Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-06-01 Epub Date: 2023-12-16 DOI:10.1177/17474930231219584
Sarah Shali Matuja, Joshua Ngimbwa, Lilian Andrew, Jemima Shindika, Goodluck Nchasi, Anna Kasala, Innocent Kitandu Paul, Mary Ndalahwa, Akili Mawazo, Fredrick Kalokola, Patrick Ngoya, Ladius Rudovick, Semvua Kilonzo, Bahati Wajanga, Fabian Massaga, Samuel E Kalluvya, Patricia Munseri, Mohamed A Mnacho, Kigocha Okeng'o, Henrika Kimambo, Mohamed Manji, Paschal Ruggajo, Tumaini Nagu, Rashid Ali Ahmed, Faheem Sheriff, Karim Mahawish, Halinder Mangat, Mai N Nguyen-Huynh, Deanna Saylor, Robert Peck
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Abstract

Background: Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania.

Methods: We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression.

Results: The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47-2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22-1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52-2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03-1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02-1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02-1.37, p = 0.027).

Conclusion: We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.

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坦桑尼亚城市中风特征和结果:来自前瞻性湖区中风登记的数据。
背景:中风是全球第二大死亡原因,估计每四个成年人中就有一个在其一生中遭受中风。我们的目的是描述坦桑尼亚西北部城市成人脑卒中的临床特征、护理质量和结果。方法:我们分析了2020年3月至2022年10月期间来自坦桑尼亚第二大城市姆万扎的Bugando医疗中心的前瞻性卒中登记处的去识别数据。该登记包括所有≥18岁且符合世界卫生组织卒中临床定义的入住我院的成年人。收集的信息包括:人口统计学、危险因素、卒中严重程度(采用美国国立卫生研究院卒中量表)、脑成像、护理质量指标、出院修正兰金量表和住院死亡率。我们使用逻辑回归检查了与死亡率相关的独立因素。结果:纳入成人566例,其中52%(294例)为女性,平均年龄65±15岁。大多数人第一次中风88%(498)。有86%(488人)存在病前高血压,但只有41%(200人)在入院前服用降压药;6%(32人)有HIV感染。缺血性中风占66%(371例),但只有6%(22例)在症状出现后4.5小时内发生。住院死亡率为29%(127)。与死亡率相关的独立因素有:严重卒中(aOR为1.81,95% CI为1.47 - 2.24)。结论:我们报告了坦桑尼亚西北部城市中住院预后较差的卒中队列。早期诊断和治疗高血压可预防该地区的脑卒中。需要做更多的工作来提高人们对中风症状的认识,并确保中风患者接受指南指导的治疗。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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