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NEUROEPIDEMIOLOGY / NEUROEPIDEMIOLOGIE
 
NEUROLOGIC ADMISSIONS IN THE NIGER DELTA AREA OF NIGERIA - A TEN YEAR REVIEW

LES MALADIES NEUROLOGIQUES OBSERVEES EN HOSPITALISATION, SUR UNE PERIODE DE 10 ANS DANS LA REGION DU DELTA AU NIGERIA


  1. Dept. of Internal Medecine, KING SAUD HOSPITAL P.O. BOX 1905, UNAIZAH 81888 UNAIZAH, AL QASSIM REGION KINGDOM OF SAUDI ARABIA

E-Mail Contact - CHAPP-JUMBO Emmanuel N. : drchappjumbo (at) yahoo (dot) com


ABSTRACT

Background
The Niger-delta area of Nigeria constitutes about 20% of the population of the nation. The pattern of neurologic diseases in this area is not known.

Objective
The study was undertaken to determine the pattern of these diseases, compare this with those elsewhere and to have a baseline for future studies.

Methods
The medical records of all cases admitted with neurologic diseases in the University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt between April 1993 and March 2003 were retrospectively reviewed and the frequency of neurologic diseases, sex, age and outcome of these diseases analyzed.

Results
Neurologic diseases constituted 1.5% and 33.1% of hospital and medical admissions respectively with M: F ratio of 1.4:1 and mean age of 52.6 years. The five topmost diseases were stroke (61.6%), meningitis and encephalitis (13.4%), tetanus (6.5%), spinal cord diseases (6.5%) and epilepsy (3.8%). Apart from stroke, the others were commoner in the young. Other neurologic diseases were rare causes of neurologic admissions. Neurologic deaths constituted 3.7% and 28.9% of hospital and medical deaths respectively. The common causes of neurologic deaths were stroke (65%), meningitis and encephalitis (18.7%) and tetanus (8.5%).

Conclusions
Neurologic diseases are common in this part and have a similar pattern as in other parts of southern Nigeria. Stroke and CNS infections are a major cause of morbidity and mortality. This finding makes the establishment of regional stroke units; improvement of the sanitary conditions of the home and environment, widespread use of immunizations for those at risk a matter of urgent healthcare priority.

Keywords : Africa, Epidemiology, Neurologic disease, Neurology, Nigeria, Stroke units


RESUME

Introduction
Le Delta du Niger constitue environ 20 % environ de la population du Nigeria, et le profil des affections neurologiques de cette région n’est pas connu.

Objectif
L’étude présentée a pour but de déterminer les aspects de ces maladies neurologiques en les comparant avec celles menées par d’autres équipes. Le travail servira de base pour mener d’autres études ultérieures.

Méthode
Les données médicales de tous les cas admis à l’université de Port Harcourt entre avril 1993 et mars 2003 ont été examinées rétrospectivement à partir des dossiers d’hospitalisation. La fréquence de maladie neurologique, le sexe, l’âge et l’évolution ont été analysés.

Résultats
Les maladies neurologiques représentent 1,5 % et 33,1 % des admissions respectivement en hospitalisation et sur l’ensemble de la pathologie médicale. Le ratio homme / femme est de 1,4 : 1 avec une moyenne d’âge de 52,6 ans. Les cinq maladies les plus fréquemment observées ont été : les accidents vasculaires cérébraux (61,6 %, les méningites et encéphalites (13,4 %) le tétanos (6,5 %), les maladies de la moelle épinière (6,5 %) et les épilepsies (3,8 %). En dehors des accidents vasculaires cérébraux, ces affections sont communes aux jeunes. Les autres affections neurologiques sont rares. Les décès imputables à la pathologie neurologique représentaient 3,7 % et 28,9 %, respectivement au niveau hospitalier et au plan médical. La cause de décès la plus importante a été les accidents vasculaires cérébraux suivis des méningites et encéphalites (18,7 %) et tétanos (8,5 %)

Conclusion
Les affections neurologiques habituellement rencontrées ont un aspect similaire à celles observées dans le sud du Nigéria. Les AVC et les affections du système nerveux sont les principales causes de morbidité et de mortalité. Ces données impliquent la mise en place d’unités régionales d’AVC de même que l’amélioration des conditions sanitaires de l’environnement et de l’habitat et l’élargissement des vaccinations.

Mots-clefs : Afrique, maladies neurologiques, Nigéria, unité d’urgence neuro-vasculaire, épidémiologie.

INTRODUCTION

The Niger-delta extends over an area of about 70,000km2 and accounts for 7.5% of Nigeria’s land mass. It covers a coastline of 560km, about a third of the entire coastline of Nigeria, traversing nine states (Abia, Akwa Ibom, Bayelsa, Cross River, Delta, Edo, Imo, Ondo and Rivers) of the 36 states of the country with an estimated population of 20 million (1). The predominant occupation in the area are farming and fishing, with the oil sector as the main industrial base and responsible for over 90% of the nation’s export earnings. Port Harcourt, the Rivers State capital is the official capital of this area and harbors one of the four teaching hospitals in this area. Only two of these hospitals have the CT scan facility and there is no facility for the MRI. There are only two neurologists in this area. This study was conducted in the University of Port Harcourt Teaching Hospital (UPTH), a 484-bed tertiary referral center, with catchments area covering Rivers, Bayelsa, Abia, Akwa Ibom, Imo and parts of Cross River states and has an annual admission rate of 10,000 (2). The hospital started active clinical services at its present temporary site in 1984. The Neurology Unit of the Department of Medicine was only recently created with the installation of a CT Scanning facility in the hospital in 2002. The pattern of neurologic admissions in this area is not known. This study was therefore undertaken to determine the pattern of these diseases, compare it with those elsewhere in the country and also serve as a baseline for proper planning of the new unit and a yardstick for future studies.

MATERIALS AND METHODS

The records of all medical admissions between April 1993 and March 2003 were collected from the medical wards and the medical records department of the hospital. Admission into the medical wards is from age of 14 years, so patients below this were not included. Figures of hospital admissions and deaths during the same period were also collected from the medical records department. Cases admitted for purely neurologic disorders were extracted for the study. The following data were extracted from these patients’ records - age, sex, date of admission, diagnosis, date of discharge and outcome (whether discharged, died, discharged against medical advise or absconded, or referred to other tertiary centers or departments). These data were then analyzed. The neurologic diseases were grouped into the following diseases: stroke, TIAs (transient ischemic attacks), meningitis (bacterial, included tuberculous and viral) and encephalitis (viral, included rabies), spinal cord diseases (included Pott’s disease, cervical and lumbar spondylosis, and disc disease), tetanus, Parkinson’s disease and other movement disorders (included tremors, dystonias and dyskinesias), epilepsies, cerebellar syndromes, primary CNS tumors, neuropathies (cranial, autonomic and peripheral neuropathies included diabetic neuropathies), myopathies and neuromuscular disorders (included muscular dystrophies, polymyositis and myasthenia gravis), primary dementias and the primary headaches (migraine, cluster and tension headaches).

The diagnoses were made clinically in the majority of the patients, with laboratory confirmation in a few. The laboratory tests, depended on the suspected neurologic disease process and included complete blood count, ESR, serum biochemistry, ECG, x-rays, serological tests, microbiology, histopathology. CT scanning was used in a very small minority of patients since it became available only in 2002 and also because of affordability. The EEG, nerve conduction studies, EMG, carotid angiography, viral studies, histochemistry and other higher technology neurologic investigative tools were not utilized in the diagnoses of these patients because these facilities were not available. Lumbar puncture and muscle biopsies were used where these were indicated.

RESULTS

A total of 1,748 patients were admitted with neurologic disorders during the period under review out of which 1393 cases had sufficient data to be included into the study. The frequency of sex, age, morbidity and outcome of neurologic diseases were analyzed. Neurologic diseases constituted 1395 (33.1%) of 4213 medical admissions and 1.5% of 92,544 hospital admissions while in terms of mortality, they constituted 509(28.9%) of 1,759 medical deaths and 3.7% of 13,933 hospital deaths. The sex distribution of patients was 810 (58.1%) males and 585 (41.9%) females (Table 2), giving a sex ratio (M: F) of 1.4:1. The ages of the patients ranged from 14 - 110 years with a mean of 52.6 years. The mean age for males and females was 51.5 years and 54.1 years respectively. The shortest duration and longest duration of hospitalization was 1 day and 254 days respectively with a mean of 16.08 days. The mean duration of hospitalization for males and females was 15.05 and 17.49 days respectively. With regards to outcome, 787 (56.4%) of the patients were discharged, 509 (36.5%) died, 81 (5.8%) were discharged against medical advise (DAMA) or absconded and 16 (1.1%) were referred to other tertiary centers or our surgery department in the hospital. A summary of the above findings is shown in Table 1.

The frequency and the sex distribution of the various neurologic diseases as grouped above are shown in Tables 3, Fig. 1 and Table 4 respectively. Table 5 and Fig. 2 show the respective frequency of age ranges of the neurologic diseases individually and collectively. The frequency of admissions and deaths in relation to medical and hospital admissions and deaths are shown in tables 6. Tables 7 - 15 show the outcome neurologic diseases, as a whole and individually. The duration of hospitalization of these patients is on Tables 16 and 17.

DISCUSSION

This study revealed that neurologic diseases are common in the Niger-delta area of Nigeria. These diseases included stroke, TIAs, meningitis (mainly bacterial, including tuberculous meningitis and viral) and encephalitis (mainly viral including rabies), spinal cord disorders (mainly Pott’s disease, cervical and lumbar spondylosis, and disc disease), tetanus, Parkinson’s disease and other movement disorders (mainly tremors, dystonias and dyskinesias), epilepsies, cerebellar syndromes, primary CNS tumors, neuropathies (mainly cranial, autonomic and peripheral neuropathies, including diabetic neuropathies), myopathies and neuromuscular disorders(included muscular dystrophies, polymyositis and myasthenia gravis), primary dementias and primary headaches (migraine, cluster and tension headaches). These diseases constituted 1.5% of all hospital admissions and 33.1% of medical admissions. There was no significant sex predominance in these diseases as a whole. The mean age of the patients was 52.6 years with a slightly lower mean age in males. The highest peak age range of cases was between 60 to 64 years. The frequency of occurrence revealed that stroke (mainly cerebral infarction), infections (meningitis, encephalitis and tetanus), spinal cord diseases and epilepsies were the most common neurological disorders admitted with frequency rates of 61.6%, 19.9%, 6.5% and 3.8% of all neurologic admissions respectively. These four major disorders constituted 91.8% of all neurologic cases admitted. It was also noted that four of the cases of viral encephalitis had rabies, all of who died. Pott’s disease was the predominant cause of spinal cord diseases (31%). Other less common neurologic diseases were Parkinson’s disease and movement disorders 2.2%, neuropathies 1.8%, TIAs 1.2%, CNS tumors 1.1%, primary dementias 0.8%, primary headaches 0.4%, myopathies and neuromuscular disorders 0.5% and cerebellar diseases 0.3%. All these represented only 8.2% of the neurologic admissions. Parkinson’s disease constituted 83.3% of cases in the group of patients with movement disorders.

The above findings compare with those of Talabi (3) in UCH, Ibadan who reported frequencies of: stroke (50.4%), tetanus (14.2%), meningitis (12.4%) and myelopathies (8.1%). These disorders and seizures were reported as the most common neurologic diseases in that study. The difference in frequency rates in the two studies may be related to the difference in the duration of the study periods. The overall outcome of neurologic diseases showed that 787 (56%) were discharged, 509 (36.5%) died, 81(5.8%) were discharged against medical advice or absconded and 16 (1.1%) were referred to other hospital departments or tertiary centers. The death rate represented 28.9% and 3.7% of medical and hospital deaths respectively. The duration of hospitalization of patients with neurologic diseases was usually long, ranging from less than one day observed mainly in patients who died soon after admission, to 254 days, with a mean of 16.08 days. Females had a longer period of hospitalization (mean 21.37 days) than males (mean 16.04 days).

The age and sex distribution, outcome and period of hospitalization for the different types of neurologic diseases also varied. For the most common neurologic diseases, the following were observed: Stroke - The peak age of admission was 60 to 64 years. This was in keeping with previous findings that stroke is a disease of the elderly in this environment (4) as is elsewhere (5), in contrast to earlier reports that stroke was more common below the age of 50 in the African (6,7). This trend may be related to the improving standard of living and longevity in our environment. However, when compared with Caucasians, a higher proportion of relatively younger Africans and Asians appear to suffer from stroke (8). There was a slight male preponderance (M: F=1.2:1) as had been noted previously (9). In terms of outcome, 468 (54.5%) of stroke admissions were discharged, 331 (38.5%) died, 52 (6.1%) were discharged against medical advice and 6 (0.7%) were referred. This stroke mortality represented 65% of neurologic deaths, 18.8% medical deaths and 2.37% hospital deaths. This shows that stroke mortality is quite high in this environment. Previous workers have also observed this finding. Odia and Wokoma (10) reported that cerebrovascular disease was the most common cause of deaths in the medical wards of UPTH, accounting for 15.9% of medical deaths. In Lagos Nigeria, Adegabite et al (11) noted stroke mortality of 36.5% and in Ibadan Nigeria; Adetuyibi et al (12) also observed that stroke was the commonest cause of neurologic deaths. The mean duration of hospitalization of stroke patients was 16.5 days. Meningitis and encephalitis - This condition was also noted to be a significant cause of neurologic admissions and affected mainly the younger age group, with the highest age peak occurring in the age-range 15 to 19 years with a sex ratio (M: F) of 1.6:1. In the cases with this condition, 79 (42.2%) were discharged, 95 (50.8%) died, and 13 (7%) were discharged against medical advice. This group of patients recorded the highest mortality of 50.8%, although this represented 18.7% of neurologic deaths, 5.4% of medical deaths and 0.68% of hospital deaths. This mortality rate was very high when compared with that reported by Peters et al (13) in Calabar who recorded 19 (28.8%) deaths out of 66 cases studied. Their study however, did not include cases with encephalitis and was over a 5-year period. The mean duration of hospitalization of these patients was also the shortest (10 days), second only to patients admitted with TIAs. This was probably related to the high mortality rate. Tetanus - This was another infective condition of the CNS affecting mainly the younger population. The peak age range affected was 20 to 24 years with a male predominance (M: F=2:1). In this group of patients, 45 (50%) were discharged, 43 (47.8%) died, 1 (1.1%) was discharged against medical advise and 1 (1.1%) was referred. The mortality represented 8.5% of neurologic deaths, 2.4% medical deaths and 0.31% hospital deaths. The high mortality rate noted in this group of patients is well known(14) and this is related to the low immunization rates of the population, late presentation, and inadequate intensive care facilities. The mean duration of hospitalization among these patients was 13.4 days.

Spinal cord diseases - The most common disease in this group was Pott’s disease and this was also more prevalent among the younger patients, with peak age-range 25 to 29 years and a sex ratio (M: F) of 1.8:1. Sixty-one (67%) of the cases were discharged, 15 (16.5%) died, 8 (8.8%) were discharged against medical advise and 7 (7.7%) were referred. The major cause of death was complicating secondary infections. The mortality represented 2.9% neurologic deaths, 0.9% medical deaths and 0.11% hospital deaths. This group of patients had the longest duration of hospitalization ranging from 1 day to 254 days, as they were usually bedridden, with a mean of 30.5 days. Epilepsies - Majority of the patients in this group were also young with peak age-range 30 to 34 years and most had idiopathic epilepsy and were admitted with status epilepticus. There was no significant sex predilection. Forty (75.5%) of cases were discharged, 10 (18.5%) died and 3 (5.7%) were discharged against medical advise. Mortality was mainly due to status epilepticus and represented 1.9% neurologic deaths, 0.5% medical deaths and 0.07% hospital deaths. The mean duration of hospitalization was 13.2 days.

CONCLUSION

The Niger-delta area of Nigeria is unique in geography but not in the pattern of neurologic diseases. Stroke mainly cerebral infarction, is the commonest neurologic admission and the commonest cause of neurologic and medical death in this area as is noted elsewhere. Nearly two-fifths of stroke patients die. Infections of the central nervous system mainly meningitis, encephalitis and tetanus is the next common cause of admission and affect mainly the younger population. This group of diseases was also noted to have the highest mortality rate (mean 49.3%). Parkinson’s disease and movement disorders, neuropathies, TIAs, CNS tumors, primary dementias and headaches, myopathies and neuromuscular disorders, and cerebellar disorders were rare causes of neurologic admissions in this area. In view of the above findings, the provision of a regional stroke unit with modern primary, secondary (including standard Intensive Care Units) and tertiary intervention facilities; the improvement of the sanitary conditions of the home and environment; the widespread use of immunizations against meningitis, tetanus and rabies for those at risk, cannot be over-emphasized. These interventions will to cut down drastically the scourge caused by stroke and CNS infections.

ACNOWLEGEMENTS
My gratitude goes to the Almighty God for His mercies and Guidance; to the Matron, Dept of Medicine and the staff of the Medical Records Dept of UPTH, Port Harcourt for their assistance in the collection of the data and finally to my family for ensuring a conducive study environment at home.

TABLE 1 - Summary of major findings

TOTAL NO. NEUROLOGIC ADMISSIONS 1748
TOTAL NO. OF PATIENTS INCLUDED IN THE STUDY (I.E.TOTAL NEUROLOGICAL ADMISSIONS) 1395
TOTAL NO. OF PATIENTS EXCLUDED FROM THE STUDY 353
TOTAL NEUROLOGIC DEATHS 509
TOTAL HOSPITAL ADMISSIONS 92,544
TOTAL HOSPITAL DEATHS 13,933
TOTAL MEDICAL ADMISSIONS 4,213
TOTAL MEDICAL DEATHS 1759
% MEDICAL ADMISSIONS OF HOSPITAL ADMISSIONS 4.6%
% NEUROLOGIC ADMISSIONS OF HOSPITAL ADMISSIONS 1.5%
% NEUROLOGIC DEATHS OF HOSPITAL DEATHS 3.7%
% NEUROLOGIC ADMISSIONS OF MEDICAL ADMISSIONS 33.1%
% NEUROLOGIC DEATHS OF MEDICAL DEATHS 28.9%
MEAN AGE OF NEUROLOGIC PATIENTS 52.6YRS
MEAN AGE (MALES) 51.5YRS
MEAN AGE (FEMALES) 54.1YRS
MEAN DURATION OF HOSPITALIZATION OF ALL PATIENTS 16.07 DAYS
MEAN DURATION OF HOSPITALIZATION (MALES) 15.05 DAYS

TABLE 2 - Sex frequency

Frequency Percent Valid Percent Cumulative Percent
Female 585 41.9 41.9 41.9
Male 810 58.1 58.1 100.0
Total 1395 100.0 100.0

TABLE 3 - Frequency distribution of neurologic diseases (also see Fig 1).

NEUROLOGICDISEASES Frequency Percent Valid Percent Cumulative Percent
Cord diseases (CD) 91 6.5 6.5 6.5
Cerebellar lesions (CL) 4 .3 .3 6.8
Dementia (D) 11 .8 .8 7.6
Meningitis & encephalitis (ME) 187 13.4 13.4 21.0
Primary headaches (H) 6 .4 .4 21.4
Myopathies (MP) 7 .5 .5 21.9
Parkinson’s disease/Movement disorders (PMD) 30 2.2 2.2 24.1
Neuropathies (N) 25 1.8 1.8 25.9
Epilepsies (E) 53 3.8 3.8 29.7
CNS Tumors (CT) 15 1.1 1.1 30.8
Stroke (STR) 859 61.6 61.6 92.3
Tetanus (TET) 90 6.5 6.5 98.8
Transient ischemic attacks (TIA) 17 1.2 1.2 100.0
TOTAL 1395 100.0 100.0

TABLE 4 - Sex frequency of Neurologic diseases.

DIAGNOSIS SEX (F) SEX (M) Total
Cord diseases 33 58 91
Meningitis & encephalitis 71 116 187
Myopathies 2 5 7
Parkinson’s disease/Movement disorders 7 23 30
Neuropathies 7 18 25
CNS Tumors 5 10 15
Transient ischemic attacks 7 10 17
Cerebellar lesions 4 4
Dementia 6 5 11
Primary headaches 5 1 6
Epilepsies 26 27 53
Stroke 386 473 859
Tetanus 30 60 90
TOTAL 585 810 1395

TABLE 5 - Age-range distribution of neurologic diseases

AGE GRP CASE NO. CD ME MP PMD N CT TIA CL DEM H E STR TET TOTAL
<15y 1 1 1 2
15-19 2 8 37 1 3 2 15 66
20-24 3 6 25 2 4 1 2 6 2 21 69
25-29 4 12 27 4 1 2 5 1 16 68
30-34 5 7 18 1 4 2 9 12 8 61
35-39 6 4 14 1 3 2 2 1 2 30 6 65
40-44 7 8 13 1 1 3 2 1 4 53 11 97
45-49 8 8 10 1 3 1 1 1 71 4 100
50-54 9 5 10 2 2 2 2 1 4 113 1 142
55-59 10 7 7 2 1 2 2 6 98 3 128
60-64 11 8 8 1 10 2 3 2 5 123 3 165
65-69 12 7 8 3 1 3 4 1 110 1 138
70-74 13 7 4 2 1 1 7 109 131
75-79 14 1 2 3 2 4 70 82
>79 15 3 3 4 1 1 1 67 1 81
TOTAL 91 187 7 30 25 15 17 4 11 6 53 859 90 1395

CD=cord diseases ME=meningitis & encephalitis MP=myopathies, PMD=Parkinson\u2019s disease/movement disorders N=neuropathies CT=CNS tumors TIA=transient ischemic attack CL=cerebellar lesions DEM=dementia H=primary headaches E=epilepsies STR=stroke TET=tetanus

TABLE 6 - Frequency of admissions and deaths of neurologic diseases in relation to medical and hospital admissions and deaths.

DISEASE ADMS %NA DTHS %ND %MA %MD %HA %HD
STROKE 859 61.6 331(38.5%) 65.0 20.4 18.8 0.93 2.37
MENINGITIS & ENCEPHALITIS 187 13.4 95(50.8%) 18.7 4.4 5.4 0.20 0.68
CORD DISEASE 91 6.5 15(16.5%) 2.9 2.2 0.9 0.10 0.11
TETANUS 90 6.4 43(47.8%) 8.5 2.1 2.4 0.10 0.31
EPILEPSIES 53 3.8 10(18.9%) 1.9 1.3 0.5 0.06 0.07
PD/MD 30 2.2 5(16.7%) 1.0 0.7 0.3 0.03 0.04
NEUROPATHIES 25 1.8 2(8.0%) 0.4 0.6 0.1 0.03 0.01
TIA 17 1.2 0 0 0.4 0 0.02 0
CNS TUMORS 15 1.1 7(46.7%) 1.4 0.4 0.4 0.02 0.05
DEMENTIA 11 0.8 1(9.1%) 0.2 0.3 0.1 0.01 0.01
HEADACHES 6 0.4 0 0 0.1 0 0.01 0
MYOPATHIES 7 0.5 0 0 0.1 0 0.01 0
CEREBELLAR LESIONS 4 0.3 0 0 0.1 0 0.004 0
TOTAL 1395 100% 509(36.5%) 100% 33.1% 28.9% 1.51% 3.65%

ADMS=admissions DTHS=deaths NA=neurologic admissions ND=neurological deaths MA= medical admissions MD=medical deaths HA=hospital admissions HD=hospital deaths

TABLE 7 - Outcome of all neurologic diseases

Frequency Percent Valid Percent Cumulative Percent
Valid 608 43.6 43.6 43.6
Discharged 787 56.4 56.4 100.0
Total 1395 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 886 63.5 63.5 63.5
Died 509 36.5 36.5 100.0
Total 1395 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 1298 93.0 93.0 93.0
DAMA 81 5.8 5.8 98.9
Referred 16 1.1 1.1 100.0
Total 1395 100.0 100.0

TABLE 8 - Stroke outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 528 61.5 61.5 61.5
Died 331 38.5 38.5 100.0
Total 859 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 391 45.5 45.5 45.5
Discharged 468 54.5 54.5 100.0
Total 859 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 801 93.2 93.2 93.2
DAMA 52 6.1 6.1 99.3
Referred 6 .7 .7 100.0
Total 859 100.0 100.0

TABLE 9 - Cord diseases outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 30 33.0 33.0 33.0
Discharged 61 67.0 67.0 100.0
Total 91 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 76 83.5 83.5 83.5
Died 15 16.5 16.5 100.0
Total 91 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 76 83.5 83.5 83.5
DAMA 8 8.8 8.8 92.3
Referred 7 7.7 7.7 100.0
Total 91 100.0 100.0

TABLE 10 - Epilepsies outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 43 81.1 81.1 81.1
Died 10 18.9 18.9 100.0
Total 53 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 13 24.5 24.5 24.5
Discharged 40 75.5 75.5 100.0
Total 53 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 50 94.3 94.3 94.3
DAMA 3 5.7 5.7 100.0
Total 53 100.0 100.0

TABLE 11 - Tetanus outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 47 52.2 52.2 52.2
Died 43 47.8 47.8 100.0
Total 90 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 45 50.0 50.0 50.0
Discharged 45 50.0 50.0 100.0
Total 90 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 88 97.8 97.8 97.8
DAMA 1 1.1 1.1 98.9
Referred 1 1.1 1.1 100.0
Total 90 100.0 100.0

TABLE 12 - Meningitis & Encephalitis outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 92 49.2 49.2 49.2
Died 95 50.8 50.8 100.0
Total 187 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 108 57.8 57.8 57.8
Discharged 79 42.2 42.2 100.0
Total 187 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 174 93.0 93.0 93.0
DAMA 13 7.0 7.0 100.0
Total 187 100.0 100.0

TABLE 13 - Neuropathies outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 3 12.0 12.0 12.0
Discharged 22 88.0 88.0 100.0
Total 25 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 24 96.0 96.0 96.0
DAMA 1 4.0 4.0 100.0
Total 25 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 23 92.0 92.0 92.0
Died 2 8.0 8.0 100.0
Total 25 100.0 100.0

TABLE 14 - Parkinson’s disease/movement disorders outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 25 83.3 83.3 83.3
Died 5 16.7 16.7 100.0
Total 30 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 6 20.0 20.0 20.0
Discharged 24 80.0 80.0 100.0
Total 30 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
29 96.7 96.7 96.7
DAMA 1 3.3 3.3 100.0
Total 30 100.0 100.0

TABLE 15 - CNS tumors outcome

Frequency Percent Valid Percent Cumulative Percent
Valid 9 60.0 60.0 60.0
Died 6 40.0 40.0 100.0
Total 15 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 8 53.3 53.3 53.3
Discharged 7 46.7 46.7 100.0
Total 15 100.0 100.0
Frequency Percent Valid Percent Cumulative Percent
Valid 13 86.7 86.7 86.7
DAMA 1 6.7 6.7 93.3
Referred 1 6.7 6.7 100.0
Total 15 100.0 100.0

TABLE 16 - Duration of hospitalization of all neurologic patients.

N Minimum Maximum Mean Std. Deviation
WARD STAY 1395 1 254 16.08 18.49
Valid N (listwise) 1395
SEX Mean N Std. Deviation
F 17.49 585 21.37
M 15.05 810 16.04
Total 16.08 1395 18.49

TABLE 17 -Duration of hospitalization of individual neurologic diseases

NEUROLOGICDISEASES Shortest duration of ward stay (days) Longest duration of ward stay (days) Mean duration of ward stay(days)
Stroke 1 160 16.5
TIA 3 32 1
Parkinson’s disease/Movement disorders 1 58 16.7
Meningitis & encephalitis 1 66 10
Cerebellar lesions 3 22 14.8
Epilepsies 1 61 13.2
Tetanus 1 159 13.4
Cord diseases 1 254 30.5
Myopathies 2 42 11.3
Neuropathies 1 42 18.3
CNS Tumors 1 44 12.9
Dementia 4 38 14
Headaches 7 22 13


(JPG)
FIGURE 1 - Frequency distribution of neurologic diseases (also see Table 3)


(JPG)
FIGURE 2 - Age range distribution bar chart of all neurologic diseases.

Case Number from Table 5:
1=<15years,
2=16-19years,
3=20-24years,
4=25-29years,
5=30-34years,
6=35-39years,
7=40-44years,
8=45-49years,
9=50-54years,
10=55-59years,
11=60-64years,
12=65-69years,
13=70-74years,
14=75-79years,
15=>79years.

_

REFERENCES

  1. http://www.nddconline.org/The NigerDelta/index.shtml
  2. University of Port Harcourt Teaching Hospital (UPTH) Annual Reports, 1990.
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