Understanding Delays in Presentation for Stroke at a Tertiary Care Hospital in Zambia: Identifying Opportunities to Improve Care and Outcomes
Gabriel Sneh1, Melody Asukile2, Meron Gebrewold2, Sarah Braun3, Lorraine Chishimba2, Mashina Chomba4, Musisye Luchembe2, Viyani Masanzi2, Taonga Msimko2, Bwalya Mulenga2, Julia Mwamba5, Diwell Mwansa2, Coolwe Namangala2, Samhita Nanduri6, DAVID NASSORO2, Madalitso Nthere2, Alexandra Peloso2, Theresa Shankanga2, William Tembo2, Leroy Yankae2, Stanley Zimba2, Deanna Saylor7
1University of North Carolina, Chapel Hill, 2University Teaching Hospital, 3University Teaching Hospital, Lusaka, Zambia, 4University of Zambia, 5University Teaching Hopsital, 6Drexel University College of Medicine, 7Johns Hopkins Hospital
Objective:
Acute stroke interventions, which are time-dependent and reduce stroke disability and mortality in high-income countries, are currently unavailable in Zambia. We aimed to identify pre-hospital barriers that contribute to delays in care for patients with acute stroke in Zambia to facilitate the eventual provision of acute stroke interventions and improve stroke outcomes.
Background:
Stroke is the second leading cause of death amongst adults in Zambia. Delays in presentation render patients ineligible for acute therapy and increase rates of complication and death.
Design/Methods:
We conducted a prospective cohort study of individuals with stroke admitted to a hospital in Zambia between March 2024 and June 2024. Demographic and clinical information were collected. Participants completed a questionnaire and semi-structured interview to assess care-seeking decisions and barriers to presenting to medical care. Descriptive statistics are reported.
Results:
Participants (n=128) had an average age of 58+/-14 years and 54% were female. 36% of patients presented to any healthcare facility within 1 hour of recognizing symptoms and 97% presented within 24 hours. However, 77% first presented to a lower level of care that could not provide acute stroke treatment, and only 21% arrived at the tertiary facility within 4.5 hours. Only 32% of patients recognized symptoms as being due to stroke, and only 36% sought medical care as their first action following symptom onset. 37% identified transportation as a primary barrier to seeking care, 36% cited cost, 18% cited family caregiving obligations, and 15% thought nothing could be done.
Conclusions:
Low knowledge on stroke recognition and treatment, cost, and transportation barriers result in care-seeking delays to any healthcare center, and initial presentations to primary healthcare facilities further delay presentation to the tertiary hospital. Community awareness campaigns for stroke recognition and novel stroke triaging systems like a mobile stroke unit or tele-neurology system may substantially improve stroke outcomes in this population.
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