Assess discharge readiness amongst adults with stroke and their caregivers at the point of discharge from the inpatient setting to home in Lusaka, Zambia.

Africa has the highest stroke incidence, prevalence, and case-fatality rate of all world regions, and prior work in Zambia has shown high in-hopsital (22%) and post-discharge (50% within one year) stroke mortality. Further work is needed to understand knowledge gaps and discharge readiness to improve post-discharge outcomes in Zambia.

We conducted a cross-sectional study of adults with stroke admitted to a newly implemented stroke unit in Lusaka, Zambia. On the day of discharge, patients and/or caregivers completed the the Readiness for Hospital Discharge (RHD) scale and the Functional Independence Measure (FIM). The RHD assesses self-reported readiness in several domains on a scale of 1 (least ready) to 10 (very ready) while the FIM assesses specific functional limitations in multiple motor and cognitive domains (1: total assistance; 7: total independence).

We enrolled 181 adults with stroke with mean age 60+15 years of whom 56% (n=101) were female and the median modified Ranking Scale at discharge was 4 (Interquartile range: 3, 4). From the RHD scale, the highest median score was for pain/discomfort [median 9, IQR (8,9), indicating little or no pain while the lowest median score [6, IQR (4,8) was for physical ability to take care of oneself at home. On the FIM, only 3/13 motor domains (eating, bladder and bowel management) had median scores >5 while all 5 cognitive domains had median scores >5.

Zambian adults with stroke report high levels of discharge readiness but require significant assistance with most motor functions.  Lack of reported effects on cognitive function may indicate low recognition of cognitive impacts of stroke.