Distribution and determinants of stroke severity among patients treated in public hospitals in the Lake Region counties of Kenya

Abstract

Stroke ranks as the fifth leading cause of death in the United States, impacting nearly 795,000 individuals annually and resulting in fatalities for about 20% of those affected within the first year after the event. Global estimate reports suggest that the number of individuals experiencing strokes has increased in the range of 7.1% to 9.6% mortalities, 15 million people suffer a stroke annually, 5 million deaths occur, and 5 million people develop disabilities. In Kenya the incidence and prevalence of stroke largely remain unknown due to substantial gaps in the national data. A recent study conducted in rural hospitals revealed a stroke prevalence of 0.6% in a referral hospital in western Kenya. The aim of this study was to assess the distribution and determinants of stroke severity among patients treated in public hospitals in the lake region counties of Kenya. This research was guided by Donabedian model. A mixed-methods research approach was employed. A total of 173 stroke patients were enrolled in the study from four county referral hospitals, with 87 allocated to the intervention group(two hospitals) and 86 to the control group(two hospitals).Data was collected using a structured questionnaire, key interview guide, health facility checklist, and a review of patient health records. Both descriptive and inferential statistical analyses were applied with significance set at p ≤ 0.05. The National Hospital Institute of Stroke Scale (NHISS) scores was used and categorized stroke as mild (0–4), moderate (5–15) and severe (≥16).The results revealed that among the study participants 47.4% (n=82) had mild stroke, 37.6% (n=65) had moderate stroke while 15% (n=26) had severe stroke. Further, the findings on the type of stroke revealed that among the participants 62.4% (n=108) had Ischemic stroke while 37.6% (n=65) had hemorrhagic type of stroke. Qualitative findings revealed that patient factors such as age, comorbidities, stroke type, and severity level, distance, time of onset, presentation to the health facility and level of severity contributed to the patient-outcomes. In conclusion, stroke severity at admission is skewed towards moderate to severe types of stroke. This distribution is influenced by a combination of clinical, socio-demographic, and health system factors. In particular, low socioeconomic status, poor health literacy, and geographic barriers delay access to care, leading to more severe neurological outcomes. Overall, the study demonstrates a clear relationship between stroke type and severity, with more severe presentations observed among patients with hemorrhagic stroke. This study recommends that, targeted strategies should focus on improving the control of modifiable risk factors, enhance early health-seeking behavior, and increase investment in stroke units and diagnostic capacity within public hospitals.