Cardiovascular Journal of Africa: Vol 26 No 2 Supplement (March/April 2015)

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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
DOI: -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-analysis8 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,
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