Stroke mortality is a growing concern in low-income countries, including Madagascar. This study examines stroke-related deaths in Mahajanga, a coastal city in western Madagascar, using death registers to better understand the local epidemiological burden of stroke.

A retrospective analysis of death registers from the Municipal Hygiene Office (BMH) in Mahajanga was conducted for 2019. All deaths recorded within the city were included, excluding non-residents and incomplete records. Stroke-related deaths were identified using ICD-9/10 codes or explicit descriptions. Demographic data and years of life lost (YLL) were analyzed.

Among 1701 reported deaths, 161 (9.4%) were attributed to stroke. Stroke accounted for 9.4% of all-cause mortality and 14.5% of deaths among individuals aged ≥ 50 years. The mean age of stroke-related deaths was 61.3 years, and males predominated (sex ratio 1.3). More than half (52.1%) of stroke deaths occurred at home. Stroke accounted for 2324.7 years of life lost (YLL) and represented 59.62% of all neurological-related deaths.

Stroke was identified as a major cause of mortality in Mahajanga. The findings indicate a rising trend in stroke-related deaths over recent decades, reflecting persistent challenges in stroke prevention and management. High rates of garbage coding (26.27%) in death certification limit data reliability.