Abstract:

Introduction: Globally stroke is the 2nd leading cause of death with highest mortality in Lowmiddle-income countries particularly in sub-Saharan Africa. Little is known about the 30-day outcomes and predictors among stroke patients admitted at Bugando Medical Centre, Northwest Tanzania.

Objective: We aimed to investigate the predictors of 30-day mortality among stroke patients admitted at a tertiary teaching hospital in Northwestern Tanzania.

Methodology: This cohort study recruited patients with a World Health Organization clinical definition for stroke. Baseline data and post-stroke complications were recorded. Head CT-scan and a 12-lead electrocardiography was performed. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess stroke severity and outcomes respectively. Kaplan-Meier analysis was used to describe survival and Cox-proportional hazards model was used to examine predictors of mortality.

Results: A total of 135 participants were included in the final analysis. The mean age was 64.5 years, and 64.8% had ischemic stroke. More than one third of the participants (37%) died within 30 days and 25% of patients died within 17 days. Among participants with hemorrhagic stroke 25% died within 5 days vs 23 days for ischemic stroke. Participants with hemorrhagic stroke 25% were located in multiple areas within the cortical and sub-cortical regions followed by the thalamus 22.7% and 63.6% had interventricular extension. 62.9% had ischemic strokes in multiple regions. ECG changes were observed in 54.6% and 46.9% of patients with hemorrhagic and ischemic stroke respectively. The most common ECG patterns was ST changes 29.6% vs 30.9%, T wave inversion 34.1% vs 38.3% and U waves 18.2% vs 1.2% in hemorrhagic and ischemic strokes respectively. Independent predictors for 30-day case fatality were: NIHSS score [aHR 1.09; (95% CI: 1.02-1.18)], mRS score (4-5) [aHR 5.50; (95% CI: 2.02- 15.04)], aspiration pneumonia [(aHR: 3.69; (95% CI: 1.71-13.69) and ECG changes [aHR: (2.28; 95% CI: 1.86, 5.86)].

Conclusion: Stroke is associated with a high 30-day mortality in Northwestern Tanzania. Concerted efforts are warranted in the prevention and management of stroke patients with special attention to individuals with severe strokes, ECG changes, and swallowing difficulties in order to reduce early morbidity and mortality.