Mohammed Ammas Siraj, Degu Amsalu, Woldekidan Nigist Alemayehu, Adem Fuad, Edessa Dumessa
Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy and Health Science, United States International University Africa, Nairobi, Kenya.
SAGE Open Med. 2021 Jul 31;9:20503121211036789. doi: 10.1177/20503121211036789. eCollection 2021.
To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa.
The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute's critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model.
A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17-0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24-0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12-0.19) and Southern Africa (18%, 95% confidence interval = 0.06-0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function.
The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.
评估撒哈拉以南非洲地区急性中风的院内死亡率及其预测因素。
在PubMed/Medline、Embase、CINAHL和谷歌学术数据库中进行文献检索。通过标题和摘要筛选检索到的研究，然后评估全文是否符合纳入标准。使用乔安娜·布里格斯研究所的批判性评价清单评估纳入研究的方法学质量。使用漏斗图不对称性和埃格检验评估发表偏倚。使用Stata软件15.0版采用随机效应模型进行数据分析。
本系统评价和荟萃分析共纳入27项研究，总样本量为6331。中风导致的院内死亡率合并估计患病率为22%（95%置信区间=0.17 - 0.27）。西非的中风死亡率（37%，95%置信区间=0.24 - 0.50）高于东非（15%，95%置信区间=0.12 - 0.19）和南非（18%，95%置信区间=0.06 - 0.19）。在三项研究中，出血性中风的死亡率（25%）高于缺血性中风（14%）。与较高死亡率相关的危险因素包括入院时格拉斯哥昏迷量表评分、中风严重程度、年龄、性别、高血压的存在以及肾功能下降。
撒哈拉以南非洲地区中风的住院死亡率很高。因此，迫切需要进一步开展关于中风亚型的流行病学研究，并进行患者层面的荟萃分析，以了解与死亡率相关的危险因素，并开展适当干预以遏制该地区的高死亡率。
