Social determinants of stroke among stroke patients attending medical outpatient clinic at Kenyatta National Hospital

Abstract

Introduction: Almost half of the disease burden in low-and middle income countries is now from Non communicable diseases. Globally stroke is the leading cause of death. It’s a disease which predominantly occurs in the adult and the elderly in 2001 it was estimated that cerebral vascular diseases, stroke included, accounted for 5.5 million deaths worldwide. Two thirds of these deaths occurred in the developing countries and 40 % of the subjects were aged less than 70 years. Many patients who suffer stroke are disabled and need help in daily activities which is often provided by family members, or the health system. Established risk factors for stroke are; hypertension, diabetes mellitus, tobacco use, hyperlipidemia, micro-vascular rupture, male gender, age and co morbidities such as sickle cell disease, HIV/AIDS infection and cerebral malaria. Objective: To describe the social determinants of stroke among stroke patients attending medical outpatient clinic at Kenyatta National Hospital. Subjects: Patients with recorded diagnosis of stroke/cerebral vascular accident and health care workers working at clinic. Setting: Kenyatta National Hospital medical outpatient clinic. Methodology: The design of the study was descriptive cross sectional. Consecutive sampling was used to select respondents. Data was collected using a pretested semi structured questionnaire, and Key Informant Interviews guide (KII guide). Data analysis: The data was analyzed using SPSS version 20. Descriptive data was summarised into means, frequencies and percentages and was presented in the form of tables, bar charts and pie charts. Study application: This study is expected to be used by the ministry of health, to develop public health policies using the social determinants of health approach, in partnership with other sectors, which will lead to equitable management of stroke in the country. Results A total of 66 stroke patients were recruited, 44 (66.7%) were female and 33 (33.3%) were male. The mean age at experiencing first stroke was 53.7 and ranged 22-85 years. Majority of the respondents were of low household income bracket, 12 (18.2%) were past smokers, 4 (6.1%) were passive smokers, 2 (3%) were taking the recommended portions of fruits and vegetables. Overall 60 (90.9%) had co morbidities and of these, 52 (78.8%) had hypertension, 6 (9.1%) had diabetes mellitus, 45 (66.6%) had less than secondary level of education, 12 (18.2%) were employed, 17 (25.8%) unemployed and not able to work. 37 (56.1%) did not know how long they were going to be on take medication. 25 (37.9%) were not taking their xv medication daily. Drug availability and affordability were some of the main reasons cited for not taking medication daily. The main challenges the respondents were facing was not being able to work as before 24 (46.2%), walking and financial difficulties at 19 (28.8%) each. 5 (7.6%) were taking herbal or traditional remedy for their stroke. 21 (31.8%) had family member suffering stroke. 62 (93.9%) paid cash for the services rendered at the facility and only 35 (54.7%) had their CT scan done within the WHO recommended 24 hours. Only 34 (51.5%) of the respondents received all the services. Conclusion Overall majority of patients were female, the respondents had low education background low monthly household income and experienced stroke at younger age. The risk factors observed were; hypertension, diabetes mellitus, cigarette smoking, inappropriate diet and physical inactivity. The health system was ill prepared for management of stroke as evidenced by out of pocket payments, lack of a stroke register and stroke team in management of stroke patients, inadequate qualified staff. Risk factors were also not uniformly communicated to the respondents. Recommendations A national strategy for stroke should be developed, spearheaded by the ministry of health and all stakeholders, to include national stroke register, national stroke team, stroke unit in major hospitals, policies for prevention of modifiable risk factors. The management of Kenyatta National Hospital should have a stroke unit and ensure there is continuous patient education.