Stroke Presentation and Outcome in Developing Countries

Abstract

Background and Purpose-Despite increasing burden of stroke in Africa, prospective descriptive data are rare. Our objective was to describe, in The Gambia, the clinical outcome of stroke patients admitted to the Royal Victoria Teaching Hospital in the capital Banjul, to assess mortality and morbidity, and propose preventive and therapeutic measures. Methods-Prospective data were collected on consecutive patients older than 15 years old admitted between February 2000and February 2001 with the diagnosis of nonsubarachnoid stroke. Risk factors, clinical characteristics, and social consequences were assessed using a modified National Institutes of Health Stroke Scale (mNIHSS), the Barthel Activity in Daily Living scale, the Siriraj score for subtypes, and the Bamford criteria for location/extension. Patients were followed-up at home up to 1 year after discharge. Results-Ninety-one percent (148/162) of eligible patients were enrolled and followed-up. Hypertension and smoking were the most prevalent risk factors. Severity was high at admission, especially in women, and was strongly correlated to the outcome. mNIHSS and consciousness level on admission were strong predictors of the mortality risk. Swallowing difficulties at admission, fever, lung infection, and no aspirin treatment were, independently, risk factors for a lethal outcome susceptible to being addressed by treatment. Mortality was 41% in-hospital and 62% after 1 year. In survivors, autonomy levels improved over time. Drug compliance was poor. At home, family members provided care. Long-term socioeconomic and cultural activities were affected in most patients. Conclusions-Case-fatality was high compared with Western cohorts. Preventive measures can be developed. Rational treatment, in the absence of head imaging for initial assessment, requires adapted protocols. Providers should be trained, both at hospital and community levels.

Epidemiological Aspects of Cerebrovascular Accidents in the Diabetic: Experience of the Medical Clinic II of the Hospital Center Abass Ndao of Dakar

“…This average age is close to that of a predominantly black American population [8] studies favored a male preponderance with a ratio between 1.3 and 1.5 [13] [14] [15]. Ratios to 2 have been described [10], as well as a female preponderance with ratios between 0.82 and 0.97 [16] [17]. The predominance was female in our study with a sex ratio of 0.92.…”

“…Immediate evolution: patients who had hemorrhagic stroke were all transferred to an intensive care unit and some ischemic stroke (15.18%). The evolution was marked by a death in 20.25% (16) cases. The Table 3 shows the distribution of patients according to paraclinical characteristics.…”

Case fatality of patients with stroke over a 12-month period post stroke

“…15 The high mortality rate substantiates that the majority of the 5.7 million deaths attributed to stroke annually occur in low-and middle-income countries. 16 The short hospital stay and few physiotherapy treatment sessions received during hospitalisation could have contributed to the poor patient functional ability and high case fatality.…”

Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access and Action

“…This high death toll is even much more in SSA where mortality and case fatality rates are alarming ranging from 21% to as much as 50.6% [24][25][26][27][28][29][30][31][32][33][34]. In addition, stroke has also been noted to be a major cause of unregistered deaths in many developing countries [14,16].…”

“…In fact, until recently many tertiary/referral hospitals in sub Saharan Africa did not have CT scan machines [24,37]. Few stroke persons were opportune to have a CT scan viz: 5.83% 24, 11.11% [62] in Nigeria, 10% from Madagascar [63] and even 0% from Gambia [64]. More recently, the percentages are increasing gradually as one Nigerian study showed that 40.8% patients had CT brain, while 5.6% had magnetic resonance imaging (MRI) [65] and 34.9% in Zimbabwe [60].…”