The Quality of Post-discharge Community Care Received by Ischaemic Stroke Patients in Iraq: A Multi-governorate Study ۲۰۲۱-۲۰۲۴

Background and Aim: Post-discharge community care is a critical determinant of recovery following ischaemic stroke, yet its quality in resource-limited settings, such as Iraq, remains poorly documented. International guidelines, including those of the World Stroke Organization (WSO), Royal College of Physicians (RCP) UK, and European Stroke Organization (ESO), mandate early rehabilitation, structured follow-up, written caregiver information, and multidisciplinary community support. The extent to which these standards are met in the Iraqi community setting has not been prospectively examined. This study aimed to document the quality of post-discharge community care received by ischaemic stroke patients across three cities in Iraq, to benchmark these findings against WSO, RCP UK, and ESO guideline standards, and to identify specific, actionable deficiencies in local practice. Materials and Methods: A prospective, descriptive cross-sectional study was conducted between October ۲۰۲۱ and December ۲۰۲۴ across three Iraqi governorates. A structured, interviewer-administered questionnaire was completed by caregivers and family members of ۱۳۸ eligible ischaemic stroke patients (anterior circulation territory; aged ۴۰–۶۵ years; discharged within one week of onset; with measurable neurological deficit). Participants were followed for a maximum of six months post-discharge. Descriptive statistics were used; findings were benchmarked against the three selected international guideline frameworks. Results: Of ۳۲۳ caregivers approached, ۱۳۸(۴۲.۷%) were enrolled. Key findings included that no patient (۰%) received written discharge information; only ۱۶% commenced physiotherapy within the first week, and ۵۹.۴% received no structured rehabilitation. Major complication rates were pressure ulcers ۷۶.۸%, urinary tract infection (UTI) ۷۹.۷%, deep vein thrombosis ۳۷.۷% (with pulmonary embolism in ۱۰.۱%), chest infection ۳۴.۸%, recurrent ischaemic stroke ۲۲.۵%, intracerebral hemorrhage ۱۳.۸%, and cardiac events ۲۸.۲%. None of the ۱۳۸ patients achieved functional independence at six weeks, ۶۰.۹% were rated as having poor quality of life at three months, and ۸۰.۴% demonstrated clinically significant depression or anxiety, of whom ۷۴.۷% received no treatment. Thirty-four patients (۲۴.۶%) died within three months, all from preventable complications. Conclusion: This study documents a pervasive, multi-dimensional failure of post-discharge community stroke care in Iraq, with a resulting three-month mortality rate of ۲۴.۶%, substantially exceeding international benchmarks. All recorded deaths and the overwhelming majority of complications were attributable to deficiencies that are both identifiable and correctable. Urgent policy interventions are required, including the introduction of structured discharge information, community nursing services, accessible rehabilitation programs, blood pressure monitoring pathways, and formal caregiver education. These findings provide an evidence base for national stroke care policy reforms.

کلیدواژه ها:

Ischaemic stroke ، Community care ، Post-discharge rehabilitation ، Caregiver support ، Stroke outcomes