title: The effect of season and temperature variation on hospital admissions for incident stroke events in Maputo, Mozambique.
abstract: BACKGROUND
  Identifying locale-specific patterns regarding the variation in stroke incidence throughout the year and with atmospheric temperature may be useful to the organization of stroke care, especially in low-resource settings.
  
  
  OBJECTIVE
  We aimed to describe the variation in the incidence of stroke hospitalizations across seasons and with short-term temperature variation, in Maputo, Mozambique.
  
  
  METHODS
  Between August 1, 2005, and July 31, 2006, we identified 651 stroke events in Maputo dwellers, according to the World Health Organization's STEPwise approach. The day of symptom onset was defined as the index date. We computed crude and adjusted (humidity, precipitation and temperature) incidence rate ratios (IRRs) and 95% confidence intervals (CIs) with Poisson regression.
  
  
  RESULTS
  Stroke incidence did not vary significantly with season (dry versus wet: crude IRR = .98, 95% CI: .84-1.15), atmospheric temperature at the index date, or average atmospheric temperature in the preceding 2 weeks. The incidence rates of stroke were approximately 30% higher when in the previous 10 days there was a decline in the minimum temperature greater than or equal to 3 °C between any 2 consecutive days (variation in minimum temperature -5.1 to -3.0 versus -2.3 to -.4, adjusted IRR = 1.31, 95% CI: 1.09-1.57). No significant associations were observed according to the variation in maximum temperatures.
  
  
  CONCLUSIONS
  Sudden declines in the minimum temperatures were associated with a higher incidence of stroke hospitalizations in Maputo. This provides important information for prediction of periods of higher hospital affluence because of stroke and to understand the mechanisms underlying the triggering of a stroke event.
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health-University of Porto, Porto, Portugal. Electronic address: joanacostabgomes@hotmail.com.
authors.forename: Joana
authors.initials: J
authors.lastname: Gomes
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Albertino
authors.initials: A
authors.lastname: Damasceno
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Carla
authors.initials: C
authors.lastname: Carrilho
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Vitória
authors.initials: V
authors.lastname: Lobo
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Hélder
authors.initials: H
authors.lastname: Lopes
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Tavares
authors.initials: T
authors.lastname: Madede
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Pius
authors.initials: P
authors.lastname: Pravinrai
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Carla
authors.initials: C
authors.lastname: Silva-Matos
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Domingos
authors.initials: D
authors.lastname: Diogo
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health-University of Porto, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health-University of Porto, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
mesh_terms: D006801:Humans; D006813:Humidity; D015994:Incidence; D009073:Mozambique / Q000453:epidemiology; D010343:Patient Admission; D011891:Rain; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013696:Temperature; D013997:Time Factors
keywords: Mozambique; Stroke; seasons; temperature