Pathological sub-types, risk factors and outcome of stroke at the Nairobi hospital, Kenya

Abstract

Background: Stroke is one of the most common causes of morbidity and mortality the world over. Established risk factors such as arterial hypertension, diabetes mellitus, cigarette smoking, hyper-lipidaemia, micro-vascular rupture, male gender, age and observed co-morbities such as sickle cell disease, HIV/AIDS infection and cerebral malaria are increasingly being encountered in the tropics. Objectives: To determine pathological sub-types, risk factors, in-hospital period prevalence and in-hospital outcome of stroke. Design: Hospital-based retrospective study. Setting: The Nairobi Hospital, Nairobi, Kenya. Subjects: Patients with recorded diagnosis of stroke/cerebral vascular accident; as per WHO criteria for diagnosis of stroke, all gender and age ≥ 18 years were studied. Results: A total of 2629 patients were admitted to the division of medicine at the hospital during study period. Eighty patients had diagnosis of stroke; giving an in-hospital period prevalence of 3042/100,000. Mean age was 61.3 years, mode; 63 years, range 34-95 years. Males were 43 (53.8%), M to F ratio 1.2:1 stroke sub-types: Ischaemic stroke 68(85%), haemorrhagic stroke seven (8.8%). In five patients (6.3%) no evidence of stroke sub-type was on-record. Established risk factors for stroke included hypertension and diabetes mellitus. Hypertension was found in 64 patients (80%) and diabetes-mellitus in 27(33.7%). Twenty three patients (28.8%) had both hypertension and diabetes-mellitus. Co-morbidities were observed and included mitral-stenosis, cardiac-arrhythmias cardio-myopathy, HIV/AIDS, Left Ventricular Hypertrophy (LVH), infective endocarditis, atrial septal aneurysm, carotid plaques with or without stenosis and hyper-homocystenemia. Mean hospital stay was 12.5 days; range 22-70 days. Seventy five patients (93.8%) were discharged and four (5%) died in hospital. All patients who died had anterior circulation ischaemic stroke as per Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Conclusion: Ischaemic stroke is the most common pathological sub-type observed in this study. Hypertension is the leading observed risk factor for stroke. Hospital period prevalence for stroke of 3042/100,000 was found. Seventy five patients (93.8%) were discharged and four (5%) died in hospital.