Original articles

Community-based care of stroke patients in a rural African setting

Sean Adam Wasserman, Linda de Villiers, Alan Bryer


In order to develop a community based-model of stroke care we assessed discharge planning of stroke patients, available resources, and continuity of care between hospital and community in a remote rural setting in South Africa. We sought to determine outcomes, family participation and support needs, as well as implementation of secondary prevention strategies

Thirty consecutive stroke patients from the local hospital were assessed clinically (including Barthel Index and modified Rankin scores) at time of discharge. Patients were re-assessed three months after discharge in their homes by a trained field worker using a structured questionnaire.

Two thirds of all families received no stroke education before discharge. At discharge 27 (90%) were either bed or chair-bound. All the patients were discharged into family care as there was no stroke rehabilitation facility available to the community. Of 30 patients recruited, 20 (66.7%) were alive at 3 months, 9 (30%) were deceased, and 1 was lost to follow-up. At 3 months, 55% of survivors were independently mobile as compared with 10% at discharge. A total of 13 (65%) patients in our cohort were visited by home-based carers. Only 45% reported taking aspirin at 3 months.

The 3 month mortality rate was high. Most survivors improved functionally but were left with significant disability. Measures to improve family education and the level of home-based care can be introduced in a model of stroke care attempting to reduce carer strain and improve functional disability in rural stroke patients.

Authors' affiliations

Sean Adam Wasserman, Groote Schuur Hospital

Linda de Villiers, Groote Schuur Hospital

Alan Bryer, Groote Schuur Hospital

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Stroke; Rural; Community

Cite this article

South African Medical Journal 2009;99(8):579.

Article History

Date submitted: 2009-02-17
Date published: 2009-08-06

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