Background and Purpose-Already a major cause of death and disability in high-income countries, the burden of stroke in sub-Saharan Africa is also expected to be high. However, specific stroke data are scarce from resource-poor countries. We studied the incidence, characteristics, and short-term consequences of hospitalizations for stroke in Maputo, Mozambique. Methods-Over 12 months, comprehensive data from all local patients admitted to any hospital in Maputo with a new stroke event were prospectively captured according to the World Health Organization's STEPwise approach to stroke surveillance program. Disability levels (pre-and posthospital discharge) and short-term case-fatality (in-hospital and 28 days) were also studied. Results-Overall, 651 new stroke events (mean age 59.1Ϯ13.2 years and 53% men) were captured by the registry with 601 confirmed by CT scan (83.4%) or necropsy (8.9%). Crude and adjusted (world reference population) annual incidence rates of stroke were 148.7 per 100 000 and 260.1 per 100 000 aged Ն25 years, respectively. Of these, 531 (81.6%) represented a first-ever stroke event comprising 254 ischemic (42.0%) and 217 (36.1%) an intracerebral hemorrhage. Before admission, 561 patients (86.2%) had hypertension and 271 (41.6%) had symptoms for Ͼ24 hours. In-hospital and 28-day case-fatality were 33.3% and 49.6% (72.3% for hemorrhagic stroke), respectively. From almost no preadmission disability, 64.4% of 370 survivors at 28 days had moderate-to-severe disability. Conclusions-The burden of disease associated with stroke is high in Maputo, emphasizing the importance of primary prevention and improvement of the standards of care in a developing country under epidemiological transition. (Stroke.

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The burden of stroke is increasing in developing countries that struggle to manage it efficiently. We identified determinants of early case-fatality among stroke patients in Maputo, Mozambique, to assess the impact of in-hospital complications. Patients admitted to any hospital in Maputo with a new stroke event were prospectively registered (n = 651) according to the World Health Organization's STEPwise approach, in 2005-2006. We assessed the determinants of in-hospital and 28-day fatality, independently of age, gender and education, and computed population attributable fractions. In-hospital mortality was higher among patients with Glasgow score at admission ≤ 6 (more than fivefold) or needing cardiopulmonary resuscitation during hospitalization (approximately 2.5-fold). Pneumonia and deep vein thrombosis/other cardiovascular complications during hospitalization were responsible for 19.6% (95% confidence interval, 5.3 to 31.7) of ischaemic stroke and 15.9% (95% confidence interval, 5.8 to 24.9) of haemorrhagic stroke deaths until the 28th day. Ischaemic stroke patients with systolic blood pressure 160-200 mmHg had lower in-hospital mortality (relative risk = 0.32, 95% confidence interval, 0.13 to 0.78), and, for those with haemorrhagic events (haemorrhagic stroke), 28-day mortality was higher when systolic blood pressure was over 200 mmHg (hazard ratio = 3.42; 95% confidence interval, 1.02 to 11.51), compared with systolic blood pressure 121-140 mmHg. Regarding diastolic blood pressure, the risk was lowest at 121-150 mmHg for ischaemic stroke and at 61-90 mmHg for haemorrhagic stroke. Early case-fatality was mostly influenced by stroke severity and in-hospital complications. The allocation of resources to the latter may have a large impact on the reduction of the burden of stroke in this setting.