Stroke burden in Benin 2008 to 2018: systematic review of the Literature

International audienc

Long-Term Mortality of Stroke Survivors in Parakou: 5-Year Follow-Up

International audienceThe burden of stroke is high in Africa, but few data are available on the long-term outcome of strokes in this area. Aim: We aimed to study the long-term outcome of stroke survivors in Parakou from 2012 to 2018. Methods of Study: It was a cohort study and included 247 stroke patients admitted to the University Hospital of Parakou from January 1, 2012 to April 30, 2018. Each patient was followed up for at least 1 year. The modified RANKIN scale was used to evaluate patients. Verbal autopsy was used to ascertain the cause of death. The survival probability was estimated using the Kaplan-Meier method. Predictors of mortality were estimated using the Cox proportional model and the hazard ratio (HR) and their 95% confidence intervals were determined. The data were analyzed using Stata Software. Results: The mean age was 58.1 ± 13.4 years with a sex ratio of 1.12. Among stroke survivors, the mortality was 10.1% at 3 months, 11.7% at 6 months, 15.4% at 1 year, 21.5% at 3 years, and 23.5% at 5 years. The probability of survival after a stroke was 66.5% at 5 years. Factors associated with mortality were age with adjusted HR 1.4 (1.2-1.7) for each 10 years, male sex with aHR 2.3 (1.2-4.6), history of hypertension with aHR 2.0 (1.0-4.1) and the severity of the initial neurological impairment National Institute of Health Stroke Scale with aHR 1.1 (1.0-1.2) for each 1 point. The main causes of death were recurrent stroke, infectious diseases, and cardiac disease. The proportion of patients with functional disability was 53.8% at 1 year. The quality of life was generally impaired in terms of physical health, personal environment, and finances. Conclusions: The long-term prognosis of stroke patients in Parakou is poor. It requires urgent action to reduce this burden

Stroke case-fatality in sub-saharan Africa: systematic review and meta-analysis

International audienceBackground: The burden of stroke is high in sub-Saharan Africa; however, few data are available on long-term mortality.Objective: To estimate over one-month stroke case fatality in sub-Saharan Africa.Methods: A systematic review and meta-analysis were performed according to meta-analysis of observational studies in epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42020192439), on five electronic databases (PubMed, Science direct, AJOL, EMBASE, and Web of Sciences).We searched all studies on stroke case fatality over one month in sub-Saharan Africa published between 1st January 2000 and 31st December 2019.Results:We included 91 studies with a total of 34,362 stroke cases. The one-month pooled stroke case-fatality rate was 24.1% [95% CI: 21.5–27.0] and 33.2% [95% CI: 23.6–44.5] at one year. At three and five years, the case-fatality rates were respectively 40.1% [95% CI: 20.8–63.0] and 39.4% [95% CI: 14.3–71.5] with high heterogeneity. Hemorrhagic stroke was associated with a higher risk of mortality at one month, but ischemic stroke increased the risk of mortality over six months. Diabetes was associated with poor prognosis at 6 and 12 months with odds ratios of 1.64 [95% CI: 1.22–2.20] and 1.85 [1.25–2.75], respectively.Conclusion: The stroke case fatality over one month was very high, compared to case fatalities reported in Western countries and can be explained by a weak healthcare systems and vascular risk factors

Stroke care and outcomes in the Department of Neurology in Parakou, Benin: Retrospective cohort study

International audienceIntroduction: Stroke is one of the most common causes of high mortality rates in Africa with many unknownaspects around its prognosis. In this study we aim to describe stroke characteristics and in-hospital mortality ofstroke in Parakou.Methods: This is a retrospective cohort study including all stroke patients admitted to the Department ofNeurology at Parakou Teaching Hospital from January 1, 2013 through to December 31, 2019. Clinical data,vascular risk factors, stroke subtype and outcome data were recorded. The in-hospital case-fatality and itsassociated factors were determined. The study was approved by the Local Ethics Committee of Biomedicalresearch and has been registered under the unique indentifying number researchregistry5687 and is available athttps://www.researchregistry.com/browse-the-registry#home/Results: Stroke cases represented 51.5% of all patients. There were 372 patients included in the study with a meanage of 58.2 � 14.2 years. The sex ratio was 1:3. Ischemic stroke accounted for 40.3%, intracerebral hemorrhage30.4%, and unknown 29.3%. The main vascular risk factors were hypertension (69.1%), alcoholism (23.9%) anddiabetes mellitus (16.9%). The mean NIHSS at admission was 9.4 � 5.7 and the length of hospital stay was 9.0 �7.3. The most common complications recorded during the acute phase were swallowing disorders (10.2%),pneumonia (9.1%) and urinary tract infections (8.3%). The in-hospital case fatality was 6.2% and was associatedwith loss of consciousness (p ¼ 0.0001), high NIHSS on admission (p ¼ 0.001), fever (p ¼ 0.0001), swallowingdisorders (p ¼ 0.001) and leukocytosis (p ¼ 0.021). On discharge, 27.6% were independent and 97.8% were onantihypertensive drugs.Conclusion: The in-hospital stroke mortality was close to that reported by other studies in Africa