Stroke Epidemiology in Douala: Three Years Prospective Study in a Teaching Hospital in Cameroon
Author(s)
Yacouba N. Mapoure1,2*,
C. Kuate3,
Clet B. Tchaleu2,4,
Hugo B. Mbatchou Ngahane1,
Gérard N. Mounjouopou1,
Hamadou Ba3,
Salomon Mbahe2,
Julius Y. Fonsah5,
Gérard Beyiha6,
Henry N. Luma2,3,
Albert S. Mouelle2,
Philomène K. Ndouongo7,
Alfred K. Njamnshi3
Affiliation(s)
1 Department of Clinical Sciences, University of Douala, Douala, Cameroon. 2 Department of Internal Medicine, Douala General Hospital, Douala, Cameroon. 3 Department of Internal Medicine, University of Yaoundé I, Douala, Cameroon. 5 Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon. 6 Department of Surgery, University of Douala, Douala, Cameroon. 7 Department of Neurology, University of Health Sciences, Libreville, Gabon.
1 Department of Clinical Sciences, University of Douala, Douala, Cameroon. 2 Department of Internal Medicine, Douala General Hospital, Douala, Cameroon. 3 Department of Internal Medicine, University of Yaoundé I, Douala, Cameroon. 5 Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon. 6 Department of Surgery, University of Douala, Douala, Cameroon. 7 Department of Neurology, University of Health Sciences, Libreville, Gabon.
ABSTRACT
Background and Objectives: Cerebro-vascular accident or stroke constitutes a major challenge in sub-Saharan Africa. In Cameroon, basic epidemiologic data are not routinely available. Aims: The aim of this study was to determine the type, the associated risk factors, time to admission, the clinical presentation and the case fatality of stroke at the Douala General Hospital (DGH) in Cameroon. Methods: A cross-sectional study was performed from January 1, 2010 to December 31, 2012 at the neurology and intensive care units of the DGH. All patients above 15 years of age with a diagnosis of established stroke were enrolled. For each patient, socio-demographic, clinical and paraclinical data were recorded as well as the duration of hospitalization and the case fatality. Results: In all, 325 patients were enrolled with males constituting 68.1% and general mean age of 58.66 ± 13.6 years. The mean initial consultation delay was 47.36 ± 18.48 hours. The majors cerebro-vascular risk factors were hypertension (81.15%), chronic alcohol consumption (28.3%), diabetes mellitus (20.61%), obesity (18.15%), cigarette smoking (16%), dyslipidemia (8.9%) and atrial fibrillation (3.07%). Ischemic stroke accounted for 52% of cases while 48% were hemorrhagic. The mean duration of hospitalization was 8.58 ± 6.35 days with a case fatality rate of 26.8%. Septic conditions appeared to be the leading cause of death accounting for 35.6% of cases. Conclusion: Stroke in the DGH is associated with a high case fatality rate and hypertension remains the number one risk factor. There is a clear and urgent need for public health authorities to reinforce measures for the control of modifiable stroke risk factors.
Background and Objectives: Cerebro-vascular accident or stroke constitutes a major challenge in sub-Saharan Africa. In Cameroon, basic epidemiologic data are not routinely available. Aims: The aim of this study was to determine the type, the associated risk factors, time to admission, the clinical presentation and the case fatality of stroke at the Douala General Hospital (DGH) in Cameroon. Methods: A cross-sectional study was performed from January 1, 2010 to December 31, 2012 at the neurology and intensive care units of the DGH. All patients above 15 years of age with a diagnosis of established stroke were enrolled. For each patient, socio-demographic, clinical and paraclinical data were recorded as well as the duration of hospitalization and the case fatality. Results: In all, 325 patients were enrolled with males constituting 68.1% and general mean age of 58.66 ± 13.6 years. The mean initial consultation delay was 47.36 ± 18.48 hours. The majors cerebro-vascular risk factors were hypertension (81.15%), chronic alcohol consumption (28.3%), diabetes mellitus (20.61%), obesity (18.15%), cigarette smoking (16%), dyslipidemia (8.9%) and atrial fibrillation (3.07%). Ischemic stroke accounted for 52% of cases while 48% were hemorrhagic. The mean duration of hospitalization was 8.58 ± 6.35 days with a case fatality rate of 26.8%. Septic conditions appeared to be the leading cause of death accounting for 35.6% of cases. Conclusion: Stroke in the DGH is associated with a high case fatality rate and hypertension remains the number one risk factor. There is a clear and urgent need for public health authorities to reinforce measures for the control of modifiable stroke risk factors.
Cite this paper
Mapoure, Y. , Kuate, C. , Tchaleu, C. , Ngahane, H. , Mounjouopou, G. , Ba, H. , Mbahe, S. , Fonsah, J. , Beyiha, G. , Luma, H. , Mouelle, A. , Ndouongo, P. and Njamnshi, A. (2014) Stroke Epidemiology in Douala: Three Years Prospective Study in a Teaching Hospital in Cameroon. World Journal of Neuroscience, 4, 406-414. doi: 10.4236/wjns.2014.45044.
Mapoure, Y. , Kuate, C. , Tchaleu, C. , Ngahane, H. , Mounjouopou, G. , Ba, H. , Mbahe, S. , Fonsah, J. , Beyiha, G. , Luma, H. , Mouelle, A. , Ndouongo, P. and Njamnshi, A. (2014) Stroke Epidemiology in Douala: Three Years Prospective Study in a Teaching Hospital in Cameroon. World Journal of Neuroscience, 4, 406-414. doi: 10.4236/wjns.2014.45044.
References
[1] Lopez, A.D., Mathers, C.D., Ezzah, M., Jamison, D.T. and Murray, C.J. (2006) Global and Regional Burden of Disease and Risk Factors. Systematic Analysis of Population Health Data. The Lancet, 367, 1747-1757.
http://dx.doi.org/10.1016/S0140-6736(06)68770-9 [2] Volster, H.H. (2002) The Emergence of Cardiovascular Disease during Urbanization of Africans. Public Health Nutrition, 5, 239-243. [3] Echouffo-Tcheugui, J.B. and Kengne, A.P. (2011) Chronic Non-Communicable Disease in Cameroun-Burden, Determinant and Current Policies. BMC Global Heath, 7, 44. [4] Njamnshi, A.K., Mbong, E.N., Wonkam, A., et al. (2006) The Epidemiology of Stroke in Sickle Cell Patients in Yaounde, Cameroon. Journal of the Neurological Sciences, 250, 79-84.
http://dx.doi.org/10.1016/j.jns.2006.07.003 [5] Njamnshi, A.K., Blackett, K.N., Mbuagbaw, J.N., Gamedze, F., Gupta, S. and Wiysonge, C.S. (2006) Chronic Chlamydiae Pneumoniae Infection and Stroke in Cameroon: A Case Control Study. Stroke, 37, 796-799.
http://dx.doi.org/10.1161/01.STR.0000204223.04182.4a [6] Obama, M.T., Dongmo, L., Nkemayim, C., Mbede, J. and Hagbe, P. (1994) Stroke in Children in Yaoundé, Cameroon. Indian Pediatrics, 31, 791-795. [7] Mikande, Z., Ndoumba, A., Beyiha, G., et al. (2012) Stroke in the H?pital Gynéco-Obstétrique et Pédiatrique de Yaoundé, epidemiology and paraclinical aspects. Schweizer archiv fur neurologie und psychiatrie, 163, 54-57. [8] Beyiha, G., Minkande, E., Binam, F. and Sosso, M.A. (2008) Aspect épidémiologique et facteurs de gravité des AVC au Cameroun. Journal maghrébin d’anesthésie-réanimation et de médecine d’urgence, 15, 293-297. [9] Chiasseu, M. and Mbahe, S. (2011) Descriptive Study of Cerebro-Vascular Accidents in Douala, Cameroon. Medecine Tropicale, 71, 492-494. [10] Mapoure, N.Y., Luma, N.H., Ngahane, H.B.M., et al. (2012) Prevalence of Stroke Risk Factors among Urban Population in Douala, Cameroon. Revue Médecine et de Pharmacie, 2, 143-144. [11] Osuntokun, B.O., Bademosi, O., Akinkugbe, O.O., et al. (1979) Incidence of Stroke in a Africa City: Results from the Stroke Registry Ibadan, Nigeria, 1973-1975. Stroke, 10, 205-207.
http://dx.doi.org/10.1161/01.STR.10.2.205 [12] Sagui, E., M’baye, P.S., Dubecq, C., et al. (2005) Ischemic and Hemorrhagic Strokes in Dakar, Senegal: A Hospital Based Study. Stroke, 36, 1844-1847.
http://dx.doi.org/10.1161/01.STR.0000177864.08516.47 [13] Kumral, E., Ozkaya, B., Sagduyu, A., et al. (1998) The Ege Stroke Registry: A Hospital-Based Study in the Aegean Region, Izmir, Turkey. Analysis of 2.000 Stroke Patients. Cerebrovascular Diseases, 8, 278-288.
http://dx.doi.org/10.1159/000015866 [14] Awada, A. and Al Rajeh, S. (1999) The Saudi Stroke Bank. Analysis of the First 1000 Cases. Acta Neurologica Scandinavica, 100, 265-269. http://dx.doi.org/10.1111/j.1600-0404.1999.tb00392.x [15] Moulin, T., Tatu, L., Crépin-Leblond, T., et al. (1997) The Besan?on Stroke Registry: An Acute Stroke Registry of 2.500 Consecutive Patients. European Neurology, 38, 10-20.
http://dx.doi.org/10.1159/000112896 [16] Bornstein, N.M., Aronovich, B.D., Karepov, V.G., et al. (1996) The Tel Aviv Stroke Registry 3600 Consecutive Patients. Stroke, 27, 1770-1773. [17] Kouna, N.P., Millogo, A., Siemefo, K.F., et al. (2007) Aspects épidémiologiques et évolutifs des accidents vasculaires cérébraux au centre hospitalier de Libreville (Gabon). African Journal of Neurological Sciences, 26, 122-130. [18] Komolafe, M.A., Komolafe, E.O., Fatoye, F., et al. (2007) Profile of Stroke in Nigerians: A Prospective Clinical Study. African Journal of Neurological Sciences, 27, 360-365. [19] Sagui, E. (2007) Les accidents vasculaires cérébraux vasculaires en Afrique subsaharienne. Medecine Tropicale, 67, 596-600. [20] Feuzeu, L., Kengne, A., Balkau, B., et al. (2010) Ten-Year Change in Blood Pressure Levels and Prevalence of Hypertension in Urban and Rural Cameroon. Journal Epidemiology Community Health, 64, 360-365.
http://dx.doi.org/10.1136/jech.2008.086355 [21] Amu, E., Ogunrin, O. and Danesi, M. (2005) Re-Appraisal of Risk Factors for Stroke in Nigerian Africans: Prospective Case-Control Study. African Journal of Neurological Sciences, 24, 78-83. [22] Apetse, K., Matelbe, M., Assogba, K., et al. (2011) Prevalence of Dyslipidemia, Hyperglycemia and Hyperuricemia in Stroke Patients in Togo. African Journal of Neurological Sciences, 30, 88-93. [23] Toure, K., Diagne, S.N., Seck, L.B., et al. (2010) Predictors of Stroke Mortality at the Department of Neurology, Fann University Teaching Hospital, Dakar-Senegal. Facteurs prédictifs de morbidité par AVC à la clinique neurologique du CHU de FANN, Dakar-Senegal. African Journal of Neurological Sciences, 29, 325-334. [24] Napon, C., Sawadogo, R., Lampo, L., et al. (2011) Facteur de risque et étiologie de l’accident vasculaire cérébral ischémique du sujet jeune au Burkina Faso. Médecine d’Afrique noire, 58, 541-544.
[1] Lopez, A.D., Mathers, C.D., Ezzah, M., Jamison, D.T. and Murray, C.J. (2006) Global and Regional Burden of Disease and Risk Factors. Systematic Analysis of Population Health Data. The Lancet, 367, 1747-1757.
http://dx.doi.org/10.1016/S0140-6736(06)68770-9 [2] Volster, H.H. (2002) The Emergence of Cardiovascular Disease during Urbanization of Africans. Public Health Nutrition, 5, 239-243. [3] Echouffo-Tcheugui, J.B. and Kengne, A.P. (2011) Chronic Non-Communicable Disease in Cameroun-Burden, Determinant and Current Policies. BMC Global Heath, 7, 44. [4] Njamnshi, A.K., Mbong, E.N., Wonkam, A., et al. (2006) The Epidemiology of Stroke in Sickle Cell Patients in Yaounde, Cameroon. Journal of the Neurological Sciences, 250, 79-84.
http://dx.doi.org/10.1016/j.jns.2006.07.003 [5] Njamnshi, A.K., Blackett, K.N., Mbuagbaw, J.N., Gamedze, F., Gupta, S. and Wiysonge, C.S. (2006) Chronic Chlamydiae Pneumoniae Infection and Stroke in Cameroon: A Case Control Study. Stroke, 37, 796-799.
http://dx.doi.org/10.1161/01.STR.0000204223.04182.4a [6] Obama, M.T., Dongmo, L., Nkemayim, C., Mbede, J. and Hagbe, P. (1994) Stroke in Children in Yaoundé, Cameroon. Indian Pediatrics, 31, 791-795. [7] Mikande, Z., Ndoumba, A., Beyiha, G., et al. (2012) Stroke in the H?pital Gynéco-Obstétrique et Pédiatrique de Yaoundé, epidemiology and paraclinical aspects. Schweizer archiv fur neurologie und psychiatrie, 163, 54-57. [8] Beyiha, G., Minkande, E., Binam, F. and Sosso, M.A. (2008) Aspect épidémiologique et facteurs de gravité des AVC au Cameroun. Journal maghrébin d’anesthésie-réanimation et de médecine d’urgence, 15, 293-297. [9] Chiasseu, M. and Mbahe, S. (2011) Descriptive Study of Cerebro-Vascular Accidents in Douala, Cameroon. Medecine Tropicale, 71, 492-494. [10] Mapoure, N.Y., Luma, N.H., Ngahane, H.B.M., et al. (2012) Prevalence of Stroke Risk Factors among Urban Population in Douala, Cameroon. Revue Médecine et de Pharmacie, 2, 143-144. [11] Osuntokun, B.O., Bademosi, O., Akinkugbe, O.O., et al. (1979) Incidence of Stroke in a Africa City: Results from the Stroke Registry Ibadan, Nigeria, 1973-1975. Stroke, 10, 205-207.
http://dx.doi.org/10.1161/01.STR.10.2.205 [12] Sagui, E., M’baye, P.S., Dubecq, C., et al. (2005) Ischemic and Hemorrhagic Strokes in Dakar, Senegal: A Hospital Based Study. Stroke, 36, 1844-1847.
http://dx.doi.org/10.1161/01.STR.0000177864.08516.47 [13] Kumral, E., Ozkaya, B., Sagduyu, A., et al. (1998) The Ege Stroke Registry: A Hospital-Based Study in the Aegean Region, Izmir, Turkey. Analysis of 2.000 Stroke Patients. Cerebrovascular Diseases, 8, 278-288.
http://dx.doi.org/10.1159/000015866 [14] Awada, A. and Al Rajeh, S. (1999) The Saudi Stroke Bank. Analysis of the First 1000 Cases. Acta Neurologica Scandinavica, 100, 265-269. http://dx.doi.org/10.1111/j.1600-0404.1999.tb00392.x [15] Moulin, T., Tatu, L., Crépin-Leblond, T., et al. (1997) The Besan?on Stroke Registry: An Acute Stroke Registry of 2.500 Consecutive Patients. European Neurology, 38, 10-20.
http://dx.doi.org/10.1159/000112896 [16] Bornstein, N.M., Aronovich, B.D., Karepov, V.G., et al. (1996) The Tel Aviv Stroke Registry 3600 Consecutive Patients. Stroke, 27, 1770-1773. [17] Kouna, N.P., Millogo, A., Siemefo, K.F., et al. (2007) Aspects épidémiologiques et évolutifs des accidents vasculaires cérébraux au centre hospitalier de Libreville (Gabon). African Journal of Neurological Sciences, 26, 122-130. [18] Komolafe, M.A., Komolafe, E.O., Fatoye, F., et al. (2007) Profile of Stroke in Nigerians: A Prospective Clinical Study. African Journal of Neurological Sciences, 27, 360-365. [19] Sagui, E. (2007) Les accidents vasculaires cérébraux vasculaires en Afrique subsaharienne. Medecine Tropicale, 67, 596-600. [20] Feuzeu, L., Kengne, A., Balkau, B., et al. (2010) Ten-Year Change in Blood Pressure Levels and Prevalence of Hypertension in Urban and Rural Cameroon. Journal Epidemiology Community Health, 64, 360-365.
http://dx.doi.org/10.1136/jech.2008.086355 [21] Amu, E., Ogunrin, O. and Danesi, M. (2005) Re-Appraisal of Risk Factors for Stroke in Nigerian Africans: Prospective Case-Control Study. African Journal of Neurological Sciences, 24, 78-83. [22] Apetse, K., Matelbe, M., Assogba, K., et al. (2011) Prevalence of Dyslipidemia, Hyperglycemia and Hyperuricemia in Stroke Patients in Togo. African Journal of Neurological Sciences, 30, 88-93. [23] Toure, K., Diagne, S.N., Seck, L.B., et al. (2010) Predictors of Stroke Mortality at the Department of Neurology, Fann University Teaching Hospital, Dakar-Senegal. Facteurs prédictifs de morbidité par AVC à la clinique neurologique du CHU de FANN, Dakar-Senegal. African Journal of Neurological Sciences, 29, 325-334. [24] Napon, C., Sawadogo, R., Lampo, L., et al. (2011) Facteur de risque et étiologie de l’accident vasculaire cérébral ischémique du sujet jeune au Burkina Faso. Médecine d’Afrique noire, 58, 541-544.