Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania

Regenhardt, Robert W; Biseko, Maijo R; Shayo, Agness F; Mmbando, Theoflo N; Grundy, Sara J.; Xu, Ai; Saadi, Altaf; Wibecan, Leah; Kharal, G. Abbas; Parker, Robert A.; Klein, Joshua P.; Mateen, Farrah J.; Okeng'o, Kigocha

doi:10.1093/intqhc/mzy188

Cited by 34 publications

(23 citation statements)

References 44 publications

(32 reference statements)

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“…Stroke accounted for 5.5 million deaths and was the second leading cause of death globally in 2016 [1]. Stroke contributed to an overall mortality of 12% in Ethiopia between 2012 and 2014 [10] and 50% at 90 days following first ever stroke in Tanzania in 2017 [11].…”

Section: Introductionmentioning

confidence: 99%

Outcomes within a year following first ever stroke in Tanzania

2021

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Background Stroke contributes to a significant proportion of deaths and disability worldwide, with a high fatality rate within 30 days following a first ever stroke. We describe the outcomes within one year among patients who succumbed a first ever stroke and survived the first 30 days. Methods Participants were patients who survived after 30 days from succumbing a first ever stroke admitted at the Muhimbili University of Health and Allied Sciences Academic Medical Center. Stroke survivors or their next of kin were contacted at one year after succumbing a first stroke to determine the outcomes. We assessed participants’ vital status and level of disability using the modified Rankin scale. Assessment on utilization of stroke secondary preventive measures among survivors was done by an interviewer-based questionnaire that assessed the number of times participants attended follow up clinics, medication refill and adherence. Participants were examined for waist-hip ratio, body mass index and blood pressure. Cholesterol levels were assessed at one year post first stroke for survivors. Outcomes were summarized as proportions, survival at one year was estimated by using the Kaplan Meier analysis and Cox regression analysis was performed to determine for predictors of mortality. Results We recruited 130 first stroke survivors. Mortality within one year was 53/130 (40.8%) and disability rate measured by Modified Rankin Scale with scores of 3–5 was 29/77 (37.7%) among survivors. Factors associated with mortality were residual disability HR = 8.60, {95% CI (1.16–63.96)}, severe stroke, HR = 2.67 {95% CI (1.44–4.95)} and residing in Dar-es-Salaam HR = 2.15 {95% (CI 1.06–4.36)}. Non-adherence rates to antihypertensives, antiplatelets and statins was 11/73 (15.1%), 9/23 (39.1%) and 18/22 (81.8%) respectively. Attendance rates of follow-up clinics among all survivors and physiotherapy among survivors with disability are 45/77 (58.4%) and 16/29 (55.2%) respectively. Conclusions The mortality and disability rates within a year following a first ever stroke among 30 days stroke survivors is high. Secondary stroke preventive measures should be enhanced to mitigate stroke adverse outcomes. Community outreach programs could be useful interventions in preventing the adverse outcomes of stroke.

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Section: Introductionmentioning

confidence: 99%

Outcomes within a year following first ever stroke in Tanzania

2021

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“…For example in Uganda, 30-day mortality was found to be 43% compared to 27% in Gambia [6,9]. While 90-day mortality was estimated at 50% in Tanzania compared to 29.4% in Korea [10,11]. Furthermore, studies in Nigeria and South Africa, indicated that overall mortality at 1 month ranged between 30 and 35% [12,13].. Reports have shown that mortality rates increased with increasing age and were higher for hemorrhagic stroke (HS) than for ischaemic stroke (IS) and, is often associated with a higher risk of early death [9,14].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, studies in Nigeria and South Africa, indicated that overall mortality at 1 month ranged between 30 and 35% [12,13].. Reports have shown that mortality rates increased with increasing age and were higher for hemorrhagic stroke (HS) than for ischaemic stroke (IS) and, is often associated with a higher risk of early death [9,14]. Previous studies have linked the excess mortality in patients with HS to more severe strokes [11,15]. In Dublin, using the modified Ranking Scale (mRS), overall good outcome at 28 days was more common in IS (44.4%) compared with HS (26.8%) [16].…”

Section: Introductionmentioning

confidence: 99%

Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study

Namale

Kamacooko

Makhoba

et al. 2020

BMC Cardiovasc Disord

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Background We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients. Methods Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality. Results We enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39–8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85–10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68–10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13–4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7–13 days (aHR = 0.31, 95% CI: 0.11–0.93) and being married (aHR = 0.22 (95% CI: 0.06–0.84) had protective effects for 30 and 90-day mortality respectively. Conclusion Mortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke- standard of care in the country.

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“…Ischemic strokes due to large vessel occlusion (LVO) account for the largest proportion of stroke‐related disability and death 1,2 . Endovascular thrombectomy (EVT) has revolutionized the acute care of these patients, 3–5 but over half are functionally disabled or dead at 90 days despite treatment 3 .…”

Section: Introductionmentioning

confidence: 99%

Infarct Growth despite Endovascular Thrombectomy Recanalization in Large Vessel Occlusive Stroke

Regenhardt

Etherton

Das

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Endovascular thrombectomy (EVT) has revolutionized large vessel occlusion stroke care. However, not all patients with good endovascular results achieve good outcomes. We sought to understand the clinical significance of magnetic resonance imaging defined infarct growth despite adequate reperfusion and identify associated clinical and radiographic variables. METHODS History, presentation, treatments, and outcomes for consecutive EVT patients at a referral center were collected. Adequate reperfusion was defined as thrombolysis in cerebral infarction (TICI) score 2b‐3. Region‐specific infarct volumes in white matter, cortex, and basal ganglia were determined on diffusion‐weighted imaging. Infarct growth was defined as post‐EVT minus pre‐EVT volume. Good outcome was defined as 90‐day modified Rankin Scale ≤2. RESULTS Forty‐four patients with adequate reperfusion were identified with median age 72 years; 64% were women. Each region showed infarct growth: white matter (median pre‐EVT 7 cubic centimeters [cc], post‐EVT 16 cc), cortex (4 cc, 15 cc), basal ganglia (2 cc, 4 cc), total (20 cc, 39 cc). In multivariable regression, total infarct growth independently decreased the odds of good outcome (odds ratio = .946, 95% CI = .897, .998). Further multivariable analyses for determinants of infarct growth identified female sex was associated with less total growth (β = −.294, P = .042), TICI 3 was associated with less white matter growth (β = −.277, P = .048) and cortical growth (β = −.335, P = .017), and both female sex (β = −.332, P = .015) and coronary disease (β = −.337, P = .015) were associated with less cortical growth. CONCLUSIONS Infarct growth occurred despite adequate reperfusion, disproportionately in the cortex, and independently decreased the odds of good outcome. Infarct growth occurred while patients were hospitalized and may represent a therapeutic target. Potential determinants of region‐specific infarct growth were identified that require confirmation in larger studies.

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Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania

Cited by 34 publications

References 44 publications

Outcomes within a year following first ever stroke in Tanzania

Outcomes within a year following first ever stroke in Tanzania

Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study

Infarct Growth despite Endovascular Thrombectomy Recanalization in Large Vessel Occlusive Stroke

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