title: Stroke presentation and outcome in developing countries: a prospective study in the Gambia.
abstract: OBJECTIVE
  Despite increasing burden of stroke in Africa, prospective descriptive data are rare. Our objective was to describe, in The Gambia, the clinical outcome of stroke patients admitted to the Royal Victoria Teaching Hospital in the capital Banjul, to assess mortality and morbidity, and propose preventive and therapeutic measures.
  
  
  METHODS
  Prospective data were collected on consecutive patients older than 15 years old admitted between February 2000 and February 2001 with the diagnosis of nonsubarachnoid stroke. Risk factors, clinical characteristics, and social consequences were assessed using a modified National Institutes of Health Stroke Scale (mNIHSS), the Barthel Activity in Daily Living scale, the Siriraj score for subtypes, and the Bamford criteria for location/extension. Patients were followed-up at home up to 1 year after discharge.
  
  
  RESULTS
  Ninety-one percent (148/162) of eligible patients were enrolled and followed-up. Hypertension and smoking were the most prevalent risk factors. Severity was high at admission, especially in women, and was strongly correlated to the outcome. mNIHSS and consciousness level on admission were strong predictors of the mortality risk. Swallowing difficulties at admission, fever, lung infection, and no aspirin treatment were, independently, risk factors for a lethal outcome susceptible to being addressed by treatment. Mortality was 41% in-hospital and 62% after 1 year. In survivors, autonomy levels improved over time. Drug compliance was poor. At home, family members provided care. Long-term socioeconomic and cultural activities were affected in most patients.
  
  
  CONCLUSIONS
  Case-fatality was high compared with Western cohorts. Preventive measures can be developed. Rational treatment, in the absence of head imaging for initial assessment, requires adapted protocols. Providers should be trained, both at hospital and community levels.
authors.affiliation: Medical Research Council Laboratories, Fajara, Gambia. jgarbusinski@hotmail.com
authors.forename: Johanne M
authors.initials: JM
authors.lastname: Garbusinski
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Emmanuel J
authors.initials: EJ
authors.lastname: Bartholome
authors.forename: Michèle
authors.initials: M
authors.lastname: Dramaix
authors.forename: Alieu
authors.initials: A
authors.lastname: Gaye
authors.forename: Rosalind
authors.initials: R
authors.lastname: Coleman
authors.forename: Ousman A
authors.initials: OA
authors.lastname: Nyan
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
authors.forename: Keith P W J
authors.initials: KP
authors.lastname: McAdam
authors.forename: Gys E
authors.initials: GE
authors.lastname: Walraven
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction; D015331:Cohort Studies; D003153:Community Health Services; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome