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Post-stroke case fatality within an incident population in rural Tanzania
  1. Richard W Walker1,2,
  2. Ahmed Jusabani3,
  3. Eric Aris4,
  4. William K Gray1,
  5. David Whiting5,
  6. Gregory Kabadi6,
  7. Ferdinand Mugusi4,
  8. Mark Swai3,
  9. George Alberti7,
  10. Nigel Unwin2,8
  1. 1North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK
  2. 2Institute of Health and Society, University of Newcastle-upon-Tyne, UK
  3. 3Kilimanjaro Christian Medical Centre, Moshi, Tanzania
  4. 4Department of Neurology, Muhimbili University Hospital, Dar-es-Salaam, Tanzania
  5. 5International Diabetes Federation, Brussels, Belgium
  6. 6Ifakara Health Institute, Dar-es-Salaam, Tanzania
  7. 7Department of Endocrinology and Metabolism, St Mary's Hospital Campus, Imperial College, London, UK
  8. 8Faculty of Medical Sciences, Cave Hill Campus, University of the West Indies, Barbados
  1. Correspondence to Professor R W Walker, Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK; richard.walker{at}nhct.nhs.uk

Abstract

Background and purpose To establish post-stroke case fatality rates within a community based incident stroke population in rural Tanzania.

Methods Incident stroke cases were identified by the Tanzanian Stroke Incidence Project and followed-up over the next 3–6 years. In order to provide a more complete picture, verbal autopsy (VA) was also used to identify all stroke deaths occurring within the same community and time period, and a date of stroke was identified by interview with a relative or friend.

Results Over 3 years, the Tanzanian Stroke Incidence Project identified 130 cases of incident stroke, of which 31 (23.8%, 95% CI 16.5 to 31.2) died within 28 days and 78 (60.0%, 95% CI 51.6 to 68.4) within 3 years of incident stroke. Over the same time period, an additional 223 deaths from stroke were identified by VA; 64 (28.7%, 95% CI 20.9 to 36.5) had died within 28 days of stroke and 188 (84.3%, 95% CI 78.1 to 90.6) within 3 years.

Conclusions This is the first published study of post-stroke mortality in sub-Saharan Africa from an incident stroke population. The 28 day case fatality rate is at the lower end of rates reported for other low and middle income countries, even when including those identified by VA, although CIs were wide. Three year case fatality rates are notably higher than seen in most developed world studies. Improving post-stroke care may help to reduce stroke case fatality in sub-Saharan Africa.

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Footnotes

  • Funding This work was funded by a grant from the Wellcome Trust (grant No 066939).

  • Competing interests None.

  • Ethics approval A favourable ethical opinion was obtained from the National Institute of Medical Research in Tanzania and from the Newcastle and Northumberland Joint Ethics Committee, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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