The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study

Abstract

Background. Despite stroke being a leading cause of morbidity and mortality globally, there is a dearth of information on the burden and outcomes of stroke in sub-Saharan Africa and Namibia in particular. Methods. A hospital-based, retrospective cohort study was conducted to analyse non-electronic medical records of all consecutive stroke patients who were admitted to one of the highest tertiary-level hospitals in Namibia for 12 months (2019-2020). The primary outcome of the study was to establish the in-hospital mortality, stroke subtypes, and associated complications. Results. In total, 220 patients were included in the study, their mean age was 53 (SD13.8) years, and 55.5% were males. 61.0% had an ischaemic stroke (IS), and 39.0% had a haemorrhagic stroke (HS). The mean age was significantly lower in patients with HS vs. IS ( 48.2 ± 12.2 vs. 56.1 ± 13.3 , p < 0.001 ). Of the IS patients, the majority (29.0%) had total anterior circulation infarct (TACI), while in the HS group, 34.0% had basal ganglia haemorrhage with or without intraventricular extension. Hypertension ( p = 0.015 ), dyslipidaemia ( p = 0.001 ), alcohol consumption ( p = 0.022 ), and other cardiovascular diseases ( p = 0.007 ) were more prevalent in patients with IS compared to those with HS. The prevalence rate of intravenous thrombolysis was 2.2% in IS and use of intravenous antihypertensives in 25.9% of patients with HS than IS. The in-hospital mortality was 26.4% with complications such as raised ICP, aspiration pneumonia, hydrocephalus, and sepsis significantly high in those that died. Aspiration pneumonia (OR 2.79, 95% CI 1.63-4.76, p < 0.001 ) and increased ICP (OR 0.30, 95% CI 0.16-057, p < 0.001 ) were independent predictors of in-hospital mortality on the multivariate analysis. Conclusion. Our findings showed a younger mean age for stroke and mortality rate comparable to other low- to middle-income countries (LMICs). Hypertension and alcohol consumption were the main risk factors for both stroke subtypes, while aspiration pneumonia and raised intracranial pressure predicted in-hospital mortality.

Inpatient Burden of Neurological Disorders: A Route Map for Allocation of Resources and Postgraduate Training

“…The proportion of stroke sub-types according to TOAST classification was comparable to two other large studies from India though we had a slightly larger number of small vessel diseases [2,3]. A similar distribution was seen in a study conducted at a tertiary care center in Namibia where 60.9% of the total stroke admissions had ischemic strokes and 39.1% had hemorrhagic strokes while also reporting a higher prevalence of alcohol consumption as a risk factor [4].…”

30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan–Africa: A systematic review and meta-analysis

“…A total of ten (10) significant risk factors were identified. These were low Glasgow Coma Score <8 [24,28,34,35,48,50,58,61,63,73,95,96,100,105], high (�10) National Institute Health Stroke Scale score [40,57,58,60,78,82,87,92,114], aspiration pneumonia [27,63,73,82,87,88,90,95,100,114], hemorrhagic stroke [29,40,92,95,105], brain edema/ intra-cranial pressure [28,34,88,114], hyperglycemia [35,40,50], untyped stroke (stroke diagnosis not confirmed by neuroimaging) [28,34,95], recurrent stroke [29,…”