# Understanding hydration and stroke outcomes in Zambia

> **NIH NIH R21** · JOHNS HOPKINS UNIVERSITY · 2021 · $169,147

## Abstract

PROJECT SUMMARY
A large percentage of patients are dehydrated (more accurately, in a volume contracted state) at the time of
stroke, and there is accumulating evidence that these patients do not recover as well as patients who are not
dehydrated. Although administering more intravenous fluids may benefit these patients by increasing
circulation to the brain, clinicians are often cautious in light of the risks for heart failure and brain swelling which
are common after stroke. Application of US guidelines about rehydration strategies after stroke may not be
appropriate seen in prior studies of rehydration in pediatric patients with malaria. Furthermore, no information
exists about stroke patients with varying comorbid conditions in low and middle income countries like those in
sub-Saharan Africa. In order to advance our knowledge, we need to understand the hydration status of stroke
patients in Zambia, explore physician perspectives about rehydration in the early stroke period and create
regionally appropriate tools to measure stroke outcomes.
In this proposal, we seek to demonstrate that simple and broadly available laboratory markers are capable of
quantifying a patient’s volume status at the time of stroke and to explore the relationship between volume
status and stroke outcomes using tools adapted for use in local Zambian languages. We will additionally
conduct focus group interviews with physicians to understand perspectives and current practices in Zambia.
Stroke patients from a single hospital in Zambia will have baseline lab testing to assess for dehydration and
quantification of stroke severity and functional outcomes over thirty days. We anticipate that the study will
establish the clinical relevance of a surrogate composite of labs to identify dehydration in the early stroke
period and explore the connection to stroke outcomes in this population. If dehydration is associated with
worsened outcomes after stroke, this research will provide the foundation for implementation of a scalable
rehydration intervention in future clinical trials. The long-term goal of this study team is to identify potential
interventions to improve morbidity and mortality after stroke that are applicable in both resource-rich and
resource-limited settings.
This research will provide critical data about dehydration and stroke in sub-Saharan Africa, help establish a
sustainable system for clinical research and stroke care in Zambia, and inform a future international trial of
rehydration after stroke. Given the high stroke rates and projections that stroke burden in sub-Saharan Africa
will continue to substantially increase in coming years, interventions are urgently needed to improve patient
outcomes in these countries. Such an intervention should be scalable and feasible to administer in non-tertiary
settings, with minimal resources, and by non-physician healthcare workers. Emerging evidence indicates that
early rehydration after stroke could be such an interventi...

## Key facts

- **NIH application ID:** 10250547
- **Project number:** 5R21NS118543-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Mona N Bahouth
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $169,147
- **Award type:** 5
- **Project period:** 2020-09-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10250547

## Citation

> US National Institutes of Health, RePORTER application 10250547, Understanding hydration and stroke outcomes in Zambia (5R21NS118543-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10250547. Licensed CC0.

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