Stroke in Sierra Leone

Stroke in Sierra Leone (SISLE) is a research group aiming to improve outcomes for stroke patients in Sierra Leone. Led by Professor Catherine Sackley, we are a collaboration between King’s, University of Glasgow, University of Central Lancashire, Guy's and St Thomas' NHS Foundation Trust, and the College of Medicine and Allied Health Sciences in Sierra Leone.

We are funded by the Global Health Research strand of the National Institute for Health Research (NIHR).

Stroke is becoming more common in many low- and middle-income countries, where as many as 86% of all stroke related deaths occur.

We hope that our work can lead to improvements in the health system, clinical care and risk factor management that has reduced both the incidence and mortality of stroke in high income countries.

Members

Ann Kelly

Head, Department of Global Health & Social Medicine

Stroke Register

We set up the stroke register to find out how many people in Sierra Leone have a stroke and how stroke affects them and their families. We use this information to: increase our knowledge about stroke; help improve quality of care at the hospital and in the community; publish scientific articles about stroke. We collect stroke data from Connaught Hospital, the main adult referral hospital in Freetown, using a stroke register model, a prospective longitudinal cohort study. Progress: We established a stroke register at Connaught Hospital, and started collecting data in April 2019, we now have over 500 participants on the register. We collected data at admission on: 1) Socio-economic factors 2) Stroke risk factors 3) Care seeking 4) Stroke severity, and post-stroke disability 5) Investigations 6) In hospital care 7) Patient outcome We also follow up register participants, at 90 days and one-year post admission. We collect data through a combination of telephone, and community follow-up. We aim to document through follow-up data on: 1) Patient status 2) New symptoms 3) Admission to health facilities 4) Cost of post-stroke care 5) Disability level

Capacity Building

This project aims to improve research and healthcare delivery capacity of Sierra Leone. We are currently working on three different elements within this project. We are supporting three Masters of Public Health, a PhD, and a College of Medicine and Allied Health Sciences Medical Students' stroke-related dissertations. As the project develops, we will also support the training of healthcare staff to deliver our intervention at Connaught Hospital. We are also delivering continuous Good Clinical Practice (GCP) training for all the staff involved with the project.

Stroke survivors community engagement meeting Freetown

Qualitative Research and Community Engagement

The purpose of this area of SISLE is to ensure that the design and implementation of our research is sensitive to local needs and priorities. Progress: A stroke survivors’ group was set up in July 2019 as a platform for dialogue and decision-making between service users, service providers and the research team. The group now meets monthly and has blossomed into a dual platform for research-specific community engagement and peer support. In a joint effort with the survivors and families, we were able to represent Sierra Leone in the World Stroke Organisation’s virtual relay for the first time in 2019. In the final year of our programme, our efforts will be focused on planning and enacting sustainability measures to ensure our positive impact continues beyond the lifetime of the programme.

Surgical ward nurses training course Sierra Leone

Nurse-Led Intervention

This project is aimed at improving care of stroke patients at Connaught Hospital. We have identified through the stroke register that patients who present at Connaught with strokes do not receive any swallow assessment and we also see that a large number of patients develop pneumonia during their time in the hospital. With this in mind, we are looking at intervening in stroke care through implementation of a culturally specific swallow screening tool. We are currently working on a rapid review on swallow screening tools for stroke in Sub-Saharan Africa. This will help inform the work on creating a swallow screen tool that can be used at Connaught Hospital.

Study Governance

This work package is responsible for the governance, managerial, financial and ethical management of the award and is led by Professor Catherine Sackley.

We are collecting data at the moment and aim to start publishing research soon.

Our partners

The project is funded by the Global Health Research strand of the National Institute for Health Research (NIHR). It is implemented in collaboration with University of Glasgow, University of Central Lancashire, Guy's and St Thomas' NHS Foundation Trust, and the College of Medicine and Allied Health Sciences at the University of Sierra Leone.