Stroke in the community.
Article Type: Brief article
Subject: Mortality (South Africa)
Mortality (Analysis)
Stroke (Disease) (Analysis)
Stroke (Disease) (Risk factors)
Stroke patients (Health aspects)
Pub Date: 08/01/2009
Publication: Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 South African Medical Association ISSN: 0256-9574
Issue: Date: August, 2009 Source Volume: 99 Source Issue: 8
Geographic: Geographic Scope: South Africa Geographic Code: 6SOUT South Africa
Accession Number: 262583608
Full Text: The South African National Burden of Disease Study found that stroke for the year 2000 was the third most common cause of death in South Africa (6.5% of all deaths) after HIV/AIDS and ischaemic heart disease. It represents the dominant type of vascular disease in sub-Saharan Africa.

To develop a community-based model of stroke care, Wasserman, de Villiers and Bryer conducted a multi-centre longitudinal cohort study of stroke patients at Ingwavuma in northern KwaZulu-Natal in urban, semi-rural and rural sites. (1) Their high 3-month mortality is similar to the all-stroke case fatality (from hospital-based studies in developing countries) of about 30% at 3 months. Hypertension was by far the most important and prevalent risk factor for stroke, which is consistent with others who have identified hypertension as the most powerful predictor for stroke in sub-Saharan Africa. Most of their patients had severe disabilities that, at the time of discharge, required assistance with daily living activities from another person. Despite their high death and severe death and debility rate at 3 months, most survivors had significant functional improvement.

In his accompanying editorial, (2) Bryer notes that there are more stroke deaths in older groups than in younger groups. Stroke is largely preventable by reducing vascular risk factors. The risk of recurrent stroke is highest soon after the first ever stroke. And in the post-acute phase of stroke, management efforts are directed at early rehabilitation and secondary prevention.

Because of the common occurrence and serious nature of strokes and absence of skills to manage them in rural areas, the authors suggest specific training of existing home-based carers to do so.
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.