A scoping review of stroke registers in Sub-Saharan Africa.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-07-31 DOI:10.1177/17474930241262936
Daniel Youkee, Mamadu Baldeh, Anthony Rudd, Marina Soley-Bori, Charles DA Wolfe, Gibrilla F Deen, Iain J Marshall
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Abstract

Background: Stroke registers are recommended as a key priority by the Lancet Neurology World Stroke Organization Commission for Stroke, 2023, and the African Stroke Leaders' Summit, 2022.

Aims: This scoping review aims to map where stroke registers have been implemented in Sub-Saharan Africa (SSA). The article then compares and critiques the methods and definitions used and summarizes key results from the registers. The scoping review searched EMBASE, MEDLINE, and CABI Global Health databases and included all studies with a prospective longitudinal design in SSA, where adult acute stroke was the primary condition studied. Articles were screened against inclusion and exclusion criteria independently by two authors.

Summary: We identified 42 unique stroke registers from 48 individual studies. The registers were located in 19 countries, with 19 from East Africa, 15 West Africa, 6 Central Africa, and 2 from Southern Africa. Cumulatively, the registers recruited 12,345 participants with stroke, the median number of participants was 183 (interquartile range (IQR): 121-312), and the range was 50-1018. Only one study was a population-based register, and 41 were hospital-based registers. Of the hospital-based registers, 29 were single site, 10 were conducted at two sites, and 2 at three sites. Twenty-three (54.7%) of the registers were located in the capital city of their respective country, and only one of the hospital-based registers was in a self-described rural area. Length of recruitment ranged from 4 months to 6 years; the median length of recruitment was 12 months. Methodology and definitions were heterogenous between the registers. Only seven (19.4%) registers referenced the WHO STEPwise approach to implementing stroke registers. Twenty-seven (64.3%) registers used the WHO definition of stroke. The mean neuroimaging rate was 84%, and ranged from 0% to 100%. Stroke severity was measured using the National Institute of Health Stroke Scale (NIHSS) in 22 (52.4%) registers, four registers used the Glasgow Coma Scale (GCS), two registers used the miniNIHSS, one used the Scandinavian Stroke Scale, one modified Rankin Scale (mRS), and 11 registers did not report a stroke severity measure. Seventeen (40.5%) registers used the mRS to measure function, six registers used Barthel Index alone, and three registers used both mRS and Barthel Index. Only two registers included a quality-of-life measure, the EQ-5D. Eight registers included a quality-of-care measure, and 26 (61.9%) registers recorded socioeconomic status or a socioeconomic status proxy, most frequently educational attainment.

Conclusions: This scoping review found high heterogeneity of methods and definitions used by stroke registers, with low uptake of the WHO stepwise method of stroke surveillance. A drive to standardize methodology would improve the comparability of stroke data in SSA. The shared use of educational attainment by registers in our review may enable future meta-analyses of inequities in stroke in SSA. Incorporating health-related quality-of-life measures, such as EQ-5D, into stroke registers should be encouraged, bringing a patient perspective, and allow the estimation of quality-adjusted life years lost to stroke. Agreement on a standardized register methodology or further promotion and uptake of the WHO stepwise method is essential to produce comparable data to improve stroke prevention and care.

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撒哈拉以南非洲地区中风登记范围审查。
背景:柳叶刀神经病学世界卒中组织委员会(2023 年)和非洲卒中领导人峰会(2022 年)均建议将卒中登记册作为重点优先事项。摘要:我们从 48 项研究中发现了 42 个独特的卒中登记册。这些登记册分布在 20 个国家,其中 19 个来自东非,15 个来自西非,6 个来自中非,2 个来自南部非洲。这些登记册共招募了 12345 名中风患者,中位数为 183 人(IQR:121-312),范围为 50-1018 人。只有一项研究是基于人群的登记,41 项研究是基于医院的登记。在以医院为基础的登记册中,29 项为单一地点登记,10 项在两个地点登记,2 项在三个地点登记。23个登记册(54.7%)位于各自国家的首都,只有一个医院登记册位于自称的农村地区。招募时间从 4 个月到 6 年不等,招募时间的中位数为 12 个月。只有 7 个登记册(19.4%)参照世界卫生组织 STEPwise 方法实施卒中登记。27个登记册(64.3%)使用了世界卫生组织的卒中定义。平均神经影像学检查率为 84%,范围在 0-100% 之间。22 个登记册(52.4%)使用美国国立卫生研究院卒中量表(NIHSS)测量卒中严重程度,4 个登记册使用格拉斯哥昏迷量表(GCS),2 个登记册使用迷你 NIHSS,1 个登记册使用斯堪的纳维亚卒中量表,1 个登记册使用 mRS,11 个登记册未报告卒中严重程度测量方法。17 个登记册(40.5%)使用 mRS 测量功能,6 个登记册仅使用 Barthel 指数,3 个登记册同时使用 mRS 和 Barthel 指数。只有两份登记册包含了生活质量测量指标 EQ-5D。8个登记册采用了护理质量测量方法,26个登记册(61.9%)记录了社会经济状况或社会经济状况替代指标,最常见的是教育程度:本次范围界定审查发现,卒中登记册使用的方法和定义存在很大差异,对世界卫生组织卒中监测逐步法的采用率较低。推动方法标准化将提高 SSA 中风数据的可比性。在我们的研究中,各登记处共同使用了教育程度,这有助于今后对撒哈拉以南非洲地区中风的不平等现象进行荟萃分析。应鼓励将健康相关的生活质量测量(如 EQ-5D)纳入脑卒中登记册,这样可以从患者的角度出发,估算因脑卒中而损失的质量调整生命年。就标准化登记方法达成一致或进一步推广和采用世界卫生组织的分步法对于生成可比数据以改善中风预防和护理至关重要。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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