Dataset Information

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

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.

SUBMITTER: Sarfo FS

PROVIDER: S-EPMC10080070 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

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

Sarfo Fred S FS Akpa Onoja M OM Ovbiagele Bruce B Akpalu Albert A Wahab Kolawole K Obiako Reginald R Komolafe Morenikeji M Owolabi Lukman L Ogbole Godwin G Fakunle Adekunle A Okekunle Akinkunmi Paul AP Asowata Osahon J OJ Calys-Tagoe Benedict B Uvere Ezinne O EO Sanni Taofeek T Olowookere Samuel S Ibinaiye Philip P Akinyemi Joshua O JO Arulogun Oyedunni O Jenkins Carolyn C Lackland Daniel T DT Tiwari Hemant K HK Isah Suleiman Y SY Abubakar Sani A SA Oladimeji Adebayo A Adebayo Philip P Akpalu Josephine J Onyeonoro Ugochukwu U Ogunmodede James A JA Akisanya Cynthia C Mensah Yaw Y Oyinloye Olalekan I OI Appiah Lambert L Agunloye Atinuke M AM Osaigbovo Godwin O GO Adeoye Abiodun M AM Adeleye Osimhiarherhuo Ohifemen OO Laryea Ruth Y RY Olunuga Taiwo T Ogah Okechukwu S OS Oguike Wisdom W Ogunronbi Mayowa M Adeniyi Wasiu W Olugbo Obiabo Y OY Bello Abiodun H AH Ogunjimi Luqman L Diala Samuel S Dambatta Hamisu A HA Singh Arti A Adamu Sheila S Obese Vida V Adusei Nathaniel N Owusu Dorcas D Ampofo Michael M Tagge Raelle R Fawale Bimbo B Yaria Joseph J Akinyemi Rufus O RO Owolabi Mayowa O MO

The Lancet. Global health 20230216 4

<h4>Background</h4>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.<h4>Methods</h4>The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeri ...[more]

PMID: 36805867

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Dataset Information

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

Background

Methods

Findings

Interpretation

Funding

Translations

Publications

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

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