A retrospective study
Senior Registrar and Chief Resident Dept. of Internal Medicine. University of Benin Teaching Hospital (UBTH) Benin City. P.M.B. 1111 ,Nigeria.
Assistant Secretary, Medical Women Association of Nigeria, Edo State, Nigeria
Introduction
Cerebrovascular accident otherwise called stroke is defined in this communication as rapidly developing clinical signs of focal neurological deficit lasting more than 24 hours or leading to death with no apparent cause other than of vascular origin. This definition includes subarachnoid haemorrhage, but excludes transient ischaemic attack, subdural haematoma and heamorrhage or infarction caused by infection or tumour.
Nowadays stroke has a dominant place in the structure of neurological morbidity. According to data of the World Health Organization, stroke is the third highest cause of morbidity and mortality in developed countries of the world immediately following Ischeamic heart disease and malignant diseases.
In Africa stroke is increasing becoming a major cause of morbidity and death. It accounts for 2.8 – 4.5% of total deaths. The appearance of the disease is influenced by many aetiological factors, that is risk factors.
Natural risk factors are hereditary, age, sex, ethnicity etc, other diseases e.g. hypertension, diabetes, heart disease to name but a few.
Both men and women are affected by stroke. However almost 1 in 4 men and nearly 1 in 5 women aged 45 years can expect to have a stroke, if they live to their 85th year. Although the lifetime risk of having an acute stroke is higher in men than in women the converse is true for the life time risk of dying of stroke. Thus about 16% of all women are likely to die of a stroke Vs 8% of all men. This difference is largely attributable to the higher mean age of stroke onset in women and to their greater life expectancy.
In Spain stroke is the commonest cause of death in women and the 2nd commonest in men. In Taiwan women also experienced a higher mortality rate (139.8 per 1000 persons years than men 126.4 per 1000 person years).
Back home in Nigeria, most of the available data on stroke morbidity and mortality are derived from investigation and follow up of patients in the hospitals and information rather scanty. However in most published series. Stroke affects men and women as well, resulting in death and major loss of independence with immense human and financial loss.
This study therefore aims at presenting the results of a 10 year retrospective study which focuses mainly on factors associated with morbidity and mortality of stroke in Nigeria women.
Methodology
This is an analytical retrospective study. Over a 10 year period between January 1990 to January 1999, women who have had a stroke were identified from the medical records of UBTH, Benin City. The minimal criteria for diagnosis of stroke consisted of the abrupt onset of a focal neurological deficit such as hemiparesis, hemiplegia, aphasia hemifacioparesis, or homonymos hemianopia.
Factors that may be related to the development of stroke were identified from the medical records. These included sex, age, occupation, dietary habits, family history of stroke, previous stroke, weight, blood pressure, blood glucose, type of deficit.
Analysis
For the purpose of analysis of data, the chi-square test, the t-test, analysis of variance were used.
Results
Table I - Stroke type distribution
Current selection: sex = “F”
An expected value is < 5. Chi square not valid.
Chi square = 5.47
Degrees of freedom = 6
P value = 0.484847476
Table II - Pattern of Clinical Deficit
Current selection: sex = “F”
Student’s “t”, testing whether mean differs from zero.
T statistic = 15.061, df = 41 p-value = 0.00000
Table III & IV - Relationship of Aetiological factors and outcome (blood pressure and blood sugar).
Current selection: sex = “F”
An expected value is < 5. Chi Square not valid.
Chi square = 10.06
Degrees of freedom = 6
P value = 0.12226614
Table 4
Table 5
Conclusion
The following factors were found to be significantly associated with morbidity and mortality among Nigerian women with stroke.
Stroke Type - Haemorrhagic Stroke
The Severity of Blood Pressure – Systolic blood
Pressure greater than 160mmHg
Pattern of Clinical Deficit – Dense hemiplegia
The age and occupation appear to have no bearing on morbidity and mortality.
Recommendations
1. Research into the estimation and reduction in morbidity and mortality of the illness in Nigeria should be encouraged.
2. The introduction of the national health insurance scheme to make adequate medical attention available and affordable to all.
3. Clear diagnostic and treatment guidelines for stroke in our environment should be developed to facilitate early diagnosis and adequate institution of appropriate management.
4. In view of the high morbidity and mortality of stroke, an emphasis on prevention of it via early identification and treatment of the aetiological factors (risk factors) appropriately in high-risk subjects. Awareness campaign to highlight the importance of regular blood pressure measurement would help reduce the prevalence of untreated hypertension which is the most important single aetiological agent of stroke in Nigeria.
5. The introduction of stroke units - a multi disciplinary team of committed professional staff has been proven to significantly reduce morbidity and mortality of stroke. In the absence of sophisticated facilities for investigation and management of stroke in a developing country like Nigeria, the organisation of stroke unit for all communities should be encouraged as this would provide the hope for a better outcome in the developing countries of Africa.
