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Years: 2019-2020

Training Site: University of Zambia (UNZA)

Country: Zambia

Mentors: Deanna Saylor, MD, MHS; Kondwelani Meteyo, MBchB, MMed

Title: “Developing a Clinical Prediction Score to Distinguish Ischemic vs. Hemorrhagic Stroke in the Zambian population”

Program Objectives:

Aim 1: Establish stroke frequency, morbidity, and mortality. Hypotheses:

1) Stroke patients will constitute >10% of all admissions to the inpatient medicine wards at UTH.

2) Hemorrhagic stroke patients will constitute >40% of all stroke patients.

3) Patients with hemorrhagic stroke will have a higher morbidity and mortality (>50%) than patients with ischemic stroke.

Aim 2: Evaluate the performance characteristics of the Siriraj, Guy’s Hospital, Greek, and JUST scores in differentiating ischemic from hemorrhagic stroke. Hypotheses:

1) The JUST score will prove to have the highest validity of all scores tested.

2) All scores will demonstrate lower sensitivity and specificity in the Zambian population than in the original population in which they were developed.

Aim 3: Identify risk factors for ischemic and hemorrhagic stroke. Hypotheses:

1) Both traditional (e.g. hypertension, diabetes, hyperlipidemia) and non-traditional (e.g. rural vs. urban location, HIV infection, socioeconomic status, etc.) risk factors for stroke subtype will be identified.

2) A clinical prediction score for ischemic versus hemorrhagic stroke that is applicable to the Zambian population can be developed based on risk factors identified in this cohort.

NIH Support: Fogarty scholars doctoral training award; Gilead Foundation supplement