Objectives: To determine whether mortality from and the pattern of stroke have changed since the last study in Accra in 1981, the sites of the different types of stroke and the role of hypertension and cerebrovascular disease and to describe the age and sex distribution.
Design: Cross-sectional study of fatal stroke cases over a five-year period.
Setting: Korle Bu Teaching Hospital, Accra, Ghana.
Subjects: All fatal strokes in persons aged 20 years and above, confirmed at autopsy.
Results: Mortality from stroke constituted eleven per cent of autopsies carried out at the Korle Bu Teaching Hospital, Accra, in the five-year period 1994 to 1998. A similar study in 1981 showed the same proportion indicating that the proportion of deaths due to stroke has not changed. The overall male to female ratio was 1.2:1 but the relative risk (RR) of death from stroke was higher for females at 1.23 (95% CI=1.10-1.38). Although haemorrhagic stroke was still more common than cerebral infarction the proportion (61 %) was much less than that of the previous study (89%). Males were more likely (RR 2.07 95% CI=1.75-2.45) to die from haemorrhagic stroke than females (RR 1.32, 95% CI=1.10-1.57). Sixty nine per cent of stroke patients died in less than 24 hours after onset of stroke. The peak age of fatal haemorrhagic stroke was 50-59 years and that of infarction was 60-69 years. Male mortality exceeded female mortality in all age groups up to 60-69 years after which female mortality became preponderant (chi2 with Yates correction = 4.28,0.05>p<0.02). Hypertension was the dominant factor in haemorrhage and an important factor in infarction while cerebral atherosclerosis was the major factor in infarction. Haemorrhage into intraparenchymal sites, mainly the cerebral hemispheres, was more common than into the subarachnoid space.
Conclusion: The proportion of deaths from stroke in autopsy cases has not changed since the last study in 1981 and stroke still remains an important cause of death in Accra. Cerebral haemorrhage is still a more common cause of fatal stroke than infarction, although the pattern appears to be changing gradually. Females have a slightly greater risk of dying from stroke than males. A community-based study is needed to provide more insight into some aspects of the problem and to provide the basis for appropriate interventions and policy, especially with regard to a control of risk factors.