Low-cost options to aid recovery after stroke in The Gambia

What happens to people in The Gambia after they’ve had a stroke? A study by a group of UK researchers looked at rates and causes of death or survival following strokes in a Banjul hospital. They suggest low-cost strategies to help improve recovery among survivors.

The study involved patients coming to the Royal VictoriaHospital with a diagnosis of stroke or having a stroke as an impatient during aone year period. Researchers followed the progress of patients in the communityat one month, six months and three to four years. If a patient died, they notedthe date and the likely cause of death. Of 106 patients, 70 (66 percent) weremen. The average age when the stroke occurred was 58 years.

Key findings include:

• Stroke patients make up five percent of adultmedical admissions. With a mean hospital stay of 19 days, they occupy tenpercent of medical bed time.
• By one and six months, 27 percent and 44percent, respectively, die. Only 25 percent survive for three to four years.Causes of death include the initial stroke (61 percent), further stroke (sevenpercent) and infection (12 percent).
• Death is more likely if the patient isincontinent in the first 24 hours, has sensory inattention or has impaired gagreflex on admission. However, the likelihood of death is unrelated to factorssuch as age, sex, previous stroke, smoking and alcohol use.
• After one month, 8.5 percent of patients havefully recovered. At six months, a third are on medicationfor high blood pressure, 18 percent have made a full recovery, and anotherthird are left with a severe impairment.
• At three or four years, only 18 percent arestill alive and living with stroke-related disability in the community.

The study shows that the death rate from stroke is higher inThe Gambia than in many wealthier countries. This supports previous reportsthat there are quite low numbers of people living with stroke-relateddisability in sub-Saharan Africa. Stroke patients in The Gambia stay inhospital for about the same length of time as in developed countries, but thereis no institutional care available afterwards if they have major disability.

The most common cause of death after stroke in developedcountries is ischaemic heart disease (obstruction ofthe arterial blood supply), but this appears to be virtually non-existent here.Instead, two thirds of deaths are due to the initial or subsequent stroke, so strategiesthat increase recovery from the stroke itself could have a big impact on deathrates. However, many low-income countries lack facilities and staff forapproaches such as physiotherapy and occupational therapy. The researchers suggestsome low-cost options, including:

• training health workers, relatives andcaregivers to carry out therapy
• educating patients and caregivers about preventinga second stroke
• providing aspirin anddrugs to control high blood pressure in stroke survivors.