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  • Title: Recent patterns and predictors of neurological mortality among hospitalized patients in Central Ghana.
    Author: Sarfo FS, Awuah DO, Nkyi C, Akassi J, Opare-Sem OK, Ovbiagele B.
    Journal: J Neurol Sci; 2016 Apr 15; 363():217-24. PubMed ID: 27000253.
    Abstract:
    BACKGROUND: Although neurological disorders are projected to escalate globally in the coming decades, there is a paucity of enumerated data on the burden, spectrum and determinants of outcomes of adult neurological admissions in resource-limited settings, especially within sub-Saharan Africa. OBJECTIVE: To evaluate the diversity, demography, and determinants of mortality among adult patients presenting with neurological disorders over a 6-year period in a tertiary medical referral institution in the Central belt of Ghana. METHODS: A retrospective analysis of data on neurological admissions and in-patient outcomes between 2008 and 2013 was undertaken. Data collected for analyses included age, gender, neurological diagnosis, documented comorbidities, duration of admission and vital status at discharge. Predictors of in-patient mortality were evaluated using Kaplan-Meier survival curves and Cox Proportional Hazards regression models. RESULTS: The 6494 admissions with neurological disorders represented 15.0% of all adult medical admissions over the study period. Male-to-female ratio of admissions was 1.6:1.0 with a mean±SD age of 52.9±20 years. The commonest neurological disorders were Cerebrovascular, Infectious, Seizures/epilepsy, Alcohol-use and Spinal cord disorders representing 54.0%, 26.7%, 10.3%, 4.0% and 2.3% of admissions respectively. Despite the low national HIV prevalence of 2.0%, the frequency of HIV infection among patients with infectious disorders of the nervous system was 40.9%. Overall crude mortality rate for neurologic admissions was 30.6% being 39.1% and 33.9% for Infectious affectations of the nervous system and stroke respectively and 7.4% for seizure disorders. Probability of death was higher for females than males aHR (95% CI) of 1.53 (1.40-1.68) and increasing age aHR (95% CI) of 1.11 (1.06-1.17) for each 20-year increase in age. CONCLUSION: Almost one in three patients admitted with neurological disease to a tertiary care center in Ghana died in the hospital, and the majority of these deaths were due to non-communicable conditions. Enhanced multi-dimensional public health disease prevention strategies and neurological inpatient care processes are warranted.
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