Improving post-discharge outcomes for people with stroke requires an

understanding of adverse events that occur during this period. We identified

causes of death amongst adults with stroke in Zambia.

83 deaths occurred during the post-discharge period. Causes of death were

provided for 68 (82%) and comprised of complications of stroke (25%, n=17), 

recurrent stroke (18%, n=12),aspiration pneumonia (16%, n=11), cardiac

disease (7%, n=5), kidney failure (7%, n=5), decubitus ulcers (4%, n=3), 

sepsis (4%, n=3), poorly controlled hypertension (4%, n=3), diabetes (4%, 

n=3), failure to feed (3%, n=2), anemia (3%, n=2), COVID (1%, n=1), and liver

failure (1%, n=1). Nearly one-quarter (n=19, 23%) of participants developed

new or distressing symptoms prior to death, including refractory

hypertension, decubitus ulcers, heart disease, deep vein thrombosis, kidney

failure, insomnia, failure to thrive, severe headache, hypotension, 

uncontrolled pain, and diarrhea. Half of deaths (n=25, 49%) occurred at

home because caregivers reported deaths were sudden or unexpected.

Nearly two-thirds of post-discharge deaths were preventable, and three- 

quarters of distressing end-of-life symptoms were preventable and/or

manageable with adequate medical care. A high percentage of at-home

deaths potentially suggests caregivers are unaware of warning signs of

deterioration or when to seek care. Improving post-discharge medical services for individuals with stroke could substantially improve long-term stroke outcomes in Zambia.