Stroke admission and case-fatality in an urban medical unit in sub-Saharan Africa: A fourteen year trend study from 1999 to 2012

Background: Data on recent stroke trends in the context of rapidly deteriorating risk profile of populationswithin Africa is very limited. We investigated the admission trend for stroke and related outcomes in a major referral hospital in Cameroon. Methods: Admission and discharge registries, and patient files for the period 1999-2012 of the medical department of the Yaoundé Central Hospitalwere reviewed for evidence of admission for stroke, and outcomes during hospitalization. Trajectories of case-fatality and risk factors over time were assessed, with adjustment for confounders using logistic regression models. Results: Of the 28,239 medical admissions registered during the study period, 1688 (6.0%) were due to stroke. This proportion ranged from 2.5% in 1999-2000 to 13.1% in 2011-2012 overall and similarly in men and women. Mean age, alcohol consumption and history of stroke varied across years (all p ≤ 0.006). Computed tomography confirmed that stroke increased from 34.4% in 1999-2000 to 84.2% in 2011-2012, while the length of stay decreased from 21 to 10 days (both p < 0.0001 for linear trend). Case-fatality rate increased from 14.4% to 22.4%. The adjusted odd ratio (95% CI) 2011-2012 vs. 1999-2000 was 2.93 (1.40-6.13), p < 0.0001 for the linear trend across years. The unadjusted relative risk of death from stroke patients vs. general admissions was 0.95 (0.87-1.05) overall, 0.82 (0.71-0.94) in men and 1.08 (0.95-1.23) in women. Conclusion: During the last decade and a half, stroke admissions and case-fatality have increased in the study setting, reflecting in part the inadequate coping capacity of the health care system.