<b><i>Introduction:</i></b> Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. <b><i>Methods:</i></b> This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. <b><i>Results:</i></b> The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (<i>p</i> value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41–3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20–2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04–2.67) are factors that increased significantly the lethality. <b><i>Conclusion:</i></b> The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.
