Factors Associated With Stroke Mortality in an Urban-Rural Environment: The Case of the MONKOLE Hospital Centre

Abstract

Background: Stroke is a fatal disease, and knowledge of the factors associated with this mortality in different environments is necessary in order to take appropriate action. This article presents data from a hospital located in an urban-rural setting in Kinshasa: The Monkole hospital centre. Methods: This is a cross-sectional study conducted at Monkole hospital Centre from 01/01/2020 to 31/01/2023 in all patients with a confirmed diagnosis of stroke admitted to intensive care, emergency or internal medicine. Sociodemographic, clinical, paraclinical, therapeutic and outcome data were collected from hospital registers and patient records. Student's t, Anova, Chi-squared or Fischer's exact tests and logistic regression were performed with SPSS 25.0 with p less than 5%. Ethical principles were respected. Results: Of 3,629 patients admitted during the study period, 148 (4%) were admitted for stroke. The mean age was 62.6 years and the predominant sex was male. 51.4% of patients were admitted from home, with the following comorbidities: arterial hypertension, diabetes mellitus and embolism-induced heart disease. Frequent reasons for consultation were: disturbed consciousness, increased blood pressure and convulsions. Frequent physical signs were: disturbed consciousness, increased blood pressure, neurological deficit and pupillary abnormalities. The average time to hospital was 13.6 ± 8.2 hours. The accident was ischaemic in 70.3% and haemorrhagic in 29.7%. Treatment was medical in 100% of cases, with no thrombolysis. Mortality was 11.5% and 36.5% of survivors had moderate to severe functional disability. Advanced age (OR 2.34, 95% CI 1.36-4.04), hypertension (OR 2.19, 95% CI 1.24-3.88) and low socio-economic status (OR 1.81, 95% CI 1.02-3.21) were associated with mortality. Conclusion: Mortality in this series was 11.5%, associated with advanced age, hypertension and low socioeconomic status. Controlling blood pressure and improving living conditions could reduce this mortality