Published Online
on June 19, 2003

A more recent version of this article appeared on July 1, 2003

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Submitted on January 20, 2003
Accepted on February 19, 2003

Mortality and Recovery After Stroke in The Gambia

Richard W. Walker FRCP^*; Michael Rolfe FRCP; Peter J. Kelly BSc; Melville O. George FWACS; and Oliver F.W. James FRCP

From the Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK (R.W.W.); Department of Medicine, Withybush General Hospital, Haverfordwest, Pembrokeshire, UK (M.R.); Tees Health Authority, Nunthorpe, UK (P.J.K.); WHO Country Office, Accra, Ghana, Africa (M.O.G.); and Department of Medicine, Medical School, University of Newcastle Upon Tyne, UK (O.F.W.J.).

^* To whom correspondence should be addressed. E-mail: Richard.Walker{at}northumbria-healthcare.nhs.uk.

Background and Purpose--There are no previously published studies of the long-term outcome of stroke in sub-Saharan Africa. Our goal was to determine the case fatality, time to and cause of death, and recovery in a hospital cohort of stroke patients in The Gambia.

Methods--For 1 year beginning April 1, 1990, any patient presenting to the Royal Victoria Hospital (Banjul) with a diagnosis of stroke or having a stroke as an inpatient was recruited. After a standardized assessment, patients were followed up at 1 month, 6 months, and 3 to 4 years to assess recovery or, for those who died, record the date and likely cause of death.

Results--Mean age of the 106 patients (70 men) was 58 years (range, 20 to 93 years). By 1 and 6 months, 29 (27%) and 47 (44%), respectively, had died, with only 27 (25%) surviving to final follow-up (4 patients not traced). Death occurred in hospital in 43 patients (57%). Cause of death was the initial stroke in 46 (61%), further stroke in 5 (7%), infection in 9 (12%), miscellaneous in 8 (11%) (only 1 vascular), and unknown in 7 (9%). On Cox regression analysis, incontinence in the first 24 hours, sensory inattention, and impaired gag reflex on admission were significant predictors of mortality. Predictors of recovery were similar to those of developed countries.

Conclusions--Despite the young mean age, there was a high case fatality rate. The main cause of death was the stroke itself, and ischemic heart disease was very rare.

Key words: Africa south of the Sahara • fatal outcome • recovery of function • stroke

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