Abstract Details

Title Characteristics of Adults With First-Ever and Recurrent Strokes in Zambia

Topic Global Health and Neuroepidemiology

Presentation(s) S37 - Global Neurology (3:42 PM-3:54 PM)

Poster/Presentation
Number 002

Background

Stroke prevalence and stroke-related mortality in sub-Saharan Africa are amongst the highest in the world. Understanding risk factors and outcomes for first-ever and recurrent stroke in this region could lead to improvements in stroke prevention strategies.

Objective Evaluate risk factors and outcomes of first-ever and recurrent stroke in Zambia.

Design/Methods

We conducted a retrospective chart review of sociodemographic, clinical and hospitalization characteristics of all adults with stroke admitted to the University Teaching Hospital in Lusaka, Zambia. Vital status at 90-days was obtained by phone call. Participants were dichotomized into first-ever versus recurrent stroke, and group characteristics were compared.

Results

Participants with first-ever stroke (n=253; 78%) were more likely to be male (42% vs. 25%, p=0.01) and younger (58+18 vs 66+14 years, p<0.001). Ischemic strokes (69% vs. 55%) were more common and intracerebral hemorrhage (ICH; 15% vs. 32%) less common amongst those with recurrent stroke (p=0.03). Adults with recurrent stroke more commonly presented with GCS<12 (92% vs 64%, p=0.004) and were more likely to have hypertension, heart disease, and a family history of stroke. Only 58% and 50% of those with recurrent stroke and known hypertension and diabetes, respectively, were on treatment. Adults with recurrent stroke had longer length of stay (10 vs 7 days, p=0.008) and higher rates of aspiration pneumonia (30% vs 12%, p=0.001). In-hospital mortality did not differ (31% vs 22%, p=0.12), but 90-day mortality was higher amongst those with recurrent stroke (59% vs. 36%, p=0.001).

Conclusions

Adults with recurrent stroke in Zambia are older, at higher risk of aspiration pneumonia, and require longer hospitalizations. Secondary stroke prevention regimens were non-optimal in many adults with recurrent stroke. While in-hospital mortality did not differ, post-discharge mortality was markedly higher in adults with recurrent stroke. This suggests both primary and secondary prevention programs are needed to reduce stroke burden and improve outcomes in Zambia.

Authors/Disclosures
Aparna Nutakki, MD PRESENTER	Ms. Nutakki has received research support from UJMT Fogarty Global Health Fellowship Program. Ms. Nutakki has received research support from AAN Medical Student Research Scholarship. Ms. Nutakki has received research support from Gold Humanism Student Summer Fellowship.
Lorraine Chishimba, MBChB, MMED (University Teaching Hospital)	Dr. Chishimba has nothing to disclose.
Mashina Chomba, MBChB (University of Zambia)	Dr. Chomba has nothing to disclose.
Stanley Zimba, MBBS (University Teaching Hospital)	Dr. Zimba has nothing to disclose.
Deanna Saylor, MD, MHS (Johns Hopkins Hospital)	The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.