Characteristics of adults with first-ever stroke vs. recurrent stroke at the university teaching Hospital in Lusaka, Zambia

Stroke burden is increasing in sub-Saharan Africa. We studied differences in stroke risk factors, hospital characteristics, and outcomes between adults with first-ever and recurrent stroke in Zambia.

We retrospectively collected demographics, clinical presentation, medical history, and in-hospital outcomes and at 90-days post-discharge from adults admitted to the University Teaching Hospital in Lusaka, Zambia between October 2018 - March 2019. We compared descriptive statistics between participants with first-ever and recurrent strokes using t-tests for continuous parametric variables, Wilcoxon rank-sum tests for continuous nonparametric variables, and chi-square or Fisher exact tests for categorical variables.

This stroke cohort (n = 324) consisted of 253 (78 %) patients with first-ever stroke and 71 (22 %) hospitalized with recurrent stroke. Adults with first-ever stroke were younger than individuals with recurrent stroke (58 ± 18 vs 66 ± 14 years, p < 0.001), more likely to present with undiagnosed hypertension (19 % vs. 6 %, p = 0.01), and had higher rates of intracerebral hemorrhage (32 % vs. 15 %, p = 0.03). Adults with recurrent stroke were more likely to have medical comorbidities, including prior diagnosis of hypertension (90 % vs. 77 %, p = 0.02), atrial fibrillation (26 % vs. 6 %, p = 0.01), and had higher rates of aspiration pneumonia (30 % vs. 12 %, p = 0.001). In-hospital mortality did not differ between groups (31 % in recurrent vs. 22 % in first-ever, p = 0.12) but those with recurrent stroke had higher 90-day mortality (59 % vs 36 %, p = 0.001).

Our findings suggest improvements in both primary and secondary prevention strategies and programs are needed. Improved hypertension screening and diagnosis while developing chronic disease management programs are necessary for stroke prevention.