Stroke prevalence and stroke-related mortality in sub-Saharan Africa are amongst the highest in the world.  Understanding risk factors and outcomes for first-ever and recurrent stroke in this region could lead to improvements in stroke prevention strategies.

We conducted a retrospective chart review of sociodemographic, clinical and hospitalization characteristics of all adults with stroke admitted to the University Teaching Hospital in Lusaka, Zambia.  Vital status at 90-days was obtained by phone call.  Participants were dichotomized into first-ever versus recurrent stroke, and group characteristics were compared. 

Participants with first-ever stroke (n=253; 78%) were more likely to be male (42% vs. 25%, p=0.01) and younger (58+18 vs 66+14 years, p<0.001). Ischemic strokes (69% vs. 55%) were more common and intracerebral hemorrhage (ICH; 15% vs. 32%) less common amongst those with recurrent stroke (p=0.03).  Adults with recurrent stroke more commonly presented with GCS<12 (92% vs 64%, p=0.004) and were more likely to have hypertension, heart disease, and a family history of stroke.  Only 58% and 50% of those with recurrent stroke and known hypertension and diabetes, respectively, were on treatment.  Adults with recurrent stroke had longer length of stay (10 vs 7 days, p=0.008) and higher rates of aspiration pneumonia (30% vs 12%, p=0.001).  In-hospital mortality did not differ (31% vs 22%, p=0.12), but 90-day mortality was higher amongst those with recurrent stroke (59% vs. 36%, p=0.001).

Adults with recurrent stroke in Zambia are older, at higher risk of aspiration pneumonia, and require longer hospitalizations.  Secondary stroke prevention regimens were non-optimal in many adults with recurrent stroke.  While in-hospital mortality did not differ, post-discharge mortality was markedly higher in adults with recurrent stroke.  This suggests both primary and secondary prevention programs are needed to reduce stroke burden and improve outcomes in Zambia.