TY - JOUR

T1 - Incidence and characteristics of stroke in Zanzibar-a hospital-based prospective study in a low-income island population

AU - Jorgensen, Jutta M. Adelin

AU - Christensen, Dirk Lund

AU - Nielsen, Karoline Kragelund

AU - Sadiq, Halima Saleh

AU - Khan, Muhammad Yusuf

AU - Jusabani, Ahmed M.

AU - Walker, Richard

PY - 2022

Y1 - 2022

N2 - Background: Stroke in adults is a critical clinical condition and a leading cause of death and disability globally. Epidemiological data on stroke in sub-Saharan Africa are limited. This study describes incidence rates, stroke types and antecedent factors among patients hospitalized with stroke in Zanzibar. Methods: This was a prospective, observational study of stroke patients at hospitals in Unguja, Zanzibar. Socioeconomic and demographic data were recorded alongside relevant past medical history, medicine use and risk factors. The modified National Institute of Health Stroke Scale (mNIHSS) was used to assess admission stroke severity and, when possible, stroke was confirmed by neuroimaging. Results: A total of 869 stroke admissions were observed from 1(st) October 2019 through 30(th) September 2020. Age-standardized to the World Health Organization global population, the yearly incidence was 286.8 per 100,000 adult population (95%CI: 272.4-301.9). Among these patients, 720 (82.9%) gave consent to participate in the study. Median age of participants was 62 years (53-70), 377 (52.2%) were women, and 463 (64.3%) had a first-ever stroke. Known stroke risk factors included hypertension in 503 (72.3%) patients, of whom 279 (55.5%) reported regularly using antihypertensive medication, of whom 161 (57.7%) had used this medication within the last week before stroke onset. A total of 460 (63.9%) participants had neuroimaging performed; among these there was evidence of intracerebral hemorrhage (ICH) in 140 (30.4%). Median stroke severity score using mNIHSS was 19 (10-27). Conclusion: Zanzibar has high incidence of hospitalization for stroke, indicating a very high population incidence of stroke. The proportion of strokes due to ICH is substantially higher than in high-income countries. Most stroke patients had been in contact with health care providers prior to stroke onset and been diagnosed with hypertension. However, few were using antihypertensive medication at the time of stroke onset.

AB - Background: Stroke in adults is a critical clinical condition and a leading cause of death and disability globally. Epidemiological data on stroke in sub-Saharan Africa are limited. This study describes incidence rates, stroke types and antecedent factors among patients hospitalized with stroke in Zanzibar. Methods: This was a prospective, observational study of stroke patients at hospitals in Unguja, Zanzibar. Socioeconomic and demographic data were recorded alongside relevant past medical history, medicine use and risk factors. The modified National Institute of Health Stroke Scale (mNIHSS) was used to assess admission stroke severity and, when possible, stroke was confirmed by neuroimaging. Results: A total of 869 stroke admissions were observed from 1(st) October 2019 through 30(th) September 2020. Age-standardized to the World Health Organization global population, the yearly incidence was 286.8 per 100,000 adult population (95%CI: 272.4-301.9). Among these patients, 720 (82.9%) gave consent to participate in the study. Median age of participants was 62 years (53-70), 377 (52.2%) were women, and 463 (64.3%) had a first-ever stroke. Known stroke risk factors included hypertension in 503 (72.3%) patients, of whom 279 (55.5%) reported regularly using antihypertensive medication, of whom 161 (57.7%) had used this medication within the last week before stroke onset. A total of 460 (63.9%) participants had neuroimaging performed; among these there was evidence of intracerebral hemorrhage (ICH) in 140 (30.4%). Median stroke severity score using mNIHSS was 19 (10-27). Conclusion: Zanzibar has high incidence of hospitalization for stroke, indicating a very high population incidence of stroke. The proportion of strokes due to ICH is substantially higher than in high-income countries. Most stroke patients had been in contact with health care providers prior to stroke onset and been diagnosed with hypertension. However, few were using antihypertensive medication at the time of stroke onset.

KW - acute stroke

KW - sub-Saharan Africa

KW - hypertension

KW - CVD risk factors

KW - low-income countries (LICs)

KW - incidence rate

KW - Zanzibar

KW - GLOBAL BURDEN

KW - RISK-FACTORS

KW - INVESTIGATIVE RESEARCH

KW - SYSTEMATIC ANALYSIS

KW - DISEASE

KW - AFRICA

KW - COMMUNITY

KW - GENETICS

KW - SIREN

U2 - 10.3389/fneur.2022.931915

DO - 10.3389/fneur.2022.931915

M3 - Journal article

C2 - 35968303

VL - 13

JO - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

M1 - 931915

ER -