Stroke remains a significant global health crisis, particularly in low- and middle-income countries (LMICs) where modifiable risk factors like hypertension are highly prevalent and access to adequate prevention and treatment is often limited.1 In Somaliland, reliable epidemiological data on stroke is critically scarce, hindering the development of targeted public health strategies and primary care referral pathways.2 This study aimed to determine the hospital-based prevalence of stroke and to identify its associated clinical risk factors among adult patients at Adal Hospital in Borama, Somaliland.
This is a retrospective cohort study using medical records from 542 adult patients (≥18 years) admitted to the Internal Medicine Department of Adal Hospital between January and December 2024. Data on sociodemographic (age, sex), lifestyle (khat chewing, smoking), and clinical comorbidities (hypertension, atrial fibrillation (AF), previous stroke, heart failure, diabetes mellitus, dyslipidemia) were extracted using a standardized form. Stroke diagnosis was confirmed from documented clinical and imaging reports. Multivariable binary logistic regression was performed using STATA (Version 16) to identify independent predictors, reporting adjusted odds ratios (AOR) with 95% confidence intervals (CI). The overall prevalence of stroke among the 542 adult participants was 5.35% (95% CI: 3.74%–7.60%). The comparison of stroke subtypes revealed an almost equal distribution: 51.7% (n = 15) were ischemic strokes and 48.3% (n = 14) were hemorrhagic strokes.
Multivariable logistic regression analysis identified three clinical factors as strong, independent predictors of stroke (Table 1). Hypertension emerged as the most significant modifiable predictor (AOR = 13.05, 95% CI: 3.44–49.47, p < 0.001). Atrial fibrillation showed the highest risk association (AOR = 33.24, 95% CI: 3.99–277.11, p = 0.001). A history of previous stroke was also a powerful independent predictor of a current event (AOR = 10.65, 95% CI: 2.38–47.71, p = 0.002). While heart failure was significant in bivariate analysis, it did not remain an independent predictor in the multivariable model, nor did diabetes or dyslipidemia. Unexpectedly, pneumonia and typhoid fever were associated with significantly lower odds of stroke, a spurious finding likely attributed to selection bias in the retrospective hospital data, which warrants cautious interpretation.3, 4, 5 Khat chewing, though significantly associated in bivariate analysis, was not an independent predictor after adjustment.
Table 1.
Multivariable logistic regression analysis of key independent clinical predictors of stroke (n = 542).
| Risk factor | Adjusted odds ratio (AOR) |
95% confidence interval | p-Value |
|---|---|---|---|
| Hypertension (yes) | 13.05 | 3.44–49.47 | <0.001 |
| Atrial fibrillation (yes) | 33.24 | 3.99–277.11 | 0.001 |
| Previous stroke (yes) | 10.65 | 2.38–47.71 | 0.002 |
This study confirms that stroke is a major health challenge at Adal Hospital, with a high proportion of hemorrhagic strokes that may reflect poor control of hypertension in the community. Hypertension, AF, and secondary prevention failure are the strongest independent clinical predictors.6 These findings underscore the urgent need for a public health strategy focused on universal blood pressure screening, prompt treatment for hypertension and AF (including anticoagulation), and aggressive secondary prevention protocols in primary care settings, which offer the greatest promise for reducing the stroke burden in Borama.
Ethical considerations
Ethical approval for this study was obtained from the Institutional Review Board (IRB) of Amoud University and the administration of Adal Hospital. For this retrospective cohort study, data were extracted from medical records. To ensure patient confidentiality, all data were anonymized by removing personal identifiers (names and ID numbers) prior to analysis. The study was conducted in accordance with the Declaration of Helsinki.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors affirm that there are no conflicts of interest pertaining to the publication of this article.
Acknowledgments
We would like to thank the management and the medical records department staff of Adal Hospital for their cooperation and assistance in data retrieval.
References
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