Trend in the profile of Congolese patients admitted in tertiary hospitals for stroke between 1970 and 2017

Abstract

Introduction: Stroke is a major global public health problem in terms of morbidity and mortality. The first studies of stroke in the Democratic Republic of the Congo (DRC) date back to 30 years ago. However, several recent data show an epidemiological change in risk factors of stroke in this country, which probably have an impact on the current profile of Congolese patients with stroke. This work aimed at studying the trend in the profile of Congolese stroke patients between 1970 and 2017. Materials and Methods: Clinical and paraclinical data on stroke were retrospectively collected from two cohorts of Congolese stroke patients admitted between 1970 and 1986, and between 2015 and 2017 respectively. A prospective modeling of mortality by the Kaplan-Meier estimator was carried out. Results: Between 1970 and 2017, there was a significant (p<0.05) increase in the prevalence, respectively, of advanced age from 30.4% to 45.6%, of female patients from 35.5% to 44.5%, of obesity from 14.0% to 23.0%, of hypertension from 53.0% to 70.1%, of diabetes mellitus from 12.0% to 23.0%, of previous stroke event from 14.0% to 18.6% and for ischemic stroke from 48% to 86.5%. The trend was to a significant decrease (p<0.05) in the proportion of patients presenting with coma on admission from 55.0% to 40.7%, of the hemorrhagic stroke from 52.0% to 13.5% and of the death rate from 44.0% to 18.1%. The major determinants of death were coma (HR = 2.8, p = 0.007) and hemorrhagic stroke (HR = 2.2, p = 0.02). Conclusion: The profile of Congolese patients admitted for stroke has substantially changed from 1970 to 2017. We observed an increase in the prevalence of most modifiable risk factors, a reversal of the proportions of hemorrhagic and ischemic strokes, and an improvement of the vital prognosis. Thus, an effort on primary and secondary prevention of stroke in the DRC is needed to be strengthened to further improve the life-threatening outcome of these conditions.