Hemorrhagic and ischemic stroke in an urban hospital setting in Uganda

Ondertitel:risk factors, outcomes, caregiver burden and experiences

Background: The trend towards an increasing burden of cardiovascular diseases including stroke in developing countries is of great concern. In sub-Saharan Africa (SSA), there is a significant burden of ischemic stroke and hemorrhagic stroke and yet data on risk factors and outcomes for each stroke type are sparse. In Uganda, stroke is one of the top five causes of adult death, and it accounts for 3.7% of all admissions in Ugandan hospitals. The overall aim of the thesis was to assess the risk factors and outcomes for both hemorrhagic and ischemic stroke among adults, and to document caregiver burden and experiences in Uganda. These findings will inform policy to plan for the required resources to meet this increasing stroke disease burden in Uganda. Methods: The thesis describes four sub-studies which were performed between December 2016 and March 2019 at St Francis Hospital Nsambya, Kampala Uganda. The overall study design was a mixed-methods approach. SUB-STUDY I was a systematic review to understand risk factors for haemorrhagic and ischemic stroke in Sub-Saharan Africa. SUB-STUDY II was a prospective hospital - based case control study to assess risk factors for haemorrhagic and ischemic stroke at an urban hospital in Uganda. SUB-STUDY III was a qualitative cross sectional study to document caregiver burden and experiences on caring for a stroke patient. SUB- STUDY IV was a prospective hospital - based cohort study to examine short term outcomes of haemorrhagic and ischemic stroke and associated factors. All study participants were consented and enrolled consecutively. Results: The findings demonstrated that hypertension, diabetes and HIV were independently associated ischemic stroke and hemorrhagic stroke. Mortality was high during the first 30 days of stroke. Mortality was also higher among hemorrhagic stroke compared to ischemic stroke patients. The caregivers experienced caregiver burden mainly due to high care giving demands, financial difficulties, emotional distress, and grief, yet there was lack of rehabilitation and follow up support services in their communities. Conclusions: Interventions to reduce modifiable risk factors among populations in Uganda are urgently needed. Given the high mortality during the acute phase, critically ill stroke patients would benefit from interventions established as the post-stroke- standard of care in the country. There is need for interventions to support stroke patients and their caregivers.

Jaar van publicatie:2020

Trefwoorden:Doctoral thesis

Toegankelijkheid:Closed