Stroke services in MENA: What is there and what is needed (original) (raw)
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Frontiers in Neurology
BackgroundAcute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa.ObjectiveEvaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke.MethodOnline questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022.ResultsThe survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250–1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15–75%) of patients treated with IVT wi...
International Journal of Stroke, 2019
Background and methods Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. Results Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20–13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4–13) and age was 65 years (56–76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed ...
The epidemiology of stroke in the Middle East
Purpose: The purpose of this paper is to review and synthesize data from different countries in the Middle East on stroke and its potential risk factors. Method: A systematic review of all published stroke articles in the Middle East between 1980 and May 2015 was conducted. Findings: Sixty-four papers were included in the review. The incidence rate for all strokes ranged between 22.7 and 250 per 100,000 population per year. The prevalence rate for stroke ranged between 508 and 777 per 100,000 population. Among studies reporting gender differences, 75% reported a high male-to-female ratio among stroke patients. The mean age of stroke was within the sixth and the seventh decade. Ischemic stroke was the most reported type followed by intracerebral hemorrhage and subarachnoid hemorrhage. Hypertension was the most reported risk factor followed by diabetes. The overall case-fatality rate within one month was 12-32%. Discussion: During the last decades, there was an increase in stroke incidence and mortality rates in the Middle East. The Middle East faces low rates of self-awareness and control of noncommunicable diseases and also lacks knowledge for stroke risk factors, awareness, causes, and symptoms. Conclusion: There is an urgent need to develop more efficient and accurate methods to measure stroke in the Middle East. There is also a significant call to increase public awareness and implement interventions on stroke and its risk factors and symptoms to help people understand the negative impact of stroke on quality of life and potentially prevent this disease.
Journal Of Cardiovascular, Neurovascular & Stroke, 2022
This manuscript aims to outline how pre-existing resources can be used for stroke care and how public and government awareness can be raised (influencer model). We likewise portray the achievement of the LGH stroke program as an example of advancement. In LGH, reperfusion treatment has begun in recent years and this paper portrays the one of a kind experience in Pakistan. The aim of this study is to do a comparative analysis between Pakistan, Thailand and Egypt and their approaches to stroke care management and treatment. These countries fall under similar economic standing (LMICs) but Egypt and Thailand have relatively better healthcare systems for stroke management as compared to Pakistan. Hence, this paper looks into these differences and presents potential solutions to how stroke care management can be improved in Pakistan. Additionally, current stroke management in Pakistan is reviewed.
Human Resources for Health
Background Ischaemic stroke care requires a co-ordinated multi-disciplinary approach to optimise patient outcomes. Current care provision in Saudi Arabia is below international recommendations, and with increasing patient numbers, variable access to new therapies, and sub-optimal co-ordination of staff, the Kingdom’s Ministry of Health has prioritised strategies to develop stroke care. Our objective was to use local epidemiological data to predict stroke incidence and to combine this with international staffing recommendations to estimate future staff requirements and their costs over a 10-year period. Methods We researched existing stroke services and staff availability within Saudi Arabia to establish current provision, undertook epidemiological modelling to predict stroke incidence, and used international staffing recommendations for acute and rehabilitation services to develop a care pathway to provide state-of-the-art stroke services. This information was used to determine the ...
Changing the Landscape of Stroke in Egypt
Cerebrovascular Diseases Extra, 2021
Egypt, a low-middle-income country, is the most populated nation in the Middle East with a high overall crude prevalence rate of stroke (963/100,000 inhabitants), accounting for 6.4% of all deaths. In this article, we discuss how, through a corrective plan, we could change the landscape of stroke services in Egypt, in a relatively short time, raising thrombolysis rate from <1% to 12.3%, with shortening of door-to-needle time. We could build a database that now exceeds 5,000 patients, our centers received international accreditation and several awards, and we developed tele-stroke service.
Burden of stroke in Egypt: current status and opportunities
International Journal of Stroke, 2014
Middle East and North Africa (MENA) countries have a diversity of populations with similar life style, dietary habits, and vascular risk factors that may influence stroke risk, prevalence, types, and disease burden. Egypt is the most populated nation in the Middle East with an estimated 85.5 million people. In Egypt, according to recent estimates, the overall prevalence rate of stroke is high with a crude prevalence rate of 963/ 100 000 inhabitants. In spite of disease burden, yet there is a huge evidence practice gap. The recommended treatments for ischemic stroke that are guideline include systematic supportive care in a stroke unit or stroke center is still deficient. In addition, the frequency of thrombolysis in Egypt is very low for many reasons; the major one is that the health insurance system is not covering thrombolysis therapy in nonprivate sectors so patients must cover the costs using their own personal savings; otherwise, they will not receive treatment. Another important factor is the pronounced delay in prehospital and in hospital management of acute stroke. Improvement of stroke care in Egypt should be achieved through multi and interdisciplinary approach including public awareness, physicians' education, and synergistic approach to stroke care with Emergency Medical System.
Stroke Care Services in Africa: A Systematic Review
Journal of Stroke Medicine
Background: Stroke is the second leading cause of death and adult-onset disability globally. Although its incidence is reducing in developed countries, low- and middle-income countries, especially African countries, are witnessing an increase in cases of stroke, leading to high morbidity and mortality. Evidently, a new paradigm is needed on the continent to tackle this growing burden of stroke in its preventative and treatment aspects. Aims and Objectives: The aim of this study was to determine the scope of stroke care services, where they exist, and their relationship with currently existing health systems. Methods: A detailed literature search was undertaken referring to PubMed and Google Scholar for articles from January 1960 to March 2018, using a range of search terms. Of 93 publications, 45 papers were shortlisted, and 21 reviewed articles on existing stroke services were included. Results: The literature on models of stroke services in Africa is sparse. We identified focused ...
Introduction: Stroke is considered a growing health issue with high burden.The study was conducted among 258 participants in Soba university hospital, Ibrahim Malik teaching hospital, and Bahri teaching hospital. The study aimed to compare the clinical practice of the management protocol to the NICE guidelines for stroke 2016, and to determine the level of appropriate reporting of stroke management in the medical records. Materials and methods: Observational cross-sectional hospital-based study. Total coverage of stroke patients' medical records in the period between February to March 2021. Data were coded, and analyzed by SPSS version 23. Results: About two third of the participants had their blood pressure lowered within the primary management. The hospitals were 100% adherent to secondary prevention measures' guidelines. However, Lower adherence was reported for the early hospital management (81.4%) and the primary management (83.8%). Furthermore, there was marked under-documentation of cases in both primary and secondary management with only (35.4%) and (20.8%) of stroke patients were reported respectively. Conclusion: Three-quarters of the participants received an emergency assessment by a specialist physician and were monitored closely. Moreover, The majority of the hemorrhagic stroke had their blood pressure lowered with minimum surgical intervention, this was explained by lack of adequate surgical infrastructure due to poor health finance in Sudan. Fortunately, high overall adherence rates to the stroke management guidelines were shown among different hospitals in this study. However, under-documentation of cases and their details was noticed.