According to the WHO stroke definition, stroke is confirmed in the presence of “rapidly developed clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 h or leading to death, with no apparent cause other than of vascular origin” (Bindslev et al., 2023). Stroke is a primary cause of significant, long-term physical disability, with long-term detrimental effects on quality of life, social life, independence, emotions, and productivity. In the absence of a strong global public health response, the worldwide burden of stroke is expected to exceed 23 million new cases and 7.8 million fatalities per year by the end of 2030 (Hilari, 2011; van Eeden et al., 2012; Satink et al., 2013; De Wit et al., 2017; Avan et al., 2019; Mairami et al., 2020).

Stroke epidemiology's worldwide burden and clinical consequences are rapidly evolving. Stroke prevalence in low- and middle-income countries (LMICs) has more than doubled over the previous four decades, whereas stroke incidence in wealthy nations has fallen by 42%. Furthermore, LMICs have the greatest stroke mortality rate, accounting for 5 million fatalities per year. The majority of stroke deaths occur in LMICs, indicating that the developing world suffers the greatest burden of stroke mortality, morbidity, and disability (Bindslev et al., 2023). Research has also revealed that, in LMICs, there is low use of evidence-based practice for acute stroke care (Alene et al., 2020). In 2015, the age-standardized annual stroke incidence rate in Africa was 316 per 100,000 persons, with an age-standardized prevalence of 981/100,000 (Owolabi et al., 2015).

Stroke accounts for 4.71% of all fatalities, according to WHO data published in 2014 (Johnson et al., 2016). A large number of studies on the epidemiology of stroke in Ethiopia have indicated important differences in the clinical and demographic characteristics of patients compared to those in developed nations. A higher percentage of hemorrhagic stroke than ischemic stroke has been reported in Ethiopian hospitals. In Ethiopia, the burden and outcomes of ischemic and hemorrhagic stroke vary by area and time period (Alene et al., 2020; Baye et al., 2020; Abate et al., 2021). The majority of deaths in Ethiopia occur shortly after admission due to the severe neurologic and medical consequences of stroke. In-hospital mortality is increased due to late presentation, poor care, and insufficient rehabilitation services, and the vast majority of patients leave the hospital with significant physical disabilities (Deresse and Shaweno, 2015; Shenkutie Greffie, 2015; Alene et al., 2020; Baye et al., 2020; Abate et al., 2021).

There is limited data on the burden of stroke, its risk factors, and treatment outcomes in our country, especially in eastern Ethiopia. Therefore, this study assessed the treatment outcomes and factors associated with stroke that would be essential to strengthen and revitalize existing health care policies and strategies to reduce the burden of stroke in the region and identify areas of improvement in the care of stroke patients.

In this study, we analyzed the treatment outcomes and associated variables among adult stroke patients admitted to HFSUH in eastern Ethiopia. Accordingly, poor treatment outcomes among adult stroke patients were prevalent in the study area. Age 45–64 years, urban residence, aspiration pneumonia, high systolic blood pressure upon admission, and high serum creatinine were shown to be independent indicators of poor treatment outcomes among adult stroke patients.

The study showed that the mean age of stroke presentation is 54.7 years, which is lower than cases admitted in many European countries, where the average age at admission is 73 years. To the contrary, a similar study done in Africa found that the mean age at which patients have a stroke was lower than in other parts of the world: 55 years in Zambia, 58 years in Gambia, and 60 years in Senegal (Atadzhanov et al., 2012). Within their fourth or fifth decade of life, many Africans experience a stroke, which can have a major impact on the person who suffers the stroke, their family, and society as a whole. This age distribution is especially significant since younger stroke victims often experience a higher loss of self-worth and socioeconomic productivity than older victims (Akinyemi et al., 2021).

The epidemiology of ischemic stroke, the most common cerebrovascular accident subtype, was 58.6%. This result is aligned with that of studies from the Nekemte Referral Hospital (52.7%) (Fekadu et al., 2020). In our study, 59.3% of adult stroke patients have poor treatment outcomes in comparison to 37.8% in central Ethiopia, 48.1% Debre Markos referral hospital in northwestern Ethiopia, and 46.2% in Felege Hiwot comprehensive specialized hospital, respectively (Kefale et al., 2020; Mulugeta et al., 2020; Gadisa et al., 2021). However, in another study conducted at St. Paul Millennium Medical College, the rate of poor treatment outcomes was 75.5% (Tesfaye, 2017). These disparities can be explained by the large sample size used in our study compared to studies that reported a lower prevalence of poor treatment outcomes. The research showed that the prevalence of poor treatment outcomes among hemorrhagic stroke patients (60.8%) was roughly comparable to the prevalence of poor treatment outcomes among those with ischemic stroke (58.2%).

The most commonly prescribed medicines at HFSUH are statins (59.3%), antihypertensive therapy (57.9%), and aspirin (56.6%), The findings are consistent with research conducted in southwestern Ethiopia (Zewudie et al., 2020). However, these numbers are lower than that in a study conducted on the prescription pattern of drugs in stroke patients in India (Abbasi and Ali, 2012). Mannitol is the mainstay management of intra cranial pressure (ICP), particularly for hemorrhage stroke; 25.5% of patients received treatment during their hospital stay. This result is lower than the one obtained in research done at Felege Hiwot Compressive Hospital (47.7%) and a clinical trial conducted by Wang et al., respectively (Wang et al., 2015; Kefale et al., 2020). None of our patients received thrombolytic therapy because of its unavailability. In the multivariable analysis, the probability of an adverse outcome was twice as high among patients aged 45–64 years compared to those younger than 45 years of age. This finding was in line with studies conducted in India in 2015 and in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia (Krishnamurthi et al., 2015; Kassaw Asres et al., 2020). A possible explanation for this association might be due to their vulnerabilities and higher chances of risky exposures; practicing multiple risky behaviors, such as alcohol drinking, Khat chewing, and smoking cigarettes; and many other risky behaviors and being less likely to adhere to therapy that certainly increases the chance of having poor treatment outcomes.

Several studies have revealed that the presence of stroke-associated pneumonia, a low GCS score (<8), and high blood pressure at admission are significantly associated with poor treatment outcomes (Atadzhanov et al., 2012; Asgedom et al., 2020; Kassaw Asres et al., 2020), which is similar to our study findings. This might be due to poor health care delivery systems and facilities in sub-Saharan African countries, which are not capable of early diagnosis and proper treatment of such patients.

This study found that patients with poor treatment outcomes were three times more likely to have a history of renal injury (serum creatinine level > 1). This finding is supported by a study on acute kidney injury after stroke, which showed that acute kidney injure (AKI) after a stroke is linked with increased hospital death in 1 month after discharge and persistent disability (Huang et al., 2020).

More than half of all stroke patients hospitalized had poor treatment outcomes. The most prevalent form of stroke in the hospitals is ischemic stroke. In addition, most patients were admitted to the hospital within 24 h of the onset of symptoms. Aspirin, statins, and antihypertensive medication were commonly ordered medications in stroke treatment. Moreover, age, uncontrolled hypertension, GCS score at admission, and serum creatine have been the most identified factors that have significant associations with poor treatment outcomes in stroke patients. Finally, we recommend that a community-based stroke prevention program should give priority to screening and management of hypertension and awareness creation about the benefits of treatment adherence is recommended, as this is the most prevalent comorbidity, as well as risk factors identified for poor treatment outcome in this study.

The study's drawback is that it was done at a single hospital in eastern Ethiopia; therefore, the findings cannot be applied to all stroke patients in Ethiopia. Data from patients' medical records were inadequate to evaluate outcome variables objectively using outcome scores such as the Modified Ranking Scale; hence, the outcome of interest was measured subjectively.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving humans were approved by Ethical clearance was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of College of Health and Medical Sciences, Haramaya University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

ZA: Conceptualization, Data curation, Investigation, Methodology, Software, Writing—original draft, Writing—review & editing. SM: Supervision, Validation, Visualization, Writing—review & editing. AA: Supervision, Validation, Visualization, Writing—review & editing. TW: Supervision, Validation, Visualization, Writing—review & editing. AB: Data curation, Investigation, Software, Writing—review & editing. BM: Conceptualization, Data curation, Investigation, Methodology, Software, Writing—review & editing.