MECHANICAL THROMBECTOMY (MT) FOR STROKE ACCESS IN AFRICA: A GLOBAL MT 2020+ CAMPAIGN SURVEY

Abstract

Background Mechanical thrombectomy (MT) is the evidence-based treatment for acute large vessel occlusion stroke; however, access to MT varies widely between regions. Our aim was to compare access to MT in Africa to that in other regions of the world. Methods Country-wise data on the number of MT centers, MT operators, and reimbursement for MT were obtained from the global survey by MT2020+ campaign. Countries were classified into low/lower-middle, upper-middle and high-income based on their World Bank classification. MT access rate was defined as the proportion of estimated LVO patients receiving MT. Data was log transformed and analyzed using univariable and multivariable regression. Results Of all survey respondents (n=60), 15% were from Africa. 33% of African countries had no M centers. Median MT access in Africa was 0.4%(IQR 0.0-2.4%), compared to 29.7%(IQR 21.6 - 37.9) in North America and 3.7% (IQR 0.4-6.9) in Asia. In univariate linear regression models, Africa had significantly less MT access when compared to most other regions of the world including Europe (p=0.004), Middle East (0.002), North America (p=0.002) and New Zealand (p=0.009). On multivariate analysis, compared to high income countries, middle income and low income countries had significantly less access (p-values <0.001). Presence of reimbursement was also positively associated with MT access (p=0.014). Conclusion Access to MT in Africa is far below that of other regions. MT access is independently predicted by income class and reimbursement for MT. Public health interventions must be prioritized in order to increase access to MT in Africa. Mechanical thrombectomy (MT) is the evidence-based treatment for acute large vessel occlusion stroke; however, access to MT varies widely between regions. Our aim was to compare access to MT in Africa to that in other regions of the world. Country-wise data on the number of MT centers, MT operators, and reimbursement for MT were obtained from the global survey by MT2020+ campaign. Countries were classified into low/lower-middle, upper-middle and high-income based on their World Bank classification. MT access rate was defined as the proportion of estimated LVO patients receiving MT. Data was log transformed and analyzed using univariable and multivariable regression. Of all survey respondents (n=60), 15% were from Africa. 33% of African countries had no M centers. Median MT access in Africa was 0.4%(IQR 0.0-2.4%), compared to 29.7%(IQR 21.6 - 37.9) in North America and 3.7% (IQR 0.4-6.9) in Asia. In univariate linear regression models, Africa had significantly less MT access when compared to most other regions of the world including Europe (p=0.004), Middle East (0.002), North America (p=0.002) and New Zealand (p=0.009). On multivariate analysis, compared to high income countries, middle income and low income countries had significantly less access (p-values <0.001). Presence of reimbursement was also positively associated with MT access (p=0.014). Access to MT in Africa is far below that of other regions. MT access is independently predicted by income class and reimbursement for MT. Public health interventions must be prioritized in order to increase access to MT in Africa.