Research Article

Determinants of Stroke and Its Severity in A Rural Teaching Hospital in Southern Nigeria

Abstract

Background: There is a paucity of information on the determinants of stroke and severity among indigenous Africans, which is largely preventable. Knowledge of its determinants and severity would influence practice, prevention and better health seeking behaviours. Unfortunately, its awareness is poor among Nigerians at increased risk especially in rural areas. Method: This was a hospital-based cross sectional study of 152 stroke patients consecutively recruited at the Family Medicine clinics and medical wards of Irrua Specialist Teaching Hospital between March, 2022 and January, 2023. Stroke was diagnosed clinically based on the WHO criteria and its clinical presentation was obtained from medical history and clinical investigations. Stroke severity was determined using the National Institute of Health Stroke Scale (NIHSS). Data was entered into Epi version 3.1 and analysed using SPSS version 20.0. Results: The patients were all black Africans with a mean age of (66.05±10.43) years with a Male:Female ratio of 1.5:1. Hypertension (91.4%) was the commonest modifiable determinant followed by obesity (64.5%), diabetes mellitus (DM) (48.7%), alcohol consumption (35.5%), dyslipidaemia (21.7%) and cigarette smoking (17.8%). Hemiparesis (100%) was the commonest clinical presentation, followed by dysarthria (77.6%), sudden facial weakness (57.9%), headache (42.8%), and loss of consciousness (39.5%). Ischaemic stroke was a commoner subtype (65.8%). Majority of the patients had moderate stroke severity (79.6%) and elderly subjects were significantly most likely to have severe strokes. Stroke severity seemed to be more on females than males. Conclusion: The patients were mostly elderly with low socioeconomic status. Hypertension was the commonest determinant and hemiparesis the commonest presentation, meanwhile, convulsion, vomiting, aphasia, coma, and headache were significant presentation in patients with haemorrhagic stroke. The majority of subjects had moderate stroke severity as the elderly were likely to have severe stroke.