Abstract
ObjectivesThe burden of stroke on healthcare services in sub‐Saharan Africa (SSA) is increasing. However, long‐term outcomes from stroke in SSA are not well described. We aimed to investigate case‐fatality and health outcomes for stroke survivors at 7‐ to 10‐year follow‐up.Materials and methodsThe Tanzanian Stroke Incidence Project (TSIP) recruited incidence stroke cases between 2003 and 2006. We followed up cases in 2013, recording date of death in those who had died.ResultsOf 130 stroke cases included in this study, case‐fatality and date of death data were available for 124 at 7–10 years post‐stroke. Of these, 102 (82.3%) had died by 7 years post‐stroke. Functional disability, as measured by the Barthel index immediately post‐stroke, was a significant predictor of case‐fatality at seven‐year follow‐up with those with severe disability having an almost four‐fold increase in the odds of death compared with those with no, mild or moderate disability.ConclusionsCase‐fatality rates are higher than reported in high‐income countries, with post‐stroke disability a significant predictor of death. Sustainable interventions to reduce post‐stroke disability in this setting should be investigated.
Highlights
The burden of stroke in sub-Saharan Africa (SSA) appears to be increasing, and post-stroke disability rates in some areas are as high as in high-income countries [1, 2]
We have previously reported 28-day (23.8%) and 3-year (60.0%) case-fatality rates for 130 cases recruited to the Tanzanian Stroke Incidence Project (TSIP) between 2003 and 2006 [12]
Case-fatality rates in yearly intervals from 3 to 7 years post-stroke are presented in Table 1, and a Kaplan–Meier survival curve is presented in Fig. 1, with cases split into those aged 65 and over (n = 84), and those aged less than 65 (n = 40), at the time of the incident stroke
Summary
The burden of stroke in sub-Saharan Africa (SSA) appears to be increasing, and post-stroke disability rates in some areas are as high as in high-income countries [1, 2]. The reasons for this are likely to be multifactorial, demographic ageing and a reducing burden of communicable diseases, such as malaria, tuberculosis and HIV/AIDS, may be key factors. Post-stroke outcomes vary widely between, and within, world regions depending on a range of factors including demographic profile, stroke type and severity and immediate and long-term poststroke care [3,4,5,6]. Long-term post-stroke outcomes in SSA are poorly described, with most studies being hospital-based. As the majority of stroke cases may not attend hospital, such data cannot be relied upon to give an accurate picture of the epidemiology of stroke in SSA [7].
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