High early mortality and contributing factors in seropositive neuromyelitis optica spectrum disorder at a tertiary hospital in Zambia.

BACKGROUND/

OBJECTIVES

Mortality of aquaporin-4 positive neuromyelitis optica spectrum disorder (NMOSD) in Africa is understudied. This study sought to report preliminary findings of one-year mortality among a cohort of seropositive NMOSD patients in Zambia and characterize key contributing factors.

METHODS

This cross-sectional study included seropositive patients with NMOSD (via ELISA) at a tertiary care hospital in Zambia between 2019 and 2025. Demographic, clinical, treatment characteristics and mortality at one year are reported using descriptive statistics.

RESULTS

Among 13 seropositive NMOSD patients, the mean age at symptom onset was 33.7 years, and most were female (n = 11, 85%) and black African (n = 12, 92%). Of ten patients with at least one year of follow-up, four died within one year of symptom onset. All deceased patients were female, had at least two relapses within the first year of disease onset, and all developed longitudinally extensive transverse myelitis (LETM). Half of the deceased patients had been initiated on immunosuppression, both with rituximab. One-year mortality was higher in seropositive NMOSD as compared with multiple sclerosis and stroke in Zambia.

CONCLUSIONS

Higher mortality among those with LETM, more relapses, immobility-related complications, and limited access to immunosuppression all likely contributed to the observed high early mortality among seropositive NMOSD in Zambia. Urgent action to address contributing factors is needed.