Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study
Fred Stephen Sarfo, Onoja Akpa, Bruce Ovbiagele, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Morenikeji Komolafe, Lukman Owolabi, Godwin Ogbole, Adekunle Fakunle, Akinkunmi Paul Okekunle, Osahon Jeffery Asowata, Benedict Calys‐Tagoe, Ezinne Uvere, Taofeek Adedayo Sanni, Samuel Anu Olowookere, Philip Ibinaiye, Joshua Akinyemi, Oyedunni Arulogun, Carolyn Jenkins, Daniel T. Lackland, Hemant K. Tiwari, Suleiman Y Isah, Sani Abubakar, Oladimeji Adebayo, Philip Adebayo, Josephine Akpalu, Ugochukwu Onyeonoro, James Ayodele Ogunmodede, Cynthia Akisanya, Yaw Mensah, Olalekan Oyinloye, Lambert Appiah, Atinuke Agunloye, Godwin Osaigbovo, Abiodun M. Adeoye, Osimhiarherhuo Adeleye, Ruth Laryea, Taiwo Olunuga, Okechukwu S. Ogah, Wisdom Oguike, Mayowa Ogunronbi, W. O. Adeniyi, Obiabo Olugbo, Abiodun Bello, Luqman Ogunjimi, Samuel Diala, Hamisu A. Dambatta, Arti Singh, Sheila Adamu, Vida Obese, Nathaniel Adusei, Dorcas Owusu, Michael Ampofo, Raelle Tagge, Bimbo Fawale, Joseph Yaria, Rufus Akinyemi, Mayowa Owolabi
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: , 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.