German Natl Cohor, Wiesbaden, Germany

[39] Univ Auckland, Sch Psychol, Clin Training Programme, Auckland, New Zealand

[40] Univ Auckland, Sch Psychol, Dept Psychol, Clin Training Programme, Auckland, New Zealand

[41] Univ Copenhagen, Rigshosp, Dept Neurol, Copenhagen, Denmark

[42] Univ Perugia, Div Cardiovasc Med, Stroke Unit, Perugia, Italy

[43] Manipal Coll Allied Hlth Sci, Manipal, Karnataka, India

[44] Raffles Hosp, Raffles Neurosci Ctr, Singapore, Singapore

[45] Natl Res Univ, Higher Sch Econ, Moscow, Russia

来源：

NEUROEPIDEMIOLOGY | 2017年 / 49卷 / 1-2期

关键词：

Low and Middle Income Countries (LMICs); Stroke services; Strategies; Stroke units; Pre-hospital stroke transport; ACUTE ISCHEMIC-STROKE; INTRAVENOUS THROMBOLYSIS; EMERGENCY-MEDICINE; HEMORRHAGIC STROKE; PREHOSPITAL CARE; TRANSPORT TIME; UNIT CARE; SMOKING; RISK; REHABILITATION;

D O I：

10.1159/000479518

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority. (C) 2017 S. Karger AG, Basel

引用

页码：45 / 61

页数：17

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