In-hospital mortality and its predictors among adult stroke patients admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Prevalence of diabetes mellitus among stroke patients in Ethiopia: Systematic review and meta-analysis

Background

Diabetes mellitus (DM) is a chronic metabolic condition that considerably increases the risk of stroke. According to studies, stroke patients with diabetes have a greater mortality rate and are more likely to have repeated strokes than those without diabetes. Therefore, this systematic review and meta-analysis determined the pooled prevalence of diabetes mellitus among stroke patients in Ethiopia.

Methods

The searches were conducted in electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar. Observational study designs were selected, and studies published until November 30, 2023, addressing the prevalence of diabetes mellitus among stroke patients were identified. EndNote Citation Manager software version X9 for Windows was used to collect and organize the search outcomes and remove duplicate articles. Relevant data were extracted from the included studies using a format prepared in Microsoft Excel and exported to STATA 18.0 software for outcome measures analyses and subgrouping.

Results

Twenty-eight research articles were included in the final analysis. The studies included an evaluation of 6589 stroke patients, among whom 645 were diagnosed with DM. This resulted in a pooled prevalence estimate of 10 % (95 % CI: 8-13 %)] DM. The subgroup analysis by region revealed that the highest pooled prevalence of DM was 16 % [95 % CI: (9 %-24 %)], which was from the Oromia region, followed by Addis Ababa city 12 % [95 % CI: (10 %-14 %)]. The other three regions (Tigray, South Nations nationalities and people's region and Amhara) had similar pooled prevalence of DM 7 % [95 % CI: (3 %-10 %)], 7 % [95 % CI: (3 %-11 %)], 7 % [95 % CI: (4 %-9%)], respectively.

Conclusion

Overall, the prevalence of DM among stroke patients is high. Notably, the Oromia region exhibited the highest prevalence rate at 16 %, followed by Addis Ababa city at 12 %. Conversely, the other three regions displayed similar rates of 7 %. These findings underscore the critical importance of screening and managing DM in stroke patients.

Predictors of 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal observational study

Background and Aims

Stroke is the leading cause of disability and the second most common cause of death after ischemic heart disease worldwide. Understanding predictors of early poststroke mortality provides opportunities for interventions and favorable outcomes. This study aimed to determine the incidence and predictors of 30-day mortality among patients admitted with the first stroke at referral hospitals in Dodoma.

Methods

A prospective longitudinal observational design enrolled patients with acute stroke confirmed by CT scan or MRI admitted at referral hospitals in Dodoma. The National Institute of Health Stroke Scale was used to assess stroke severity at baseline. A comparison of risk factors, clinical profiles, and mortality was done using the Chi-square test. A logistic regression model was used to determine the predictors of 30-day mortality in patients with the stroke while the 30-day probability of survival was estimated using Kaplan-Meier analysis.

Results

Out of 226 patients with first-ever stroke, 121(54%) were males, and the population mean age was 63(15) years. The 140(62%) had Ischemic stroke, and 154(68%) survived at the 30th day. Patients with a history of smoking 2.4 [95% confidence interval (CI) (1.0-5.6), p = 0.048], loss of consciousness 2.7 [95% CI (1.2-6.4; p = 0.019] and unequal pupil size 13.7 [95% CI (4.1-58.1, p < 0.001 were significantly more associated with mortality within 30 days. The median survival was 7 (3-9) days, whereas alcohol drinkers and those aged above 60 years had a shorter time to mortality compared to non-alcohol drinkers and those aged <60 years.

Conclusion

The study showed a high incidence of mortality within 30 days after the first stroke episode, with the highest proportion dying within 7 days of being hospitalized. Advanced age of ≥60 years, smoking, alcohol use, and severe stroke at admission warrant special attention.

Treatment outcomes, types, risk factors, and common manifestations of stroke among admitted stroke patients in Ethiopia: Systematic review and meta-analyses

INTRODUCTION

Stroke is the sudden onset of a reduced cerebral perfusion-related localized or widespread neurologic impairment. The two main causes of poor treatment outcomes are uncontrolled blood pressure and hospital arrival delays. Identifying the risk factors, types of stroke presentation, and treatment options might be used in the prevention, early detection, and management of stroke to provide the best care to patients.

OBJECTIVE

This systematic review and meta-analysis aimed to assess the treatment outcomes, types, and risk factors of stroke patients in Ethiopia.

METHODS

A variety of databases were searched, including African Journals Online (AJOL), Google Scholar, Scopus, EMBASE (Ovid), and HINARI, and published and unpublished articles from the Ethiopian Universities repository. To pool the outcome variables, a weighted inverse variance random-effects model at 95% Cl was employed. Heterogeneity and publication bias were assessed using Cochrane I2 statistics and Egger's test with funnel plot, respectively. A subgroup analysis was conducted based on sample size, case definition, and region to detect source of heterogeneity.

RESULT

This study contained data from 26 studies, involving 6291 study participants, from different regions of Ethiopia. Out of 19 articles with I2 = 96.1%, p<0.001, the pooled prevalence of improved stroke treatment outcome was 47.50% (95% CI: 40.20-54.80), while the prevalence of mortality was 18.95% (95% CI: 15.62-22.29) from 19 articles with I2 = 87.9%, p<0.001. In Ethiopia, ischemic stroke accounted for 59.34% of all stroke cases (95% CI: 53.73-64.95). Among risk factors, substance abuse ranked second at 36.58% (95% CI: 25.22-47.93), after hypertension at 50.90% (95% CI: 43.77-56.27). According to the findings, hemiparalysis or hemiplegia was mentioned as a frequent clinical sign associated with stroke (56.87%) (95% CI: 45.65-68.06).

CONCLUSION

The improved treatment outcome was not satisfactory, and the most common type of stroke was an ischemic stroke. Hypertension was the most common risk factor, followed by substance use. As a result, there should be a strengthening of post-stroke care and the creation of awareness about the risk factors and clinical manifestations for prevention and early detection of stroke in Ethiopian people.

30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis

Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.