Abstract
SummaryObjectiveInformation 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.MethodsWe 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.ResultsCommunity-based studies revealed an age-standardised 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.ConclusionsWhile the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.
Highlights
Urbanisation and other socio-demographic and lifestyle changes in Africa, as in other parts of the developing world, are increasing rapidly, and the results from this study suggest that, in the absence of effective preventive measures, this is likely to lead to further substantial increases in stroke incidence
The low prevalence rate recorded in Ethiopia in 1988, included in the meta-analysis, may have been due to the high fatality rates from stroke, which have generally been reported in many parts of Africa.[8,17,34,36]
As a population undergoes health transition, the pattern of vascular disease is thought to change from one dominated by stroke, with a high proportion caused by cerebral haemorrhage, to a pattern dominated by atherosclerotic stroke, coronary heart disease and peripheral vascular disease.[16,53]. This scenario is expected to occur in Africa, as suggested by a study exploring the relationship of vascular risk factors to stroke type among Africans, in which we found age above 61 years and previous transient ischaemic attack to be associated with ischaemic stroke, while uncontrolled hypertension predicted haemorrhagic stroke.[54]
Summary
Using the GBD data (Fig. 2), increase in age-standardised ischaemic stroke incidence from 1990 to 2010 ranged between 5.2% (South Africa) and 27.8% (DRC, Table 3).
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