Stroke mortality and disability in Northwest Ethiopia: multi-center evidence for Sub-Saharan Africa (2022–2024)

Abstract Background Stroke remains a leading cause of death and long-term disability worldwide, with the greatest burden in low- and middle-income countries (LMICs). Sub-Saharan Africa (SSA) faces a rapidly growing stroke burden, yet regionally representative data integrating both survival and functional outcomes remain scarce. Objective To determine the prevalence and predictors of in-hospital mortality and functional disability among stroke patients in Northwest Ethiopia, providing context-specific evidence to guide stroke care improvement in SSA. Methods An institution-based multicenter retrospective cohort study was conducted by reviewing medical records of 298 stroke patients admitted between November 2022 and October 2024. Data were extracted from medical records and analyzed using SPSS version 27. Multivariable logistic regression identified independent predictors of poor outcomes, defined as a Modified Rankin Scale (mRS) score of 3–6 at discharge. Statistical significance was set at p < 0.05. Results The prevalence of poor outcomes (mRS 3–6) was 63.4%, including 20.8% in-hospital mortality. The mean age of participants was 59.7 years (SD ± 14.9). Infectious complications (AOR = 2.64; 95% CI: 1.33–5.27), neurological complications (AOR = 5.36; 95% CI: 2.53–11.40), hospital stay ≥ 7 days (AOR = 2.96; 95% CI: 1.53–5.72), and admission blood pressure ≥ 140/90 mmHg (AOR = 2.75; 95% CI: 1.53–4.94) were independently associated with poor functional outcome, while a prior history of hypertension (AOR = 0.37: 95% CI: 0.20–0.66) was independently associated with reduced odds of poor outcome. Conclusions Poor functional outcomes and in-hospital mortality were common among stroke patients in Northwest Ethiopia and were associated with infectious complications, neurological complications, prolonged hospital stay, and elevated admission blood pressure.