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Abstract Details

Understanding Delays in Presentation for Stroke at a Tertiary Care Hospital in Zambia: Identifying Opportunities to Improve Care and Outcomes
General Neurology
P6 - Poster Session 6 (11:45 AM-12:45 PM)
11-013
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.
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.
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.
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.
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.
Authors/Disclosures
Gabriel Sneh, MD (Johns Hopkins)
PRESENTER 		Dr. Sneh has nothing to disclose.
Melody T. Asukile, MBBS (University Teaching Hospital) Dr. Asukile has received research support from Royal Society for Tropical Medicine and Hygiene. The institution of Dr. Asukile has received research support from Leverhulme Trust. Dr. Asukile has received personal compensation in the range of $0-$499 for serving as a meeting speaker with American Neurological Association.
Meron Gebrewold, MD (Addis Ababa University) Dr. Gebrewold has nothing to disclose.
Sarah Braun, MD (University Teaching Hospital, Lusaka, Zambia) Sarah Braun has nothing to disclose.
Lorraine Chishimba, MBChB, MMED (University Teaching Hospital) Dr. Chishimba has nothing to disclose.
Mashina Chomba, MBChB (University of Zambia) Dr. Chomba has nothing to disclose.
Musisye Luchembe Musisye Luchembe has nothing to disclose.
Viyani Masanzi, MD Dr. Masanzi has nothing to disclose.
Taonga Msimuko, MD The institution of an immediate family member of Dr. Msimuko has received research support from Africa Development Bank.
Bwalya Mulenga Bwalya Mulenga has nothing to disclose.
Julia Mwamba (University Teaching Hopsital) Julia Mwamba has nothing to disclose.
Diwell Mwansa (UNZA Ridgeway campus) Diwell Mwansa has nothing to disclose.
Coolwe Namangala Dr. Namangala has nothing to disclose.
Nagapranati Nanduri Ms. Nanduri has nothing to disclose.
David Nassoro, MD (Ministry of Health) DAVID NASSORO has nothing to disclose.
Madalitso Nthere, MBBS Dr. Nthere has nothing to disclose.
Alexandra Peloso, MD Dr. Peloso has nothing to disclose.
Theresa Shankanga (University of Zambia, ridgeway campus) Miss Shankanga has nothing to disclose.
William Tembo, MD An immediate family member of Mr. Tembo has received research support from City University of New York (CUNY).
Leroy Yankae, MD Leroy Yankae has nothing to disclose.
Stanley Zimba, MBBS (University Teaching Hospital) Dr. Zimba has nothing to disclose.
Deanna Saylor, MD, MHS (Johns Hopkins Hospital) Dr. Saylor has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from 好色先生. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and 好色先生al Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.