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AFRICA

S27

CVJAFRICA • Volume 26, No 2, H3Africa Supplement, March/April 2015

The burden of stroke in Africa: a glance at the present

and a glimpse into the future

Mayowa O Owolabi, Sally Akarolo-Anthony, Rufus Akinyemi, Donna Arnett, Mulugeta Gebregziabher,

Carolyn Jenkins, Hemant Tiwari, Oyedunni Arulogun, Albert Akpalu, Fred Stephen Sarfo, Reginald

Obiako, Lukman Owolabi, Kwamena Sagoe, Sylvia Melikam, Abiodun M Adeoye, Daniel Lackland,

Bruce Ovbiagele, as members of the H3Africa Consortium

Abstract

Objective:

Information on the current burden of stroke in

Africa is limited. The aim of this review was to comprehensively

examine the current and projected burden of stroke in Africa.

Methods:

We systematically reviewed the available literature

(PubMed and AJOL) from January 1960 and June 2014

on stroke in Africa. Percentage change in age-adjusted

stroke incidence, mortality and disability-adjusted life years

(DALYs) for African countries between 1990 and 2010

were calculated from the Global Burden of Diseases (GBD)

model-derived figures.

Results:

Community-based studies revealed an age-standard-

ised annual stroke incidence rate of up to 316 per 100

000

population, and age-standardised prevalence rates of up to

981 per 100 000. Model-based estimates showed significant

mean increases in age-standardised stroke incidence. The

peculiar factors responsible for the substantial disparities in

incidence velocity, ischaemic stroke proportion, mean age

and case fatality compared to high-income countries remain

unknown.

Conclusions:

While the available study data and evidence are

limited, the burden of stroke in Africa appears to be increasing.

Keywords:

stroke, Africa, epidemiology, incidence, mortality,

prevalence

Cardiovasc J Afr

2015;

26

: S27–S38

www.cvja.co.za

DOI:

10.5830/CVJA

-2015-038

African countries are undergoing an epidemiological transition

driven by socio-demographic and lifestyle changes.

1

The burden

of non-communicable diseases (NCD), including cardiovascular

risk factors is increasing.

1-3

Consequently, the incidence of stroke,

a cardinal complication of cardiovascular risk factors, appears

to be rising in Africa and other low- and middle-income country

(LMIC) settings.

3

Therefore, 86% of all stroke deaths around the

world is contributed by LMIC in Africa and other continents.

4

By contrast, the incidence of stroke appears to be declining in

high-income countries.

4,5

Ironically, there is insufficient information on the current

epidemiology of stroke in African countries and other LMICs,

where this knowledge is needed most. This is due to and

contributes to deficient manpower and other resources to

combat the epidemic.

6

Accurate, up-to-date information on

stroke burden is necessary for the development and evaluation of

effective and efficient preventative acute care and rehabilitation

programmes for stroke patients.

In an attempt to fill this gap, in 2013 and 2014, the Global

Burden of Diseases (GBD) collaborators published data on the

burden of stroke and stroke subtype based on multi-state models

implemented in the software program DisMod III. These models

were used to estimate the incidence, prevalence and disability-

adjusted life years (DALYs) of ischaemic and haemorrhagic

stroke in various countries across the globe but without specific

focus on Africa.

2,7

However, one meta-analysis

8

focused solely on the prevalence

and incidence of stroke in Africa, albeit with pooled data

of uneven quality. In addition, there are some publications

derived from primarily hospital-based data on the burden

of stroke in Africa. Nevertheless, no recent publication has

examined the burden of stroke in Africa, longitudinally and

in its entirety,

9

while identifying gaps in data and proposing

appropriate interventions. This complete longitudinal picture is

College of Medicine, University of Ibadan and University

College Hospital, Ibadan, Nigeria

Mayowa O Owolabi, MD,

mayowaowolabi@yahoo.com

Oyedunni Arulogun, MD

Sylvia Melikam, MD

Abiodun M Adeoye, MD

Harvard University, USA

Sally Akarolo-Anthony, MD

Federal Medical Centre, Abeokuta, Nigeria

Rufus Akinyemi, MD

University of Alabama at Birmingham, USA

Donna Arnett, MD

Hemant Tiwari, MD

Medical University of South Carolina, USA

Mulugeta Gebregziabher, MD

Carolyn Jenkins, MD

Daniel Lackland, MD

Bruce Ovbiagele, MD

University of Ghana, Ghana

Albert Akpalu, MD

Kwamena Sagoe, MD

Kwame Nkrumah University of Science and Technology,

Kumasi, Ghana

Fred Stephen Sarfo, MD

Ahmadu Bello University, Zaria, Nigeria

Reginald Obiako, MD

Bayero University, Kano, Nigeria

Lukman Owolabi, MD