Magnitude of risk factors and in-hospital mortality of stroke in Ethiopia: a systematic review and meta-analysis

Determinants of stroke among adult hypertensive patients on follow up in Addis Ababa public hospitals, Ethiopia: A case control study

BACKGROUND

Stroke is a non-communicable disease that causes sudden global or focal neurological disorders. It is one of the major public causes of morbidity and mortality in low- and middle-income countries, including Ethiopia. Early identification of the determinants and prompt intervention remains critical to reduce morbidity and mortality from stroke.

OBJECTIVE

The study aimed to identify determinants of stroke among adult hypertensive patients on follow up in Addis Ababa public hospitals, Ethiopia.

METHODS

Unmatched case-control study design was conducted among 326(109 cases and 217 controls) study participants in Addis Ababa public hospitals from September 1-30, 2021. The cases were adult hypertensive patients who developed a stroke and the controls were adult hypertensive patients. The study participants were selected by consecutive sampling technique. Pretested structured interviewer assisted questionnaire and checklist were used to collect data. Data were entered into Epi data version 3.1; exported and analysed by SPSS version 23. All independent variables with p-value < 0.25 in the bi-variable logistic regression analysis were entered into multivariable logistic regression analysis. Finally, variables with p-value <0.05 were considered as determinants of the stroke.

RESULTS

In this study, current cigarette smoker(AOR = 5.55, 95% CI: 2.48, 12.43), current alcohol drinker(AOR = 4.27, 95% CI: 1.94, 9.38), medication non-compliance(AOR = 3.23, 95% CI: 1.62, 6.44), uncontrolled systolic blood pressure (AOR = 3.42, 95% CI: 1.64, 7.16), uncontrolled diastolic blood pressure(AOR = 4.29, 95% CI: 2.06, 8.93), high low density lipoprotein(AOR = 6.89, 95% CI: 3.57, 13.35) and diabetic mellitus(AOR = 3.25, 95% CI: 1.58, 6.69) were more likely to develop a stroke.

CONCLUSION AND RECOMMENDATION

Cigarette smoking, alcohol use, non-adherence to medication, uncontrolled systolic pressure, uncontrolled diastolic blood pressure, high low-density lipoprotein, and diabetic mellitus were determinants of stroke. Providing health education about lifestyle changes and the consequences of hypertension at all follow-up is very important.

In-hospital mortality and its associated factors among hospitalized stroke patients at public hospitals of Eastern Ethiopia

BACKGROUND

Stroke is rapidly developing clinical signs of focal/ global disturbance of cerebral function, with symptoms lasting more than 24 h and leading to death. Data showed that stroke deaths in Ethiopia reached nearly seven percent of total deaths. Despite this report, there is a paucity of investigations about the problem.

OBJECTIVE

To determine in-hospital mortality and its associated factors among hospitalized stroke patients in Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, eastern Ethiopia from September 2016-August 2022 G.C.

METHODS

A retrospective cohort study was conducted among hospitalized stroke patients. A sample size of 395 medical records was selected from a total of 564 stroke patients by a simple random sampling technique. The data was analyzed by SPSS version 26 using bivariable and multivariable cox-regression models. A p-value of 0.05 and less at a 95% confidence interval was used to establish a statistically significant association.

RESULTS

Of the total, 109 (27.6%) died in the hospital while 57.2% and 15.2% of them were discharged with improvement and against medical advice, respectively. Age greater than 65 (AHR = 4.71, 95% CI = 1.11-19.96), creatinine level > 1.2 mg/dl (AHR = 1.54, 95% CI = 1.0-2.39), and co-morbidity with atrial fibrillation (AHR = 1.48, 95% CI = 1.0-2.21) were significantly associated with in-hospital mortality.

CONCLUSION

In-hospital mortality was found in more than a quarter of stroke patients. Mortality was more likely increased among the patients with age > 65, serum creatinine level > 1.2 mg/dl, and atrial fibrillation. Hence, these high-risk patients need to be monitored.

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.

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.

Diagnostic performance of plasma D-dimer, fibrinogen, and D-dimer to fibrinogen ratio as potential biomarkers to predict hypertension-associated acute ischemic stroke

Background

Ischemic stroke is a common type of stroke that leads to death and functional disability in hypertensive patients. However, there are no well-studied non-invasive and less expensive fluid biomarkers routinely used to detect ischemic stroke in hypertensive patients. Hence, this study aimed to tease out the performance of D-dimer, fibrinogen, and the D-dimer to fibrinogen ratio (DDFR) in predicting hypertension-associated acute ischemic stroke.

Methods

A hospital-based cross-sectional study was done from October 2022 to January 2022 at Yikatit 12 Hospital Medical College, Ethiopia. We recruited 55 hypertensive patients who had an ischemic stroke and 110 who did not. A ROC curve was used to calculate the areas under the curves (AUCs) and determine the diagnostic power of the D-dimer, fibrinogen, and DDFR. The Youden index was used to find the best cut-off points for biomarkers in detecting acute ischemic stroke. A De Long test was employed to show whether there was a significant difference between the AUCs of biomarkers in diagnosing ischemic stroke.

Results

D-dimer yielded the highest diagnostic power (AUC = 0.776) in detecting acute ischemic stroke, followed by DDFR (AUC = 0.763) and fibrinogen (AUC = 0.694), but there was no significant difference between them. At 0.52 μg/ml cut-off point, D-dimer had 82.9% sensitivity, 66.7% specificity, 62.5% PPV, and 85.3% NPV to diagnose acute ischemic stroke. Fibrinogen could detect acute ischemic stroke at 405.85 mg/dl level, with 70.0% sensitivity, 57.1% specificity, 41.2% PPV and 81.6% NPV. At a 1.83 ratio, DDFR might also identify ischemic stroke with 80.0% sensitivity, 67.1% specificity, 51.1% PPV, and 88.7% NPV.

Conclusion

We showed D-dimer, fibrinogen, and DDFR as promising, affordable, and non-invasive biomarkers for the detection of ischemic stroke among subjects with hypertension. This will help clinicians make an early diagnosis and better guide patient therapy.

Risk factors for stroke-related functional disability and mortality at Felege Hiwot Referral Hospital, Ethiopia

BACKGROUND

Stroke is one of the top causes of functional disability around the world. The main objective was to identify stroke-related functional outcomes and risk factors. A good functional outcome is defined as the absence of problems secondary to the stroke event, a poor functional outcome as the presence of complications, and mortality as the existence of complications.

METHOD

A retrospective cohort analysis was used to observe factors in 298 eligible adult (18 or older) stroke patients who attend outpatient clinics every three months at Felege Hiwot Referral Hospital between September 2019 and August 2021 to predict outcomes.

RESULT

The likelihood of dying from a poor outcome was 9%, and the likelihood of recovering was 24%. The average time spent on good and poor outcomes for different levels of independent variables varies according to their risk. During the first three years of follow-up, the instantaneous risk with a 95% confidence interval of transitioning from good to poor outcome in the women, aged 60 or older, with hypertension, atrial fibrillation, and hemorrhage stroke versus men stroke patients, aged 18 to 59, without hypertension, atrial fibrillation, and ischemic stroke were 1.54 (1.10, 2.15), 1.73 (1.19, 2.52), 2.34 (1.55, 3.53), 2.74 (1.64, 4.56), and 1.52 (1.10, 2.19) respectively. The hazard ratio of transitioning from poor outcome to death for patients with diabetes mellitus and atrial fibrillation versus those without diabetes mellitus and atrial fibrillation was estimated to be 1.95 (1.10, 3.46) and 3.39 (1.67, 6.89), respectively.

CONCLUSION

Women over 60 with hypertension, atrial fibrillation, and hemorrhagic stroke were more likely to progress from a good to a poor outcome. Diabetes and atrial fibrillation were also risk factors for progressing from a poor outcome to death. The states and transitions, as well as a clinical control of the hazards for the transition through states, should improve the physician's decision-making process. Since gender and age are difficult to control, early intervention by patients and the hospital may be critical in influencing functional outcomes.

Diabetes Mellitus as a risk factor for stroke among Nigerians: A systematic review and meta-analysis

Background

Diabetes mellitus is one of the modifiable risk factors for stroke. Stroke is common in Nigeria, but there is a paucity of national data on the frequency of diabetes in stroke. This study aimed to estimate to what extent diabetes a risk factor for stroke in Nigeria.

Methods

The study design is a systematic review, and the PRISMA guidelines were strictly followed. African Journal Online (AJOL), PubMed, SCOPUS and Google Scholar were systematically searched. The Newcastle-Ottawa scale was used to assess the quality, heterogeneity was determined with the I² statistic, and the DerSimonian Laird random effect model was selected for the meta-analysis.

Results

The studies were distributed across different regions of the country. The total sample size was 9397. The weighted average age of the patients with stroke was 53.7 years. The attributable risk of diabetes in stroke, among Nigerian patients, was 0.20 (95% CI: 0.17-0.22; p < 0.0001). The attributable risk has been rising steadily since the advent of the new century, and it is relatively higher in southern Nigeria.

Conclusion

The attributable risk of diabetes in stroke, among Nigerian patients is high. This varies across the regions but it is rising progressively nationally.

Survival status and predictors of mortality among adult Stroke patients admitted to Jimma University Medical Center, South west Ethiopia: A retrospective Cohort study

Background

Stroke is the leading cause of cardiovascular disease death in sub-Saharan Africa and the second leading cause of mortality worldwide. In 2016, 6.23% of all fatalities in Ethiopia were stroke-related.

Objective

To assess survival status and predictors of mortality among adult stroke patients admitted to Jimma University Medical Center from April 1/2017 to March 31/2022.

Methods

A retrospective cohort study was conducted on 480 adult stroke patients selected by simple random sampling from patients admitted to the Jimma University Medical Center Stroke Unit from April 1, 2017 to March 31, 2022. Data were extracted from May to June 2022 and entered Epi-data v.3.1 and analyzed by R v.4.2. The Kaplan-Meier curve with Log rank test was used to estimate survival time and to compare survival experience between categories of explanatory variables. The Cox regression model was computed to identify predictors of survival status in stroke patients. Then the 95% CI of the hazard ratio was set with corresponding p-value < 0.05 to declare statistical significance.

Results

During 4350 person-days of follow-up; 88 (18.33%) patients died; resulting in an incidence mortality of 20.23 per 1000 person-days, with a median survival time of 38 days. Glasgow coma score <8 on admission (AHR = 7.71; 95% CI: 3.78, 15.69), dyslipidemia (AHR = 3.96; 95% CI: 2.04, 7.69), aspiration pneumonia (AHR 2.30; 95% CI: 1.23-4.26), and increased intracranial pressure (AHR = 4.27; 95% CI: 2.33, 7.81), were the independent predictors of the time until death.

Conclusion

The incidence of stroke mortality was higher at the seven and fourteen days. Glasgow Coma Scale, increased intracranial pressure, dyslipidemia, and aspiration pneumonia were independent predictors of mortality.

Incidence of stroke and its predictors among hypertensive patients in Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia, a retrospective follow-up study

BACKGROUND

Globally, one in three adults has hypertension, a condition that causes 51% of all deaths from stroke. Stroke is becoming a major public health problem and the most common cause of morbidity and mortality among non-communicable diseases in the world and Ethiopia. Therefore, this study assesses the incidence of stroke and its predictors among hypertensive patients in Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia 2021.

METHODS

A hospital-based retrospective follow-up study design was used, simple random sampling technique was used to select 583 hypertensive patients that had follow-up registration between January 2018 and December 30th, 2020. Data were entered into Epi-data version 3.1 and exported to STATA version 14. The adjusted hazard ratio for each predictor with a 95% confidence interval was calculated using the Cox proportional hazards regression model, and a P-value ≤  0.05 was used to denote statistical significance.

RESULTS

From 583 hypertensive patients 106(18.18%) [95% CI 15-20] were developed stroke. The overall incidence rate was 1 per 100 person-years (95% CI 0.79-1.19). Comorbidities (Adjusted hazard ratio(AHR): 1.88, 95% CI 1.0-3.5), stage two hypertension (AHR = 5.21, 95%CI 2.75-9.8), uncontrolled systolic blood pressure (AHR: 2, 95% CI 1.21-354), uncontrolled diastolic blood pressure (AHR:1.9, 95% CI 1.1-3.57), alcohol consumption (AHR = 2.04, 95%CI 1.2-3.49), age 45-65 (AHR = 10.25, 95%CI 7.47-11.1); and drug discontinuation (AHR = 2.05,95% CI 1.26-3.35) were independent predictors for the incidence of stroke among hypertensive patients.

CONCLUSION

The incidence of stroke among hypertensive patients was high and various modifiable and non-modifiable risk factors highly contributed to its incidence. This study recommends early screening of blood pressure, giving priority to comorbid patients and patients with advanced stage hypertension, and giving health education about behavioral risks and drug adherence.

Development and internal validation of a clinical risk score for in-hospital mortality after stroke: a single-centre retrospective cohort study in Northwest Ethiopia

OBJECTIVE

To develop and validate a clinical risk score for in-hospital stroke mortality.

DESIGN

The study used a retrospective cohort study design.

SETTING

The study was carried out in a tertiary hospital in the Northwest Ethiopian region.

PARTICIPANTS

The study included 912 patients who had a stroke admitted to a tertiary hospital between 11 September 2018 and 7 March 2021.

MAIN OUTCOME MEASURES

Clinical risk score for in-hospital stroke mortality.

METHODS

We used EpiData V.3.1 and R V.4.0.4 for data entry and analysis, respectively. Predictors of mortality were identified by multivariable logistic regression. A bootstrapping technique was performed to internally validate the model. Simplified risk scores were established from the beta coefficients of predictors of the final reduced model. Model performance was evaluated using the area under the receiver operating characteristic curve and calibration plot.

RESULTS

From the total stroke cases, 132 (14.5%) patients died during the hospital stay. We developed a risk prediction model from eight prognostic determinants (age, sex, type of stroke, diabetes mellitus, temperature, Glasgow Coma Scale, pneumonia and creatinine). The area under the curve (AUC) of the model was 0.895 (95% CI: 0.859-0.932) for the original model and was the same for the bootstrapped model. The AUC of the simplified risk score model was 0.893 (95% CI: 0.856-0.929) with a calibration test p value of 0.225.

CONCLUSIONS

The prediction model was developed from eight easy-to-collect predictors. The model has excellent discrimination and calibration performance, similar to that of the risk score model. It is simple, easily remembered, and helps clinicians identify the risk of patients and manage it properly. Prospective studies in different healthcare settings are required to externally validate our risk score.

The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study

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.

Angiotensin-converting enzyme gene insertion/deletion polymorphism and risk of ischemic stroke complication among patients with hypertension in the Ethiopian population

Background

Ischemic stroke is a complicated, multifaceted condition brought on by a confluence of vascular, environmental, and genetic variables. The burden of ischemic stroke is currently rising in terms of death, morbidity, and disability worldwide. Genetic variables also play significant roles in the pathophysiology of hypertension and ischemic stroke in addition to the greatest effects of demographic, clinical, and behavioral risk factors. The key functional variation of the ACE gene that has drawn the most interest is the ACE I/D variant. Even though the ACE gene I/D polymorphism has been widely studied, the findings of investigations on the involvement of this polymorphism in ischemic stroke were contradictory and provide conflicting data. The goal of this study was to look into the effect of the ACE gene I/D polymorphism on the risk of ischemic stroke in patients with hypertension.

Methods

A hospital-based case-control study was carried out in 36 cases of patients with hypertensive IS and 36 age- and sex-matched healthy controls. Clinical and biochemical parameters were measured to assess the associated risk factors. The DNA was isolated from blood samples, and the ACE I/D genotypes were identified using polymerase chain reaction and analyzed by agarose gel electrophoresis.

Results

The ACE-DD genotype (OR = 3.71, 95% CI = 1.02-13.5; P < 0.05) and D allele (OR = 2.07, 95% CI = 1.06-4.03; P < 0.05) were significantly more common in patients than in controls, indicating that it is a risk factor for the development of ischemic stroke in hypertensive individuals.

Conclusion

There is a significant correlation between the ACE gene I/D polymorphism and the development of ischemic stroke in patients with a history of hypertension in the Ethiopian population.

Estimation and predictors of direct hospitalisation expenses and in-hospital mortality for patients who had a stroke in a low-middle income country: evidence from a nationwide cross-sectional study in Iranian hospitals

OBJECTIVE

Stroke is the second most prevalent cardiovascular disease in Iran. This study investigates the estimation and predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke in Iranian hospitals.

SETTING

Patients who had a stroke in Iran between 2019 and 2020 were identified through the data collected from the Iran Health Insurance Organization and the Ministry of Health and Medical Education. This study is the first to conduct a pervasive, nationwide investigation.

DESIGN

This is a cross-sectional, prevalence-based study. Generalised linear models and a multiple logistic regression model were used to determine the predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke.

PARTICIPANTS

A total of 19 150 patients suffering from stroke were studied.

RESULTS

Mean hospitalisation expenses per patient who had a stroke in Iran amounted to US$590.91±974.44 (mean±SD). Mean daily hospitalisation expenses per patient who had a stroke were US$55.18±37.89. The in-hospital mortality for patients who had a stroke was 18.80%. Younger people (aged ≤49 years) had significantly higher expenses than older patients. The OR of in-hospital mortality in haemorrhagic stroke was significantly higher by 1.539 times (95% CI, 1.401 to 1.691) compared with ischaemic and unspecified strokes. Compared with patients covered by the rural fund, patients covered by Iranian health insurance had significantly higher costs by 1.14 times (95% CI, 1.186 to 1.097) and 1.319 times (95% CI, 1.099 to 1.582) higher mortality. There were also significant geographical variations in patients who had a stroke's expenses and mortality rates.

CONCLUSION

Applying cost-effective stroke prevention strategies among the younger population (≤49 years old) is strongly recommended. Migration to universal health insurance can effectively reduce the inequality gap among all insured patients.

Factors associated with stroke associated pneumonia among adult stroke patients admitted to university of Gondar hospital, Northwest Ethiopia

Stroke is the major cause of disability and death in sub-Saharan African countries. The presence and severity of complications play a major role in the outcome of stroke. Stroke associated pneumonia is often noticed post stroke infection that has been linked to an increased risk of hospital mortality, a longer hospital stay and higher healthcare expenses. Report on details of stroke-associated pneumonia has never been documented in countries of sub-Saharan Africa. This study aimed to determine the incidence and risk factors of stroke-associated pneumonia among adult stroke patients in hospital settings, Northwest Ethiopia. The study was undertaken at a stroke care unit, University of Gondar hospital between January 1, 2020 and December 31, 2020. A convenience sampling method was used to recruit study subjects. Relevant clinical history was taken, focused physical examination was done, and brain imaging (CT scan or MRI) was performed to settle the diagnosis of stroke. A modified Centre for Disease Control and Prevention (CDC) criteria was used to diagnose stroke-associated pneumonia. All patients with stroke-associated pneumonia were treated according to the 2016 Infectious Diseases Society of America/American Thoracic Society Clinical Practice Guidelines. The Data were cleaned in Epi Info version 4.6.0.2, and analyzed using SPSS version 26. Variables associated with stroke-associated pneumonia were computed using logistic regression analysis. P value < 0.05 was considered to declare statistical significance. The study comprised a total of 325 adult stroke patients. The mean age of study subjects was 65.2 years (SD ± 15.7). The most prevalent type of stroke was ischemic stroke, which accounted for 68% of all cases. Hemiparesis (94%), facial palsy (87%), and swallowing disturbance (51%) were the frequently noticed neurological findings. Stroke-associated pneumonia complicated 116/325 (36%) of stroke patients. Multi-variate regression analysis revealed that patients who were elderly (age > 75 years) (AOR = 3.910, CI 1.181-12.936, P = 0.026), had swallowing disturbance (AOR = 4.656, CI 2.356-9.202, P-value < 0.001), epileptic seizures (AOR = 2.678, 95% CI 1.253-5.721, P-value < 0.001) and moderate to severe stroke (NIHSS score = 16-21) (AOR = 5.994, 95% CI 2.043-17.585, P-value < 0.001) were at risk of developing stroke-associated pneumonia. SAP was a substantial medical complication among stroke patients. Early identification and prompt intervention measures for the identified risk factors might address the burden of SAP.

Magnitude and Predictors of In-Hospital Stroke Mortality in Ethiopia: A Systematic Review and Meta-Analysis

Introduction

Stroke is the second leading cause of mortality worldwide, accounting for approximately 5.5 million deaths each year. Due to demographic and health changes, the epidemiology of stroke is shifting from industrialized to low- and middle-income nations. Ethiopia is a developing country with a population that reflects this shift. Therefore, this systematic review and meta-analysis are aimed at evaluating the extent of in-hospital mortality of both ischemic and hemorrhagic stroke in Ethiopia and determining relevant factors associated with the mortality.

Methods

Observational studies published as of July 15, 2020, that reported the magnitude, predictors, and causes of in-hospital mortality of stroke were systematically and comprehensively retrieved using the PRISMA 2020 criteria from databases such as PubMed/MEDLINE, Science Direct, and Google Scholar. The review papers were chosen based on the study methodology (facility-based observational), the study area (Ethiopia), the study population (adult patients with stroke), the outcome (in-hospital mortality), and the fact that they were published in English.

Result

A total of 3709 patients with stroke were included in this systematic review and meta-analysis, which included 19 publications. In-hospital mortality was 14.03 percent on average in the studies, with reports ranging from 6.04 percent to 37.37 percent. Patients with hemorrhagic type stroke, admission Glasgow Coma Scale less than or equal to 12, impaired mental status, National Institutes of Health Stroke Scale stroke level greater than 13, prolonged hospital stay, any incontinence, pneumonia, and/or swallowing trouble had an increased risk of death after stroke.

Conclusion

The magnitude of in-hospital mortality of patients with stroke in Ethiopia is high. The assessment of the level of consciousness is vital for clinical management and as an indicator of prognosis. Patients with unfavorable prognostic signs, such as entry Glasgow Coma Scale, National Institutes of Health Stroke Scale stroke level > 13, hemorrhagic stroke, pneumonia, incontinence, and dysphagia, should be given priority.

Stroke Related Knowledge, Prevention Practices and Associated Factors Among Hypertensive Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021

Introduction

Stroke is a global health problem, causing significant morbidities and mortalities in both developing and developed countries. Patients living with chronic diseases like hypertension are at a high risk of stroke. Approximately 80% of strokes could be prevented with necessary preventive practices. There is scarce evidence in the preventive practices in Ethiopia, particularly in the study area. Therefore, this study aimed to assess knowledge and prevention practices related to stroke among hypertensive patients at the University of Gondar comprehensive specialized hospital, northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 393 hypertensive patients at the University of Gondar Comprehensive Specialized Hospital from May 1st to June 30th, 2021. The study participants were selected by a systematic random sampling technique. A semi-structured and interviewer-administered questionnaire was used to collect data. The data was entered into EPI Info version 7.2.1 and analyzed with SPSS version 23.0. Binary logistic regression analyses were undertaken to identify associated factors. The level of significance was determined using the adjusted odds ratio (AOR) with its 95% CI at a p-value of 0.05.

Results

Participants in this study had adequate knowledge of stroke and good prevention practices in 40.7% (95% CI: 35.9, 45.5) and 51.7% (95 CI: 46.8, 56.5) of cases, respectively. Attending secondary education and above 4.6 (95% CI: 2.08, 10.17), knowing someone who has had a stroke 13.17 (95% CI: 7.3, 23.77), and physical activity 4.05 (95% CI: 2.23, 7.36) were all significantly associated with adequate stroke knowledge. Furthermore, educational status (attending primary education 2.61 (95% CI: 1.44, 4.73) and secondary education and above 3.75 (95% CI: 1.99, 7.05), being an urban dweller 9.65 (95% CI: 5.04, 18.44), duration of hypertension 1.9 (95% CI: 1.15, 3.14), knowing someone with a stroke 2.27 (95% CI: 1.30, 3.93), and physical activity 1.76 (95% CI: 1.03, 3.01) were associated with good stroke prevention practices.

Conclusion

The proportion of participants with good-related knowledge and prevention practice is relatively good.

Burden of depression and predictors among Ethiopian stroke survivors: Cross-sectional study

BACKGROUND

stroke is a common cause of mortality and morbidity in low- and middle-income countries. It is a very sudden episode in the patients' lives and can lead to multiple psychosocial, social, and economic consequences, and psychiatric problems. poststroke depression is the most common and major neuropsychiatric consequence of stroke that affects one-third of stroke survivors. The aim of this study to assess the burden of depression and its predictors among stroke survivors with local version validated Patient Health Questionnaire.

METHODS

An institutional-based cross-sectional study was conducted among stroke patients at selected tertiary level hospitals. Data were collected by interview method using structured questionnaires, and patient medical record reviews and data were recruited by using consecutive sampling method. Bivariate and multivariable binary logistic regression model analysis was used with SPSS version 23 to identify factors associated with depression.

RESULTS

A total of one hundred eighty stroke patients participated in the study with a response rate of 88.2%. The overall prevalence of depression is 49.6% (95% CI: 42.8, 56.7). Occupation, marital status, level of education of stroke patients was significantly associated with post stroke depression with P < 0.05.

CONCLUSION

The study findings presented that nearly half of the stroke patients suffered from post stroke depression. Post-stroke depression was strongly associated with patient occupation, marital status, and level of education There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.

The burden of stroke and modifiable risk factors in Ethiopia: A systemic review and meta-analysis

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.

Pharmacotherapy Pattern and Treatment Outcomes of Stroke Patients Admitted to Jimma University Medical Center, Ethiopia

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.

In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis

Objective

To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa.

Method

The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute's critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model.

Result

A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17-0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24-0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12-0.19) and Southern Africa (18%, 95% confidence interval = 0.06-0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function.

Conclusion

The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.

Risk factors for 30-day in-hospital mortality for in-patient with stroke in sub-Saharan Africa: protocol for a systematic review and meta-analysis

INTRODUCTION

While individual studies have reported on in-hospital stroke mortality rates in sub-Saharan Africa (SSA), the estimates are highly variable and inconclusive, buttressing the need for precise and reliable estimations. To overcome these inconsistencies, a well-structured systematic review and meta-analytical models are necessary. However, to the best of our knowledge, there is no published systematic review and meta-analysis on risk factors for 30-day mortality for in-hospital patients with stroke in SSA.

METHOD AND ANALYSIS

We will include all retrospective and prospective facility-based observational studies reporting on the incidence and/or risk factors for in-hospital stroke mortality in SSA. Electronic databases such as PubMed, Google scholar and Africa Journal Online (AJOL) will be searched for potentially relevant studies on in-hospital stroke mortality and risk factors in SSA. The search will be limited to studies conducted from January 1990 to December 2020. Two independent authors will screen titles and abstract to find studies that meet the prespecified eligibility criteria for inclusion in the review. The incidence of 30-day in hospital stroke mortality will be pooled. Meta-regression will be used to assess the factors associated with in-hospital stroke mortality in SSA. If possible, subgroup analysis will be performed based on subregion, publication year and study design, and quality score to determine possible source of heterogeneity. If possible, a sensitivity analysis will be performed to determine the robustness of the estimates obtained from the meta-analysis.

ETHICS AND DISSEMINATION

Ethical approval is not required as this is a secondary research and will use reported data in scientific literature. A full manuscript will be submitted to a reputable peer-review journal for publication.

PROSPERO REGISTRATION NUMBER

CRD42021227367.

Effects of Colchicine on Cardiovascular Outcomes in Patients with Coronary Artery Disease: A Systematic Review and One-Stage and Two-Stage Meta-Analysis of Randomized-Controlled Trials

AIM

Colchicine has received emerging interest due to its cardiovascular benefits in patients with coronary artery disease (CAD). We conducted a one-stage meta-analysis of reconstructed individual patient data (IPD) from randomized-controlled trials to summarize the effects of colchicine on cardiovascular outcomes in patients with CAD.

METHODS

Four databases (PubMed, Embase, Cochrane, SCOPUS) were searched for articles published from inception to 30th September 2020, examining the effect of colchicine on cardiovascular outcomes in patients with CAD, yielding 10 randomized-controlled trials with a combined cohort of 12,781 patients. IPD was reconstructed from Kaplan-Meier curves published in 3 studies and analysed using the shared-frailty Cox model. Aggregate data meta-analysis of all 10 studies was performed for outcomes unsuitable for IPD reconstruction.

RESULTS

In patients receiving colchicine compared to placebo, one-stage meta-analysis demonstrated a hazard ratio of 0.70 (95% CI 0.61-0.80) for the composite outcome of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and urgent hospitalization for angina requiring coronary revascularization. Aggregate data meta-analysis demonstrated a significant reduction in hazard rate for stroke (HR 0.45; 95% CI 0.27-0.75) and urgent revascularization (HR 0.59; 95% CI 0.38-0.91); and a relative risk reduction for myocardial infarction (RR 0.72; 95% CI of 0.52-1.00) and post-operative atrial fibrillation (RR 0.64; 95% CI 0.48-0.86).

CONCLUSION

Given the significant benefits of colchicine demonstrated on IPD, and its consistent benefits when analyzed using aggregate data meta-analysis, we propose that colchicine may be considered as an additional pharmacological adjunct to the first line therapy for patients with coronary artery disease.

Clinical Characteristics, Treatment Outcomes, and its Predictors Among Hospitalized Stroke Patients in Ambo University Referral Hospital, West Ethiopia: A Retrospective Hospital-Based Study

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.