Early insights from a multi-centre national stroke surveillance initiative in Tanzania

Abstract

BACKGROUND: Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry. METHODS: From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality. RESULTS: A total of 1000 patients were registered with a mean age 60.2±15 years and 56.2% (562/1000) were females. Most strokes occurred in those aged 50-69 years 46.3% (463/1000). Hypertension was the most common risk factor 90.1% (901/1000), followed by diabetes 13.1% (131/1000), prior stroke 10.6% (106/1000) and HIV infection 3.5% (35/1000). Haemorrhagic and ischaemic strokes accounted for 57.9% (579/1000) and 38.3% (383/1000) of cases, respectively; and 5% (19/383) of ischaemic strokes presented within 4.5 h from symptom onset. In-hospital mortality was 31.5% (315/1000), highest among patients aged 50-59 years (23.2%). Independent predictors of mortality included previous cardiac disease (aOR 2.15; 95% CI: 1.18-3.94) and haemorrhagic stroke (aOR 1.38; 95% CI: 1.12-2.02). CONCLUSIONS: Stroke imposes a high burden in Tanzania, with substantial mortality and delayed presentation. Strengthening hypertension control, early stroke recognition, and organized stroke unit care are critical priorities. These findings provide foundational data for the national stroke surveillance initiative and support evidence-based planning for stroke prevention, acute care, and system readiness across Tanzania.