Ischemic and Hemorrhagic Stroke in Bahir Dar, Ethiopia: A Retrospective Hospital-Based Study.
INTRODUCTION
The epidemiology of stroke in sub-Saharan countries is poorly characterized because of lack of population-based studies and national vital statistics systems with complete death registration.


OBJECTIVE
To describe risk factors, clinical presentations, the pattern of brain insult, and outcomes of stroke patients admitted to a hospital in Ethiopia.


METHOD
A retrospective hospital-based study was conducted on 508 patients, 303 of whom had computed tomography proven stroke, who were admitted to medical wards of Felege Hiwot Referral Hospital, Bahir Dar Ethiopia, from February 2014 to August 2016.


RESULTS
From 508 patients with a clinical diagnosis of stroke, 303 patients had computed tomography and complete medical record. Of the latter, 63% were male and 32% were in the age group 61-70 years. The most common initial clinical presentation was hemiplegia (61%). Common risk factors documented with stroke were hypertension (36.3%), dyslipidemia (20.4%), atrial fibrillation (12.2%), and structural cardiac disease (9.2%). Ischemic stroke comprised 59.4%, whereas 40.6% were hemorrhagic stroke. Only 3.6% patients arrived at the hospital within 3 hours of onset of clinical symptoms. Among subjects with preexisting treated hypertension, 56% had discontinued antihypertensive medications. One third of patients with atrial fibrillation were on warfarin or aspirin. In-hospital mortality rate was 11%. The cerebral cortex was affected in 36.6%.


CONCLUSION
Poor adherence to drugs and uncontrolled high blood pressure might have resulted in a high proportion of hemorrhagic stroke. Use of anticoagulants for atrial fibrillation should be standard in patient with risk factors for stroke in Ethiopia.