Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross Sectional Study in Mogadishu Somalia

Abstract

Background and Objective: Intravenous thrombolysis (IVT) is now considered the best a standard treatment for acute ischemic stroke in eligible patients who present within 4.5 h of symptom onset. The low rates of thrombolysis for ischemic stroke in our country and other developing countries have been attributed to delays in arrivals to the hospital. This study aims to investigate the factors that influence the early hospital arrival of patients with acute ischemic stroke to the hospital in Mogadishu, Somalia. Methods: This is a cross-sectional study conducted in teaching hospital in Mogadishu, Somalia. Adult patients diagnosed with acute ischemic stroke admitted to the emergency department between June 2021 and May 2022 were included in the study. A questionnaire-based interview was administered to adult patients or patients’ relatives. Patients within the hospital while developing an ischemic stroke were excluded from the study. Patients' demographic characteristics, stroke risk factors, NIHSS Score, time to hospital arrival, factors influencing early hospital arrival including travel distance, ambulance availability, time of stroke onset, knowledge of stroke symptoms, and thrombolytic treatment were all assessed. Results: of the 212 patients in the study, 113(53.3%) of the subjects were male, while 99(46.7%) were female. The mean age of the patients was 62±10. The majority of the patients (153 (72%) were above 60 years of age. Hypertension was the most common risk factor among patients 121(57%), followed by diabetes mellitus (65(31%)) and hyperlipidemia 73(34%). MCA infarct was the most common arterial territory of infarction 117(55%). 140(66%) of the patients lived in the city, while 72(34%) lived outside of the city. 85(40%) of the patients were brought to the ER by ambulance, and only 32(15%) reached the hospital in less than 4 hours. The thrombolytic treatment rate was 1.4% of the cases in this study. 121(57%) had no idea about stroke symptoms, and only 34(16%) of the patients/relatives knew about thrombolytic treatment for acute stroke. In univariate and binary logistic regression analysis, delays in hospital arrivals were associated with travel distance of more than 10 km, transportation via non-ambulance means, living alone, lack of recognition of stroke symptoms, night time stroke onset, and lack of knowledge about thrombolytic treatment for acute stroke and non-hemiplegic presentation. Conclusion: This study demonstrates factors delaying early hospital arrivals of patients with ischemic stroke. Improving the modifiable factors through public education will prevent delays in early hospital arrival of the stroke patients and will improve early thrombolytic intervention and over all outcome of these patients.