ArticleThe Lancet. Global health2023
Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study.
Article in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Advances in Primordial, Primary, and Secondary Prevention of Stroke in Diverse Populations.Stroke · 2024Pooled it
- Effect of a Cardiovascular Polypill on Poststroke Cognition Among Ghanaians: Secondary Analysis of a Randomized Clinical Trial.Journal of the American Heart Association · 2024Trial
- A cardiovascular polypill for secondary stroke prevention in a tertiary centre in Ghana (SMAART): a phase 2 randomised clinical trial.The Lancet. Global health · 2023Trial
- Transcending Social and Cultural Barriers to Transform Global Stroke Care: An SVIN Mission Thrombectomy Initiative.Stroke (Hoboken, N.J.) · 2026Review
- In-hospital survival and predictors of mortality among stroke patients at a tertiary hospital in Ghana: A retrospective cohort study.PloS one · 2026Article
- Knowledge Graph-Enhanced Deep Learning Model (H-SYSTEM) for Hypertensive Intracerebral Hemorrhage: Model Development and Validation.Journal of medical Internet research · 2025Article
- Screening for Post-Stroke Cognitive Impairment in Sub-Saharan Africa: A Good IDEA?Brain sciences · 2025Article
- Revisiting Africa's Stroke Obstacles and Services (SOS).Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Profile and determinants of acute stroke outcome: a prospective cohort study in a tertiary healthcare facility in Makurdi, North Central Nigeria.The Pan African medical journal · 2025Article
- Understanding healthcare providers' perspectives on barriers to accessing stroke care at a resource-limited hospital in East Africa: A qualitative study from Mnazi Mmoja Referral Hospital in Zanzibar.PLOS global public health · 2025Article
- Enhancing Africa's stroke workforce to address the stroke burden: a proposal from the African's stroke organization's educational and training committee.Frontiers in stroke · 2025Article
- Mortality rate and predictors among stroke patients in the public hospitals in Harari region, Eastern Ethiopia.PLOS global public health · 2025Article
- Comparison of admitting neutrophil/lymphocyte ratio with baseline NIH stroke scale score in discriminating poor 30-day stroke outcome among Nigerian Africans.Frontiers in stroke · 2025Article
- A scoping review of stroke registers in Sub-Saharan Africa.International journal of stroke : official journal of the International Stroke Society · 2025Article
- Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry.International journal of stroke : official journal of the International Stroke Society · 2024Article
- The African Stroke Organization Conference 2023.The Lancet. Neurology · 2024Article
- Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study.Journal of the neurological sciences · 2024Article
- 30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis.PLOS global public health · 2024Article
- Artificial Intelligence-based automated CT brain interpretation to accelerate treatment for acute stroke in rural India: An interrupted time series study.PLOS global public health · 2024Article
- Prevalence and predictors of low folate levels among stroke survivors in a country without mandatory folate food fortification: Analysis of a Ghanaian sample.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2023Article
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Abstract
backgroundEvery 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.
methodsThe 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.
findingsOverall, 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 cm
interpretationStudies 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.
fundingUS National Institutes of Health. TRANSLATIONS: For the Twi, Yoruba and Hausa translations of the abstract see Supplementary Materials section.
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