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Theses

Épidémiologie et pronostic des accidents vasculaires cérébraux à Parakou au Bénin

Abstract : Scarce data are available on stroke prognosis in Africa. The aim of this thesis is to study the epidemiology and prognosis of stroke in northern Benin. Firstly, a first study on the prevalence of stroke in the urban community of Titirou in Parakou. This was a cross-sectional study that included 4671 subjects over 15 years of age selected in a door-to-door survey. The World Health Organization Stroke Screening Tool was used. Subjects with suspected stroke were reviewed by a stroke neurologist for confirmation. A total of 54 subjects were confirmed as having a stroke with a prevalence of 1156 per 100,000 population [95% CI 850-1426]. Of these, 44 could not perform a CT scan for the stroke subtype. For the 10 who did have a scan, there were 6 ischaemic and 4 haemorrhagic strokes. Risk factors identified were age, high blood pressure, diabetes, low fruit and vegetable intake, previous heart disease and a family history of stroke. We conducted a systematic review and meta-analysis in sub-Saharan Africa and found that the 1 month stroke case fatality was 24.1% [95% CI: 21.5-27.0] and 33.2% [95% CI: 23.6-44.5] at 1 year. At 5 years, approximately 40% of the stroke patients had died. Diabetes was associated with high lethality and haemorrhagic stroke predicted short-term mortality while ischemic stroke was associated with high long-term mortality among survivors. Next, mortality was studied in a hospital cohort of stroke patients in Parakou. The mean age of the stroke patients was 58.2+/-14.2 years and ischaemic stroke accounted for 40% and 29.3% were undetermined (no CT scan). In-hospital mortality was estimated at 6.2%. Factors associated with this lethality were significant neurological deficit, impaired alertness on admission and complications in the acute phase. In the long term, in this hospital cohort, the case fatality was 25.8% at 3 months, 30.1% at 1 year and 42.1% after 5 years. The main causes of death after the first stroke were recurrence (30.5%); infectious causes (16.9%); metabolic disorders (8.5%) and cardiac causes (6.8%). Predictors of long-term death were age, high blood pressure and significant neurological deficit. Survivors had an impaired quality of life and 46.3% were independent at 1 year and 77.5% at 5 years. Compliance was poor with only 25.5% of survivors having good therapeutic adherence. In order to improve the prognosis and social participation of stroke survivors we proposed a clinical trial protocol to show the importance of group physical activity to improve social participation. In conclusion, strokes are frequent in the general population in Parakou with a high mortality similar to that observed in sub-Saharan Africa. This mortality would be explained by vascular risk factors (such as hypertension, diabetes mellitus), the complications in the acute phase and a deficit in terms of secondary prevention strategy. An approach based on group physical activity could not only improve the management of vascular risk factors but also social participation and reduce this mortality and the burden of stroke in this area.
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Tododjitche Thierry Armel Adoukonou. Épidémiologie et pronostic des accidents vasculaires cérébraux à Parakou au Bénin. Médecine humaine et pathologie. Université de Limoges; Université d'Abomey-Calavi (Bénin), 2021. Français. ⟨NNT : 2021LIMO0056⟩. ⟨tel-03553252⟩

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