Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
School of Public Health, University of Sydney, Australia.
J Neurol Sci. 2020 Nov 15;418:117117. doi: 10.1016/j.jns.2020.117117. Epub 2020 Sep 4.
Stroke is a major public health issue in many low- and middle-income countries (LMICs). Despite the emergence of new effective interventions for acute stroke care, uptake remains slow and largely inaccessible to patients in LMICs, where health systems response has been inadequate. In this paper, we propose a policy framework to optimise access to acute stroke care in LMICs. We draw on evidence from relevant primary studies, such as availability of evidence-based acute stroke care interventions, barriers to uptake of interventions for stroke care and insights on stroke mortality and morbidity burden in LMICs. Insights from review of secondary studies, principally systematic reviews on evidence-based acute stroke care; and the accounts and experiences of some regional experts on stroke and other NCDs have been taken into consideration. In LMICs, there is limited availability and access to emergency medical transport services, brain imaging services and best practice interventions for acute stroke care. Availability of specialist acute stroke workforce and low awareness of early stroke signs and symptoms are also major challenges impeding the delivery of quality stroke care services. As a result, stroke care in LMICs is patchy, fragmented and often results in poor patient outcomes. Reconfiguration of LMIC health systems is thus required to optimise access to quality acute stroke care. We therefore propose a ten-point framework to be adapted to country-specific health system capacity, needs and resources: Emergency medical transport and treatment services, scaling-up interventions and services for acute stroke care, clinical guidelines for acute stroke treatment and management, access to brain imaging services, human resource capacity development strategies, centralisation of stroke services, tele-stroke care, public awareness campaigns on early stroke symptoms, establish stroke registers and financing of stroke care in LMICs. While we recognise the challenges of implementing the recommendations in low resource settings, this list can provide a platform as well serve as the starting point for advocacy and prioritisation of interventions depending on context.
中风是许多低收入和中等收入国家（LMICs）的主要公共卫生问题。尽管出现了新的急性中风治疗有效干预措施，但在卫生系统反应不足的情况下，这些措施在 LMICs 中的采用仍然缓慢，并且对患者来说难以获得。在本文中，我们提出了一个政策框架，以优化 LMICs 中急性中风护理的可及性。我们借鉴了相关主要研究的证据，例如基于证据的急性中风护理干预措施的可用性、中风护理干预措施采用的障碍以及 LMICs 中风死亡率和发病率负担的见解。对二级研究的综述、主要是基于证据的急性中风护理的系统评价、以及一些区域中风和其他非传染性疾病专家的意见和经验也被考虑在内。在 LMICs 中，紧急医疗运输服务、脑部成像服务和最佳实践急性中风护理干预措施的可用性和可及性有限。急性中风专业人员的可用性以及对早期中风症状和体征的认识不足也是阻碍提供高质量中风护理服务的主要挑战。因此，LMICs 的中风护理参差不齐、支离破碎，往往导致患者预后不良。因此，需要重新配置 LMIC 卫生系统，以优化获得优质急性中风护理的机会。因此，我们提出了一个十点框架，以适应特定国家的卫生系统能力、需求和资源：紧急医疗运输和治疗服务、扩大急性中风护理干预措施和服务、急性中风治疗和管理的临床指南、脑部成像服务的获取、人力资源能力发展战略、中风服务的集中化、远程中风护理、早期中风症状的公众宣传运动、建立中风登记处和中风护理在 LMICs 的融资。虽然我们认识到在资源匮乏的环境中实施这些建议的挑战，但这份清单可以提供一个平台，并作为宣传和优先考虑干预措施的起点，具体取决于背景。
