Stroke in a resource-constrained hospital in Madagascar

Abstract

BackgroundStroke is reported as the most frequent cause of in-hospital death in Madagascar. However, no descriptive data on hospitalized stroke patients in the country have been published. In the present study, we sought to investigate the feasibility of collecting data on stroke patients in a resource-constrained hospital in Madagascar. We also aimed to characterize patients hospitalized with stroke.MethodsWe registered socio-demographics, clinical characteristics, and early outcomes of patients admitted for stroke between 23 September 2014 and 3 December 2014. We used several validated scales for the evaluation. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS), disability by the modified Rankin Scale (mRS), and function by the Barthel Index (BI).ResultsWe studied 30 patients. Sixteen were males. The median age was 62.5 years (IQR 58–67). The NIHSS and mRS were completed for all of the patients, and BI was used for the survivors. Three patients received a computed tomography (CT) brain scan. The access to laboratory investigations was limited. Electrocardiographs (ECGs) were not performed. The median NIHSS score was 16.5 (IQR 10–35). The in-hospital stroke mortality was 30%. At discharge, the median mRS score was 5 (IQR 4–6), and the median BI score was 45 (IQR 0–72.5).ConclusionsAlthough the access to brain imaging and supporting investigations was deficient, this small-scale study suggests that it is feasible to collect essential data on stroke patients in a resource-constrained hospital in Madagascar. Such data should be useful for improving stroke services and planning further research. The hospitalized stroke patients had severe symptoms. The in-hospital stroke mortality was high. At discharge, the disability category was high, and functional status low.

Post-stroke Quality of Life Index: A quality of life tool for stroke survivors from Sri Lanka

“…It includes 21 items under four domains of physical/social, pain/emotional, financial stability and environmental domains. Hence it addresses many of the deficiencies of utilizing current QOL measures within the resource-constrained settings [26][27][28][29]31].…”

“…Stroke-related literature is scarce in relation to LMICs. Hence most of the evidence on stroke rehabilitation which come from Western settings which might not be applicable for lower-middle income settings [26][27][28][29][30]. The development of new QOL tools for stroke survivors would enable more context-related QOL measurements [31].…”

Access to acute care resources in various income settings to treat new-onset stroke: A survey of acute care providers

“…These findings fit with known reported delays in presentation and diagnosis [7] , [8] . It is most likely also what contributes to the reported poor outcome [9] , [10] , [11] . The reported better access to tele-radiology in LMICs were reassuring when considering the significant lack of specialised care.…”

Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access and Action

“…In fact, until recently many tertiary/referral hospitals in sub Saharan Africa did not have CT scan machines [24,37]. Few stroke persons were opportune to have a CT scan viz: 5.83% 24, 11.11% [62] in Nigeria, 10% from Madagascar [63] and even 0% from Gambia [64]. More recently, the percentages are increasing gradually as one Nigerian study showed that 40.8% patients had CT brain, while 5.6% had magnetic resonance imaging (MRI) [65] and 34.9% in Zimbabwe [60].…”

“…Regrettably, some are unaware of the presence of these risk factors or are poorly controlled if know [74]. High blood pressure is the most powerful predictor of stroke, and its treatment can reduce the risk of stroke by ≥ 40% [62]. In one case however, as much as 64% of the stroke patients had the hypertension diagnosed for the first time [29].…”