Treatment, rehabilitation and awareness of stroke in a region with limited resources A descriptive study in the West Bank, the occupied Palestinian territory

Abstract

Master Thesis, Programme in Medicine TITLE: Treatment, rehabilitation and awareness of stroke in a region with limited resources – A descriptive study in the West Bank, the occupied Palestinian territory AUTHOR: Johan Hultegård, 2014 Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Supervisors: Karin Manhem, Professor, Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden Zaid Ghanim, Assistant Professor, Neuroscience & neurology, Faculty of Medicine, Al Quds University, the occupied Palestinian territory

Background Stroke is the second most common global cause of death. Screening, post-stroke rehabilitation, secondary prevention, an increased knowledge of stroke symptoms and risk factors could decrease the mortality of stroke. Aim The purpose was to describe the general conditions in cerebrovascular health care at Palestine Medical Complex (PMC) and further to investigate the awareness of risk factors and symptoms in stroke among non-stroke patients at PMC. Methods Twenty-nine patients with diagnosed stroke were included and examined during eight weeks at PMC for an observational study. Ninety-two non-stroke patients were included at a general ward, PMC, for a questionnaire study. Results Twenty-five percent of ischemic stroke patients were prescribed the combination acetylsalicylic acid + Plavix®. Furosemid® (39%) were most common treatment of hypertension. Patients with NIHSS 3-14 (National Institutes of Health stroke scale) and patients under 65 years were more frequently receiving rehabilitation and follow-up than patients with NIHSS >15 and elderly patients. Seventy-five percent of the non-stroke patients recognized ≥1 correct symptom. Patients with university studies were more likely to recognize >2 correct risk factors (OR 9.6, 95% CI 1.9-49.5, P=0.007). Patients in 40-59 years and in ≥60 years were more likely to recognize ≥1 correct symptoms (OR 4.1, 95% CI 1.4-12.2, P=0.011 respectively OR 8.8, 95% CI 1.7-44.3, P=0.009). Conclusion Patients with severe stroke and high age were less frequently receiving rehabilitation and follow-up in our stroke population. Some generally unproven treatment combinations were common among stroke patients. Future studies is needed which could possibly contribute to guidelines for treatment and rehabilitation at PMC. The awareness study showed a lack of general knowledge concerning stroke symptoms. University studies and high age were associated with increased recognition of stroke symptoms and risk factors. A study representative for the whole population is suggested to address the areas for public information.