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Stroke care in Sierra Leone

As we mark World Stroke Day, a team at King's is embarking on a three-year programme which looks to establish NHS-style stroke care in Sierra Leone, West Africa.

Stroke is now one of the leading causes of death and disability in Africa, responsible for an estimated 451,000 fatalities a year, according to the World Health Organisation (WHO). Sierra Leone is the 8th worst affected country in the world, and with a population of nearly seven million people, there is currently no dedicated stroke unit and very limited physiotherapy capacity.

The £2million programme is part of the NIHR’s Global Health Research programme, which was launched in 2016 to apply the UK’s research expertise to addressing health issues affecting the poorest countries through international aid funding. The first step will be to identify the main causes of stroke locally to inform improvements to the healthcare system.

King's already has a partnership with the country’s main hospital, The Connaught, where it deploys specialist-trained volunteers.

‘Currently, the physio department at the Connaught has two qualified physios and nurses who help with rehab. But few people can afford to get to the hospital and pay for care and they don’t have stroke beds so it’s going to be hard,’ said lead Cath Sackley, professor of rehabilitation and head of physiotherapy at King’s College London, marking for the first time in the UK that a major global health grant is being led by a physiotherapist as part of a multidisciplinary team.

‘There are only six qualified physios in the entire country.'

It is estimated that 1,000 stroke patients are admitted every year to the two largest hospitals in the capital, Freetown. The reasons why people have strokes vary regionally and between different ethnic groups. ‘We know there is a genetic predisposition, along with lifestyle risks, including high diabetes rates, unmanaged high blood pressure and smoking’, said Professor Sackley. ‘The average stroke age is also much younger than in the UK, so it can hit the breadwinner and the consequences are more devastating for the whole family.’ She has also learned that rehab may be delayed because of a belief among some people that stroke is a spiritual affliction and they might see a traditional healer first.

The King's team in conjunction with the University of Sierra Leone, will develop a a blanket referall route, and a register to record stroke patients as they come into the hospital akin to the Stroke Audit in the UK, so care can be monitored long-term. ‘At the moment we don’t know what happens with stroke in Sierra Leone. People who can afford it come to hospital, and nobody has ever followed them up in the community,’ said Professor Sackley. ‘Physiotherapists are dependent on referral and there’s currently a lack of a process, which is a problem.’

Interestingly of the few who do return to hospital for outpatient care, its been noted that they are more likely to opt for physiotherapy than pills. Indeed, two of the team from King's have begun training Sierra Leonian physiotherapists and nurses. The programme will start at the Connaught, and as the team follow people out they are hoping to start including other centres. At the same time, the country’s first BSc physiotherapy programme is about to launch, with funding from Norway.

‘By the end of the programme the idea is to have developed a system whereby stroke patients are managed optimally. So, they move from A&E to a dedicated stroke unit. This will serve as a hub for stroke care and education. We’ll also know more about stroke care in Sierra Leone which will help with prevention and secondary prevention,’ said Professor Sackley.

There will also be the mutual benefit of training places for King’s students.