| dc.description.abstract |
Background: The prevalence of stroke is increasing in sub-Saharan Africa due to
increases in size of aging population and stroke risk factors.We assessed risk factors,
quality of care and outcomes of stroke to identify modifiable risk factors and areas of
care that need improvement for better outcomes.
Objectives: To describe the stroke types, risk factors, outcomes and stroke quality of
care in a large academic medical centre hospital.
Design: Hospital based retrospective study.
Setting: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.
Subjects: All patients >18 years admitted with a diagnosis of stroke as per the WHO
definition and with a supporting brain imaging (CT scan/ MRI )were included in
the study. Data abstracted from the files included demographic details, stroke sub type, stroke risk factors, inpatient stroke care quality indicators(based on US Joint
Commission stroke quality indicator definitions) and in hospital stroke outcomes.
Descriptive statistics was used to summarise the data.
Results: A total of 155 patients had stroke between January 2010 and December 2014
of whom 42% were male, the median age was 61 (IQR: 49-72) years. Majority (73%)
had hypertension. The prevalence of diabetes was 4%. Left hemiplegia/hemiparesis
was the predominant presentation (50%). Haemorrhagic strokes were frequent (52%)
with anterior circulation stroke comprising 97% of all strokes. Assessment of quality
of care indicators showed that overall, 84% of the patients had a brain CT scan on day
one of admission,93% had a GCS documented at admission, 32% were on statins and
3% were screened for dysphagia before oral intake. Among patients with ischaemic
strokes; none underwent thrombolysis, 24% received DVT prophylaxis, 54% received
statins, and 73% received anti-thrombotic therapy by hospital day two. In hospital
mortalityoccurred in 43(27%)with a higher rate among haemorrhagic strokes (31%)
compared to ischaemic stroke (24%)(p=0.364).
Conclusion: Haemorrhagic stroke was the most common type of stroke admitted,
hypertension was the predominant risk factor and most strokes involved the anterior
circulation. In-hospital mortality was 27%.There were several opportunities to improve
evidence-based quality of care indicators |
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