Barriers to initial stroke care in Zanzibar - a qualitative study on the perspectives of doctors at Mnazi Mmoja Hospital

Abstract

Background The global stroke burden is unevenly distributed, with Sub-Saharan Africa (SSA) especially affected. Despite stroke being very common in SSA, there however exists both uncertainty and barriers that impede its optimal management. To date, knowledge of the perspectives of stroke care professionals (SCPs) in SSA is scarce. As such knowledge greatly facilitates improvement of stroke care, the aim of this study was to understand the perspectives of doctors involved in initial stroke care at Mnazi Mmoja Hospital (MMH) in Zanzibar, on the care they provide and on the barriers they perceive to providing it. Methods Seven semi-structured interviews were conducted, followed by qualitative content analysis. Results SCPs at MMH overall consider the quality of the stroke care they provide as suboptimal. Five categories of barriers with 16 sub-categories were identified. These were barriers on the patient (lacking knowledge, ignorance, poor compliance, poor health seeking behavior and alternative beliefs), community (family and societal level), health professional (insufficient knowledge and confidence, poor teamwork amongst doctors, low degree of investment), hospital (inadequate quality, insufficient resources, inadequate staffing, insufficient organization and insufficient staff education) and policy level. Conclusions The results are generally similar to those from studies previously carried out in SSA, with some differences in underlying context. The perceived barriers also share commonalities with those found in high-income countries, although with even greater difference in the context shaping them. The results of this study can be of great value to decision-makers in Tanzania, and especially Zanzibar, when considering means to combat the growing stroke problem. They also contribute to a field where research is scarce. More research is needed to assess to what degree the similarities uncovered extend to other parts of SSA.