In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis

Abstract

Objective: To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa. Method: The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute’s critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model. Result: A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17–0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24–0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12–0.19) and Southern Africa (18%, 95% confidence interval = 0.06–0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function. Conclusion: The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.

Magnitude and Predictors of In-Hospital Stroke Mortality in Ethiopia: A Systematic Review and Meta-Analysis

“…This concept is well supported by the current findings where lower admission GCS and altered mental status increased the odds of in-hospital mortality (OR = 8.51 and OR = 5.59, respectively. Besides, it was consistent with the systematic review and meta-analysis performed in the sub-Sharan Africa region, and other hospital-based studies in Uganda, Nigeria, and China [ 11 , 19 , 23 , 32 ].…”

“…The pooled prevalence of in-hospital stroke mortality was found to be 14.03%. This finding was in line with the result of systematic reviews and meta-analyses conducted in Ethiopia and Eastern African countries with a mortality rates of 18% and 15%, respectively [ 16 , 19 ]. But it was higher than a study conducted in Argentina (2.5%) [ 20 ].…”

Factors associated with stroke associated pneumonia among adult stroke patients admitted to university of Gondar hospital, Northwest Ethiopia

“…The difference in timing of stroke admissions among sub-Saharan countries could be explained by difference in health seeking behavior, access to a nearby health facility for early referral, and a preference to use alternative traditional treatments. Delay in admission could waste an effective intervention period to minimize subsequent neurological insults 16 , 27 . Stroke associated pneumonia complicated 36% of stroke patients.…”

Prevalence and Effect of Stroke Associated Pneumonia on in-Hospital Stay, Mortality and Functional Outcome at Discharge from Hospital

“…A convenience sampling method was used to recruit 500 patients. Sample size was determined by considering 95% confidence interval, 5% margin of error, and previous estimated prevalence of stroke associated pneumonia 44% [17]. Demographic details, clinical characteristics, neurological features, and behavioral factors were different independent variables.…”