Factors facilitating pre-hospital delays in stroke patients' presentation to hospital by their caretakers in Uganda and suggested interventions.

Abstract

Background: Benefit from stroke therapy for eligible stroke patients is time dependent, it is recommended to be timeously administered. The median time to hospital arrival after stroke in Africa has been documented to be around 31 h which is a stark contrast to the 33-365 min range in the global north. Therefore, poor outcomes after stroke in African countries like Uganda, may be contributed to by patients not receiving acute stroke interventions due to ineligibility by time criteria, that sometimes is solely due to late hospital arrival following pre-hospital delays. This brief article is an extension of a prior knowledge gap analysis of knowledge levels of acute stroke alarm signs by first contact healthcare providers (HCPs) and stroke patients' caretakers (PCs) in Uganda's two largest stroke referral hospitals, and further explores the factors that contribute to pre-hospital delays in stroke patients' presentation to hospital by their caretakers in Uganda, with suggestions of how they can be addressed.

Methods: The precedent study to this extension article used a cross-sectional survey design at two study site hospitals that are Uganda's largest stroke referral public hospitals. Data gathered over eight weeks between December 2024 and January 2025 using structured, in-depth interviews of 120 consented adult respondents (60 first contact HCPs and 60 PCs), of whom 10 PCs not at least educated to a primary seven level were excluded to leave 110 respondent entries, were analyzed using the IBM SPSS statistics package. Descriptive variables were compared using Fisher's exact tests and correlations were analyzed using Kendall's tau-b or tau-c. Ethics approval for the study was obtained from the Mulago Hospital Research Ethics Committee (MHREC-2024-147, September 25, 2024), administrative clearance from KNRH (November 15, 2024), and a research permit from the Uganda National Council of Science and Technology (HS5181ES, December 2, 2024).

Results: The details of the results were reported in a precedent study to this extension article. 20 (33.3%) HCPs were knowledgeable in acute stroke algorithms and none of the PCs were. These PCs had a median age of 31.5 years (IQR 25.0-41.3), most of them (41, (82%)) were next of kin relatives to their stroke patients and most (44, (88%)) were first-time stroke patient caretakers. Only 9 (18%) of the PCs had had university education and 26 (52%) had had a secondary school education. Half of the PCs brought their stroke patients to the hospital beyond 24 h after their time last well.

Conclusion: Pre-hospital delays in stroke patients' presentation to hospital by their caretakers in Uganda, that were recently observed by a local knowledge gap analysis study, are multifactorial. Targeted stroke literacy programs in Uganda should be developed with the local cultural context in mind and should be extended to not only the general public but also to clinical and alternative healthcare workers, being supported at national policy making levels with interventions to improve nationwide transport and hospital infrastructure aimed at promoting timeliness in the seeking and delivery of emergent stroke care services in the country.