Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Apr;11(4):e575-e585.
doi: 10.1016/S2214-109X(23)00038-4. Epub 2023 Feb 16.

Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study

Fred S Sarfo  1 , Onoja M Akpa  2 , Bruce Ovbiagele  3 , Albert Akpalu  4 , Kolawole Wahab  5 , Reginald Obiako  6 , Morenikeji Komolafe  7 , Lukman Owolabi  8 , Godwin Ogbole  9 , Adekunle Fakunle  10 , Akinkunmi Paul Okekunle  11 , Osahon J Asowata  12 , Benedict Calys-Tagoe  4 , Ezinne O Uvere  13 , Taofeek Sanni  14 , Samuel Olowookere  7 , Philip Ibinaiye  6 , Joshua O Akinyemi  12 , Oyedunni Arulogun  15 , Carolyn Jenkins  16 , Daniel T Lackland  16 , Hemant K Tiwari  17 , Suleiman Y Isah  8 , Sani A Abubakar  6 , Adebayo Oladimeji  18 , Philip Adebayo  19 , Josephine Akpalu  4 , Ugochukwu Onyeonoro  20 , James A Ogunmodede  5 , Cynthia Akisanya  21 , Yaw Mensah  22 , Olalekan I Oyinloye  5 , Lambert Appiah  23 , Atinuke M Agunloye  24 , Godwin O Osaigbovo  20 , Abiodun M Adeoye  25 , Osimhiarherhuo Ohifemen Adeleye  21 , Ruth Y Laryea  4 , Taiwo Olunuga  21 , Okechukwu S Ogah  13 , Wisdom Oguike  6 , Mayowa Ogunronbi  21 , Wasiu Adeniyi  21 , Obiabo Y Olugbo  26 , Abiodun H Bello  5 , Luqman Ogunjimi  27 , Samuel Diala  13 , Hamisu A Dambatta  8 , Arti Singh  1 , Sheila Adamu  23 , Vida Obese  23 , Nathaniel Adusei  1 , Dorcas Owusu  1 , Michael Ampofo  23 , Raelle Tagge  12 , Bimbo Fawale  7 , Joseph Yaria  13 , Rufus O Akinyemi  28 , Mayowa O Owolabi  29 ; SIREN
Affiliations
Multicenter Study

Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study

Fred S Sarfo et al. Lancet Glob Health. 2023 Apr.

Abstract

Background: Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria.

Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs.

Findings: Overall, 814 (21·8%) of the 3739 patients admitted with stroke died as inpatients: 476 (18·1%) of 2635 with ischaemic stroke and 338 (30·6%) of 1104 with intracerebral haemorrhage. The variability in the odds of stroke fatality that could be attributed to the system-level factors across study sites assessed using model intracluster correlation coefficient was substantial at 7·3% (above a 5% threshold). Stroke units were available at only five of 16 centres. The aRRs of six patient-level factors associated with stroke fatality were: low vegetable consumption, 1·19 (95% CI 1·07-1·33); systolic blood pressure, 1·02 (1·01-1·04) for each 10 mm Hg rise; stroke lesion volume more than 30 cm3, 1·48 (1·22-1·79); National Institutes of Health Stroke Scale (NIHSS) score, 1·20 (1·13-1·26) for each 5-unit rise; elevated intracranial pressure, 1·75 (1·31-2·33); and aspiration pneumonia, 1·79 (1·16-2·77).

Interpretation: Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted.

Funding: US National Institutes of Health.

Translations: For the Twi, Yoruba and Hausa translations of the abstract see Supplementary Materials section.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

Figure:
Figure:. Flow chart for stroke cases included in the analysis
See this image and copyright information in PMC

Comment in

References

    1. Owolabi MO, Akarolo-Anthony S, Akinyemi R, et al. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J S Afr 2015; 26 (suppl 1): S27–38. - PMC - PubMed
    1. Ezejimofor MC, Uthman OA, Maduka O, et al. Stroke survivors in Nigeria: a door-to-door prevalence survey from the Niger Delta region. J Neurol Sci 2017; 372: 262–69. - PubMed
    1. Sarfo FS, Awuah DO, Nkyi C, Akassi J, Opare-Sem OK, Ovbiagele B. Recent patterns and predictors of neurological mortality among hospitalized patients in Central Ghana. J Neurol Sci 2016; 363: 217–24. - PubMed
    1. Walker RW, Jusabani A, Aris E, et al. Post-stroke case fatality within an incident population in rural Tanzania. J Neurol Neurosurg Psychiatry 2011; 82: 1001–05. - PubMed
    1. Feigin VL, Forouzanfar MH, 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: 245–54. - PMC - PubMed

Publication types