Abstract
Background
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.
Objective
To evaluate 30-year trends in stroke admission and mortality rates in central Ghana.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 03, 2015
Accepted:
July 29,
2015
Received:
July 27,
2015
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
