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The burden of suspected strokes in uMgungundlovu – Can biomarkers aid prognostication?

Juan M. Jansen van Vuuren
Somasundram Pillay
Ansuya Naidoo


Background: The burden of stroke is increasing worldwide. The hierarchical healthcare referral system in South Africa (SA) poses unique  challenges to clinicians when caring for people with suspected strokes (PsS). To improve health outcomes, novel strategies are required to provide adequate care, including prognostication, in SA.

Aim: To determine the subjective burden of and challenges posed by  suspected stroke cases and the potential usefulness of biomarkers in prognostication.

Setting: This study was conducted in the  uMgungundlovu Health District (UHD), KwaZuluNatal, SA.

Methods: An online questionnaire was distributed to doctors within the UHD.  Demographic data and answers to a series of 5-point-Likert-type statements were collected.

Results: Seventy-seven responses were  analysed. A third of doctors worked in primary healthcare facilities (PHCare) and saw ≥  2.15 suspected strokes-per-doctor-per-week, compared to ≥ 1.38 seen by doctors working in higher levels of healthcare. Neuroimaging was relied upon by > 85% of doctors, with  nearly half of PHCare doctors having to refer patients to facilities 5 km – 20 km away, with resultant delays. Knowledge about prognostic  biomarkers in strokes was poor, yet most doctors believed that a biomarker would assist in the prognostication process and they would  use it routinely.

Conclusion: Doctors in this study faced a significant burden of strokes and rely on neuroimaging to guide their  management; however, many challenges exist in obtaining such imaging, especially in the PHCare setting. The need for prognostic  biomarkers was clear.

Contribution: This research lays the platform for further studies to investigate prognostic biomarkers in stroke in  our clinical setting. 

Journal Identifiers

eISSN: 2071-9736
print ISSN: 1025-9848