Survival of Stroke Patients According to Hypertension Status in Northern Ethiopia: Seven Years Retrospective Cohort Study

Background

Globally, stroke appears as a major cause of preventable deaths and disabilities. In Ethiopia, the intra-hospital mortality of stroke is significant; however, epidemiologic data are scarce whether there is a difference in the overall survival time between hypertensive and non-hypertensive adult stroke patients admitted in specialized hospitals. This study was intended to determine the survival of stroke patients according to their hypertension status admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia from March 1, 2012, to February 28, 2019.

Methods and Findings

A hospital-based retrospective cohort study was conducted among all cohorts of confirmed first-ever stroke patients admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Kaplan–Meier survival analysis was applied to estimate the survival probability of hypertensive and non-hypertensive first-ever stroke patients. Cox proportional hazards regression model was used to determine the adjusted hazard ratio of death for each main baseline predictor variable with 95% CI, and P-value <0.05 was used to declare statistical significance. The assumptions of the Cox proportional hazards regression model assessed by the global test, Schoenfeld residuals. There were 503 (323 were hypertensive, 180 Non-hypertensive) confirmed first, ever adult stroke patients, the overall median age of the patients was 65 years, IQR (53–75) years. Seventy-five (14.9%) of them were dead, with a median survival time of 48 days and 428 (85.1%) of them were censored. At any particular point in time, the hazard of death among hypertensive patients was two times higher than non-hypertensive patients, but this was not found to be a statistically significant (adjusted HR=2.13: 95% CI 0.66–6.81). Glasgow Coma Scale 3–8 at admission (adjusted HR=10.12; 95% CI 2.58–40.68), presence of stroke complications (adjusted HR=7.23; 95% CI 1.86–28.26) and borderline high total cholesterol level (adjusted HR=3.57; 95% CI 1.15–11.1) were the only independent predictors of intra-hospital patient mortality.

Conclusion

The overall survival time difference between hypertensive and non-hypertensive first-ever adult stroke patients was not statistically significant. Early identification and treatment of stroke complications, co-morbidities along strict follow-up of comatose patients may improve the intra-hospital survival of stroke patients, and we also recommend community-based studies using a large sample size.

Assessment of Chronic Respiratory Health Symptoms and Associated Factors Among Flour Mill Factory Workers in Addis Ababa, Ethiopia, 2019: A Cross-Sectional Study

Background

Flour mill workers are at high risk of developing respiratory symptoms due to exposure to flour dust in their working environment. Exposure to flour dust linked with the development of chronic respiratory disorders. However, very little evidence has been available on the respiratory symptoms of exposed workers in large-scale flour mill factories. Therefore, the aim of this study was to assess chronic respiratory health symptoms and associated factors among flour mill workers in Addis Ababa, Ethiopia.

Methods

Cross-sectional study was conducted among a sample of 424 randomly selected workers from Addis Ababa flour mill factories. Respiratory health symptoms were assessed using an American Thoracic Society standard questionnaire customized with local context. Data were checked for completeness and Epi-Info V. 7.2 and SPSS V.21 statistical software were used for data entry and analysis, respectively. Multivariable logistic regression model was used to identify variables associated with chronic respiratory health symptoms. Variables that had significant association were identified based on adjusted odds ratio (AOR) with 95% confidence interval (CI) and p <0.05. Data were presented using tables, texts and figures.

Results

The prevalence of chronic respiratory health symptoms among flour mill factory workers was 58.3% (95% CI: 53.7–63.4). Chronic respiratory health symptoms were significantly associated with age group (AOR=1.95, 95% CI; 1.17–2.79 and AOR=12.3, 95% CI; 4.39–34.6), monthly income (AOR=1.68, 95% CI; 1–2.79), work experience (AOR=2.58, 95% CI; 1–6.62), past dust exposure (AOR=1.86, 95% CI; 1.08–3.2) and utilization of respiratory protective equipment (AOR=2.29, 95% CI; 1.27–4.13).

Conclusion and Recommendation

Chronic respiratory health symptoms were highly prevalent among flour mill factory workers. Supportive supervision and cooperation between Ministry of Labour and Social Affairs, flour mill managers and workers are needed to reduce exposure and improve working environment.