Stroke in limited resource setting: characterization of acute stroke patients at a tertiary hospital in Fiji from 2013 to 2014.
Main Article Content
Keywords
Stroke, Fiji, Cardiovascular, Pacific, Risk factors
Abstract
Background: Stroke is a major cause of disability and death worldwide. It is the third commonest cause of death in Fiji. Despite the high burden of stroke in Fiji, descriptive data on stroke patients is rare.
Aim: To describe the socio-demographic profile, comorbidity pattern, clinical characteristics, investigative and management factors of acute stroke patients admitted to Colonial War Memorial Hospital.
Methods: Retrospective data was collected on stroke patients admitted between January 2013 and December 2014. Socio-demographic details, risk factors, clinical examination, investigative and management aspects were assessed.
Results: 565 patients were included in the study. 68.5% had history of hypertension, 29.9% diabetes mellitus and 21.9% previous stroke. On admission, 42.9% had dysphasia, 50.6% had hemiplegia, 40.4% had dysphagia and 7.8% had seizures. Neuroimaging was performed in 73.6% patients, of whom 72.8% had an ischemic stroke, 23.9% intracerebral haemorrhage and 3.4% subarachnoid haemorrhage. The mean time to hospital from onset of symptoms was 20.4 hours (SD +/- ) and the mean time to neuroimaging from arrival was 62.5 hours (SD +/- ). Respiratory complications (24.8%) were the most common in-hospital complications. The in-hospital case fatality rate was 29.7%.
Conclusion: In-hospital mortality and complications, especially respiratory complications were high. Our findings indicate that urgent combined efforts are required to improve awareness and inpatient stroke A standardized guideline for both the pre- and post-admission of stroke care is likely to benefit the management of patients with stroke.
References
2. Feigin V, Forouzanfar M, Krishnamurthi R, Mensah G, Connor M, Bennett D et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383(9913):245-255.
3. Feigin V, Lawes C, Bennett D, Barker-Collo S, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355-369.
4. Feigin V, Krishnamurthi R. Stroke Prevention in the Developing World. Stroke. 2011;42(12):3655-3658.
5. Yang S, Deng M, Ren X, et al. Global burden of disease study highlights the global, regional and national trends of stroke. J Neurol Neurosurg Psychiatry. 2025 12;97(1):13-24. doi: 10.1136/jnnp-2025-335954. PMID: 41047223.
6. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025;20(2):132-144. doi:10.1177/17474930241308142.
7. Snowdon W, Waqa G, Raj A, Kanungo A, Robinson H. Non-communicable diseases and health system responses in Fiji. The University of Melbourne; 2013.
8. Ministry of Health and Medical Services, Fiji. Annual Report 2014. The Fijian Government; 2015 p. 62-63.
9. O'Donnell M, Yusuf S. Tackling the global burden of stroke: the need for large-scale international studies. Lancet Neurol. 2009;8(4):306-307.
10. Chhabra H, Arora M. Demographic profile of traumatic spinal cord injuries admitted at Indian Spinal Injuries Centre with special emphasis on mode of injury: a retrospective study. Spinal Cord. 2012;50(10):745-754.
11. Waloki M, Roseveare C, Tikolevu L, Ram S, Bissell K. Stroke rehabilitation in Fiji: are patients receiving services? Public Health Action. 2014;4(3):150-154.
12. Walker R, Rolfe M, Kelly P, George M, James O. Mortality and Recovery After Stroke in The Gambia. Stroke. 2003;34(7):1604-1609.
13. Basri H, Azman Ali R. Predictors of in-hospital mortality after an acute ischaemic stroke. Neurol J Southeast Asia. 2003;8:5-8.
14. Medic S, Beslac-Bumbasirevic L, Kisic-Tepavcevic D, Pekmezovic T. Short-Term and Long-Term Stroke Survival: The Belgrade Prognostic Study. J Clin Neurol. 2013;9(1):14-20
15. Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in Acute Stroke: A Systematic Review and Meta-Analysis. Stroke. 2012;43(3):645-649.
16. Cheung C, Tsoi T, Hon S, Au-Yeung M, Shiu K, Lee C et al. Using the National Institutes of Health Stroke Scale (NIHSS) to predict the mortality and outcome of patients with intracerebral haemorrhage. Hong Kong Med J. 2008;14(5):367-370.
17. Weir C, Bradford A P J, Lees K R. The prognostic value of the components of the Glasgow Coma Scale following acute stroke. QJM. 2003;96(1):67-74.
18. Truelsen T, Begg S. The global burden of cerebrovascular disease. Geneva: World Health Organization; 2006.
19. Bae H, Yoon D, Lee J, Kim B, Koo J, Kwon O et al. In-hospital medical complications and long-term mortality after ischemic stroke. Stroke. 2005;36(11):2441-2445.
20. Akhter Rathore J, Ali Kango Z, Mehraj A. Predictors of mortality after acute stroke: A prospective hospital-based study. J Ayub Med Coll Abbottabad. 2011;23(2):144-146.
21. Nedeltchev K, Renz N, Karameshev A, Haefeli T, Brekenfeld C, Meier N et al. Predictors of early mortality after acute ischaemic stroke. Swiss Med Wkly. 2010;140(17-18):254-259.
22. Wardlaw J, Seymour J, Cairns J, Keir S, Lewis S, Sandercock P. Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life. Stroke. 2004;35(11):2477-2483.
23. Ingeman A, Andersen G, Hundborg H, Svendsen M, Johnsen S. In-hospital medical complications, length of stay, and mortality among stroke unit patients. Stroke. 2011;42(11):3214-3218.
24. Smithard D, O'Neill P, Park C, Morris J, Wyatt R, England R et al. Complications and outcome after acute stroke: does dysphagia matter? Stroke. 1996;27(7):1200-1204.
25. Al-Khaled, M, Matthis, C, and Eggers, J. Stroke complications: incidence and effects on stroke outcomes – data from the stroke registry in the federal state in Schleswig-Holstein, Germany Neurology. 2013; 80 (7_supple) P04.071. doi:10.1212/WNL.80.7_supplement.P04.071
26. Bustamante A, Giralt D, García-Berrocoso T, et al. The impact of post-stroke complications on in-hospital mortality depends on stroke severity. Eur Stroke J. 2017;2(1):54-63. doi:10.1177/2396987316681872.
27. Ministry of Health NZ. Recording smoking status [Internet]. Wellington: Ministry of Health; [cited 2026 Mar 6]. Available from: https://www.health.govt.nz/strategies-initiatives/programmes-and-initiatives/smokefree-2025/information-for-practitioners-of-patients-who-are-quitting-smoking/recording-smoking-status
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Articles on this website and article downloads are provided free of charge by Open Access under a Creative Commons with the author retaining all copyright to the material. eg © PacifichealthDialog 2021. Except as provided by the NZ Copyright Act, no part of this publication may be reproduced or stored in a retrieval system in any form or by any means without the prior written permission of the copyright owner and the Pacific Health Dialog. Manuscripts can be used for private study but must not be used for commercial purposes.
Dr Shrish Acharya, Colonial War Memorial Hospital
Consultant Physician, Department of Internal Medicine, Colonial War Memorial War Hospital, Suva, Fiji
Dr Anne Drake, Fiji National University; St Vincent's Hospital Melbourne
Physician, Department of General Medicine, St Vincent's Hospital, Melbourne Adjunct Associate Professor in Internal Medicine, Fiji National University, Suva, FijiProfessor Anna Ranta, University of Otago; Wellington Hospital
Head of Department, Department of Medicine, University of Otago, Wellington
Clinical Director, National Hyper-Acute Stroke Service, Health NZ
Consultant Neurologist, Department of Neurology, Head of Department) - Department of Medicine - University of Otago, Wellington | Clinical Director – National Hyper-Acute Stroke Service – Te Whatu Ora – Health NZ | Consultant Neurologist - Department of Neurology – Wellington Hospital