**4. Outcome of stroke**

Few studies have been done on the outcomes of stroke in Sub Saharan Africa (SSA) [11, 32, 48]. Initial stroke severity and in-hospital complications were found to be determinants of 28-day case fatality in Mozambique [48]; while in South Africa the case fatality was found to be associated with poor functional ability but not with age [32]. An important outcome post stroke is function which will be discussed in the next section. In Malawi mild stroke and the male gender were associated with favourable outcomes and being HIV positive did not worsen the outcomes of stroke [11]. In Zimbabwe, a 25% in hospital case fatality rate was reported [20]. Some of the patients who died had pneumonia, most probably from aspiration [20].

As mentioned before, a third of all patients with stroke will fully recover, a third will live with some disabilities and the other third will die [13]. Those who survive stroke and are disabled will require some form of care [7, 13, 49, 50]. Several factors affect prognosis post stroke. Some of these include demographic characteristics, type of stroke, severity and immediate and long-term post stroke care [51]. Factors that may contribute to a good prognosis after stroke are youth, mild deficit, speedy resolution of symptoms, no loss of consciousness, independent sitting balance, no cognitive impairment or urinary incontinence [52]. Medical complications are frequent among individuals who have had a stroke, increasing the length of hospitalisation as well as the costs of care. These complications are a major cause of death in the acute and sub-acute stroke phases [53]. Some events, such as cardiac abnormalities, dysphagia and pneumonia, are often apparent early after stroke onset whereas others, such as bed sores, venous thrombosis, and falls, can occur after several days [54, 55]. Potential cardiac complications such as atrial fibrillation and myocardial infarction are also common after stroke [54].

Neurological recovery in stroke occurs mainly within 1–3 months post stroke, whilst functional recovery occurs more fully at 4–6 months [56]. According to Doğan et al., 10% of stroke patients recover spontaneously within the first month, and 80% of patients are candidates for rehabilitation while the last 10% do not respond to treatment [57]. This is however different from the 2007 WHO report [13]. The neurological recovery of stroke often improves significantly within 3 weeks and function may continue to improve up to 18 months [46].

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*Supporting Survivors of Stroke in Low Resource Settings DOI: http://dx.doi.org/10.5772/intechopen.86900*

tion in different regions.

as previously mentioned.

females in Ghana [68].

**4.1 Mortality among people who suffer from stroke**

more important so as to reduce mortality in communities.

Two-thirds of stroke deaths occur in people living in developing countries and 40% of those with stroke aged less than 70 years [58]. The Inter-stroke phase 1 study 2007–2009 reported that 5.7 million deaths in 2005 were due to stroke and the number is projected to rise to 7.8 million by 2030 and 87% of these will be in low or middle in-come countries. Similar findings were reported when it was estimated that approximately 80% of all deaths by stroke occur in developing countries [59]. However, age adjusted stroke mortality in adults in SSA seemed to be like developed countries [60]. This they attributed to lack of accuracy of longitudinal data collec-

In Africa, stroke accounts for 0.9–4% of hospital admissions and 2.8–4.5% of total deaths [61]. This is in line with findings elsewhere where it was reported that mortality due to stroke in low- and middle-income countries was the 5th leading cause of death in adults aged 15–59 years [62]. The same study found stroke to be the 7th leading cause of death in SSA with HIV/AIDS at the top. According to UNAIDS, HIV related deaths made up 16% in South Africa, 17% in Nigeria and 6% in Zimbabwe of total death [63]. This makes the need to support survivors of stroke

This high stroke case fatality in Africa was found to be related to limited healthcare facilities and uncontrolled risk factors such as hypertension and diabetes which conditions and resultant death can be prevented [64]. Higher values have been found from community studies where deaths due to stroke contribute 5–10% of deaths in Tanzania [65]. Other studies in Africa have reported between 20 and 45% case fatality rates between admission and one-year post stroke [31, 32]. Stroke has been projected to be the 3rd leading cause of death in low income countries by 2030. Therefore, there is need for vigilance in prevention and care of patients with stroke

In South Africa based on an 11-disability adjusted number of life years lost per 1000 of the population, stroke was declared a catastrophic illness as the prevalence of stroke in South Africa was reported to be 3000/100,000 people [66], much higher than the 500/100,000 people living with strokes in developed countries [67]. It may be safe to conclude that Sub-Saharan Africa has relatively low stroke incidence and prevalence but has high mortality rates [17]. This is may be attributed to high prevalence of smoking and other risk factors for stroke. Factors associated with mortality include severity of stroke, being a woman, haemorrhagic stroke, low level of consciousness upon admission and failing a swallow test, irreversible coma, stroke recurrence and other secondary infections and pressure sores, increased age, diabetes mellitus and stroke subtypes as independent predictors of 30-day case fatalities. Similarly, the relative risk of death from stroke was found to be higher for

Ischaemic stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score of less than 10 have a 60–70% chance of a favourable outcome at 1 year compared with only a 4–16% chance if the score is more than 20 [53]. However, ischaemic strokes have better prognosis, but less functional prognosis compared to haemorrhagic strokes [69]. Upon follow up, 23% of patients with ischaemic stroke had died while 65% of the survivors were functionally independent at 1 year [69]. Meanwhile, among the patients with haemorrhagic strokes, 62% had died, and among the survivors, 68% were functionally independent at 1 year. Among those with subarachnoid haemorrhage, 48% were dead and 76% of the survivors were functionally independent. The differences in mortality during the acute phase between the two types of strokes are said to be due to the fact that haemorrhagic strokes are more severe at onset than ischaemic strokes. This results in

*New Insight into Cerebrovascular Diseases - An Updated Comprehensive Review*

quality of life for both the stroke survivor and the caregiver.

management options.

systems for caregivers in communities.

infarction are also common after stroke [54].

**4. Outcome of stroke**

result in unsatisfactory care-giving as a result of higher caregiver burden and poor

It is not clear if during the hospitalisation period the rehabilitation personnel in developing countries meet with the caregivers of people who have survived a stroke to discuss ongoing progress and pre-discharge plans. Maybe this could facilitate caregivers' access to information on stroke and its consequences, prevention and

In Zimbabwe, management of survivors of stroke involves acute care in hospitals and not much of the rapid response and thrombolytic therapy in government hospitals. Even in private hospitals the costs of thrombolytic therapies are prohibitive. Most survivors cannot afford the CT scans and MRIs either. Once survivors are medically stable the rehabilitation professionals intervene whilst patients are still admitted. However, rehabilitation systems to support survivors of stroke have also not been fully developed. This means that hospital management of survivors of stroke is also deficient. Survivors are then discharged home with very minimal preparation and not notwithstanding the challenges of bringing them back for review. There are also no call centres in communities to assist, hence no support

Few studies have been done on the outcomes of stroke in Sub Saharan Africa (SSA) [11, 32, 48]. Initial stroke severity and in-hospital complications were found to be determinants of 28-day case fatality in Mozambique [48]; while in South Africa the case fatality was found to be associated with poor functional ability but not with age [32]. An important outcome post stroke is function which will be discussed in the next section. In Malawi mild stroke and the male gender were associated with favourable outcomes and being HIV positive did not worsen the outcomes of stroke [11]. In Zimbabwe, a 25% in hospital case fatality rate was reported [20]. Some of the patients who died had pneumonia, most probably from aspiration [20]. As mentioned before, a third of all patients with stroke will fully recover, a third will live with some disabilities and the other third will die [13]. Those who survive stroke and are disabled will require some form of care [7, 13, 49, 50]. Several factors affect prognosis post stroke. Some of these include demographic characteristics, type of stroke, severity and immediate and long-term post stroke care [51]. Factors that may contribute to a good prognosis after stroke are youth, mild deficit, speedy resolution of symptoms, no loss of consciousness, independent sitting balance, no cognitive impairment or urinary incontinence [52]. Medical complications are frequent among individuals who have had a stroke, increasing the length of hospitalisation as well as the costs of care. These complications are a major cause of death in the acute and sub-acute stroke phases [53]. Some events, such as cardiac abnormalities, dysphagia and pneumonia, are often apparent early after stroke onset whereas others, such as bed sores, venous thrombosis, and falls, can occur after several days [54, 55]. Potential cardiac complications such as atrial fibrillation and myocardial

Neurological recovery in stroke occurs mainly within 1–3 months post stroke, whilst functional recovery occurs more fully at 4–6 months [56]. According to Doğan et al., 10% of stroke patients recover spontaneously within the first month, and 80% of patients are candidates for rehabilitation while the last 10% do not respond to treatment [57]. This is however different from the 2007 WHO report [13]. The neurological recovery of stroke often improves significantly within 3

weeks and function may continue to improve up to 18 months [46].

**318**
