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A prospective stroke register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes

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Daniel Youkee, Gibrilla Deen, Edward Barrett, Julia Fox-Rushby, Israel Johnson, Peter Langhorne, Andrew Leather, Iain Marshall, Jessica O'Hara, Anthony Rudd, Albert Sama, Christella O.S. Scott, Melvina Thompson, Hatem Wafa, Jurate Wall, Yanzhong Wang, Caroline L. Watkins, Charles Wolfe, Durodami Radcliffe Lisk, Catherine Sackley

Original languageEnglish
Article number712060
Number of pages1
JournalFrontiers in Neurology
Volume12
DOIs
Accepted/In press9 Jul 2021
Published7 Sep 2021

Bibliographical note

Funding Information: This research was funded by the National Institute for Health Research (NIHR) (GHR: 17:63:66) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care. CWo, JF-R, and YW received funding from the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom, and the NIHR Applied Research Collaboration (ARC) South London, London, United Kingdom. Publisher Copyright: © Copyright © 2021 Youkee, Deen, Barrett, Fox-Rushby, Johnson, Langhorne, Leather, Marshall, O'Hara, Rudd, Sama, Scott, Thompson, Wafa, Wall, Wang, Watkins, Wolfe, Lisk and Sackley.

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Abstract

Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone. Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals. Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9–25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12–26) vs. 13 (IQR 7–22) (p < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) (p < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% (p = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6–73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0–7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65–6.75), pneumonia (OR 3.75, 1.82–7.76), subarachnoid haemorrhage (OR 43.1, 6.70–277.4) and undetermined stroke types (OR 6.35, 2.17–18.60) were associated with higher risk of in-hospital death. Discussion: We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.

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