Risk factors and outcomes of hospitalized stroke patients in Lusaka, Zambia

• Published in: Journal of the neurological sciences Vol. 424; p. 117404
• Main Authors: Nutakki, Aparna, Chomba, Mashina, Chishimba, Lorraine, Zimba, Stanley, Gottesman, Rebecca F., Bahouth, Mona N., Saylor, Deanna
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.05.2021
• Subjects: Adult; Aged; Epidemiology; Female; HIV; Hospital Mortality; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Stroke; Stroke - diagnostic imaging; Stroke - epidemiology; Sub-Saharan Africa; Zambia; Zambia - epidemiology; Zambia; Stroke; Zambia; HIV; Epidemiology; Sub-Saharan Africa; Risk factors
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2021.117404

Limited data exists about stroke risk factors and outcomes in sub-Saharan African countries, including Zambia. We aim to fill this gap by describing features of hospitalized stroke patients at University Teaching Hospital (UTH), the national referral hospital in Lusaka, Zambia. We conducted a retrospective study of consecutive adults with stroke admitted to UTH's inpatient neurology service from October 2018 to March 2019. Strokes were classified as ischemic or hemorrhagic based on CT scan results and unknown if CT scan was not obtained. Chi-square analyses and t-tests were used to compare characteristics between cohorts with differing stroke subtypes. Adults with stroke constituted 43% (n = 324) of all neurological admissions, had an average age of 60 ± 18 years, and 62% of the cohort was female. Stroke subtypes were 58% ischemic, 28% hemorrhagic, and 14% unknown. Hypertension was present in 80% of all strokes and was significantly associated with hemorrhagic stroke (p = 0.03). HIV was present in 18% of all strokes and did not significantly differ by stroke subtype. Diabetes (16%), heart disease (34%), atrial fibrillation (9%), and past medical history of stroke (22%) were all significantly more common in patients with ischemic stroke (p < 0.05). In-hospital mortality was 24% overall and highest among individuals with hemorrhagic strokes (33%, p = 0.005). This Zambian stroke cohort is notable for its young age, significant HIV burden, high in-hospital mortality, and high rates of uncontrolled hypertension. Our results demonstrate Zambia's substantial stroke burden, significant contribution of HIV to stroke, and the need to improve primary stroke prevention. •This Zambian stroke cohort was younger than most stroke cohorts in high-income countries.•Hypertension was the most common risk factor for ischemic and hemorrhagic strokes but was most common in hemorrhagic strokes.•HIV was the fourth most common stroke risk factor in this Zambian stroke cohort.•Post-stroke aspiration pneumonia substantially contributed to high in-hospital mortality.