Stroke Mortality in Kenya’s Public Tertiary Hospitals: A Prospective Facility-Based Study

Abstract

Background: Despite the increasing global burden of stroke, there are limited data on stroke from Kenya to guide in decision-making. Stroke occurrence in sub-Saharan Africa has been associated with poor health outcomes. This study sought to establish the stroke incidence density and mortality in Kenya’s leading public tertiary hospitals for purposes of informing clinical practice and policy. Methods: This is a prospective study conducted at Kenya’s leading referral hospitals, namely, Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH). Adult patients with confirmed cases of stroke were recruited from February 2015 to January 2016 and followed up for a minimum period of 1 year. The WHO 2006 Stroke STEPS instrument was used to collect data on incidence and mortality at days 10 and 28 and every 3 months for 24 months. The person-time of follow-up was computed from admission to death, loss to follow-up, or the end of the study. A survival regression analysis was done using the Cox proportional hazards model. Results: A total of 719 patients were recruited (KNH: n = 406 [56.5%]; MTRH: n = 313 [43.5%]). The mean age was 58.6 ± 18.7 years, and the male-to-female ratio was 1: 1.4. Ischemic stroke accounted for 56.1% of the stroke cases. The peak age for stroke was between 50 and 69 years, when 36.3% of the cases occurred. Mortality at day 10 and day 28 was 18.4 and 26.7%, respectively. The inpatient mortality rate was 21.6%. The stroke incidence density was 507 deaths per 1,000 person-years of follow-up. The mean survival time was significantly different between inpatients (13.9 months; 95% CI: 13.0–14.7) and outpatients (18.6 months; 95% CI: 17.2–19.9) (p < 0.001). A 1-year increase in age increased the hazard by 1.8%. Inpatients had a 3.9-fold increase in hazard compared to outpatients. Conclusions: Mortality due to stroke is high, with poor survival observed in the first year after stroke. The risk of death increases with increasing age and duration of hospital stay. There is need for attention to quality of care and long-term needs of stroke patients to mitigate the high mortality rates observed. Public health initiatives aimed at early screening and diagnosis should be enhanced. Further research is recommended to establish the true burden of stroke at the community level to inform appropriate mitigation measures.

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

“…The in-hospital mortality rate of stroke was the main outcome of interest, and the result found in this study showed that the overall in-hospital mortality rate of stroke in Ethiopia was 18% (95%:14–22). This result is comparable with other hospital-based studies conducted in sub-Saharan Africa, Cameroon, Nigeria, and Kenya [ 41 , 44 – 46 ]. However, this result is lower-than previous studies conducted in Ghana, Tanzania, Gambia, Uganda, and Burkina Faso [ 47 – 51 ].…”

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

“…There were 75 deaths (14.9%) over the seven years (with a one-month case fatality rate of 15%) out of 503 first ever-adult stroke patients. In our study, the mortality from a stroke at day 10 and 28 was 14.8 and 23.1% as compared to the study conducted in Kenya, 21 the overall mortality rates were 18.4 and 26.7% respectively.…”

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

“…29,31 However, our finding is slightly lower than what was found in Tikur Anbessa hospital, Addis Ababa, Ethiopia, and Kenya where the overall mortality rate was 19.2% and 21.6%, respectively. 19,38 It is also much lower compared to the case-fatality rates of St. Paul Hospital, Addis Ababa, Ethiopia, 30.1%, and in the Gambia, 41%. 28,35 Moreover, our finding approaches the national stroke-related in-hospital death which was 18%.…”