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Observational Study
. 2023 Jul 20;18(7):e0288030.
doi: 10.1371/journal.pone.0288030. eCollection 2023.

Stroke services in MENA: What is there and what is needed

Hany Aref  1 , Nevine El Nahas  1 , Suhail Abdulla Alrukn  2 , Maria Khan  2 , Selma Kesraoui  3 , Firas Alnidawi  4 , Elyar Sadeghi Hokmabadi  5 , Mehdi Farhoudi  5 , Muataz Fairooz  6 , Waleed Batayha  7 , Athari Salmeen  8 , Husen Abdulrahman  9 , Mohammed Faouzi Belahsen  10 , Amal M Al Hashmi  11 , Naveed Akhtar  12 , Mohammed Al-Johani  13 , Osheik Abu'Asha Seidi  14 , Anas Jouhar  15 , Chokri Mhiri  16 , Ahmed Elbassiouny  1 , Hossam Shokri  1 , Tamer Roushdy  1
Affiliations
Observational Study

Stroke services in MENA: What is there and what is needed

Hany Aref et al. PLoS One. .

Abstract

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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Availability of reperfusion therapies and health facilities providing acute stroke management.
Fig 2
Fig 2. Screening for vascular risk factors.
See this image and copyright information in PMC

References

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