Nature and outcome of strokes in adult Zambian patients admitted at the University Teaching Hospital, Lusaka, Zambia

Abstract

Introduction:Stroke is an important cause of morbidity and mortality at UTH. It is important to know the nature of stroke and the clinical outcome of different types of strokes in our setting.This study was designed to determine the frequency and types of strokes in patients admitted at UTH and to describe the demographic characteristics of ischemic and hemorrhagic strokes. We also wanted to compare the clinical outcomes of ischemic versus hemorrhagic strokes.Methodology:This research was a hospital based cohort study of adult Zambian strokes patients who were admitted at the University Teaching Hospital in Lusaka, Zambia from July to December 2010. Participants were assessed for cardiovascular and other risk factors, and general and neurologic examinations were performed. National institute of health stroke scale (NIHSS), modified Rankin scale (mRS), Glasgow outcome scale (GOS), Glasgow coma scale (GCS) were recorded. All information was entered to a Microsoft Office Access 2007 form. Analysis was performed on all selected variables using Epi Info 2005 version 3.3.2 software. We assessed characteristics, risk factors and investigations by stroke type using a Chi square test or Fisher exact test for categorical variables and student t test and ANOVAs for continuous variables. Stepwise logistic regression analysis was performed for risk factors. We considered a level of p < 0.05 as statistically significant.Results:250 patients with brain imaging confirmed strokes were assessed. Ischemic strokes represented 65% of all strokes as compared to hemorrhagic strokes found in 35%. Strokes occurred in relatively young patients with mean age of 55 ± 18years at onset of stroke with no sex difference. Hypertension was the main risk factor for ischemic and hemorrhagic strokes, it was found in 71% of participants. Other risk factors were current alcohol intake (32.6%), previous strokes (23.6%), family history of strokes (23.2%), HIV infection (25.7%), hypercholesterolemia (14%), tobacco smoking/sniffing (13.4%), atrial fibrillation (10.8%) and dilated Cardiomyopathy (9.6%). In regression analysis hypertension was independently associated with hemorrhagic strokes while atrial fibrillation and HIV infection were more common in patients with ischemic strokes. In-hospital Stroke mortality was 40%. 33% of ischemic strokes patients died compared to 53% for hemorrhagic strokes (p=0.0008). Factors associated with increased mortality were female sex, GCS≤8, pneumonia, NIHSS≥14 and hemorrhagic type of stroke. HIV infection was not associated with increased stroke mortality.Conclusion:Stroke is an important cause of admission and death at UTH. 65% of strokes are ischemic and 35% are hemorrhagic. Strokes occur in relatively young patients compared to western cohorts. It is associated with high in-hospital mortality (40%). Factors associated with stroke in-hospital mortality at UTH were female sex, GCS≤8, NIHSS≥14 and pneumonia.