Stroke presentation and outcome in developing countries: a prospective study in the Gambia.

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Prospective data on stroke outcomes in Africa are scarce, despite a growing disease burden.
• The Gambia faces a significant challenge in managing stroke patients, necessitating local data collection.
• Understanding clinical outcomes is vital for developing targeted interventions.

Purpose of the Study:

• To describe the clinical outcomes of stroke patients admitted to a teaching hospital in The Gambia.
• To assess mortality and morbidity rates among stroke survivors.
• To propose evidence-based preventive and therapeutic strategies for stroke management in the region.

Main Methods:

• Prospective data collection from consecutive non-subarachnoid stroke patients (over 15 years) over one year.
• Assessment of risk factors, clinical characteristics, and social consequences using validated scales (mNIHSS, Barthel, Siriraj, Bamford).
• One-year home follow-up for discharged patients to evaluate long-term outcomes.

Main Results:

• Hypertension and smoking were the most common risk factors; high stroke severity at admission predicted poor outcomes.
• In-hospital mortality was 41%, and 1-year mortality reached 62%, significantly higher than Western cohorts.
• Factors like swallowing difficulties, fever, and lack of aspirin treatment independently increased mortality risk.

Conclusions:

• Stroke case-fatality in The Gambia is alarmingly high, underscoring the need for urgent public health interventions.
• Developing adapted treatment protocols and training healthcare providers are essential for improving stroke care.
• Preventive strategies targeting prevalent risk factors are crucial for reducing the stroke burden in Africa.