Accessibility to rt-PA in Sub-Saharan Africa, Congolese stroke unit experience: Call for an urgent action

Accessibility to rt-PA in Sub-Saharan Africa, Congolese stroke unit experience: Call for an urgent action Dear editor, Stroke unit and thrombolysis are currently accepted as the most effective treatment of ischemic stroke.1,2 In January 2014, The University Hospital of Brazzaville has implemented the first Stroke Unit in Central Africa.The report of the first-year activity noted a decline of 30% in mortality rate, compared to the previous year.But the high cost of rt-PA has not allowed the eligible patients to have access to IV thrombolysis.We report the profile of eligible patients, who were not thrombolysed because of the lack of rt-PA, from January to September 2014.During the study period, 737 patients were admitted for stroke including 464 (63%) ischemic stroke, among them 26 (5.6%) were eligible for IV rt-PA.In eligible patients, the mean age was 54 Æ 16 years, 17 (65.4%)were men.All patients had a monitoring; Table 1 shows the parameters at admission.The mean NIHSS at 7th day was 15 Æ 7, and the mortality rate of 11.5% (n ¼ 3).The worldwide use of IV rt-PA reported by Berkowitz et al. 3 showed that in low-income countries, the use of rt-PA is 3%, and just cases reported because of many reasons.Currently, in Congo, the main reason for not using IV rt-PA is because of its high cost.Congolese patients have to pay themselves before all treatment.An action has to be made for accessibility of rt-PA for Sub-Saharan countries with stroke unit.