Stroke Care in Rural Kenya: The Gap Between Clinical Practice and Stroke Care Guidelines in Kiambu County, Kenya

Background In Kenya, stroke is one of the top five causes of mortality, with a high rate of inpatient mortality. The American Heart Association (AHA) and American Stroke Association (ASA) translated scientific evidence into evidence-based clinical practice guidelines aimed at reducing inpatient mortality and improving the quality of care for stroke patients. Despite the proven benefits of the ASA stroke guidelines in improving stroke care, translation of the guidelines in various settings remains a key challenge. This study aimed to quantify the gap between evidence-based recommendations and current stroke care practices in a peri-urban referral facility in Kiambu, Kenya. The study was conducted at xxxxxxxxxx Hospital, a peri-urban referral facility in Kiambu County, Kenya. Methods: We reviewed records of stroke patients attending xxxxxxxxxxx from January 1, 2020, to December 31, 2023. The study evaluated acute stroke management practices and secondary prevention against the 2019 American Heart Association/American Stroke Association (AHA/ASA) Guidelines for the Early Management of Acute Ischemic Stroke. Results: The median distance travelled by stroke patients to the facility was 47.8 kilometres; further, the median onset-to-presentation time was 24 hours. The study evaluated eight clinical practices against the ASA guidelines. The facility lacked a dedicated stroke unit. Remarkably, patients arriving within the therapeutic window for intravenous alteplase and thrombectomy did not receive these treatments. Secondary prevention measures, including discharge on an antiplatelet regimen, were moderately adhered to; among the 86 eligible ischemic stroke patients, 67 (77.9%) were correctly discharged on aspirin. Similarly, 84/123 (68.3%) of the patients were discharged on statin therapy. Conclusion: Evidence-based stroke care recommendations were minimally adhered to at this peri-urban referral facility in Kiambu, Kenya. Contribution: This study quantifies the gap between evidence-based stroke care recommendations and current clinical practice in a peri-urban referral facility in Kenya, providing context-specific evidence to inform quality improvement initiatives and guideline implementation efforts in similar resource-constrained settings.