title: Stroke admission and case-fatality in an urban medical unit in sub-Saharan Africa: a fourteen year trend study from 1999 to 2012.
abstract: BACKGROUND
  Data on recent stroke trends in the context of rapidly deteriorating risk profile of populations within Africa is very limited. We investigated the admission trend for stroke and related outcomes in a major referral hospital in Cameroon.
  
  
  METHODS
  Admission and discharge registries, and patient files for the period 1999-2012 of the medical department of the Yaoundé Central Hospital were reviewed for evidence of admission for stroke, and outcomes during hospitalization. Trajectories of case-fatality and risk factors over time were assessed, with adjustment for confounders using logistic regression models.
  
  
  RESULTS
  Of the 28,239 medical admissions registered during the study period, 1688 (6.0%) were due to stroke. This proportion ranged from 2.5% in 1999-2000 to 13.1% in 2011-2012 overall and similarly in men and women. Mean age, alcohol consumption and history of stroke varied across years (all p ≤ 0.006). Computed tomography confirmed that stroke increased from 34.4% in 1999-2000 to 84.2% in 2011-2012, while the length of stay decreased from 21 to 10 days (both p<0.0001 for linear trend). Case-fatality rate increased from 14.4% to 22.4%. The adjusted odd ratio (95% CI) 2011-2012 vs. 1999-2000 was 2.93 (1.40-6.13), p<0.0001 for the linear trend across years. The unadjusted relative risk of death from stroke patients vs. general admissions was 0.95 (0.87-1.05) overall, 0.82 (0.71-0.94) in men and 1.08 (0.95-1.23) in women.
  
  
  CONCLUSIONS
  During the last decade and a half, stroke admissions and case-fatality have increased in the study setting, reflecting in part the inadequate coping capacity of the health care system.
authors: Medical University of SC, Department of Neurology, Charleston, USA.
authors: Alain
authors: A
authors: Lekoubou
authors: Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, Yaoundé, Cameroon.
authors: Clovis
authors: C
authors: Nkoke
authors: Department of Internal Medicine, Douala General Hospital, Douala, Cameroon; Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors: Anastase
authors: A
authors: Dzudie
authors: Department of Medicine, University of Cape Town, Cape Town, South Africa; South African Medical Research Council of South Africa, Cape Town, South Africa. Electronic address: andre.kengne@mrc.ac.za.
authors: Andre Pascal
authors: AP
authors: Kengne
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends*; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D019037:Urban Health Services / Q000639:trends*
keywords: Cameroon; Case-fatality; Risk factors; Stroke; Sub-Saharan Africa; Trends