Prognosis of non traumatic coma: the role of some socio-economic factors on its outcome in Ibadan, Nigeria.
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Medknow: Annals of African Medicine
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Background: Coma occurring in the course of an illness, irrespective of cause, traditionally implies a poor prognosis and many factors may determine its outcome. These factors must be identified and possibly stratified in their order of importance. This research seeks to identify these factors and how they influenced the outcome of non-traumatic coma in our environment.
Methods: Two hundred consecutive patients, aged 18-79 years who met the inclusion criteria, the Glasgow coma scale (GCS) score of <8, history and physical findings suggestive of medical illness, no head trauma or sedation, were recruited into the study from August 2004 to March 2005 at the university College Hospital (UCH), Ibadan, after obtaining institutional ethical clearance and consent from patients' guardians. Detailed history of illness including the bio-data and time to present to the hospital and treatments given were noted. Thereafter, the clinical course of the patients was monitored daily for a maximum of 28 days during which the support of the family and/ or the hospital social welfare was evaluated.
Results: During the 8-month period of the study, 76% (152) of the patients died while 24% (48) survived. The following factors were associated with high mortality rate: inability to confirm diagnosis (100%), poor family support (97.1%), delay in making a diagnosis within 24 h (85.4%), poor family understanding of disease (84.1%), need for intensive care admission and management (83.3%), poor hospital social welfare support (82.4%), presentation to UCH after 6 h of coma (76.7%), and referral from private health facilities (75.7%). Others include substance abuse (100%) and seropositivity to HIV (96%) and hepatitis B surface antigen (92%) antibodies, among others.
Conclusion: This study has demonstrated that socio-economic factors such as gender, occupation, risky lifestyle behaviors, late presentation or referral to hospital, late diagnosis and treatment, and poor family support contributed to poor outcome of nontraumatic coma. It is hoped that improvement, modification, or correction of these factors may improve coma outcome
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Neurologic Pathologies and Socioeconomic Determinants: Medical Sociology Paper
Coma is a common neurologic condition occurring in the course of an illness, due to diverse causes, but whose poor prognostic outcome is associated with many social and economic factors. This study identified both clinical and socio-economic factors associated with the high mortality rate found among the 200 consecutive young and older adult patients involved in the study, including poor diagnosis, poor family support, poor family understanding of the disease, and poor hospital social welfare support, among others. Factors such as gender, occupation, risky lifestyle behaviors, and delay accessing care also accounted for the poor prognosis. This study recommends modification, or correction of these factors as a way to improve coma outcomes, and by extension other neurologic pathologies
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Obiako OR, Ogunniyi A, Anyebe E. Prognosis of non traumatic coma: the role of some socio-economic factors on its outcome in Ibadan, Nigeria. Ann Afr Med. 2009 Apr-Jun;8(2):115-21. doi: 10.4103/1596-3519.56240. PMID: 19805943.