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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
70
AFRICA
Overall, ischaemic stroke accounted for 55.6% of the
stroke cases. The occurrence of ischaemic stroke in MTRH
was significantly higher (KNH, 50.9%; MTRH 62.1%) than
haemorrhagic stroke (KNH 49.1%; MTRH 31.9%) (
p
=
0.002).
There were more women diagnosed with stroke than men
(57.5 vs 42.5%, respectively). Ischaemic stroke was more
prevalent in females (males: 41.1%; females: 58.9%) compared
to haemorrhagic stroke (males: 44.4%; females: 55.6%).
The occurrence of stroke increased with increasing age. The
distribution of stroke across the age groups
≤
30, 30–39, 40–49,
50–59, 60–69, 70–79 and
≥
80 years was 6.3, 10.8, 15.8, 16.2,
19.9, 16.1 and 14.9%, respectively. Up to 82.9% of all the stroke
patients were 40 years and older. Cases of haemorrhagic stroke
were highest in those aged 50–69 years, while ischaemic stroke
peaked in the 60–69 age group. Fig. 1 shows the distribution of
stroke type by age group.
Among the 691 patients recruited, 106 (15.4%) had suffered a
recurrent stroke, among whom 55.6% were women. A significant
association was observed between increasing age and recurrent
stroke (
p
=
0.05).
Mortality rate at day 10 and 28 in KNH was 18 and
8.4%, respectively, whereas in MTRH it was 15.5 and 10.3%,
respectively. Mortality rate at month 3, 6 and 9 was 10.6, 5.4
and 1.6% at KNH and 12, 8.2 and 8.8% at MTRH, respectively.
Table 1 shows the distribution of mortality rate at day 10 and 28
and month 3, 6 and 9 of follow up by gender, health facility and
stroke type.
More deaths occurred among haemorrhagic stroke patients by
day 10 (20.3%) and day 28 (9.9%) compared to the ischaemic cases
(14.6 and 8.9%, respectively), although this was not statistically
significant. Thereafter, mortality rate was significantly higher in
ischaemic stroke at month 3 (
p
=
0.027) and month 6 (
p
=
0.006),
and more so in MTRH at month 3 (
p
=
0.010) and month 6 (
p
=
0.011).
The most common risk factors were hypertension [77.3%
(males: 75.7%; females: 78.5%)], cigarette smoking [16.1%
(males: 26.6%; females: 8.3%)
p
<
0.001], diabetes [14.9%
(males: 15.7%; females: 14.4%)], and hypercholesterolaemia
[2.8% (males: 4.1%; females: 1.8%)
p
<
0.05]. Other factors
associated with stroke were history of previous migraine [32.8%
(males: 28.3%; females: 36.0%)
p
<
0.05], HIV infection [8%
(males: 7.2%; females: 8.6%)], use of oral contraceptives [3.9%
(females: 6.8%)] and cocaine use [0.7% (males: 0.7%; females:
0.8%)]. Table 2 shows the distribution of risk factors for stroke
by gender and age group.
Table 1. Distribution of stroke mortality rates at day 10 and 28, and month 3, 6 and 9 by gender, health facility and stroke type
Day 10
Day 28
Month 3
Month 6
Month 9
Alive (%) Dead (%)
Alive (%) Dead (%)
Alive (%) Dead (%)
Alive (%) Dead (%)
Alive (%) Dead (%)
Number
549
113
475
49
340
44
206
15
90
4
Male
84.2
14.7
87.8
10.9
85.6
11.4
89.1
5.9
92.7
4.9
Female
81.3
18.7
91.6
8.1
87.9
11.2
92.1
7.1
96.3
3.7
KNH
82.0
18.0
91.6
8.4
89.4
10.6
94.6
5.4
98.4
1.6
MTRH
83.4
15.5
87.9
10.3
84.0
12.0
85.7
8.2
88.2
8.8
Ischaemic stroke
84.6
14.6
90.1
8.9
83.3
14.0
85.5
9.9
89.8
8.2
Haemorrhagic stroke
79.7
20.3
89.6
9.9
92.5
6.9
97.9
2.1
100
0
Age group (years)
Ischaemic stroke
Haemorrhagic stroke
<
30 30–39 40–49 50–59 60–69 70–79
≥
80
Frequency (%)
25
20
15
10
5
0
Fig. 1.
Distribution of stroke type by age.
Table 2. Distribution of risk factors by gender and age group
Age groups
<
30 years
30–39 years
40–49 years
50–59 years
60–69 years
70–79 years
≥
80 years
Risk factors
Men
n
(%)
Women
n
(%)
Men
n
(%)
Women
n
(%)
Men
n
(%)
Women
n
(%)
Men
n
(%)
Women
n
(%)
Men
n
(%)
Women
n
(%)
Men
n
(%)
Women
n
(%)
Men
n
(%)
Women
n
(%)
Current tobacco use
+
1 (9.1)
0 (0)
6 (19.4) 2 (4.7) 12 (27.9) 2 (3)
17 (33.3) 2 (3.2) 18 (27.7) 4 (5.6) 11 (20)
9 (16.4) 13 (35.1) 14 (21.2)
Diabetes mellitus*
1 (9.1)
0 (0)
1 (3.2)
4 (9.3)
2 (4.7)
8 (11.9) 3 (5.9)
4 (6.6) 19 (29.2) 21 (29.2) 14 (25.5) 9 (16.4) 6 (16.2) 11 (16.7)
Hypercholesterolaemia
†
0 (0)
1 (3.1)
2 (6.5)
0 (0)
1 (2.3)
0 (0)
2 (3.9)
2 (3.2)
3 (4.6)
1 (1.4)
3 (5.5)
2 (3.6)
1 (2.7)
1 (1.5)
Hypertension
‡
5 (45.5) 15 (46.9) 15 (48.4) 25 (59.5) 29 (69) 46 (69.7) 42 (82.4) 49 (79) 57 (87.7) 68 (94.4) 47 (85.5) 51 (92.7) 26 (70.3) 56 (84.8)
Oral contraceptives
0 (0)
6 (18.8) 0 (0)
12 (27.9) 0 (0)
8 (11.9) 0 (0)
0 (0)
0 (0)
1 (1.4)
0 (0)
0 (0)
0 (0)
0 (0)
Previous migraine
4 (36.4) 18 (56.3) 14 (45.2) 19 (44.2) 12 (27.9) 30 (44.8) 16 (31.4) 20 (32.3) 20 (30.8) 27 (37.5) 9 (16.4) 14 (25.5) 8 (21.6) 15 (22.7)
HIV infection
0 (0)
7 (21.9) 3 (9.7)
7 (16.3) 9 (20.9) 12 (17.9) 5 (9.8)
5 (8.1)
3 (4.6)
2 (2.8)
1 (1.8)
1 (1.8)
0 (0)
0 (0)
Cocaine use
0 (0)
0 (0)
1 (3.2)
1 (2.3)
0 (0)
1 (1.5)
1 (2)
0 (0)
0 (0)
1 (1.4)
0 (0)
0 (0)
0 (0)
0 (0)
+
Cigarette smoking within the last five years. *Elevated fasting glucose level > 5.6 mmol/l or treatment of previously diagnosed diabetes.
†
High-density lipoprotein
cholesterol
<
1.3 mmol/l; triglycerides > 2.2 mmol/l; total cholesterol > 6.2 mmol/l; low-density lipoprotein cholesterol > 4.1 mmol/l, or specific treatment for this abnor-
mality.
‡
Elevated blood pressure 140/90 mmHg or treatment of previously diagnosed hypertension.