Risk Factors of Mortality Among Patients with Stroke in Low Middle-Income Countries:  A Series of 180 Patients

Abstract

Introduction: Stroke is one of the leading causes of acquired disability, the second cause of dementia after Alzheimer's disease and the third cause of mortality after the ischemic heart diseases, which altogether make them, therefore, a public health priority. The rapid and adequate management (diagnosis and multidisciplinary care) and keeping cardiovascular risk factors well-controlled (e.g: arterial hypertension) can help to reduce the incidence of stroke-related death. The study aims to identify factors associated with stroke mortality in low middle-income countries, especially in the Eastern region of the Democratic Republic of Congo.

Methods: This series was retrospectively carried out from 2016 to 2020 in different departments managing stroke patients of the following hospitals of Butembo and Katwa health zones: Katwa Referral Hospital, Kitatumba Referral Hospital, Matanda Hospital and the Catholic University of Graben Teaching Hospital. Files of patients with the diagnosis of stroke were retrieved and reviewed. The parameters such socio-demographics, medical history, clinical findings, treatment received and patients’ mortality outcomes were recorded. The Odds Ratio was used for assessing the risk level attributable to mortality from strokes.

Results: One hundred and eighty (180) patients with stroke were included. Stroke related mortality was 57/180 (31.7 %). Several factors have been significantly associated with this mortality especially the advanced age with a female predominance, poor compliance to antihypertensive, and anti-diabetic medication, recurrent stroke, alcoholism, and chronic smoking, obesity, hemorrhagic stroke, use of estrogen-progesterone pills by women, as well as the delayed management.

Conclusion: Stroke is a common cause of mortality in Butembo. Prevention measures, and efficient specialized care for stroke, especially targeting modifiable prognostic factors, can help to reduce mortality significantly.

Funding Statement: No funding is to be disclosed.

Declaration of Interests: The authors declare no competing interest.

Ethics Approval Statement: The proposal of this work had been presented and approved by the ethical review board of the Integrated Multidisciplinary Research Center (IMRC) of the Adventist University of Lukanga before the data gathering.