Stroke case fatality in sub-Saharan Africa: Systematic review and meta-analysis.


Adoukonou T(1)(2)(3), Kossi O(1)(2), Fotso Mefo P(2), Agbétou M(1)(2), Magne J(3), Gbaguidi G(3), Houinato D(3)(4), Preux PM(3), Lacroix P(3).
Author information:
(1)Department of Neurology, University of Parakou, Parakou, Benin.
(2)Clinic of Neurology, University Teaching Hospital of Parakou, Parakou, Benin.
(3)INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.
(4)Department of Neurology, University of Abomey-Calavi, Cotonou, Benin.


BACKGROUND: The burden of stroke is high in sub-Saharan Africa; however, few data are available on long-term mortality. OBJECTIVE: To estimate over one-month stroke case fatality in sub-Saharan Africa. METHODS: A systematic review and meta-analysis were performed according to meta-analysis of observational studies in epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42020192439), on five electronic databases (PubMed, Science direct, AJOL, EMBASE, and Web of Sciences). We searched all studies on stroke case fatality over one month in sub-Saharan Africa published between 1st January 2000 and 31st December 2019. RESULTS: We included 91 studies with a total of 34,362 stroke cases. The one-month pooled stroke case-fatality rate was 24.1% [95% CI: 21.5-27.0] and 33.2% [95% CI: 23.6-44.5] at one year. At three and five years, the case-fatality rates were respectively 40.1% [95% CI: 20.8-63.0] and 39.4% [95% CI: 14.3-71.5] with high heterogeneity. Hemorrhagic stroke was associated with a higher risk of mortality at one month, but ischemic stroke increased the risk of mortality over six months. Diabetes was associated with poor prognosis at 6 and 12 months with odds ratios of 1.64 [95% CI: 1.22-2.20] and 1.85 [1.25-2.75], respectively. CONCLUSION: The stroke case fatality over one month was very high, compared to case fatalities reported in Western countries and can be explained by a weak healthcare systems and vascular risk factors.