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Abstract
Eighty percent of people with stroke live in low- to middle-income nations, particularly in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades. More than one-third of all epilepsy−related deaths occur in SSA. HIV infection is a risk factor for neurological disorders, including stroke and epilepsy. The vast majority of the 38 million people living with HIV/AIDS are in SSA, and the burden of neurological disorders in SSA parallels that of HIV/AIDS. Local healthcare systems are weak. Many standalone HIV health centres have become a platform with combined treatment for both HIV and noncommunicable diseases (NCDs), as advised by the United Nations. The COVID-19 pandemic is overwhelming the fragile health systems in SSA, and it is feared it will provoke an upsurge of excess deaths due to the disruption of care for chronic diseases such as HIV, TB, hypertension, diabetes, and cerebrovascular disorders. Disease Relief through Excellent and Advanced Means (DREAM) is a health programme active since 2002 to prevent and treat HIV/AIDS and related disorders in 10 SSA countries. DREAM is scaling up management of NCDs, including neurologic disorders such as stroke and epilepsy. We described challenges and solutions to address disruption and excess deaths from these diseases during the ongoing COVID-19 pandemic.
Highlights
Eighty percent of people with stroke live in low- to middle-income nations, in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades
20 years, stroke greatly increased in low- to middle-income countries (LMIC); 80% of people who have had a stroke live there [7]
A systematic analysis conducted on 195 countries to evaluate performance on access to and quality of healthcare, including stroke and epilepsy, showed that SSA countries scored at the bottom of the list [43] (Figure 6)
Summary
20 years, stroke greatly increased in low- to middle-income countries (LMIC); 80% of people who have had a stroke live there [7]. Mortality rate (number of deaths per 100,000 general population) for stroke in SSA is up to 5 times higher compared to Western countries—. FastREVIEW demographic and lifestyle changes and other local factors including 4poor. PEER of 22 access to primary care [8]. In 2016, the death rate by stroke was 37 deaths per 100,000 inhabitants in SSA, similar to malaria and TB (40 deaths per 100,000 inhabitants) [5]. Of SSA countries, stroke is among the three leading causes of death [8] (Figure 3)
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