title: Trends in stroke admission and mortality rates from 1983 to 2013 in central Ghana.
abstract: BACKGROUND
  Accumulating data based on model-derived estimates suggest rising rates of stroke in sub-Saharan Africa over the next several decades. Stroke is a leading cause of death, disability, and dementia worldwide. Directly enumerated hospital-based data on the longitudinal trajectory of stroke admissions and deaths in sub-Saharan Africa could help hospital administrators, public health officials, and government policy-makers with planning and utilization of scarce resources.
  
  
  OBJECTIVE
  To evaluate 30-year trends in stroke admission and mortality rates in central Ghana.
  
  
  METHODS
  We undertook a retrospective analysis of data on stroke admissions and mortality at a tertiary referral hospital in central Ghana between 1983 and 2013. Rates of stroke admissions and mortality were expressed as stroke admissions or deaths divided by total number of hospital admissions or deaths respectively. Yearly crude case fatality from stroke was calculated and predictors of stroke mortality were determined using Cox proportional hazards regression analysis.
  
  
  RESULTS
  Over the period, there were 12,233 stroke admissions with equal gender distribution. The rate of stroke admissions increased progressively from 5.32/1000 admissions in 1983 to 13.85/1000 admissions in 2010 corresponding to a 260% rise over the period. Stroke mortality rates also increased from 3.40/1000 deaths to 6.66/1000 deaths over the 30-year period. The average 28-day mortality over the period was 41.1%. Predictors of in-patient mortality were increasing age-aHR of 1.31 (1.16-1.47) for age>80years compared with <40years and admissions in 2000's compared with 1980's; aHR of 1.32 (1.26-1.39). Of the 1132 stroke patients with neuroimaging data: 569 (50.3%) had intracerebral hemorrhage, 382 (33.7%) had ischemic stroke and 181 (16.0) had sub-arachnoid hemorrhage. Patients with ischemic stroke were significantly older than those with ICH and SAH respectively.
  
  
  CONCLUSIONS
  Rates of stroke admission and mortality have increased steadily over the past three decades in central Ghana. More intensive risk modification and optimization of acute stroke care are urgently needed to stem these worrisome trends.
authors: Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana. Electronic address: stephensarfo78@gmail.com.
authors: Fred S
authors: FS
authors: Sarfo
authors: Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors: John
authors: J
authors: Akassi
authors: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors: Dominic
authors: D
authors: Awuah
authors: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors: Sheila
authors: S
authors: Adamu
authors: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors: Clara
authors: C
authors: Nkyi
authors: University College of Ibadan, Ibadan, Nigeria.
authors: Mayowa
authors: M
authors: Owolabi
authors: Medical University of South Carolina, SC, USA.
authors: Bruce
authors: B
authors: Ovbiagele
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005869:Ghana / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality*
keywords: Admission; Ghana; Mortality; Stroke; Trends