Stroke admission and case-fatality in an urban medical unit in sub-Saharan Africa: a fourteen year trend study from 1999 to 2012

Background: Data on recent stroke trends in the context of rapidly deteriorating risk profile of populations within Africa is very limited. We investigated the admission trend for stroke and related outcomes in a major referral hospital in Cameroon.

Methods: Admission and discharge registries, and patient files for the period 1999-2012 of the medical department of the Yaoundé Central Hospital were reviewed for evidence of admission for stroke, and outcomes during hospitalization. Trajectories of case-fatality and risk factors over time were assessed, with adjustment for confounders using logistic regression models.

Results: Of the 28,239 medical admissions registered during the study period, 1688 (6.0%) were due to stroke. This proportion ranged from 2.5% in 1999-2000 to 13.1% in 2011-2012 overall and similarly in men and women. Mean age, alcohol consumption and history of stroke varied across years (all p ≤ 0.006). Computed tomography confirmed that stroke increased from 34.4% in 1999-2000 to 84.2% in 2011-2012, while the length of stay decreased from 21 to 10 days (both p<0.0001 for linear trend). Case-fatality rate increased from 14.4% to 22.4%. The adjusted odd ratio (95% CI) 2011-2012 vs. 1999-2000 was 2.93 (1.40-6.13), p<0.0001 for the linear trend across years. The unadjusted relative risk of death from stroke patients vs. general admissions was 0.95 (0.87-1.05) overall, 0.82 (0.71-0.94) in men and 1.08 (0.95-1.23) in women.

Conclusion: During the last decade and a half, stroke admissions and case-fatality have increased in the study setting, reflecting in part the inadequate coping capacity of the health care system.