In this study stroke accounted 16.5 % of total medical admissions, and 23.6 % of the total medical cases of in hospital mortality. This admission rate was higher than findings from Gambia in which the stroke patients made up 5%  and in southwestern Nigeria 4.5% of medical admission. But this was in agreement with previous study conducted in Hawasa Ethiopia in which stroke accounted for 13.7% of all medical admissions . The elevated number of stroke admission in Ethiopia may be due to lack of awareness, poor risk factor control and being hospital based study with referral bias.
A total of 91 (78.4%) patients were discharged being alive from the hospital with in hospital mortality of 25 (21.6%). From those discharged being alive more than half (57.8%) were discharged with improvement which was lower compared to study by Masood et al in Pakistan: 91% , Jowi et al in kenya : 93.8%  and Tirschwell etal in Vietnam: 65.8% , but higher than study done by Gebremariam etal in Ethiopia: 47.9% . But there was correspondence similarity with study done in Ethiopia by Greffie etal in which 59.18% were discharged with improvement. These difference in outcome/vital status of the patient during discharge may vary with the severity of stroke, set up of the hospital, complications, co morbidities associated with the patients and experts available in caring of the patient.
The mean length of hospital stay of patients was 9.21days which was shorter than study by Walker etal 19 days , Jowi et al 12.5 days , Greffie etal 13 days , Gebremariam etal 11 days , and De Carvalho etal 15.4+20.1 days . For the shorter length of hospital stay in our set up, multiple reasons could be explained. Some patients were rapidly improved and discharged due to the stroke unit had proper possible care as compared to other wards in the hospital. Secondly some patients were died rapidly, some discharged LAMA and others discharged with medical advice without improvement due to small bed occupy of the stroke unit of the hospital. In this regard if there is any change to the condition of the patient and patient stayed longer than other patients, the bed would be left for new stroke patients.
In some patients there was shorter length of stay because of stroke unit provides better quality of care during the early phase. Additionally in some patient’s delays in complimentary evaluations is one of the most feasible explanations for the prolonged admission time, which not only significantly increases the costs for stroke care, but also increases the risks for infection, other complications, and recurrence in patients with suboptimal treatment and evaluation.
The in-hospital stroke mortality (21.6%) was similar to study by De Carvalho et al in Brazil 20.9% , Desalu et al in Nigeria 23.8% . But this death rate was higher as compared study by Deresse et al in Ethiopia 14.7% , Tirschwell etal in Vietnam 6.5% , Masood etal in Pakistan 9 % , Gebremariam etal in Ethiopia 12.0% , Greffie et al in Ethiopia 13.3%  and Jowi et al in kenya (5%) . In addition, this in hospital mortality was lower as compared to study by Damasceno et al in Mozambique which was 33.3% , Atadzhanov etal in Zambia 40 %  and Walker et al in Gambia 57% . The difference in hospital mortality rate could be explained by different ways of stroke diagnosis, type of stroke, treatment approaches, risk factors, comorbidities, complications and in hospital patient care.
The prominent immediate cause was increased intracranial pressure 68.0% and respiratory failure secondary aspiration pneumonia 44.0% which complies with other studies particularly in Ethiopia [9, 14]. Additionally, it was also similar to study in Arabian Gulf countries in which both neurologic and systemic complications accounted 63% of in hospital mortality. But it was unlike to study by Walker etal in Gambia as the most immediate cause of death was the initial stroke in 61% patients. The difference could be due to difference in physician’s duty note and prediction based on comorbidities as well as complications that were developed in the patient at the end of patient’s life. Prevention, early identification and management of complications like increased intracranial pressure and aspiration pneumonia factors would at least have salvaged some of the patients.
In general the in hospital case fatality rate of stroke in our study was higher than reports from western studies, but was quite similar to SSA studies. This difference could reflect the limited access to hospital care, limited staffing, including availability of physiotherapy and occupational therapy similar to other developing countries as well as insufficient number of hospital beds for longer period care. In addition to this some caregivers/patients belief that people should die at home, where they spent most of their lives, with family members around and caring for them. Absence of treatment with thrombolytic, the low frequency of treatment with antiplatelets for patients with ischemic stroke and lack of evaluation with neuroimaging suggest that suboptimal care be the most likely explanation.
The hospital mean survival time for patients who died in hospital was 4.38days which was earlier as compared to study by Walker etal 7.5 days , Greffie etal 6 days  and Damasceno et al 6 days . However it was similar to study by Deresse et al of 4.5 days after admission . It has been stated that the high mortality rate in this study during the first one-week (17.2%) may be due to raised intracranial pressure and aspiration pneumonia.
Brain edema, urine incontinence NIHSS>13 during hospital arrival and diagnosis of stroke clinically alone were the independent predictors of in hospital mortality up on multivariable cox regression. Except stroke severity other factors were different from the study by Atadzhanov et al in Zambia . In this study increased NIHSS was associated with stroke severity constituting decreased level of consciousness. High NIHSS score as a predictor of mortality, was consistent with previous study done by Deresse et al .
In this study brain edema as complication was one predictor of in hospital mortality unlike study by Mamushet et al in Ethiopia in which mortality was not significantly associated with the complication of increased intracranial pressure .The overall difference in independent predictors of in hospital mortality could be due to sample size, study design, significance value considered and inclusion criteria of the patient.
The in hospital mortality was higher for hemorrhagic stroke (more than triple) compared to ischemic stroke patients that complies with other studies [14, 15, 19]. In contrary to this, study by Mamushet etal in Ethiopia showed that mortality was higher for cases of ischemic stroke (22%) than hemorrhagic stroke (17%) which was significant (P=0.049) . This contrary finding by Mamushet et al might be due to the study design, study population and comorbidity of the cases. Similar to our finding, study by Deresse etal showed that stroke mortality risk was not different by age and sex .