Abstract
Background The fact that the majority of patients come late creates management difficulties as these first hours are important to avoid secondary insults to the brain and preserve the ischemic penumbra. Although thrombolytic treatments are currently not available in our hospital, significant delays during the prehospital or in-hospital phases of care create management difficulties and would make such advanced treatments impossible in the future in Ethiopia. Methods Prospective observational study was carried at stroke unit of Jimma University Medical Center for 4 consecutive months from March 10 to July 10, 2017. Data was cleaned and entered to Epidata version 3.1 and then exported and analyzed using SPSS version 20.0. Results A total of 116 eligible stroke patients were recruited during the study period with mean age of 55.1±14.0 years, ranging from 23 to 96 years. The majority of stroke patients were males (62.9%) and from rural areas (72.4%). The median time elapsed between the onset of stroke symptoms and arrival to the hospital was 27 hours. Almost half (47.4%) of the patients presented within 24 hours and 26 (22.4%) patients presented to hospital beyond 72 hours. Majority of patients (40.5%) showed severe neurological deficit on admission and the mean National Institute of health stroke scale (NIHSS) was 15.71 ± 7.52. The mean Glasgow coma scale (GCS) was moderate (12.12±3.35). On hospital arrival systolic blood pressure (SBP) was highly elevated (≥140 mm Hg) in 65.5% of the patients. The circadian pattern showed a significant peak in morning for hemorrhagic stroke (35.7%) and afternoon for ischemic stroke (38.3%). Conclusions The delay of hospital arrival was a challenge similar to other high income countries for early management of the patients. Studies that attempt to determine some of the factors that impede timely presentation in patients with strokes are advisable to address those issues further.
Highlights
Cardiovascular disease is the primary global cause of death, accounting for more than 17.3 million deaths per year, a number that is expected to grow to more than 23.6 million by 2030
The study was conducted at stroke unit of Jimma University Medical Center (JUMC), a tertiary hospital found in Jimma city, southwest Ethiopia
The median time elapsed between the onset of stroke symptoms and the arrival to the hospital was 27 hours (IQR: 11.13-70.63 hours), which was delayed as compared to study in Gambia 8 hours [26], Brazil 12.9 hours [33], and Libya 12 hours [34] but earlier than in Senegal which was 2 days [29]
Summary
Cardiovascular disease is the primary global cause of death, accounting for more than 17.3 million deaths per year, a number that is expected to grow to more than 23.6 million by 2030. The data from the Global Burden of Diseases (GBD) showed that the leading cardiovascular diseases (CVD) cause of death and disability in 2010 in sub-Saharan Africa and other low- and middleincome countries (LMICs) was stroke [2,3,4]. Black people are twice as likely to have a stroke compared to white people [5] It is an important disease worldwide, constituting a big burden on the public health purse as well as on patients and their relative [3, 4]. Patients with stroke under the age of 50 years account for 5-10% of all stroke worldwide [6]. The delay of hospital arrival was a challenge similar to other high income countries for early management of the patients.
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