Introduction: While the burden of non-communicable diseases is increasing worldwide in developing countries, less is known regarding the true prevalence of such neurologic illness as cerebrovascular disease throughout sub-Saharan Africa. We sought to understand the prevalence of stroke and other neurologic conditions at Mulago Hospital, Uganda’s largest tertiary care referral center, and their association with post-event mortality.
Methods: Data was prospectively collected on 335 patients admitted to the neurology wards of Mulago Hospital from January 2009 to May 2011. Data were collected from the date of admission until discharge, including: demographic information, village of residence, admission/discharge diagnoses, HIV status, discharge disposition, and mortality data, without the benefit of an electronic medical record. Kaplan-Meier survival curves and multivariate COX proportional hazard model were used for unadjusted and adjusted analysis to predict survival.
Results: A total of 307 patients were included in the final analysis with median age is 47 years old (Range=0.9-95). Half were women (50.5%) and 53.7% resided in Kampala. Stroke (27.9%), diabetes (21.3%), head trauma (19.3%), and seizure (13.7%), were the most common diagnoses. A total of 56 (18.2%) patients died during the index hospitalization; patients with a new diagnosis of stroke had the highest mortality (53.3%) compared to patients with other diagnoses. Adjusted regression analysis showed that those unemployed/retired (Hazard Ratio [HR]=4.33, p=.024) and those discharged with stroke (HR=2.77, p=.029) or infectious conditions (HR=5.40, p=.001) had significantly worse survival (Figure).
Conclusions: Among patients admitted to a Ugandan neurology ward, stroke was the most common diagnosis and the most frequently associated with mortality. Given that such non-communicable diseases as cerebrovascular disease is becoming increasingly more important causes of death in resource-limited settings, future research should seek to understand how mortality relates to other factors during hospitalizations and whether interventions to improve delivery of care to patients at higher risk of mortality may affect patient outcomes.