Tesfaye Alemayehu, Regassa Lemma Demissie, Shegene Birhanu, Areda Nano Belema, Tola Assefa
School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia.
PLOS Glob Public Health. 2025 Sep 5;5(9):e0004414. doi: 10.1371/journal.pgph.0004414. eCollection 2025.
Stroke is a major cause of death and disability worldwide, yet there is limited information on the mortality rate and its predictors in Eastern Ethiopia. This lack of evidence is particularly significant, as hospitals in the Harari region provide the majority of healthcare services for stroke and chronic diseases. Therefore, our objective is to assess the mortality rate and predictors among stroke patients in the public hospitals in Harari. An institutional-based retrospective follow-up study was conducted among 452 randomly selected stroke patients at public hospitals in the Harari region from July 1, 2019, to June 30, 2024. The incidence of unfavorable treatment outcomes was calculated at 95% CI, and predictors of mortality were determined using Cox regression analyses. Of the 452 patients included, 292 (64.6%) improved, 21 (4.7%) were discharged with complications, 63 (13.9%) died, and 76 (16.8%) were discharged against medical advice. The 60-month follow-up revealed a mortality rate of 7.6 (95% CI: 5.9-9.7) per 1,000 person-months. The mortality risk was higher among stroke patients with hypertension (AHR: 2.0, 95% CI: 1.1-3.9), heart failure (AHR: 2.2, 95% CI: 1.1, 4.9), those with complications (AHR: 4.9, 95% CI: 1.5, 16.3), hospital-acquired infections (AHR: 3.1, 95% CI: 1.5-6.7), aspiration pneumonia (AHR: 1.9, 95% CI: 1.1-3.4), poor Glasgow Coma Scale (GCS) scores (AHR: 6.9, 95% CI: 2.4-19.9), and moderate impairment in GCS (AHR: 4.7, 95% CI: 1.6-13.3). Conversely, the use of antiplatelet drugs was associated with a reduced mortality risk in stroke patients (AHR: 0.5, 95% CI: 0.3-0.9). The mortality rate of stroke in this study was comparable to that of other studies in Ethiopia. Factors such as hypertension, heart failure, lower GCS, complications, aspiration pneumonia, and hospital-acquired infections increased mortality risks, while antiplatelet drugs reduced them. Therefore, strategies for early screening and follow-up of at-risk patients are essential.
中风是全球死亡和残疾的主要原因，但埃塞俄比亚东部地区关于死亡率及其预测因素的信息有限。由于哈拉里地区的医院为中风和慢性病提供了大部分医疗服务，这种证据的缺乏尤为严重。因此，我们的目标是评估哈拉里地区公立医院中风患者的死亡率及其预测因素。我们对2019年7月1日至2024年6月30日期间在哈拉里地区公立医院随机抽取的452名中风患者进行了一项基于机构的回顾性随访研究。计算了95%置信区间内不良治疗结果的发生率，并使用Cox回归分析确定了死亡率的预测因素。在纳入的452名患者中，292名（64.6%）病情好转，21名（4.7%）出院时伴有并发症，63名（13.9%）死亡，76名（16.8%）不听从医嘱自行出院。60个月的随访显示，每1000人月的死亡率为7.6（95%置信区间：5.9-9.7）。高血压中风患者（风险比：2.0，95%置信区间：1.1-3.9）、心力衰竭患者（风险比：2.2，95%置信区间：1.1，4.9）、有并发症的患者（风险比：4.9，95%置信区间：1.5，16.3）、医院获得性感染患者（风险比：3.1，95%置信区间：1.5-6.7）、吸入性肺炎患者（风险比：1.9，95%置信区间：1.1-3.4）、格拉斯哥昏迷量表（GCS）评分低的患者（风险比：6.9，95%置信区间：2.4-19.9）以及GCS中度受损的患者（风险比：4.7，95%置信区间：1.6-13.3）的死亡风险更高。相反，使用抗血小板药物与中风患者死亡风险降低相关（风险比：0.5，95%置信区间：0.3-0.9）。本研究中中风的死亡率与埃塞俄比亚其他研究相当。高血压、心力衰竭、GCS评分较低、并发症、吸入性肺炎和医院获得性感染等因素会增加死亡风险，而抗血小板药物则会降低死亡风险。因此，对高危患者进行早期筛查和随访的策略至关重要。
