Accumulating data based on model-derived estimates suggest rising rates of stroke in sub-Saharan Africa over the next several decades. Stroke is a leading cause of death, disability, and dementia worldwide. Directly enumerated hospital-based data on the longitudinal trajectory of stroke admissions and deaths in sub-Saharan Africa could help hospital administrators, public health officials, and government policy-makers with planning and utilization of scarce resources.
To evaluate 30-year trends in stroke admission and mortality rates in central Ghana.
We undertook a retrospective analysis of data on stroke admissions and mortality at a tertiary referral hospital in central Ghana between 1983 and 2013. Rates of stroke admissions and mortality were expressed as stroke admissions or deaths divided by total number of hospital admissions or deaths respectively. Yearly crude case fatality from stroke was calculated and predictors of stroke mortality were determined using Cox proportional hazards regression analysis.
Over the period, there were 12,233 stroke admissions with equal gender distribution. The rate of stroke admissions increased progressively from 5.32/1000 admissions in 1983 to 13.85/1000 admissions in 2010 corresponding to a 260% rise over the period. Stroke mortality rates also increased from 3.40/1000 deaths to 6.66/1000 deaths over the 30-year period. The average 28-day mortality over the period was 41.1%. Predictors of in-patient mortality were increasing age-aHR of 1.31 (1.16–1.47) for age > 80 years compared with <40 years and admissions in 2000's compared with 1980's; aHR of 1.32 (1.26–1.39). Of the 1132 stroke patients with neuroimaging data: 569 (50.3%) had intracerebral hemorrhage, 382 (33.7%) had ischemic stroke and 181 (16.0) had sub-arachnoid hemorrhage. Patients with ischemic stroke were significantly older than those with ICH and SAH respectively.
Rates of stroke admission and mortality have increased steadily over the past three decades in central Ghana. More intensive risk modification and optimization of acute stroke care are urgently needed to stem these worrisome trends.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the Neurological Sciences
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.Lancet Neurol. 2009 April; 8: 355-369
- Stroke epidemiology in the developing world.Lancet. 2005; 365: 2160-2161
- Profile of neurological admissions at the University of Nigeria Teaching Hospital Enugu.Niger. J. Med. 2010; 19: 419-422
- Psychometric properties of the HRQOLISP-40: a novel, shortened multiculturally valid holistic stroke measure.Neurorehabil. Neural Repair. 2010 November; 24: 814-825
- Profile of health-related quality of life in Nigerian stroke survivors.Eur. J. Neurol. 2009 January; 16: 54-62
- Stroke lesions and post-stroke depression among survivors in Ibadan, Nigeria.Afr. J. Med. Sci. 2013; 42: 245-251
- Profile of stroke-related late onset epilepsy among Nigerians.J. Med. Trop. 2013; 15: 29-32
- Consistent determinants of post-stroke health-related quality of life across diverse cultures: Berlin-Ibadan study.Acta Neurol. Scand. 2013; 128: 311-320
- Understanding the rise in cardiovascular diseases in Africa: harmonizing H3Africa genomic epidemiological teams and tools.Cardiovasc. J. Afr. 2014; 25: 134-136
- Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010.Lancet. 2014; 383: 245-254
- The epidemiology of cardiovascular diseases in sub-Saharans Africa: the Global Burden of Diseases, Injuries and Risk Factors 2010 Study.Prog. Cardiovasc. Dis. 2013; 56: 234-239
- The global burden of hemorrhagic stroke — a summary of findings from the Global burden of diseases, injuries and risk factors 2010 study.Glob. Heart. 2014; 9: 101-106
- National sex-specific trends in hospital-based stroke rates.J. Stroke Cerebrovasc. Dis. 2011; 20: 537-540
- Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010.Stroke. 2013; 44: 2388-2393
- Trends and survival between ethnic groups after stroke: the South London stroke register.Stroke. 2013; 44: 380-387
- Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community: the Hisayama study.Stroke. 2003; 34: 2349-2354
- Mortality from cardiovascular diseases in sub-Saharan Africa, 1990–2013: a systematic analysis of data from the Global Burden of Disease Study 2013.Cardiovasc. J. Afr. 2015; 26: S6-S10
- Cerebrovascular Disorders (Offset Publications).9241700432 World Health Organisation, Geneva1978
- The burden of stroke in sub-Saharan Africa.Am. J. Prev. Med. 2007; 33: 172-173
- An estimate of the incidence and prevalence of stroke in Africa: a systematic review and meta-analysis.PLoS One. 2014; 9: e100724
- Global and regional burden of first-ever ischemic and hemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010.Lancet Glob. Health. 2013; 1: e259-e281
- The burden of stroke in Africa: a glance at the present and a glimpse into the future.Cardiovasc. J. Afr. 2015; 26: S27-S38
- Prevalence and pattern of hypertension in a semiurban community in Nigeria.Eur. J. Cardiovasc. Prev. Rehabil. 2008; 15: 683-687
- Barriers to optimal hypertension control.J. Clin. Hypertens. (Greenwich). 2008; 10: 644-646
- Stroke prevention, treatment, and rehabilitation in sub-Saharan Africa.Am. J. Prev. Med. 2005; 29: 95-101
- Which risk factors are more associated with ischemic rather than hemorrhagic stroke in black Africans?.Clin. Neurol. Neurosurg. 2013; 115: 2069-2074
- Incidence of stroke in an African City: results from the Stroke Registry at Ibadan, Nigeria, 1973-1975.Stroke. 1979; 10: 205-207
- Stroke in the Africans.Afr. J. Med. Sci. 1977; 6: 39-53
- Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.Lancet. 2010 July 10; 376: 112-123
- Stroke incidence in rural and urban Tanzania: a prospective, community-based study.Lancet Neurol. 2010; 9: 786-792
- Post-stroke case fatality within an incident population in rural Tanzania.J. Neurol. Neurosurg. Psychiatry. 2011; 82: 1001-1005
- Ischaemic and haemorrhagic strokes in Dakar, Senegal. A hospital-based study.Stroke. 2005; 36: 1844-1847
- Mortality and recovery after stroke in the Gambia.Stroke. 2003; 34: 1604-1609
- Stroke in South West Nigeria: a 10-year review.Stroke. 2005; 36: 1120-1122
- Accuracy of the Siriraj stroke score in differentiating cerebral haemorrhage and infarction in African Nigerians.Afr. J. Neurol. Sci. 2001; 20: 21-26
- Acute stroke mortality at Lagos University Teaching Hospital.Nig. Q. J. Hosp. Med. 2000; 10: 8-10
- Thirty days case fatality of stroke at LUTH.Nig. Q. J. Hosp. Med. 2004; 14: 64-66
- The profile of risk factors and in-patient outcomes of stroke in Kumasi, Ghana.Ghana Med. J. 2014; 48: 127-134
- Case fatality of patients with stroke over a 12-month period post stroke.S. Afr. Med. J. 2012; 102: 765-767
- Health care systems in low- and middle-income countries.N. Engl. J. Med. 2014; 370: 552-557
Published online: August 03, 2015
Accepted: July 29, 2015
Received: July 27, 2015
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.