Cardiovascular Journal of Africa: Vol 29 No 2 (March/April 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018 68 AFRICA
Cardiovascular Topics
Stroke distribution patterns and characteristics in
Kenya’s leading public health tertiary institutions:
Kenyatta National Hospital and Moi Teaching and
Referral Hospital
Lydia Kaduka, Anne Korir, Chrispine Owuor Oduor, Judith Kwasa, Jane Mbui, Sylvanos Wabwire,
Robai Gakunga, Nathan Okerosi, Yvonne Opanga, Isaac Kisiang’ani, Mercy Rotich Chepkurui,
Erastus Muniu, Scot C Remick
Abstract
Background: Cardiovascular diseases are the second leading
cause of morbidity and mortality in Kenya. However, there
is limited clinico-epidemiological data on stroke to inform
decision making. This study sought to establish stroke distri-
bution patterns and characteristics in patients seeking care at
Kenyatta National Hospital (KNH) and Moi Teaching and
Referral Hospital (MTRH), with the ultimate aim of estab-
lishing the first national stroke registry in Kenya.
Methods: This was a prospective multicentre cohort study
among stroke patients. The study used a modified World
Health Organisation STEP-wise approach to stroke surveil-
lance tool in collecting data on incidence, major risk factors
and mortality rate. The Cochran’s Mantel–Haenszel chi-
squared test of conditional independence was used with
p-value set at 0.05.
Results: A total of 691 patients with confirmed stroke
were recruited [KNH 406 (males: 40.9%; females: 59.1%);
MTRH 285 (males: 44.6%; females: 55.4%)] and followed
over a 12-month period. Overall, ischaemic stroke accounted
for 55.6% of the stroke cases, with women being the most
affected (57.5%). Mortality rate at day 10 was 18.0% at KNH
and 15.5% at MTRH, and higher in the haemorrhagic cases
(20.3%). The most common vascular risk factors were hyper-
tension at 77.3% (males: 75.7%; females: 78.5%), smoking at
16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9%
(males: 15.7%; females: 14.4%). Ischaemic stroke was condi-
tionally independent of gender after adjusting for age.
Conclusions: To our knowledge this is the first pilot demon-
stration establishing a stroke registry in sub-Saharan Africa
and clearly establishes feasibility for this approach. It also
has utility to both inform and potentially guide public policy
and public health measures on stroke in Kenya. Important
and unexpected observations included the preponderance of
women affected by cerebrovascular disease and that cigarette
smoking was the second most common risk factor. The latter,
over time, will further impact on the clinico-epidemiological
profile of cerebrovascular disease in Kenya.
Keywords: stroke, Kenya, sub-Saharan Africa, mortality, risk
factors
Submitted 2/6/16, accepted 7/11/17
Cardiovasc J Afr 2018; 29: 68–72
DOI: 10.5830/CVJA-2017-046
African countries are undergoing an epidemiological transition
characterised by socio-demographic and lifestyle changes,
Centre for Public Health Research, Kenya Medical
Research Institute, Nairobi, Kenya
Lydia Kaduka, PhD,
Erastus Muniu, MSc
Centre for Clinical Research, Kenya Medical Research
Institute, Nairobi, Kenya
Anne Korir, MSc
Jane Mbui, MD
Department of Medicine, School of Medicine, College of
Health Sciences, Moi University, Eldoret, Kenya
Chrispine Owuor Oduor, MD
Department of Clinical Medicine and Therapeutics,
Kenyatta National Hospital, Nairobi, Kenya
Judith Kwasa, MD
Kenyatta National Hospital, Nairobi, Kenya
Sylvanos Wabwire, MD
Kenya Cancer Association, Nairobi, Kenya
Robai Gakunga, MD
Nathan Okerosi
School of Public Health, Moi University, Eldoret, Kenya
Yvonne Opanga
School of Public Health, Jomo Kenyatta University of
Agriculture and Technology, Nairobi, Kenya
Isaac Kisiang’ani, MSc
Mercy Rotich Chepkurui
Maine Medical Center Research Institute, Portland, ME, USA
Scot C Remick, MD, PhD