Clinical characteristic of a Haitian stroke cohort and a scoping review of the literature of stroke among the Haitian population
Background and aim: There are significant disparities in stroke care and outcomes between low- and middle-income countries compared to high-income countries. Haiti, a lower-middle-income country, suffers from a lack of resources for acute stroke management. This study is the first to report the epidemiological profile of the Haitian population presenting with stroke symptoms at the largest academic hospital in the nation.
Methods: This is an observational study conducted over a period of five months from April 2021 to August 2021 in the Internal Medicine Department of the State University Hospital of Haiti. There were 51 included patients who were suspected to have had an acute stroke. A descriptive statistical analysis was conducted. A scoping review of the literature was also conducted.
Result: Over 50% of included patients were between 19-65 years old. The mean age at presentation was 61 years, and patients were predominantly female (64.7 %). The prevalence of severe motor deficits was over 96 %. The mean National Institutes for Health Stroke Scale was 12. Only 15.7% of patients (8/51) had a CT scan during their hospitalization. The median time to CT scan was 84 hours after symptom onset. 80% of those with complications took more than 24 hours to arrive at the hospital after the onset of symptoms. Eleven percent of patients had complications, and the mortality rate was 3.9%. There was a significant association between the Modified Rankin Scale and the occurrence of complications (p=0.016). NIHSS score had a significant association with the Glasgow score (F=6.3; p<0.001) where an inversely proportional correlation was observed between them (r= -0.7; p<0.001) and a proportional correlation with the Rankin prediction score and the NIHSS (r=0.3, p=0.04). Little is known about the epidemiology of stroke patients in Haiti, and this limits the ability to develop targeted interventions to improve outcomes. In our scoping review, only three pertinent studies were identified over a 25-year period, this leads to a lack of data in regard to stroke care in Haiti mainly due to the absence of trained personnel.
Conclusion: In our cohort Stroke is mainly affecting female patients. The majority of stroke patients have moderate cerebral deficits and took more than 24 hours to arrive at the hospital. Urgent assistance is needed to strengthen personnel and infrastructure dedicated to stroke. Neurological assessment based on NIHSS and Rankin score should be systematic in stroke evaluation in Haiti.
Relevance for patients: This study is relevant for patients because it emphasizes the challenges of stroke management in Haiti due to the non-availability of reference drugs, the time to arrive at the hospital to start treatment, as well as the means of diagnosis which are limited, like the CT scan. While stroke prevalence is on the rise in the country, it is the highest in the Caribbean and Latin America region. This study is a wake-up call on the need for a stroke center in the country, with appropriate diagnostic equipment and well-trained staff, with an emphasis on continuing education and research.
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