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Stroke services in MENA: What is there and what is needed
Hany Aref1, Nevine El Nahas1, Suhail Abdulla Alrukn2
1Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Stroke care in the Middle East and North Africa (MENA) faces challenges. While treatments like intravenous thrombolysis are available, their use is low, and stroke units, registries, and training need improvement across the MENA region.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- Stroke is a growing global health challenge, particularly in the Middle East and North Africa (MENA) region.
- The shift from infectious to non-communicable diseases increases the future burden of stroke care in MENA's low-to-middle income economies.
- Understanding the current state of stroke services in MENA is crucial for informing policy and addressing healthcare gaps.
Purpose of the Study:
- To assess the current status of stroke services across the Middle East and North Africa (MENA) region.
- To identify gaps in stroke care, including risk factor screening, acute management, diagnostics, and post-discharge services.
- To provide data for policymakers to improve stroke treatment and patient outcomes in MENA.
Main Methods:
- An online survey was distributed to stroke specialists from 16 countries in the MENA region.
- The survey covered key aspects of stroke care: risk factor screening, acute management, diagnostics, medications, post-discharge services, and stroke registries.
- Data analysis focused on the availability and utilization of various stroke care components.
Main Results:
- All surveyed MENA countries have access to neuroimaging studies and medications for secondary stroke prevention.
- While 15 countries offer intravenous thrombolysis (IVT) and 13 offer mechanical thrombectomy (MT), the administration rates for IVT remain low in many countries.
- Stroke units are lacking in 4 countries, and stroke registries and structured training programs require significant implementation in most participating nations.
Conclusions:
- Despite the availability of advanced treatments like IVT and MT in most MENA countries, their low utilization and insufficient stroke unit capacity highlight significant service gaps.
- The lack of comprehensive stroke registries and structured training programs further impedes effective stroke management and research in the region.
- Further detailed studies are necessary to accurately ascertain the status of stroke services and guide targeted interventions in the MENA region.
Objectives:
Stroke represents a health care challenge to most parts of the world including the Middle East and North Africa (MENA) region. The MENA represents 6% of the world population with an age-standardized stroke rate of 87.7 (78.2-97.6) per 100,000 population. This number is subject to increase given that the cause of morbidity has recently shifted from infectious diseases to non-communicable diseases. Thus, in the coming years, treatment of stroke will pose a major burden on MENA countries which mostly lie in the low to middle income economies. Accordingly, we need to study the state of MENA stroke services in order to recognize and further inform policy makers about any gaps that need to be bridged in this domain.
Methods And Results:
Stroke specialists representing 16 countries filled an online survey that included: screening for risk factors, acute management, diagnostics, medications, post-discharge services, and stroke registries. Results showed that 11 countries screen for risk factors, 16 have neuroimaging studies, 15 provide intravenous thrombolysis (IVT), 13 mechanical thrombectomy (MT) while medications for secondary prevention are available in all countries. However, stroke units are not equally available and even absent in 4 countries, and despite the availability of IVT yet, the rate of administration is still low in 6 countries (<5%), and ranges from 5-20% in 7 countries. Stroke registries and training still need to be implemented in most countries.
Conclusion:
Although imaging, revascularization therapies and medications for secondary prevention are available in most MENA countries, yet the rate of revascularization is low, so is the number of stroke units insufficient in some countries. Additionally, registries and structured training are still defective. Further field studies are required for more accurate determination of the status of stroke services in the MENA region.
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