2BAssistant Lecturer, School of Nursing, Jimma University, Ethiopia
Objective: To assess the prevalence, associated factors and treatment outcome among stroke patients admitted to the medical ward (stroke unit) at Jimma University Medical Center, Jimma, and South West Ethiopia.
Methods: a Retrospective cross-sectional study of medical records of patients who were admitted to stroke unit from December 1, 2015, to November 31, 2017. Data collection tools were adapted after reviewing relevant literature and collected by data collectors from patients’ chart using the structured checklist. Chi-square was done to know the association between the two variables. Data was cleared and compiled on a master sheet and analyzed manually by using a scientific calculator and presented by using standard tables and diagram.
Result: Among the total sample size of 394 students 367 have participated in the study with a response rate of 93.14%. From a total of study participants, 236(64.31%) had a hemorrhagic stroke while 131(35.69%) had an ischemic stroke and the majority of them had hypertension followed by diabetes mellitus which accounts 123 (29.64%) and 89(21.45%) respectively. Regarding treatment outcome among stroke patients admitted to stroke unit during study period majority of them were died followed by improved which accounts 139(37.87%) and 97(26.43%) respectively.
Conclusion and Recommendation: More than half the study participants 64.31% had a hemorrhagic stroke while 35.69% had an ischemic stroke. There is a significant association between treatment outcome and age and gender i.e., as a p-value of both is 0.00 which is less than 0.05. Therefore, it would recommend that Jimma University Medical Center administration, Jimma University Medical Center staff and other concerned bodies should create proper awareness about risk factors, treatment outcome, and prevention of stroke.
Keywords: Stroke; prevalence; Risk factors; Treatment outcome; JUMC, Ethiopia.
Treatments of people with stroke provided by multidisciplinary teams in a stroke unit result in better outcomes. Observational studies and trials of stroke treatment of patients from Europe, Australia, and Argentina have reported considerable variation in the processes of stroke treatment and associated outcomes (4, 5).
A retrospective cross-sectional study conducted in the first Hospital of Jilin University, Chang Chun, China on prevalence of stroke and associated risk factors showed that the overall prevalence of stroke in Jilin Province was 7.2% (95% CI 6.3% to 8.2%). Of all stroke cases, 91.7% (95% CI 87.4% to 94.6%) were ischemic stroke and 8.3% (95% CI 5.4% to 12.6%) were hemorrhagic stroke. The prevalence rates of dyslipidemia, smoking, and hypertension were ranked as the top three cerebro vascular risk factors and were 62.1%, 61.8%, and 57.3%, respectively. This study also showed that hypertension, dyslipidemia and lack of exercise were associated with ischemic stroke. However, only hypertension (OR=4.064, 95% CI 1.358 to 12.160) was significantly associated with hemorrhagic stroke (6).
Another retrospective study conducted on assessments of prevalence and risk factor among admitted patients in China showed that when type of stroke was tabulated against mortality, forty-nine (out of 187) (26.2%: 95% CI=19.8;32.6) of the patients with ischemic stroke died while 51/214 (23.8% 95% CI= 18.1;29.6) died among hemorrhagic strokes. No difference in mortality was found between hemorrhagic and ischemic strokes (p=0.584) (7).
A one-year retrospective study conducted on pattern and outcomes of patients with stroke admitted in tertiary hospitals in Zimbabwe showed that form a total of 450 stroke cases, (63% women) were included in the final analysis. The proportion of stroke cases among the admissions was 0.61%. Risk factors were hypertension (58.5%), diabetes (18%) and HIV, (14%)). Inhospital mortality was 24.9%, 95% CI (20.9; 29.0%). Mortality was associated with the place of admission (p< 0.001). Gender and side of stroke were significantly associated (p< 0.001). (8).A prospective hospital-based study conducted at another center in Ethiopia reported ischemic stroke as the commonest type of stroke. The pattern of admissions for neurological diseases among Ethiopian patients at two hospitals in Addis Ababa about three decades ago showed stroke (45%) and bacterial meningitis (12%) as the two most common causes of admissions (9).
A retrospective study conducted on assessment of risk factors and treatment outcome of stroke admissions at St. Paul’s Teaching Hospital showed that hypertension was found to be the most common antecedent risk factor in 92 (56.4%) patients. Diabetes mellitus (DM) was identified as a risk factor in 19 (11.6%) patients and 14 (8.5%) patients had both hypertension and diabetes mellitus. In-hospital case fatality rate of stroke was 30.1%. Most (45.4%) patients were discharged with the significant neurologic deficit. Only 36 (22.1%) patients were discharged with significant neurologic improvement. Among in-hospital deaths, the majority (63.3%) were in those with intracerebral hemorrhage. Of 11 patients who had a previous history of stroke, 7 (63.4%) died in hospital showing a statistically significant association (p=0.049) (10).
A retrospective cross-sectional study of patients admitted with a clinical diagnosis of stroke on characteristics and outcomes of the stroke at Tikur Anbessa Teaching Hospital showed that hemorrhagic stroke was the most common cause of stroke accounting for 57% of all patients. Hypertension was the most frequent risk factor identified followed by cardiac disease, 65.6%, and 22.7% respectively. The overall mortality was44.5%. Altered mental state and non-focal neurologic deficits were the only independent predictors of mortality (11). There is a great need for organized research that is closely linked to assess prevalence, associated risk factor, and treatment outcome of stroke. On the assessment of prevalence, associated risk factor and treatment outcome of stroke study is almost non-exist in our local setting (study areas). Although stroke is being recognized as one of the health problems, its prevalence, risk factor, and treatment outcome in the Ethiopian care setup has not been well documented. Information on stroke and associated risk factors could help in tuning up the service delivery for stroke patients. Therefore, the objective of this study was to assess prevalence, associated factors and treatment outcome among stroke patients admitted to the medical ward at Jimma University Medical Center, Jimma, and South West Ethiopia.
Variables |
Category |
Frequency |
Percentage (%) |
Age |
<25 |
14 |
3.82 |
25-44 |
40 |
10.9 |
|
45-64 |
182 |
49.59 |
|
=>65 |
131 |
35.69 |
|
Total |
367 |
100 |
|
Sex |
Male |
234 |
63.8 |
Female |
133 |
36.2 |
|
Total |
367 |
100 |
|
Marital status |
Married |
336 |
91.55 |
Single |
28 |
7.63 |
|
Others (widow, divorce…) |
3 |
0.82 |
|
Total |
367 |
100 |
|
Religion |
Muslim |
143 |
38.96 |
Orthodox |
117 |
31.88 |
|
Protestant |
56 |
15.26 |
|
Catholic |
37 |
10.08 |
|
Other(Java, Waqeeffata, Adventist) |
14 |
3.82 |
|
Total |
367 |
100 |
|
Ethnicity |
Oromo |
153 |
41.69 |
Ahmara |
116 |
31.61 |
|
Tigray |
37 |
10.08 |
|
Garage |
32 |
8.72 |
|
Dawaro |
16 |
4.36 |
|
Other(Kaffa,Hadiya, Silte,sumale, ) |
13 |
3.54 |
|
Total |
367 |
100 |
Parameter |
Type of stroke No (%) |
Total |
X2 |
p-value |
|||||
Ischemic |
Hemorrhagic |
||||||||
No |
(%) |
No |
(%) |
No |
(%) |
||||
Age (years) |
<25 |
5 |
1.36 |
9 |
2.45 |
14 |
3.82 |
1.36 |
0.008 |
25-44 |
11 |
2.99 |
29 |
7.9 |
40 |
10.9 |
|||
45-64 |
66 |
17.98 |
116 |
31.61 |
182 |
49.59 |
|||
=>65 |
49 |
13.35 |
82 |
22.34 |
131 |
35.69 |
|||
Total |
131 |
35.69 |
236 |
64.31 |
367 |
100 |
|||
Gender |
Male |
92 |
25.06 |
194 |
52.86 |
286 |
77.93 |
7.02 |
0.714 |
Female |
39 |
10.62 |
42 |
11.44 |
81 |
32.07 |
|||
Total |
131 |
35.69 |
236 |
64.31 |
367 |
100 |
Risk factor |
Number |
(%) |
Hypertension |
123 |
29.64 |
Diabetes Mellitus |
89 |
21.45 |
Previous Stroke |
66 |
15.91 |
Atrial fibrillation |
45 |
10.84 |
Transient ischemic attack |
43 |
10.36 |
Structural heart disease |
43 |
10.36 |
Others(HIV, RF, CHF) |
6 |
1.44 |
Total |
415 |
100 |
Socio-demographic factor |
Treatment Outcome |
Total |
X2 |
Df |
p-value |
|||||||||
Dead |
Improved |
Discharged with Neurologic Deficit |
Discharged against Medical Advice |
|||||||||||
No |
(%) |
No |
(%) |
No |
(%) |
No |
(%) |
No |
(%) |
68.1 |
9 |
0 |
||
Age |
<25 |
2 |
0.54 |
6 |
1.63 |
2 |
0.54 |
4 |
1.09 |
14 |
3.82 |
|||
25-44 |
9 |
2.45 |
13 |
3.54 |
11 |
2.99 |
7 |
1.91 |
40 |
10.9 |
||||
45-64 |
51 |
13.89 |
66 |
17.98 |
40 |
10.89 |
25 |
6.81 |
182 |
49.59 |
||||
=>65 |
77 |
20.98 |
12 |
3.27 |
33 |
8.99 |
9 |
2.45 |
131 |
35.69 |
||||
Total |
139 |
37.87 |
97 |
26.43 |
86 |
23.43 |
45 |
12.26 |
367 |
100 |
||||
Gender |
Male |
116 |
31.61 |
78 |
21.25 |
70 |
19.07 |
22 |
5.99 |
286 |
77.93 |
25.5 |
3 |
0 |
Female |
23 |
6.27 |
19 |
5.18 |
16 |
4.36 |
23 |
6.26 |
81 |
32.07 |
||||
Total |
139 |
37.87 |
97 |
26.43 |
86 |
23.43 |
45 |
12.26 |
367 |
100 |
- GBD (2013): Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study. 2013; 385(9963):117–171. doi: 10.1016/S0140-6736(14)61682-2
- Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC et al., (2015): American Heart Association/ American Stroke Association focused update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015; 46(10):3020-3035. doi: 10.1161/STR.0000000000000074
- Donald Silberberg and Elly Katabira. (2015) Neurological Disorders: Disease and Mortality in Sub-Saharan Africa. 23: 351-359.
- Govan L, Weir C, Langhorne .P. For the Stroke Unit Trialists' Collaboration. Organized inpatient (stroke unit) care for stroke. Stroke. 39(8): 2402–2403
- Bhalla A, Grieve R, Tilling K, Rudd AG, Wolfe CD. Older stroke patients in Europe: stroke care and determinants of outcome. Age Ageing. BIOMED II European Study of Stroke Care.2004; 33(6):618-624. doi:10.1093/ageing/afh219
- Zhang F-L, Guo Z-N, Wu Y-H, Liu H-Y, Luo Y, Sun M-S, et al., Prevalence of stroke and associated risk factors: a population-based cross-sectional study from northeast China. BMJ Open.7(9):e015758
- Li J, Wang L, Chao B, et al. (2015); Prevalence of stroke and risk factor in China: A retrospective one-year study 386: S49.
- Farayi K, Aimee S, Lovemore G, Hakim J, Chikwasha V. Clinical characteristics and outcomes of patients with stroke admitted in tertiary hospitals in Zimbabwe: A retrospective one-year study.2017; 29(2):177-182.
- Alemayehu CM, Birhanesilasie SK. Assessment of stroke patients: Occurrence of an unusually high number of hemorrhagic stroke cases in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Clin Med Res.2013; 2(5): 94-100.doi: 10.11648/j.cmr.20130205.11
- Gedefa B, Menna T, Berhe T, Abera H. Assessment of Risk Factors and Treatment Outcome of Stroke Admissions at St. Paul’s Teaching Hospital, Addis Ababa, Ethiopia. J Neurol Neurophysiol. 2017; 8: 431. doi: 10.4172/2155-9562.1000431
- Zenebe G, Alemayehu M, Asmera J. Characteristics and outcomes of a stroke at Tikur Anbessa Teaching Hospital, Ethiopia. Ethiop Med J. 2005; 43(4):251-259
- Zhang F-L, Guo Z-N, Wu Y-H, Liu H-Y, Luo Y, Sun M-S, et al., Prevalence of stroke and associated risk factors: a population-based cross-sectional study from northeast China. BMJ Open. 7(9):e015758
- Li J, Wang L, Chao B, et al. (2015); Prevalence of stroke and risk factor in China: A retrospective one-year study 386: S49.
- Farayi K, Aimee S, Lovemore G, Hakim J, Chikwasha V. Clinical characteristics and outcomes of patients with stroke admitted in tertiary hospitals in Zimbabwe: A retrospective one-year study.2017; 29(2):177-182.
- Alemayehu CM, Birhanesilasie SK. Assessment of stroke patients: Occurrence of an unusually high number of hemorrhagic stroke cases in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Clin Med Res. 2013; 2(5): 94-100. doi: 10.11648/j.cmr.20130205.11
- Gedefa B, Menna T, Berhe T, Abera H (2017) Assessment of Risk Factors and Treatment Outcome of Stroke Admissions at St. Paul’s Teaching Hospital, Addis Ababa, Ethiopia. J Neurol Neurophysiol. 2017; 8:431.doi: 10.4172/2155-9562.1000431
- Zenebe G, Alemayehu M, Asmera J. Characteristics and outcomes of a stroke at Tikur Anbessa Teaching Hospital, Ethiopia. Ethiop Med J. 2005; 43(4):251-259
- Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al., Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Study. Lancet.2014;383(9913):245–254.
- Thomas Truelsen, Stephen Begg, Colin Mathers. The global burden of cerebrovascular disease.
- O. P. Adudu, OA. Ogunrin and OG. Adudu. Morbidity and Mortality Patterns among Neurological Patients in the Intensive Care Unit of a Tertiary Health Facility. Annals of African Medicine. 2007;6(4):174-179
- The Global Burden of Disease. World Health Organization. 2014 Update. Geneva.