Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study

Abstract

Introduction. Stroke recurrence accounts for a great percentage of catastrophic complications, yet no comprehensive study has analyzed the factors associated with stroke recurrence in Cameroon. We carried out this case-control study to better understand the factors associated with the stroke recurrence in Cameroon. Methods. We collected sociodemographic, clinical, neuroimaging, laboratory, and therapeutic data of eligible patients who consulted the neurology and cardiology department of the Yaounde Central Hospital in Cameroon. We included all patients at least five years removed from their first stroke event who consulted the authors’ institution as of January 15, 2019. Wilcoxon signed-rank and Fisher’s exact tests were used. Also, a Cox regression model was used to identify confounders.Results. We recruited 100 patients; seven out of ten patients had hypertension, while six out of 10 had a sedentary lifestyle. Half of the patients consumed alcohol regularly, while one patient out of five had diabetes. Most patients presented with their first stroke event, and a quarter had a stroke recurrence. Stroke recurrence was associated with right handedness (OR = 0.23, 95% CI = 0.16–0.33), congestive heart failure (OR = 3.45, 95% CI = 1.16–10.28), gout (OR = 4.34, 95% CI = 1.09–18.09), dysarthria (OR = 4.34, 95% CI = 1.30–14.54), and facial palsy (OR = 3.96, 95% CII = 1.49 – 10.51), as well as modifiable factors such as elevated abdominal circumference (P < 0.01), systolic blood pressure (P < 0.01), blood glucose level (PI <I 0.01), LDL cholesterol (P < 0.01), and triglyceride levels (P < 0.01). The mulitvariable regression model only identified laterality (B = –1.48, P = 0.04) as a statistically significant explanatory varibale for stroke recurrence. Conclusion. We mapped the landscape of recurrent strokes in Cameroon. There is a need to evaluate the causes of suboptimal drug adherence rates and both the role and adherence to nonpharmacologic interventions.

Stroke Recurrence Rate and Risk Factors Among Stroke Survivors in Sub-Saharan Africa: A Systematic Review

“…This time was 5.85 years between second stroke and third stroke. Walker RW et al 2013 Tanzania 26 Case control study 201 4 (1.99%) No mortality rates reported NA Mbonda, PC Cameroon 2021 29 Retrospective study Cross sectional prospective study 528 75 (14.20%) 23% deaths occurred among those with recurrent strokes The time between the first stroke and recurrence was 1 to 2 years in 37.8% of patients, more than 3 years in 28.4% of patients, and 14.9% of patients had recurrence within six months of the first stroke Kamgang, J Cameroon 2021 27 Case control study Retrieved data from patient records at a hospital 100 25(25%) No mortality rates The median time from the index stroke event to the second stroke was 16.0 (95% CI = 3.36–28.64) months in right-handed patients, 19.0 (95% CI = 3.76–34.25) months in patients with heart failure, and 15.0 (95% CI = 0.78–29.22) months in patients with hypertension. Lekoubou, A et al Cameroon 2017 28 Retrospective study Admission and discharge registries, and patient files for the period 1999–2012 1678 243 (14.5%) had recurrent stroke 20.6% deaths occurred among those with recurrent strokes 95% CI (1.43 (1.03–1.99) compared to deaths among first ever strokes.…”

“…The adapted Newcastle–Ottawa Scale (NOS) ratings for three studies ranged from a low of 6 to a high of 8. One study had a sample size of only 100, 27 two studies had between 200 and 300 study participants, 18 , 24 and the rest had more than 500 study participants. 25 , 28 …”

“…Other factors reported as independent factors for stroke recurrence were female sex and non-compliance with therapy after the first stroke, right-handedness, congestive heart disease, gout, facial palsy, dysarthria and 27 dyslipidemia; 25 , 29 however, one study noted no associations with medication adherence to various risk factors. 27 …”

“…Diabetes mellitus was associated with recurrent strokes in two studies, 25 , 28 while three studies reported that diabetes mellitus was not associated with stroke recurrence. 24 , 27 , 29 Though one study noted that casual blood glucose was statistically associated with recurrence. 27 …”

“… 24 , 27 , 29 Though one study noted that casual blood glucose was statistically associated with recurrence. 27 …”