Clinical Characteristic of a Haitian Stroke Cohort and a scoping review of the literature of stroke among the Haitian population

Background There is staggering evidence of stroke care disparities in Low- and Middle-Income countries compared to developed countries. Haiti like those countries suffers from a lack of resources for acute stroke management. To our knowledge, we conducted the first study reporting the epidemiological profile of the Haitian population presenting with stroke symptoms in the largest academic hospital of the nation. Methods This is an observational study conducted over a period of five months from April to August 2021 in the Internal Medicine Department of the State University Hospital of Haiti including 51 consecutive patients suspected to have acute stroke. Descriptive statistical analysis was conducted. A scoping review of the literature on Haitian population stroke was also conducted. Result More than 50% of our patients are in the age range [19-65] years, 96.1% are older than 35 years. Mean age at presentation was 61 years, predominantly female (64.74 %). Severe motor deficit was more prevalent 96 %, with presenting NIHSS of 12 on average. Only 15% of patients (8/51) had a CT scan during their hospitalization. The majority were delays with a median time to CT of 84 hours after symptoms onset. About 80% of those with complications took more than 24 hours to arrive at the hospital after the onset of symptoms. There was a significant association between the modified Rankin Score and the occurrence of complications (F=6.33; p=0.016). 11% of the patient had complications with a mortality rate of 3.9%. NIHSS score has a very highly significant association with the Glasgow score (p<0.001) where an inverse proportional correlation was measured (r=-0.7; p<0.001) and a proportional correlation with the Rankin prediction score (r=0.3, p=0.04). Conclusion Stroke affects the most economically active portion of the Haitian population and there is a salient lack of equipped healthcare facilities and appropriate treatment for stroke management in Haiti. Urgent assistance in both personnel and infrastructural resources dedicated to stroke care is needed. Neurological assessment based on NIHSS and Rankin score should be systematic in stroke Evaluation.