The need for a community-based model for stroke care in South Africa.

Abstract

Sub-Saharan Africa is faced with the huge burden of the HIV/AIDS pandemic. In South Africa the scale of the HIV epidemic has set health agendas and budgets. Consequently other diseases, particularly those relating to lifestyle, have not received the same attention, nor been considered a priority in terms of health expenditure in many provinces. In African countries, health is linked to overall development and socio-economic change. Like other developing countries, South Africa is undergoing a period of rapid urbanization associated with a change in risk environment. Infectious diseases and perinatal and nutritional disease dominate causes of death in Africa compared to non-communicable diseases in high-income countries. However, the burden of stroke and other vascular diseases is likely to increase substantially in Africa in the future with the expected health transition as the social, economic and demographic structures change. Because of wide socio-economic stratifications within the region, diseases of poverty and the emerging non-communicable diseases related to lifestyle are likely to overlap and persist for a prolonged period. This will pose an additional burden to healthcare systems in the region as we are faced with a quadruple burden of disease: HIV and other infections, violent deaths, perinatal, maternal nutrition- related diseases, and diseases of lifestyle such as stroke and ischaemic heat disease.