An Estimate of the Incidence and Prevalence of Stroke in Africa: A Systematic Review and Meta-Analysis

Abstract

BackgroundStroke is increasingly becoming a challenging public health issue in Africa, and the non-availability of data has limited research output and consequently the response to this burden. This study aimed to estimate the incidence and prevalence of stroke in Africa in 2009 towards improved policy response and management of the disease in the region.MethodsA systematic search of Medline, EMBASE and Global Health for original population-based or hospital-based studies on stroke was conducted. A random effect meta-analysis was conducted on crude stroke incidence and prevalence rates, and a meta-regression-like epidemiological model was applied on all data points. The fitted curve generated from the model was used to estimate incident cases of stroke and number of stroke survivors in Africa at midpoints of the United Nation population 5-year age groups for the year 2009.ResultsThe literature search yielded a total of 1227 studies. 19 studies from 10 African countries were selected. 483 thousand new stroke cases among people aged 15 years or more were estimated in Africa in 2009, equivalent to 81.2 (13.2–94.9)/100,000 person years. A total of 1.89 million stroke survivors among people aged 15 years or more were estimated in Africa in 2009, with a prevalence of 317.3 (314.0–748.2)/100000 population. Comparable figures for the year 2013 based on the same rates would amount to 535 thousand (87.0–625.3) new stroke cases and 2.09 million (2.06–4.93) stroke survivors, suggesting an increase of 10.8% and 9.6% of incident stroke cases and stroke survivors respectively, attributable to population growth and ageing between 2009 and 2013.ConclusionThe findings of this review suggest the burden of stroke in Africa is high and still increasing. There is need for more research on stroke and other vascular risk factors towards instituting appropriate policy, and effective preventive and management measures.

Stroke survivors in low- and middle-income countries: A meta-analysis of prevalence and secular trends

“…The higher proportion of stroke in upper-middle-income countries and urban settings compared to low-income countries and rural environments as shown in the present study and in previous reviews [6,8,43] are in line with convergence of increasing income level, urbanisation and cardio-vascular disease predictors.…”

“…Previous reviews had little representation of LMICs [44], others were based on regional [6,8,[45][46][47][48], country [28,49,50] or population-specific analysis [28,49,50]. There are also global reviews of stroke with few studies in LMICs [1,44].…”

“…Improved stroke surveillance and care, as well as for better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed. Though there are existing reviews that had looked at prevalence of stroke in LMICs and regions such as Africa and Latin America [6][7][8][9], to the best of our knowledge there is no recent attempt to compile studies on stroke prevalence across different geographic regions in LMICs. Since the publication of these reviews, there have been an increasing number of new studies from these regions.…”

“…wide pooled estimate without due consideration of human development index and gross national income per capita estimates [6,51]. Our study presents the most comprehensive and up-to-date review of stroke prevalence in LMICs.…”

Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region

“…Due to the current epidemiological transition driven by rapid economic development and combined effects of population growth and aging, and sociocultural changes, there is huge concern of continuous increase in the prevalence of stroke in LMICs including Nigeria, and among relatively younger populations [2]. Recent systematic review of population-based studies revealed a consistent evidence that the prevalence of stroke and its major risk factors particularly high blood pressure were now higher in LMICs compared to high income countries and that young adults who present with stroke were unaware of their high blood pressure [2], [5], [6] and [7]. These important revelations were poorly known or underexplored in the rural areas of most LMICs such as in the Niger Delta region in Nigeria.…”