Implementing Stroke Unit Care in Selected Hospitals in Rwanda

Abstract

Background: The burden of stroke in low-and middle-income countries (LMICs) has risen sharply in recent years and the rate of increase is set to accelerate due to socio-demographic and lifestyle changes related to the industrialization and a rise in many modifiable vascular disease risk factors.

Aims: The first aim was to establish, for countries like Rwanda, how much stroke is a major problem. The second aim was to explore whether the existing stroke services were well prepared. The third aim was to develop and implement a relevant service improvement in Rwanda.

Methods: First, I conducted systematic reviews of the literature on the epidemiology and impact of stroke, and the available stroke services in Africa. Second, I conducted a systematic review of the literature and analyzed the INTERSTROKE study data to identify the stroke key performance indicators (KPIs) that have been described in stroke care and assessed their association with patient outcomes. Finally, I selected the stroke unit care KPIs relevant to Rwandan and other LMIC settings, and used several strategies including site champions, provision of educational materials, feedback on usual care, training hospital staff on stroke KPIs, consensus discussions on service improvement by local staff, and discussions with the hospital directors to promote the implementation of the selected KPIs in two hospitals in Rwanda.

Results: Stroke was found to be common and important in Africa. However, the provision of stroke care was below the recommended standards. After adjustment for case mix and stroke onset-hospital arrival interval, I found a consistent trend of associations between my implementation intervention and improved delivery of stroke KPIs and patient outcomes.

Conclusion: Several common KPIs of stroke unit care can be implemented in hospitals in Rwanda. However, there are some major challenges that need to be addressed for optimal implementation of stroke unit care.