Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates

Abstract

Background: The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking. Aim: To determine the incidence and one-month case-fatality rates from high-quality studies of stroke epidemiology among Africans. Summary of review: We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (PubMed, ScienceDirect, Google Scholar and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle-Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, fourteen studies were eligible for inclusion. The total number of stroke cases was 5,104 (mean: 365 SD: 254) with a population denominator (total sample size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,638,304. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% CI 58.59–193.55), I2 = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI 56.31–220.12), I2 = 99.2% than females, 91.14 (95% CI 47.09–176.37), I2 = 98.9%. One–month case-fatality rate was 24.45 (95% CI 16.84–35.50), I2 = 96.8% with lower estimates among males, 22.68 (95% CI 18.62–27.63), I2 = 12.9% than females, 27.57 (95% CI 21.47–35.40), I2 = 51.6%. Conclusions: The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.

Reperfusion therapy for stroke: From improving global access, to thrombectomy beyond 24 hours

“…2,3 We have also recently published in this journal detailed analyses of stroke risk in various countries and continents including Africa, India, China, and South America. [4][5][6][7] Together these show major disparities in stroke incidence and mortality and worryingly upward trends in incidence in many LMICs, but more positively highlight how stroke risk could be reduced with environmental and cardiovascular risk factor initiatives.…”

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry

“…3 In sub-Saharan Africa (SSA), stroke affects younger individuals in their fourth to sixth decades of life and is associated with premature deaths. [4][5][6] Therefore, a multifaceted pragmatic approach to stroke prevention and treatment is urgently needed to reduce the stroke burden.…”

The global burden of stroke

“…3 In this issue we have definitive reviews of stroke in both Africa and South America. Okekunle et al 4 performed a systematic review of epidemiological data from Africa which shows a high incidence and poor outcome. They also highlight a dearth of high-quality data and provide guidance of how this could be best obtained using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework.…”