Mortality rate and predictors among stroke patients in the public hospitals in Harari region, Eastern Ethiopia

Stroke is a major cause of death and disability worldwide, yet there is limited information on the mortality rate and its predictors in Eastern Ethiopia. This lack of evidence is particularly significant, as hospitals in the Harari region provide the majority of healthcare services for stroke and chronic diseases. Therefore, our objective is to assess the mortality rate and predictors among stroke patients in the public hospitals in Harari. An institutional-based retrospective follow-up study was conducted among 452 randomly selected stroke patients at public hospitals in the Harari region from July 1, 2019, to June 30, 2024. The incidence of unfavorable treatment outcomes was calculated at 95% CI, and predictors of mortality were determined using Cox regression analyses. Of the 452 patients included, 292 (64.6%) improved, 21 (4.7%) were discharged with complications, 63 (13.9%) died, and 76 (16.8%) were discharged against medical advice. The 60-month follow-up revealed a mortality rate of 7.6 (95% CI: 5.9-9.7) per 1,000 person-months. The mortality risk was higher among stroke patients with hypertension (AHR: 2.0, 95% CI: 1.1-3.9), heart failure (AHR: 2.2, 95% CI: 1.1, 4.9), those with complications (AHR: 4.9, 95% CI: 1.5, 16.3), hospital-acquired infections (AHR: 3.1, 95% CI: 1.5-6.7), aspiration pneumonia (AHR: 1.9, 95% CI: 1.1-3.4), poor Glasgow Coma Scale (GCS) scores (AHR: 6.9, 95% CI: 2.4-19.9), and moderate impairment in GCS (AHR: 4.7, 95% CI: 1.6-13.3). Conversely, the use of antiplatelet drugs was associated with a reduced mortality risk in stroke patients (AHR: 0.5, 95% CI: 0.3-0.9). The mortality rate of stroke in this study was comparable to that of other studies in Ethiopia. Factors such as hypertension, heart failure, lower GCS, complications, aspiration pneumonia, and hospital-acquired infections increased mortality risks, while antiplatelet drugs reduced them. Therefore, strategies for early screening and follow-up of at-risk patients are essential.