Stroke presentation and outcome in developing countries: a prospective study in the Gambia.
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.
Garbusinski
Johanne M
JM
Medical Research Council Laboratories, Fajara, Gambia. jgarbusinski@hotmail.com
van der Sande
Marianne A B
MA
Bartholome
Emmanuel J
EJ
Dramaix
Michèle
M
Gaye
Alieu
A
Coleman
Rosalind
R
Nyan
Ousman A
OA
Walker
Richard W
RW
McAdam
Keith P W J
KP
Walraven
Gys E
GE
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