Profile, type and outcome of stroke patience admitted to health facilities in Limpopo

Abstract

Background: Over the past 3 decades, non-communicable diseases have become more prominent as the leading causes of death and disability globaly. Stroke, in particular, hasbecome a leading cause of morbidity and mortality. The burden of stroke is estimated to be significantly higher in lower and middle-income countries (LMICs). However, data detailing the burden of stroke and the demographic and clinical profile of stroke patients in rural areas, such as the Limpopo Province, remains scarce. Aim: To profile the characteristics, risk factors and outcomes of stroke patients admitted to Pietersburg hospital and Mediclinic Limpopo. Method: This was a cross-sectional study that retrospectively reviewed patient records. Data were collected over a one-year period, from January 2020 to December 2020. Records were selected based on a stroke diagnosis, and data extracted from records included demographic information, risk factors, brain CT scan findings and outcome. Continuous data was summarised using mean and standard deviation (SD). A Chi-squared or Fisher exact test was used to measure associations between categorical variables. A multinomial logistic regression model was used to identify factors associated with stroke subtypes. All data were analysed in SPSS Version 29. Results: Of the 384 records reviewed between Pietersburg and Mediclinic, 306 (80%) met the inclusion criteria. The mean age of stroke patients was 58 years (SD,16.5), with a mean difference of 7 years observed between the different facilities. Young stroke (<50 years) patients accounted for 103 (33%) of the total caseload. The majority of stroke patients were female, 161(52,6%), and 99 (32,4%) of all stroke patients had a clinical history of hypertension. Additionally, 25(8,2%) of stroke patients were HIV positive, with the majority of these patients 19 (79%) occurring in individuals under the age of 50. The most frequent stroke type was Ischaemic 127(41,5%). Haemorrhagic stroke accounted for 68 (22,2%), with the majority of these occurring at Pietersburg Hospital. Among stroke patients, there were 60 (19.6%) deaths, with the majority occurring in Pietersburg 33 (25,8%) and in males 33(55%). In our multivariable multinomial logistic regression model, no significant factors were associated with specific stroke subtypes. Conclusion: Stroke represents a significant public health concern, particularly in LMICs. Our study found that stroke patients tended to be younger. Of particular concern is the rising prevalence of strokes among individuals under the age of 50 years. The increasing number of young patients presenting with both HIV and stroke is a worrisome trend that further exacerbates the overall burden of disease. Our recommendations include strengthening the implementation of the NCD strategic framework and advocacy for stroke units in our tertiary hospitals.