UNFAVORABLE TREATMENT OUTCOMES AND PREDICTORS OF MORTALITY AMONG STROKE PATIENTS IN PUBLIC HOSPITALS IN HARARI REGION, EASTERN ETHIOPIA

Abstract

Background: Stroke is a leading cause of death and disability worldwide, claiming 11.6% of all lives and contributing to 57% of total disability-adjusted life years. Nearly one-fifth of stroke patients die during hospitalization, highlighting the severity of the condition and the need for improved care in Ethiopia. Identifying predictors of mortality among adult stroke patients is important for effective management. However, information regarding treatment outcomes and predictors of mortality is scarce in Harari Regional State, Eastern Ethiopia. Objective: To determine unfavorable treatment outcomes and predictors of mortality among adult patients with stroke from July 15, to August1, 2024 at public hospitals in Harari. Methodology: An institutional-based retrospective follow-up study was conducted among randomly selected 452 stroke patients at a public hospital in Harari region eastern Ethiopia, from July 1, 2019, to June 30, 2024. Mortality data was extracted from death report of medical records. The incidence of treatment outcomes was calculated at 95% CI. Kaplan Meier failure curve and the log-rank test were done to compare the probability of mortality among baseline and follow-up characteristics of patients. Predictors of mortality were determined using Cox regression analyses. Results: Of 452 included patients, 292(64.60%) improved, 21(4.65%) discharged with complications, 63(13.94 %) died and 76 (16.81 %) Discharge against medical advice. Over the 60- month follow-up period, the incidence of death was 7.59 (95% CI:5.93 – 9.72) cases per 1,000 person-months of observation. The risk of mortality was higher among stroke patients with hypertension (AHR: 2.04, 95% CI: 1.06, 3.91), heart failure (AHR: 2.23, 95% CI: 1.02, 4.88), with complications (AHR: 4.92, 95% CI: 1.49, 16.28), Hospital Acquired Infection (AHR: 3.14, 95% CI: 1.48, 6.66), Aspiration Pneumonia (AHR: 1.88, 95% CI: 1.04, 3.40), poor GCS (AHR: 6.91, 95% CI: 2.40, 19.91), moderate impairment GCS (AHR: 4.67, 95% CI: 1.64, 13.31); whereas Antiplatelet drugs reduced the risk of mortality among stroke(AHR: 0.47, 95% CI: 0.26, 0.86)). Conclusion: In-hospital mortality occurred in one out of seven stroke patients treated at public hospitals. Hypertension, Heart Failure, Lower GCS, Having Complication, Aspiration Pneumonia, HAI increased the hazards of Mortality among stroke, whereas Antiplatelet drug reduced the hazards of Mortality. Thus, it is necessary to develop strategies that allow early screening and follow-up of patients at risk and optimize the management of underlying medical conditions.