Research Article| Volume 29, ISSUE 6, 104785, June 2020

Long-Term Mortality of Stroke Survivors in Parakou: 5-Year Follow-Up


      Background: The burden of stroke is high in Africa, but few data are available on the long-term outcome of strokes in this area. Aim: We aimed to study the long-term outcome of stroke survivors in Parakou from 2012 to 2018. Methods of Study: It was a cohort study and included 247 stroke patients admitted to the University Hospital of Parakou from January 1, 2012 to April 30, 2018. Each patient was followed up for at least 1 year. The modified RANKIN scale was used to evaluate patients. Verbal autopsy was used to ascertain the cause of death. The survival probability was estimated using the Kaplan-Meier method. Predictors of mortality were estimated using the Cox proportional model and the hazard ratio (HR) and their 95% confidence intervals were determined. The data were analyzed using Stata Software. Results: The mean age was 58.1 ± 13.4 years with a sex ratio of 1.12. Among stroke survivors, the mortality was 10.1% at 3 months, 11.7% at 6 months, 15.4% at 1 year, 21.5% at 3 years, and 23.5% at 5 years. The probability of survival after a stroke was 66.5% at 5 years. Factors associated with mortality were age with adjusted HR 1.4 (1.2-1.7) for each 10 years, male sex with aHR 2.3 (1.2-4.6), history of hypertension with aHR 2.0 (1.0-4.1) and the severity of the initial neurological impairment National Institute of Health Stroke Scale with aHR 1.1 (1.0-1.2) for each 1 point. The main causes of death were recurrent stroke, infectious diseases, and cardiac disease. The proportion of patients with functional disability was 53.8% at 1 year. The quality of life was generally impaired in terms of physical health, personal environment, and finances. Conclusions: The long-term prognosis of stroke patients in Parakou is poor. It requires urgent action to reduce this burden.

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        • Feigin V.L.
        • Forouzanfar M.H.
        • Krishnamurthi R.
        • et al.
        Global and regional burden of stroke during 1990–2010 findings from the Global Burden of Disease Study 2010.
        Lancet. 2014; 383: 245-254
        • Feigin V.L.
        • Roth G.A.
        • Naghavi M.
        • et al.
        Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet Neurol. 2016; 15: 913-924
        • GBD 2016 Stroke Collaborators
        Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
        Lancet Neurol. 2019; 18: 439-458
        • Adeloye D.
        An estimate of the incidence and prevalence of stroke in Africa: a systematic review and meta-analysis.
        PLoS One. 2014; 9e100724
        • Ezejimofor M.C.
        • Chen Y.F.
        • Kandala N.B.
        • et al.
        Stroke survivors in low- and middle-income countries: a meta-analysis of prevalence and secular trends.
        J Neurol Sci. 2016; 364: 68-76
        • Cossi M.J.
        • Gobron C.
        • Preux P.M.
        • et al.
        Stroke: prevalence and disability in Cotonou, Benin.
        Cerebrovasc Dis. 2012; 33: 166-172
        • Limbole E.B.
        • Magne J.
        • Lacroix P.
        Stroke characterization in sub-Saharan Africa: Congolese population.
        Int J Cardiol. 2017; 240: 392-397
        • Agyemang C.
        • Attah-Adjepong G.
        • Owusu-Dabo E.
        • et al.
        Stroke in Ashanti region of Ghana.
        Ghana Med J. 2012; 46: 12-17
        • Adoukonou T.
        • Kossi O.
        • Agbetou M.
        • et al.
        Short term (3 months) prognosis of stroke in Parakou.
        Neurosci Med. 2018; 9: 81-93
        • Gnonlonfoun D.
        • Adjien C.
        • Ossou-Nguiet P.
        • et al.
        Stroke: medium and long-term mortality and associated factors in French-speaking West Africa, case of Benin.
        World J Neurosci. 2014; 4: 68-74
        • Kaduka L.
        • Muniu E.
        • Oduor C.
        • et al.
        Stroke mortality in Kenya's public tertiary hospitals: a prospective facility-based study.
        Cerebrovasc Dis Extra. 2018; 8: 70-79
        • Sene Diouf F.
        • Basse A.M.
        • Toure K.
        • et al.
        Prognosis of stroke in department of neurology of Dakar.
        Dakar Med. 2006; 51: 17-21
        • Sarfo F.S.
        • Akassi J.
        • Kyem G.
        • et al.
        Long-term outcomes of stroke in a Ghanaian outpatient clinic.
        J Stroke Cerebrovasc Dis. 2018; 27: 1090-1099
        • Walker R.W.
        • Jusabani A.
        • Aris E.
        • et al.
        Correlates of short- and long-term case fatality within an incident stroke population in Tanzania.
        S Afr Med J. 2013; 103: 107-112
        • Walker R.W.
        • Wakefield K.
        • Gray W.K.
        • et al.
        Case-fatality and disability in the Tanzania stroke incidence project cohort.
        Acta Neurol Scand. 2016; 133: 49-54
        • Mapoure Y.N.
        • Ayeah C.M.
        • Doualla M.S.
        • et al.
        Serum uric acid is associated with poor outcome in black Africans in the acute phase of stroke.
        Stroke Res Treat. 2017; 20171935136
        • Avode D.G.
        • Houinato D.
        • Adjien C.
        • et al.
        Mortalité et facteurs influençant le pronostic des accidents vasculaires cérébraux au CNHU de Cotonou.
        Le Benin Médical. 2006; 33: 32-36
      1. Institut national de la statistique et de l'analyse économique du Bénin. Résultats provisoires du 4e recensement général de la population et de l'habitat au Bénin en 2013 Cotonou, Bénin: INSAE, Juin2015. Available at: Accessed May 10, 2019.

        • Aho K.
        • Harmsen P.
        • Hatano S.
        • et al.
        Cerebrovascular disease in the community: results of a WHO collaborative study.
        Bull World Health Organ. 1980; 58: 113-130
        • Organisation mondiale de la Santé
        Le Manuel de Surveillance STEPS de l'OMS: l'approche STEPWISE de l'OMS pour la surveillance des facteurs de risque des maladies chroniques Suisse.
        OMS, Genève2005
        • Brott T.
        • Adams H.P.
        • Olinger C.P.
        • et al.
        Measurements of acute cerebral infarction: a clinical examination scale.
        Stroke. 1989; 20: 864-870
        • RANKIN J.
        Cerebral vascular accidents in patients over the age of 60. II. Prognosis.
        Scott Med J. 1957; 2: 200-215
        • Mahoney R.I.
        • Barthel D.W.
        Functional evaluation: the Barthel index.
        Md Sate Med J. 1965; 14: 61-65
        • Harper A.
        • Power M.
        Development of the World Health Organization WHOQOL-BREF quality of life assessment.
        Psychol Med. 1998; 28: 551-558
        • Walker R.W.
        • Jusabani A.
        • Aris E.
        • et al.
        Post‐stroke case fatality within an incident population in rural Tanzania.
        J Neurol Neurosurg Psychiatry. 2011; 82: 1001-1005
        • Benois A.
        • Raynaud L.
        • Coton T.
        • et al.
        Morbidity and mortality after intensive care management of haemorrhagic stroke in Djibouti.
        Med Trop (Mars). 2009; 69: 41-44
        • Nkoke C.
        • Lekoubou A.
        • Balti E.
        • et al.
        Stroke mortality and its determinants in a resource-limited setting: a prospective cohort study in Yaounde, Cameroon.
        J Neurol Sci. 2015; 358: 113-117
        • Walker R.W.
        • Rolfe M.
        • Kelly P.J.
        • et al.
        Mortality and recovery after stroke in the Gambia.
        Stroke. 2003; 34: 1604-1609
        • Mudzi W.
        • Stewart A.
        • Musenge E.
        Case fatality of patients with stroke over a 12-month period post stroke.
        S Afr Med J. 2012; 102: 765-767
        • Garbusinski J.M.
        • van der Sande M.A.
        • Bartholome E.J.
        • et al.
        Stroke presentation and outcome in developing countries: a prospective study in the Gambia.
        Stroke. 2005; 36: 1388-1393
        • Hansson P.O.
        • Andersson Hagiwara M.
        • Brink P.
        • et al.
        Prehospital identification of factors associated with death during one-year follow-up after acute stroke.
        Brain Behav. 2018; 8: e00987
        • Owolabi M.O.
        • Sarfo F.
        • Akinyemi R.
        • et al.
        Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study.
        Lancet Glob Health. 2018; 6: e436-e446