Stroke Mortality in Kenya's Public Tertiary Hospitals: A Prospective Facility-Based Study.
Stroke Mortality in Kenya's Public Tertiary Hospitals: A Prospective Facility-Based Study.
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DOI：
10.1159/000488205
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发表时间：
2018
影响因子：
1.9
通讯作者：
Remick S
中科院分区：
文献类型：
--
作者：
Kaduka L;Muniu E;Oduor C;Mbui J;Gakunga R;Kwasa J;Wabwire S;Okerosi N;Korir A;Remick S
尽管中风的全球负担日益增加，但肯尼亚的中风数据有限，无法指导决策。撒哈拉以南非洲的中风发生与不良健康结果有关。本研究旨在确定肯尼亚领先的公立三级医院的中风发病率密度和死亡率，以便为临床实践和政策提供信息。这是一项在肯尼亚主要转诊医院，即肯雅塔国立医院和莫伊教学和转诊医院进行的前瞻性研究。从2015年2月至2016年1月招募了确诊卒中病例的成人患者，并随访至少1年。使用WHO 2006卒中STEPS工具收集第10天和第28天以及每3个月一次的发病率和死亡率数据，持续24个月。从入院至死亡、失访或研究结束计算随访人次。使用考克斯比例风险模型进行生存回归分析。共招募了719例患者（KNH：n = 406 [56.5%]; MTRH：n = 313 [43.5%]）。平均年龄为58.6 ± 18.7岁，男女比例为1：1.4。缺血性脑卒中占56.1%。中风的高峰年龄在50 - 69岁之间，占36.3%。第10天和第28天的死亡率分别为18.4%和26.7%。住院死亡率为21.6%。中风发病率密度为每1,000人年随访507例死亡。平均生存期在住院组（13.9个月; 95%CI：13.0-14.7）和门诊组（18.6个月; 95%CI：17.2-19.9）之间有显著性差异（p < 0.001）。年龄增加1岁，风险增加1.8%。与门诊患者相比，住院患者的风险增加了3.9倍。中风的死亡率很高，中风后第一年的生存率很低。死亡风险随着年龄和住院时间的增加而增加。有必要关注中风患者的护理质量和长期需求，以降低观察到的高死亡率。应加强旨在早期筛查和诊断的公共卫生举措。建议开展进一步研究，以确定社区水平的卒中真实负担，为适当的缓解措施提供信息。
Despite the increasing global burden of stroke, there are limited data on stroke from Kenya to guide in decision-making. Stroke occurrence in sub-Saharan Africa has been associated with poor health outcomes. This study sought to establish the stroke incidence density and mortality in Kenya's leading public tertiary hospitals for purposes of informing clinical practice and policy. This is a prospective study conducted at Kenya's leading referral hospitals, namely, Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH). Adult patients with confirmed cases of stroke were recruited from February 2015 to January 2016 and followed up for a minimum period of 1 year. The WHO 2006 Stroke STEPS instrument was used to collect data on incidence and mortality at days 10 and 28 and every 3 months for 24 months. The person-time of follow-up was computed from admission to death, loss to follow-up, or the end of the study. A survival regression analysis was done using the Cox proportional hazards model. A total of 719 patients were recruited (KNH: n = 406 [56.5%]; MTRH: n = 313 [43.5%]). The mean age was 58.6 ± 18.7 years, and the male-to-female ratio was 1: 1.4. Ischemic stroke accounted for 56.1% of the stroke cases. The peak age for stroke was between 50 and 69 years, when 36.3% of the cases occurred. Mortality at day 10 and day 28 was 18.4 and 26.7%, respectively. The inpatient mortality rate was 21.6%. The stroke incidence density was 507 deaths per 1,000 person-years of follow-up. The mean survival time was significantly different between inpatients (13.9 months; 95% CI: 13.0–14.7) and outpatients (18.6 months; 95% CI: 17.2–19.9) (p < 0.001). A 1-year increase in age increased the hazard by 1.8%. Inpatients had a 3.9-fold increase in hazard compared to outpatients. Mortality due to stroke is high, with poor survival observed in the first year after stroke. The risk of death increases with increasing age and duration of hospital stay. There is need for attention to quality of care and long-term needs of stroke patients to mitigate the high mortality rates observed. Public health initiatives aimed at early screening and diagnosis should be enhanced. Further research is recommended to establish the true burden of stroke at the community level to inform appropriate mitigation measures.