Risk Factors and Outcome of Overt Stroke in Sickle Cell Patients Admitted in Two Reference Hospitals in Yaounde and Douala

Background: Worldwide, the prevalence of sickle cell disease (SCD) as of 2016 was estimated at 2%;that is 300,000 births annually. This study was focused on homozygous sickle cell disease which leads to several complications notably hemolytic crises, aplastic crises and vaso-occlusive crises like stroke. Sickle cell disease is the most common cause of childhood stroke. Stroke occurs in 17% - 24% of sickle cell children worldwide. Objectives: To determine the risk factors for overt stroke and outcome at discharge in sickle cell disease patients admitted in two reference hospitals in Cameroon. Method: This was a case-control study in two reference hospitals in Yaounde and Douala, carried out over the duration of 4 months, covering a 5-year period (December 2013 to December 2018). Included in the study, were all homozygous sickle cell children aged 6 months to 16 years during that period with or without stroke. A total of 1734 patients fulfilled the inclusion criteria. Out of these, 49 stroke patients participated and 687 were selected as controls. Data was collected from the patients’ files and books on a pretested data collection form, then entered in the software C.S Pro 7.1 before analysis. Stroke outcome at discharge was assessed using the modified Rankin scale (mRs) with structured interview. A patient was classified as good outcome if mRs < 3 and poor outcome if mRs ≥ 3. Statistical analysis was done with SPSS software version 22.0 for Windows. Results: A total of 736 patients participated in the study. Out of these, 391 (53.1%) were males and 345 (46.9%) were females. Overt stroke was found to have an estimated hospital prevalence of 3.29% in this population. Several risk and associated factors were identified such as frequent rate of acute chest syndrome (p < 0.001), acute chest syndrome in the past 2 weeks (p = 0.001), low steady state haemoglobin (p < 0.001) and previous stroke (p = 0.002). A poor outcome was observed in 16 (32.7%) of them. Conclusion: The occurrence of stroke in this population is 3.29% and several factors were associated with its occurrence.