Background: There is little information on stroke morbidity in Kenya to inform health care planning. The disability-adjusted life-years (DALYs) are a time-based measure of health status that incorporates both disability and mortality. Methods: This was a multicenter prospective study in Kenya’s public tertiary hospitals conducted in 2015–2017. Data on sex, age, and global disability outcome were collected and used to calculate the sum of years of life lost prematurely due to stroke (YLL), the years of healthy life lost due to disability (YLD), and the DALYs. Results: Up to 719 adult stroke patients participated in the study. The peak age group for stroke was 60–64 years, with ischemic stroke accounting for 56.1% of the stroke cases. After 1-year follow-up, the YLD were 2,402.50, YLL were 5,335.99, and the DALYs were 7,738.49. YLD contributed 31% of the total DALYs. The DALYs varied by sex (male: 2,835.79; female: 4,902.70 years) and by stroke type (ischemic stroke: 4,652.98; hemorrhagic stroke: 3,085.51). The young age group (< 45 years) bore a greater burden accounting for 35.6% of the total DALYs. Conclusion: The YLD, YLL, and DALYs observed reinforce the need for targeted prevention of risk factors and comprehensive stroke care initiatives in Kenya.

1.
Murray CJ; GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Lancet
. 2017 Sep; 390(10100): 1151–210.
2.
Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al.; Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
Lancet
. 2015 Aug; 386(9995): 743–800.
3.
Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et  al.; GBD 2013 Writing Group; GBD 2013 Stroke Panel Experts Group. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: the GBD 2013 Study.
Neuroepidemiology
. 2015; 45(3): 161–76.
4.
Krishnamurthi RV, Moran AE, Feigin VL, Barker-Collo S, Norrving B, Mensah GA, et al.; GBD 2013 Stroke Panel Experts Group. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study.
Neuroepidemiology
. 2015; 45(3): 190–202.
5.
Nkusi AE, Muneza S, Nshuti S, Hakizimana D, Munyemana P, Nkeshimana M, et al. Stroke burden in Rwanda: A multicentre Study of stroke management and outcome.
World Neurosurg
. 2017 Oct; 106: 462–9.
6.
Walker R, Whiting D, Unwin N, Mugusi F, Swai M, Aris E, et al. Stroke incidence in rural and urban Tanzania: a prospective, community-based study.
Lancet Neurol
. 2010 Aug; 9(8): 786–92.
7.
Walker RW, Wakefield K, Gray WK, Jusabani A, Swai M, Mugusi F. Case-fatality and disability in the Tanzanian Stroke Incidence Project cohort.
Acta Neurol Scand
. 2016 Jan; 133(1): 49–54.
8.
Okeng’o K, Chillo P, Gray WK, Walker RW, Matuja W. Early Mortality and Associated Factors among Patients with Stroke Admitted to a Large Teaching Hospital in Tanzania.
J Stroke Cerebrovasc Dis
. 2017 Apr; 26(4): 871–8.
9.
Regenhardt RW, Biseko MR, Shayo AF, Mmbando TN, Grundy SJ, Xu A, et al. Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania.
Int J Qual Health Care
. 2018, Epub ahead of print.
10.
Ministry of Health. Kenya national strategy for the prevention and control of non-communicable diseases 2015–2020; 2015
11.
Etyang AO, Munge K, Bunyasi EW, Matata L, Ndila C, Kapesa S, et al. Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems.
Lancet Glob Health
. 2014 Apr; 2(4):e216–24.
12.
Banerjee TK, Dutta S, Ray BK, Ghosal M, Hazra A, Chaudhuri A, et al. Disease burden of stroke in Kolkata, India: derivation of disability-adjusted life years by a direct method.
Neuroepidemiology
. 2013; 41(2): 88–93.
13.
Hong KS, Kim J, Cho YJ, Seo SY, Hwang SI, Kim SC, et al. Burden of ischemic stroke in Korea: analysis of disability-adjusted life years lost.
J Clin Neurol
. 2011 Jun; 7(2): 77–84.
14.
Melse JM, Essink-Bot ML, Kramers PG, Hoeymans N; Dutch Burden of Disease Group. A national burden of disease calculation: dutch disability-adjusted life-years.
Am J Public Health
. 2000 Aug; 90(8): 1241–7.
15.
World Bank.
World Development Report 1993: Investing in health – world development indicators
. New York: Oxford University Press; 1993.
16.
Hong KS, Saver JL. Quantifying the value of stroke disability outcomes: WHO global burden of disease project disability weights for each level of the modified Rankin Scale.
Stroke
. 2009 Dec; 40(12): 3828–33.
17.
Hong KS, Saver JL. Years of disability-adjusted life gained as a result of thrombolytic therapy for acute ischemic stroke.
Stroke
. 2010 Mar; 41(3): 471–7.
18.
Hong KS, Saver JL, Kang DW, Bae HJ, Yu KH, Koo J, et al. Years of optimum health lost due to complications after acute ischemic stroke: disability-adjusted life-years analysis.
Stroke
. 2010 Aug; 41(8): 1758–65.
19.
Hong KS. Disability-adjusted life years analysis: implications for stroke research.
J Clin Neurol
. 2011 Sep; 7(3): 109–14.
20.
Kaduka L, Muniu E, Oduor C, Mbui J, Gakunga R, Kwasa J, et al. Stroke mortality in Kenya’s public tertiary hospitals: A prospective facility-based study.
Cerebrovasc Dis Extra
. 2018; 8(2): 70–9.
21.
Truelsen T, Heuschmann PU, Bonita R, Arjundas G, Dalal P, Damasceno A, et al. Standard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke).
Lancet Neurol
. 2007 Feb; 6(2): 134–9.
22.
Murray CJ. 1996. Rethinking DALYs. In: Murray CJL, Lopez AD, editors. The Global Burden of Disease. Vol 1 of Global Burden of Disease and Injury Series. Cambridge, MA: Harvard School of Public Health; 1996. pp. 1–98.
23.
WHO. Global comparative assessments in the health sector. Disease burden, expenditures and intervention packages. In: Murray CJ, Lopez AD, editors.
WHO
. Switzerland; 1994.
24.
Oduor CO, Keter A, Dieor LO, Siika AM, Williams LS. Stroke types, risk factors, quality of care and outcomes at a referral hospital in Western Kenya.
East Afr Med J
. 2015; 92: 7.
25.
Nakibuuka J, Sajatovic M, Nankabirwa J, Ssendikadiwa C, Furlan AJ, Katabira E, et al. Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30 day follow-up.
Springerplus
. 2015 Aug; 4(1): 450.
26.
Sarfo FS, Acheampong JW, Appiah LT, Oparebea E, Akpalu A, Bedu-Addo G. The profile of risk factors and in-patient outcomes of stroke in Kumasi, Ghana.
Ghana Med J
. 2014 Sep; 48(3): 127–34.
27.
Urimubenshi G, Cadilhac DA, Kagwiza JN, Wu O, Langhorne P. Stroke care in Africa: A systematic review of the literature.
Int J Stroke
. 2018 Oct; 13(8): 797–805.
28.
Lin C, Vakani R, Kussin P, Guhwe M, Farjat AE, Choudhury K, et al.; Neuroscience Knowledge Base Investigator Group. Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa - A survey based approach.
J Clin Neurosci
. 2017 Aug; 42: 71–4.
29.
Maredza M, Bertram MY, Tollman SM. Disease burden of stroke in rural South Africa: an estimate of incidence, mortality and disability adjusted life years.
BMC Neurol
. 2015 Apr; 15(1): 54.
30.
Achoki T, Miller-Petrie MK, Glenn SD, Kalra N, Lesego A, Gathecha GK, et al. Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Lancet Glob Health
. 2019 Jan; 7(1):e81–95.
31.
Muli G, Rhoda A. Quality of life amongst young adults with stroke living in Kenya.
Afr Health Sci
. 2013 Sep; 13(3): 632–8.
32.
Maredza M, Bertram MY, Gómez-Olivé XF, Tollman SM. Burden of stroke attributable to selected lifestyle risk factors in rural South Africa.
BMC Public Health
. 2016 Feb; 16(1): 143.
33.
Owolabi MO, Akarolo-Anthony S, Akinyemi R, Arnett D, Gebregziabher M, Jenkins C, et al.; Members of the H3Africa Consortium. The burden of stroke in Africa: a glance at the present and a glimpse into the future.
Cardiovasc J Afr
. 2015 Mar-Apr; 26(2 Suppl 1):S27–38.
34.
Barker-Collo S, Bennett DA, Krishnamurthi RV, Parmar P, Feigin VL, Naghavi M, et al.; GBD 2013 Writing Group; GBD 2013 Stroke Panel Experts Group. Sex Differences in Stroke Incidence, Prevalence, Mortality and DALYs: Results from the Global Burden of Disease Study 2013.
Neuroepidemiology
. 2015; 45(3): 203–14.
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