Buque Helena, Smith Lee, Lopes Dino, Pizzol Damiano, Lorenzo Elder, Arroz Nachan, Bacallau Lazara, Sidat Mohsin, Bauaze Evangelina Namburete, Nzwalo Hipólito
Neurology Department, Maputo Central Hospital, Maputo 1100, Mozambique.
Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo 1100, Mozambique.
Int J Environ Res Public Health. 2025 Jun 26;22(7):1008. doi: 10.3390/ijerph22071008.
The burden of stroke is on the rise in low-income countries (LICs). Organized stroke care (OSC) is crucial for improving outcomes in LICs and is the very first step to reducing delays in diagnosis and treatment. We aim to evaluate delay times (DT) in accessing OSC at the national reference hospital of Mozambique, a LIC from southern Africa. : An observational study based on consecutive case series of 59 stroke patients confirmed by computed tomography (CT) scans over a period of 3 months (May-July 2023). The total DT (from stroke onset to inward hospitalization) was the main outcome. Other specific DTs were analyzed including initial symptoms to arrival and admission (DT0), arrival to CT scans (DT1), arrival of laboratory results (DT2), and arrival to inward hospitalization (DT3). The mean age was 61.9 (min 30-max 90) and 45.8% were female. The median total DT was 20 h. The median time DT0 was 10.6 h (interquartile range (IQR): 16.48). The median DT1 and DT2 were 4 h (IQR: 3.5) and 5 h (IQR: 2.6), respectively. The median DT3 was 10 h (IQR: 4). None of the patients were treated under a stroke code. This study reveals an unacceptable prehospital and in-hospital DT. Waiting for the CT scan contributed to a large proportion of the total DT, which among other factors can be explained by the absence of a stroke code and limited imaging capacity. These findings mirror disparities in stroke care seen in other LICs, where late presentation, scarce imaging, and limited specialized protocols are common. The urgent implementation of organized prehospital and in-hospital stroke pathways is needed in Maputo to improve outcomes.
低收入国家（LICs）中风负担正在上升。有组织的中风护理（OSC）对于改善低收入国家的治疗效果至关重要，是减少诊断和治疗延迟的第一步。我们旨在评估莫桑比克（一个来自南部非洲的低收入国家）国家参考医院获得OSC的延迟时间（DT）。：一项基于连续病例系列的观察性研究，研究对象为2023年5月至7月3个月期间经计算机断层扫描（CT）确诊的59例中风患者。总DT（从中风发作到住院）是主要结局。分析了其他特定的DT，包括从初始症状到就诊和入院（DT0）、就诊到CT扫描（DT1）、实验室结果出来（DT2）以及就诊到住院（DT3）。平均年龄为61.9岁（最小30岁 - 最大90岁），女性占45.8%。总DT中位数为20小时。DT0中位数时间为10.6小时（四分位间距（IQR）：16.48）。DT1和DT2中位数分别为4小时（IQR：3.5）和5小时（IQR：2.6）。DT3中位数为10小时（IQR：4）。没有患者在中风代码下接受治疗。这项研究揭示了院前和院内DT令人无法接受。等待CT扫描占总DT的很大一部分，这在其他因素中可以通过没有中风代码和有限的成像能力来解释。这些发现反映了其他低收入国家在中风护理方面的差异，在这些国家，就诊晚、成像稀缺和专门方案有限很常见。马普托迫切需要实施有组织的院前和院内中风治疗路径以改善治疗效果。
