Evaluate sex-specific stroke risk factors, characteristics and access to stroke care among adults with stroke in Zambia.

Sex-specific characteristics of stroke and access to post-stroke care data remain limited in sub-Saharan Africa (SSA).

Standardized data collection instruments were used to retrospectively collect demographic, clinical, laboratory and imaging results, and in-hospital mortality for consecutive adults admitted with stroke to the neurology inpatient ward at the University Teaching Hospital (UTH) in Lusaka, Zambia between October 2018 – April 2019. Strokes were classified as ischemic or hemorrhagic strokes based on CT appearance. Patients without neuroimaging were classified as unknown strokes. Descriptive statistics were compared by sex among adults with stroke using t-tests for continuous variables and chi-squared analysis for categorical variables.

Women constituted 62% (n=200) of the cohort, had lower rates of hemorrhagic stroke (22% vs 37%, p=0.001), and showed a trend toward older age (61+19 years vs 57+16 years, p=0.06). Risk factors such as hypertension (84% vs 74%, p=0.04) and diabetes (19% vs 13%, p=0.04) were more frequent in women. Several delays exist between stroke onset and care for women, including lack of CT imaging during hospitalization (82% vs 94% men, p=0.002), and, among those with neuroimaging, a trend towards longer delays in obtaining the imaging with69% of women having >1 day delay between admission and CT imaging compared to 53% of men (p=0.10).

Females with stroke have fewer hemorrhagic strokes and a higher prevalence of risk factors such as hypertension and diabetes. Women experience delays in acquiring post-stroke care, including in obtaining CT imaging, compared to men. Our data necessitates further study of social and socioeconomic factors that may result in women having reduced access to quality acute stroke and preventative care, as well as improving care at the primary care level for modifiable stroke risk factors.