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Bekele F, Tafese L, Mohammed M, Gamachu Labata B, Gerbaba Chemeda G, Fekadu G. Magnitude and predictors of stroke treatment outcomes in low resource settings: A cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study. Stroke Res Treat 2023; 2023:1978536. [PMID: 36777446 PMCID: PMC9908341 DOI: 10.1155/2023/1978536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/25/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Background Despite stroke being a leading cause of morbidity and mortality globally, there is a dearth of information on the burden and outcomes of stroke in sub-Saharan Africa and Namibia in particular. Methods A hospital-based, retrospective cohort study was conducted to analyse non-electronic medical records of all consecutive stroke patients who were admitted to one of the highest tertiary-level hospitals in Namibia for 12 months (2019-2020). The primary outcome of the study was to establish the in-hospital mortality, stroke subtypes, and associated complications. Results In total, 220 patients were included in the study, their mean age was 53 (SD13.8) years, and 55.5% were males. 61.0% had an ischaemic stroke (IS), and 39.0% had a haemorrhagic stroke (HS). The mean age was significantly lower in patients with HS vs. IS (48.2 ± 12.2 vs. 56.1 ± 13.3, p < 0.001). Of the IS patients, the majority (29.0%) had total anterior circulation infarct (TACI), while in the HS group, 34.0% had basal ganglia haemorrhage with or without intraventricular extension. Hypertension (p = 0.015), dyslipidaemia (p = 0.001), alcohol consumption (p = 0.022), and other cardiovascular diseases (p = 0.007) were more prevalent in patients with IS compared to those with HS. The prevalence rate of intravenous thrombolysis was 2.2% in IS and use of intravenous antihypertensives in 25.9% of patients with HS than IS. The in-hospital mortality was 26.4% with complications such as raised ICP, aspiration pneumonia, hydrocephalus, and sepsis significantly high in those that died. Aspiration pneumonia (OR 2.79, 95% CI 1.63-4.76, p < 0.001) and increased ICP (OR 0.30, 95% CI 0.16-057, p < 0.001) were independent predictors of in-hospital mortality on the multivariate analysis. Conclusion Our findings showed a younger mean age for stroke and mortality rate comparable to other low- to middle-income countries (LMICs). Hypertension and alcohol consumption were the main risk factors for both stroke subtypes, while aspiration pneumonia and raised intracranial pressure predicted in-hospital mortality.
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Abate TW, Zeleke B, Genanew A, Abate BW. The burden of stroke and modifiable risk factors in Ethiopia: A systemic review and meta-analysis. PLoS One 2021; 16:e0259244. [PMID: 34723996 PMCID: PMC8559958 DOI: 10.1371/journal.pone.0259244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/16/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The burden and contribution of modifiable risk factors of stroke in Ethiopia are unclear. Knowledge about this burden and modifying risk factors is pivotal for establishing stroke prevention strategies. In recent decades, the issue of lifestyle and behavioral modification is a key to improve the quality of life. The modifiable risk factors are an importance as intervention strategies aimed at reducing these factors can subsequently reduce the risk of stroke. So far, many primary studies were conducted to estimate the burden of stroke and modifiable risk factors in Ethiopia. However, the lack of a nationwide study that determines the overall pooled estimation of burden and modifiable risk factors of stroke is a research gap. METHODS To conduct this systemic review and meta-analysis, we are following the PRISMA checklist. Three authors searched and extracted the data from the CINAHL (EBSCO), MEDLINE (via Ovid), PubMed, EMcare, African Journals Online (AJOL), and Google scholar. The quality of the primary study was assessed using the Newcastle-Ottawa Scale (NOS) by two independent reviewers. The primary studies with low and moderate risk of bias were included in the final analysis. The authors presented the pooled estimated burden of stroke and its modifiable risk factors. The registered protocol number in PROSPERO was CRD42020221906. RESULTS In this study, the pooled burden of hemorrhagic and ischemic stroke were 46.42% (95%CI: 41.82-51.53; I2 = 91.6%) and 51.40% (95%CI: 46.97-55.82; I2 = 85.5%) respectively. The overall magnitude of modifiable risk factor of hypertension, alcohol consumption and dyslipidemia among stroke patients were 49% (95%CI: 43.59, 54.41), 24.96% (95CI%:15.01, 34.90), and 20.99% (95%CI: 11.10, 30.88), respectively. The least proportion of stroke recovery was in the Oromia region (67.38 (95%CI: 41.60-93.17; I2 = 98.1%). Farther more, the proportion of stroke recovery was decreased after 2017 (70.50 (56.80-84.20). CONCLUSIONS In our study, more than 90% of stroke patients had one or more modifiable risk factors. All identified modifiable stroke risk factors are major public health issues in Ethiopia. Therefore, strategy is designed for stroke prevention to decrease stroke burden through targeted modification of a single risk factor, or a cluster of multiple risk factors, used on a population, community, or individual level.
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Affiliation(s)
- Teshager Weldegiorgis Abate
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Balew Zeleke
- Department of Pediatric and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashenafi Genanew
- Department of Pharmacology, School of Health Sciences, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Beyene N, Fanta K, Tatiparthi R. Pharmacotherapy Pattern and Treatment Outcomes of Stroke Patients Admitted to Jimma University Medical Center, Ethiopia. PATIENT-RELATED OUTCOME MEASURES 2021; 12:267-275. [PMID: 34393535 PMCID: PMC8357615 DOI: 10.2147/prom.s307291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
Background Despite the fact that stroke has been reported as one of the top three leading causes of death and morbidity in Ethiopia, there are limited data regarding the management of stroke and clinical outcomes. Hence, the present study aimed to evaluate the pharmacotherapy of stroke and factors associated with poor treatment outcomes. Methods A retrospective cross-sectional study was conducted at Jimma University Medical Center (JUMC) among adult stroke patients managed from 2014 to 2017. Clinical characteristics, treatment, and outcomes data were analyzed by using SPSS version 21. Multivariable logistic regression was performed to identify the predictors of poor treatment outcomes. Two-sided P < 0.05 was accepted as statistically significant. Results A total of 153 illegible patient cases were included in this study. The majority, 111 (72.5%), were male and the mean age of the patients was 57±13.7 years. Among 153 stroke patients, 112 (73.2%) patients presented with ischemic stroke. Aspirin and statins (78.6%) were the most commonly used treatment among ischemic stroke patients, whereas enalapril was used in about (43%) of stroke patients to treat high blood pressure. About 61 (40%) stroke patients had poor treatment outcomes; of this, 36 (23.5%) died in hospital. Older age (AOR = 1.034; 95% CI: 1.003–1.069), history of heart failure (AOR = 4.26; 95% CI: 1.58–11.48), loss of consciousness diabetes (AOR = 3.05 95% CI: 1.25–7.44), and aspiration pneumonia (AOR = 5.94; 95% CI: 2.46–14.32) were significantly associated with poor treatment outcomes. Conclusion Overall, treatment of stroke patients was sub-optimal and almost half of the patients had poor treatment outcomes. Availing of thrombolytic therapy, devising appropriate preventive measures of risk factors (hypertension), and decreasing preventable complication such as aspiration pneumonia could improve patient outcomes.
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Affiliation(s)
- Nigatu Beyene
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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Gadisa DA, Busawa GB, Gebremariam ET, Tefera GM, Belete KT, Taye GM, Meskele LB, Gudeta BM, Gelaw BK. Clinical Characteristics, Treatment Outcomes, and its Predictors Among Hospitalized Stroke Patients in Ambo University Referral Hospital, West Ethiopia: A Retrospective Hospital-Based Study. Vasc Health Risk Manag 2021; 16:591-604. [PMID: 33447039 PMCID: PMC7802015 DOI: 10.2147/vhrm.s287465] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background Stroke is becoming a leading cause of death and adult disability in the developing world. Objective The objective of the study was to assess the clinical characteristics, treatment outcomes, and its predictors among stroke patients admitted to Ambo University Referral Hospital (AURH), West Ethiopia. Methods All 111 stroke patients hospitalized from April 2016 to May 2019 were included using a hospital-based retrospective study. Socio-demographic profile, past medication history, clinical presentation, drugs prescribed for comorbid condition and stroke treatment, and outcomes data were collected using data abstraction formats and results were summarized using both descriptive and inferential statistics. Key Findings According to WHO clinical criteria, 89 (80.2%) were diagnosed with ischemic stroke, and 20 (18.0%) were diagnosed with hemorrhagic stroke. The majority of the patients 94 (84.7%) had at least one antecedent risk factor in which hypertension accounted for 44.1%. More than half, 69 (62.2%), of hospitalized stroke patients had good treatment outcomes while 42 (37.8%) had a poor outcome. The overall case-fatality rate was 18 (16.2%), 12 (13.5%) from ischemic stroke, and 6 (30.0%) from hemorrhagic stroke. Acetyl salicylic acid (ASA) with atorvastatin/simvastatin, 67 (73.5%) in ischemic stroke and 12 (60.0%) in hemorrhagic stroke, was the most frequent medications prescribed for stroke during admission while it was frequently prescribed for 48 (53.6%) of ischemic stroke and 10 (50.0%) of the hemorrhagic stroke on discharge. Overall, ceftriaxone + metronidazole 32 (28.8%) was frequently prescribed concomitant medications during admission. The major predictors identified for poor stroke outcomes were substance abuse (AOR=2.839, P=0.024) and have had not received any medication for stroke treatment during admission (AOR=12.503, P≤0.001). Conclusion A significant number of the admitted stroke patients had poor treatment outcome in which the case-fatality rate was relatively high. Substance abuse and having not received medication for stroke were the significant predictors for poor treatment outcome. Hence, a well-established stroke unit setup at AURH is required for accurate diagnosis and management of stroke to overcome stroke-related mortality and/or poor treatment outcome.
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Affiliation(s)
- Diriba Alemayehu Gadisa
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Guye Betero Busawa
- Department of Pharmacy, College of Medicine and Health Sciences, Bule Hora University, Bule Hora, Ethiopia
| | | | - Gosaye Mekonen Tefera
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Kefyalew Taye Belete
- Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Getu Melesie Taye
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Lemma Bose Meskele
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Biruk Mosisa Gudeta
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Belayneh Kefale Gelaw
- Department of Pharmacy, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Fekadu G, Chelkeba L, Melaku T, Tegene E, Kebede A. 30-day and 60-day rates and predictors of mortality among adult stroke patients: Prospective cohort study. Ann Med Surg (Lond) 2020; 53:1-11. [PMID: 32274016 PMCID: PMC7132118 DOI: 10.1016/j.amsu.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/03/2020] [Accepted: 03/15/2020] [Indexed: 01/01/2023] Open
Abstract
Stroke is one of the most common medical emergencies and the leading cause of preventable death and long-term disability worldwide. A prospective cohort study was conducted at the stroke unit of Jimma university medical center for four consecutive months (from March 10 to July 10, 2017). Of the total 116 study patients, 60 (51.7%) had an ischemic stroke. At 30-day follow-up, 81 (69.8%) patients were alive, 34 (29.3%) were died, and one patient (0.9%) was lost to follow-up. Elevated alanine aminotransferase (ALT) level (AHR: 3.77, 95% CI: 1.34-10.57), diagnosis of stroke clinically alone (AHR: 3.90, 95 CI: 1.49-10.26), brain edema (AHR: 4.28, 95% CI: 1.61-11.37), and National Institute of Health Stroke Scale (NIHSS) ≥ 13 during hospital arrival (AHR: 6.49, 95% CI: 1.90-22.22) were the independent predictors of 30-day mortality. At 60-day follow-up, 68 (58.6%) patients were alive, 46 (39.7%) were died, and 2 (1.7%) were lost to follow-up. Discharge against medical advice (AHR: 6.40, 95% CI: 2.31-17.73) and severe modified Rankin score/mRS (4-5) at discharge (AHR: 3.64, 95% CI: 1.01-13.16) were the independent predictors of 60-day mortality. The median (IQR) length of survival after hospital admission for patients died within 30 and 60 days were 4.65 (2.34-11.80) and 9.3 (3.93-33) days, respectively. Stroke significantly affects the morbidity and mortality in Ethiopia. There is a need to provide better care and future planning for stroke patients as an emergency diagnosis and treatment to minimize mortality and disability.
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Affiliation(s)
- Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Legese Chelkeba
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene
- School of Medicine, Institute of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Ayantu Kebede
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
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