Three-year post-stroke outcomes in urban North-western Tanzania
Backgroundstroke is one of the leading causes of death and disability globally. Despite advancements in acute stroke care, long-term outcomes have not been extensively studied in Tanzania. This study aimed to investigate the long-term post-stroke outcomes among adults admitted with stroke to a large...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Stroke |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fstro.2025.1593092/full |
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| author | Joshua Ngimbwa Goodluck Nchasi Innocent Kitandu Paul Anna Kasala Lilian Andrew Mwamba Sospeter Berling Matilda K. Basinda Gladness Xavier Benjamin Andrew Akili Mawazo Dorice Lucas Karim Mahawish Ladius Rudovick Ladius Rudovick Bahati Wajanga Bahati Wajanga Robert Peck Robert Peck Sarah Shali Matuja |
| author_facet | Joshua Ngimbwa Goodluck Nchasi Innocent Kitandu Paul Anna Kasala Lilian Andrew Mwamba Sospeter Berling Matilda K. Basinda Gladness Xavier Benjamin Andrew Akili Mawazo Dorice Lucas Karim Mahawish Ladius Rudovick Ladius Rudovick Bahati Wajanga Bahati Wajanga Robert Peck Robert Peck Sarah Shali Matuja |
| author_sort | Joshua Ngimbwa |
| collection | DOAJ |
| description | Backgroundstroke is one of the leading causes of death and disability globally. Despite advancements in acute stroke care, long-term outcomes have not been extensively studied in Tanzania. This study aimed to investigate the long-term post-stroke outcomes among adults admitted with stroke to a large tertiary hospital in northwestern Tanzania.Methodsadults (≥18 years) with stroke who were enrolled in the Lake Zone Stroke Registry Study (LZSS) at Bugando Medical Center between March 2020 and October 2021 were prospectively followed up until October 2024. Stroke diagnosis and classification were confirmed using brain imaging, and baseline stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Data on case fatality were collected using the modified Rankin Scale along with information on secondary stroke prevention. The Kaplan–Meier analysis was used to describe survival, and the Cox regression model was used to examine independent factors associated with fatality.Resultsthe study included 301 adults, with a mean age of 65.5 ± 14 years, of whom 51% (153/301) were female and 68% (205/301) had ischemic strokes. Case fatality rates were 42.9% (98/228) at 1 year, 75.9% (173/228) at 2 years, and 96.5% (220/228) at 3 years. Independent factors associated with fatality were severe stroke (adjusted hazard ratio (aHR) 7.9, 95% CI [2.3, 27.4], p = 0.001), moderate to severe stroke (aHR 4.6, 95% CI [1.3, 16.1], p = 0.017), a lack of health insurance coverage (aHR 3.7, 95% CI [1.9, 6.8], p < 0.001), and previous stroke (aHR 3.3, 95% CI [1.3, 8.3], p = 0.01). Attendance rates of follow-up clinics and physiotherapy among survivors were 28.6% (86/301) and 8.6% (26/301), respectively. Among stroke survivors with hypertension and diabetes, 32% (83/257) and 41% (20/49) were adherent to antihypertensive and diabetic medications, respectively.Conclusionthis study highlights the high long-term case fatality rates among adults with stroke in northwestern Tanzania, with stroke severity, a lack of health insurance, and previous strokes being key factors associated with fatality. Low attendance rates at follow-up clinics and poor adherence to medications among survivors of stroke with hypertension and diabetes underline the importance of strengthening post-stroke care systems, including health insurance coverage, to improve survival and quality of life. |
| format | Article |
| id | doaj-art-0e05e0671a4e45aeab54b8e015a9e7f6 |
| institution | Kabale University |
| issn | 2813-3056 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Stroke |
| spelling | doaj-art-0e05e0671a4e45aeab54b8e015a9e7f62025-08-20T03:25:47ZengFrontiers Media S.A.Frontiers in Stroke2813-30562025-06-01410.3389/fstro.2025.15930921593092Three-year post-stroke outcomes in urban North-western TanzaniaJoshua Ngimbwa0Goodluck Nchasi1Innocent Kitandu Paul2Anna Kasala3Lilian Andrew Mwamba4Sospeter Berling5Matilda K. Basinda6Gladness Xavier7Benjamin Andrew8Akili Mawazo9Dorice Lucas10Karim Mahawish11Ladius Rudovick12Ladius Rudovick13Bahati Wajanga14Bahati Wajanga15Robert Peck16Robert Peck17Sarah Shali Matuja18Department of Internal Medicine, Aga Khan University, Dar es Salaam, TanzaniaDepartment of Pediatric Oncology, Bugando Medical Centre, Mwanza, TanzaniaDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaDepartment of Internal Medicine, Bugando Medical Center, Mwanza, TanzaniaDepartment of Internal Medicine-Neurology, Jinzhou Medical University, Jinzhou, Liaoning, ChinaDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaDepartment of Internal Medicine, Bugando Medical Center, Mwanza, TanzaniaDepartment of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Internal Medicine, Bugando Medical Center, Mwanza, TanzaniaStroke Medicine Department, Counties Manukau Health, Auckland, New ZealandDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaDepartment of Internal Medicine, Bugando Medical Center, Mwanza, TanzaniaDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaDepartment of Internal Medicine, Bugando Medical Center, Mwanza, TanzaniaDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaCenter for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, United StatesDepartment of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando School of Medicine, Mwanza, TanzaniaBackgroundstroke is one of the leading causes of death and disability globally. Despite advancements in acute stroke care, long-term outcomes have not been extensively studied in Tanzania. This study aimed to investigate the long-term post-stroke outcomes among adults admitted with stroke to a large tertiary hospital in northwestern Tanzania.Methodsadults (≥18 years) with stroke who were enrolled in the Lake Zone Stroke Registry Study (LZSS) at Bugando Medical Center between March 2020 and October 2021 were prospectively followed up until October 2024. Stroke diagnosis and classification were confirmed using brain imaging, and baseline stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Data on case fatality were collected using the modified Rankin Scale along with information on secondary stroke prevention. The Kaplan–Meier analysis was used to describe survival, and the Cox regression model was used to examine independent factors associated with fatality.Resultsthe study included 301 adults, with a mean age of 65.5 ± 14 years, of whom 51% (153/301) were female and 68% (205/301) had ischemic strokes. Case fatality rates were 42.9% (98/228) at 1 year, 75.9% (173/228) at 2 years, and 96.5% (220/228) at 3 years. Independent factors associated with fatality were severe stroke (adjusted hazard ratio (aHR) 7.9, 95% CI [2.3, 27.4], p = 0.001), moderate to severe stroke (aHR 4.6, 95% CI [1.3, 16.1], p = 0.017), a lack of health insurance coverage (aHR 3.7, 95% CI [1.9, 6.8], p < 0.001), and previous stroke (aHR 3.3, 95% CI [1.3, 8.3], p = 0.01). Attendance rates of follow-up clinics and physiotherapy among survivors were 28.6% (86/301) and 8.6% (26/301), respectively. Among stroke survivors with hypertension and diabetes, 32% (83/257) and 41% (20/49) were adherent to antihypertensive and diabetic medications, respectively.Conclusionthis study highlights the high long-term case fatality rates among adults with stroke in northwestern Tanzania, with stroke severity, a lack of health insurance, and previous strokes being key factors associated with fatality. Low attendance rates at follow-up clinics and poor adherence to medications among survivors of stroke with hypertension and diabetes underline the importance of strengthening post-stroke care systems, including health insurance coverage, to improve survival and quality of life.https://www.frontiersin.org/articles/10.3389/fstro.2025.1593092/fullstrokelong term outcomescase fatalityinsuranceregistryTanzania |
| spellingShingle | Joshua Ngimbwa Goodluck Nchasi Innocent Kitandu Paul Anna Kasala Lilian Andrew Mwamba Sospeter Berling Matilda K. Basinda Gladness Xavier Benjamin Andrew Akili Mawazo Dorice Lucas Karim Mahawish Ladius Rudovick Ladius Rudovick Bahati Wajanga Bahati Wajanga Robert Peck Robert Peck Sarah Shali Matuja Three-year post-stroke outcomes in urban North-western Tanzania Frontiers in Stroke stroke long term outcomes case fatality insurance registry Tanzania |
| title | Three-year post-stroke outcomes in urban North-western Tanzania |
| title_full | Three-year post-stroke outcomes in urban North-western Tanzania |
| title_fullStr | Three-year post-stroke outcomes in urban North-western Tanzania |
| title_full_unstemmed | Three-year post-stroke outcomes in urban North-western Tanzania |
| title_short | Three-year post-stroke outcomes in urban North-western Tanzania |
| title_sort | three year post stroke outcomes in urban north western tanzania |
| topic | stroke long term outcomes case fatality insurance registry Tanzania |
| url | https://www.frontiersin.org/articles/10.3389/fstro.2025.1593092/full |
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