Stroke distribution patterns and characteristics in Kenya’s leading public health tertiary institutions: Kenyatta National Hospital and Moi Teaching and Referral Hospital

Abstract

SummaryBackgroundCardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinico-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya.MethodsThis was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran’s Mantel–Haenszel chisquared test of conditional independence was used with p-value set at 0.05.ResultsA total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%)] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age.ConclusionsTo our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.

Effect of cigarette smoking on coronary arteries and pattern and severity of coronary artery disease: a review

“… 2 , 6 The prevalence of cardiovascular disease is rapidly increasing in developing countries. 7 The coronary arteries, which originate in the aorta and immediately above the aortic valve, are responsible for supplying blood to the heart muscle. 8 Several tests are used to diagnose cardiovascular disease.…”

Living with consequences of stroke and risk factors for unhealthy diet- experiences among stroke survivors and caregivers in Nairobi, Kenya

“…This albeit small study raises questions that will need to be further explored in order to develop and implement both the national and community-based interventions that are needed to prevent and manage stroke and a healthy diet in Kenya [ 4 ]. Kenya is currently one of seven African countries that have developed food-based dietary guidelines, but the lack of nutritional specialists and poor access to healthcare services makes the effect of these guidelines questionable [ 1 , 5 ]. There is much to learn from how HIC manage NCDs such as stroke.…”

“…In Kenya non-communicable diseases (NCDs) account for 27% of the mortality and there is often limited access to healthcare due to, poor infrastructure, insufficient numbers of healthcare professionals, as well as the varying socio-economic situation of the population [ 2 , 3 ]. The proportion of high-risk persons receiving any drug therapy and counselling to prevent heart attacks and strokes is 6% [ 4 ] but there are no national guidelines available to guide clinicians on stroke care [ 5 ].…”

Insights in the pathophysiology of haemorrhagic strokes in a sub‐Sahara African country, an epidemiological and MRI study

“…The reasons for the over-representation of ICH are unknown but are reproductible in the few epidemiological studies realized in Gambia, Cameroon, Mozambique and Kenya. [8][9][10][11] In those studies, ICH occurs more frequently, at younger age and with worse prognosis in SSA than in high income countries (HIC). Yet, the association of younger age at onset and first ICH in SSA is based on single-centre retrospective reports and may represent a selection bias.…”

“…Epidemiological reports suggest that stroke in SSA is characterised by higher proportion of intra‐cerebral haemorrhagic stroke (ICH) than ischaemic stroke (IS). The reasons for the over‐representation of ICH are unknown but are reproductible in the few epidemiological studies realised in Gambia, Cameroon, Mozambique and Kenya [8‐11]. In those studies, ICH occurs more frequently, at younger age and with worse prognosis in SSA than in high‐income countries (HIC).…”