Correlates of short- and long-term case fatality within an incident stroke population in Tanzania

Abstract

Background. This study aimed to identify correlates of case fatality within an incident stroke population in rural Tanzania. Methods. Stroke patients, identified by the Tanzanian Stroke Incidence Project, underwent a full examination and assessment around the time of incident stroke. Records were made of demographic data, blood pressure, pulse rate and rhythm, physical function (Barthel index), neurological status (communication, swallowing, vision, muscle activity, sensation), echocardiogram, chest X-ray and computed tomography (CT) head scan. Cases were followed up over the next 3 -6 years. Results. In 130 incident cases included in this study, speech, language and swallowing problems, reduced muscle power, and reduced physical function were all significantly correlated with case fatality at 28 days and 3 years. Age was significantly correlated with case fatality at 3 years, but not at 28 days post-stroke. Smoking history was the only significant correlate of case fatality at 28 days that pre-dated the incident stroke. All other significant correlates were measures of neurological recovery from stroke. Conclusions. This is the first published study of the correlates of post-stroke case fatality in sub-Saharan Africa (SSA) from an incident stroke population. Case fatality was correlated with the various motor impairments resulting from the incident stroke. Improving poststroke care may help to reduce stroke case fatality in SSA.

Mortality rate and predictors of Stroke: A Meta-Analysis and Systematic Review

“…Thirty two studies assessed overall mortality due to stroke. Twelve studies were from Africa [7][8][17][18][19][20][21][22][23][24][25][26], six from Europe [27][28][29][30][31][32], six from Asia [33][34][35][36][37][38], five from North America [39][40][41][42][43] and two from Latin America [44][45].Seventeen studies reported 30-day mortality rate of stroke whereas twenty two studies measured in-hospital mortality. Detailed explanations on study characteristics are shown in the supplementary table (table 1).…”

“…While the annual incidence of stroke declined in HICs, it increased in the LMICs by more than 100% to surpass that of the HIC. 6 The burden in LMICs has also been higher in terms of prevalence, deaths, and DALYs lost [3,6].Previous studies reported different rate of mortality of stroke ranged from (11.97%-60%) [7][8]which indicate the requirement of comprehensive data on stroke mortality globally.…”

Case‐fatality and disability in the Tanzanian Stroke Incidence Project cohort

“…The number of survivors at 7 years was too small to allow meaningful analysis of a wider range of variables as predictors of case‐fatality. However, correlates of three‐year case‐fatality in this cohort have been described previously 6.…”

“…Post-stroke outcomes vary widely between, and within, world regions depending on a range of factors including demographic profile, stroke type and severity and immediate and long-term poststroke care (3)(4)(5)(6). However, long-term post-stroke outcomes in SSA are poorly described, with most studies being hospital-based.…”

“…TSIP was a community-based stroke incidence study. We have also published details of correlates of 28-day and 3-year case-fatality (6). At both time points, markers for stroke severity (functional ability, speech, language, swallowing, confusion, hearing and gaze paresis) were the main correlates.…”