Prevalence and factors associated with pre-hospital delay among acute stroke patients at Mulago and Kiruddu National Referral Hospitals, Kampala

Abstract

Late presentation after onset of stroke contributes to poor stroke outcomes. There is a paucity of data on prevalence of pre-hospital delay and associated factors among acute stroke patients presenting to Mulago and Kiruddu national referral hospitals in Uganda. Objective This study determined the prevalence of pre-hospital delay and associated factors among acute stroke patients presenting to Mulago and Kiruddu national referral hospitals in Uganda. Methods. A hospital based cross sectional study was conducted at the Emergency units of Mulago and Kiruddu national referral hospitals among adults ≥18 years with acute stroke confirmed by Brain Computed Tomography (CT) scan. Using an interviewer administered questionnaire, data were collected on time from stroke symptoms onset to arrival at the tertiary hospital. Pre-hospital delay was defined as time from onset of stroke symptoms to time of arrival of more than 3 hours. Data were collected on socio-demographic factors, symptom onset situational factors, health system factors, and clinical factors. Modified Poisson regression analysis was used to determine factors associated with pre-hospital delay among acute stroke patients. Results One hundred and thirty 130/143 (90%) acute stroke patients arrived after 3 hours. Staying outside Kampala district (PR: 1.28 (1.22-1.34), p<0.001), and using hired or government ambulance for transport to tertiary facility (PR: 1.17 (1.13-1.20), p<0.001) were associated with pre-hospital delay. Conclusions Prevalence of pre-hospital delay among acute stroke patients presenting to tertiary hospitals in Uganda is very high. Staying outside Kampala district and using hired or government ambulance for transport to tertiary facility were associated with pre-hospital delay.