Case-fatality and disability in the Tanzanian Stroke Incidence Project cohort.
OBJECTIVE
The burden of stroke on healthcare services in sub-Saharan Africa (SSA) is increasing. However, long-term outcomes from stroke in SSA are not well described. We aimed to investigate case-fatality and health outcomes for stroke survivors at 7- to 10-year follow-up.


METHODS
The Tanzanian Stroke Incidence Project (TSIP) recruited incidence stroke cases between 2003 and 2006. We followed up cases in 2013, recording date of death in those who had died.


RESULTS
Of 130 stroke cases included in this study, case-fatality and date of death data were available for 124 at 7-10 years post-stroke. Of these, 102 (82.3%) had died by 7 years post-stroke. Functional disability, as measured by the Barthel index immediately post-stroke, was a significant predictor of case-fatality at seven-year follow-up with those with severe disability having an almost four-fold increase in the odds of death compared with those with no, mild or moderate disability.


CONCLUSIONS
Case-fatality rates are higher than reported in high-income countries, with post-stroke disability a significant predictor of death. Sustainable interventions to reduce post-stroke disability in this setting should be investigated.
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.|Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK.
R W
RW
Walker
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.
K
K
Wakefield
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.
W K
WK
Gray
Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
A
A
Jusabani
Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
M
M
Swai
Department of Medicine, Muhimbili University College Hospital, Dar-es-Salaam, Tanzania.
F
F
Mugusi
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D013636:Tanzania / Q000453:epidemiology
Tanzania; case-fatality; disability; mortality; stroke; sub-Saharan Africa