Dissertation (MMED Internal Medicine)Background: Stroke is the leading cause of disability (4.5%) and the second most common cause of death (11.85%) following ischemic heart disease worldwide. A better understanding of the predictors of stroke outcomes might benefit the interventions that aim at promoting stroke favourable outcomes. Objective: This study aimed determining the risk factors, clinical patterns, and outcomes of a stroke at 30 days post-admission among adult patients at referral hospitals in Dodoma. Methods: This study employed a prospective longitudinal observational design. The study enrolled adult patients with confirmed acute stroke by Computed Tomography scan or Magnetic Resonance Imaging, admitted in Dodoma Referral Hospitals. The National Institute of Health Stroke Scale was used to assess stroke severity at admission and Modified Rankin Score was used to assess stroke outcomes. A comparison of risk factors, clinical profiles, and outcomes was done using the Chi-square test. A multinomial logistic regression model was used to determine the predictors of stroke outcomes at thirty days. Results: This study recruited 144 first ever stroke adult patients, 73(50.69%) were females. The mean age was 65.68 15.35years. The major stroke subtype was Ischemic stroke (63.89%). Patients with >65 years p=0.011 and severe stroke (OR 4.104, p=<0.0001) were predictors of poor outcomes. Loss of consciousness (OR 65.00, p=0.0002), aspiration pneumonia (OR 12.99, p=0.0173), haemorrhagic stroke p=0.047, and limb weakness (OR 9.286, p=0.0388) were clinical presentations associated with 30days outcomes. More than half (n=82) 56.94% had recovery with neurological deficit, (n=14) 9.72% had fully recovery while mortality was (n=48) 33.33%. Conclusion: This study shows that recovery with neurological deficit is high in patients with moderate stroke and mortality was high in severe stroke. Care of acute stroke is vital to promote favourable outcomes.