Three-Year Post-Stroke Outcomes in Urban Northwestern Tanzania

Joshua Ngimbwa¹Goodluck Nchasi²Innocent Kitandu Paul³Anna Kasala⁴Lilian Andrew Mwamba⁵Sospeter Berling³Matilda K Basinda³Gladness Xaiver³Benjamin Andrew⁴Akili Mawazo⁶Dorice Lucas⁴Karim Mahawish⁷Ladius Rudovick⁴Bahati Wajanga⁴Robert Peck⁸Sarah Shali Matuja^3*

• ¹Aga Khan University, Dar es Salaam, Tanzania
• ²Department of Oncology, Bugando Medical Centre (BMC), Mwanza, Tanzania
• ³Catholic University of Health and Allied Sciences (CUHAS), Bugando, Tanzania
• ⁴Bugando Medical Centre (BMC), Mwanza, Tanzania
• ⁵Jinzhou Medical University, Jinzhou, Liaoning Province, China
• ⁶Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
• ⁷Stroke Medicine, Counties Manukau District Health Board, Auckland, Auckland, New Zealand
• ⁸Center for Global Health, Weill Cornell Medicine, Cornell University, New York, New York, United States

Background: Stroke is one of the leading causes of death and disability globally. Despite advancements in acute stroke care, the long-term outcomes in Tanzania have not been extensively studied. This study aimed to investigate the long-term post-stroke outcomes among adults with stroke admitted at a large tertiary hospital in Northwestern Tanzania.Methods: Adults (≥18 years) with stroke who were registered at the Lake Zone Stroke Registry Study at Bugando Medical Centre between March 2020 and October 2021, were prospectively followed up to October 2024. Stroke diagnosis and classification were confirmed using brain imaging, and baseline stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Data on case fatality were collected using the modified Rankin Scale along with information on secondary stroke prevention. Kaplan Meier analysis was used to describe survival, and the Cox regression model was used to examine independent factors associated with fatality.The study included 301 adults, with a mean age of 65.5±14 years, of whom 51% (153/301) were females and 68% (205/301) had ischaemic strokes. Case fatality rates were 42.9% (98/228) at 1-year, 75.9% (173/228) at 2-years, and 96.5% (220/228) at 3-years. Independent factors associated with fatality were: severe stroke {aHR 7.9, 95% CI: 2.3-27.4, p=0.001}, moderate to severe stroke {aHR 4.6, 95% CI: 1.3-16.1, p=0.017}, lack of health insurance coverage {aHR 3.7, 95% CI: 1.9-6.8, p<0.001} and previous stroke {aHR 3.3, 95% CI: 1.3-8.3, p=0.01}. Attendance rates of follow-up clinics and physiotherapy among survivors was 28.6% (86/301) and 8.6% (26/301) respectively. Among hypertensives and diabetics adults: 32% (83/257) and 41% (20/49) were adherent to anti-hypertensive and diabetic medications respectively.This study highlights the high long-term case fatality rates among adults with stroke in Northwestern Tanzania with stroke severity, lack of health insurance, and previous strokes being key factors associated with fatality. Low attendance rates at follow-up clinics and poor adherence to medications among hypertensive and diabetic stroke survivors underline the importance of strengthening post-stroke care systems including health insurance coverage to improve survival and quality of life.