Stroke in a resource-constrained hospital in Madagascar

Area of Science:

• Neurology
• Public Health
• Global Health

Background:

• Stroke is the leading cause of in-hospital death in Madagascar.
• Limited descriptive data exists on hospitalized stroke patients in Madagascar.
• This study addresses the feasibility of data collection and patient characterization in a resource-constrained setting.

Purpose of the Study:

• To assess the feasibility of collecting stroke patient data in a resource-limited Malagasy hospital.
• To characterize socio-demographics, clinical presentation, and early outcomes of hospitalized stroke patients.
• To inform improvements in stroke care and future research in Madagascar.

Main Methods:

• Prospective registration of 30 stroke patients from September to December 2014.
• Utilized validated scales: National Institutes of Health Stroke Scale (NIHSS) for severity, modified Rankin Scale (mRS) for disability, and Barthel Index (BI) for function.
• Evaluated data collection feasibility amidst limited access to brain imaging (CT scans) and laboratory investigations.

Main Results:

• Median age of patients was 62.5 years; 16 were male.
• Median NIHSS score was 16.5, indicating severe stroke.
• High in-hospital mortality (30%), high median mRS score (5), and low median BI score (45) at discharge.

Conclusions:

• Data collection on stroke patients is feasible even with resource constraints in Madagascar.
• Hospitalized stroke patients in this cohort presented with severe symptoms and poor outcomes.
• Findings highlight the urgent need for enhanced stroke services and further research in the region.