Background and Aims

The burden of stroke is increasing in Africa. Previous research suggests that the age-standardized incidence is up to 316 per 100,000 and the prevalence 1460 per 100,000 people per year. However, there is a paucity of available data and a lack of uniform methods across published studies. This review summarized data for incidence, prevalence and fatality to provide evidence for stroke epidemiology in Africa.

Methods

A search strategy was modified from the Cochrane Stroke Strategy and adapted to search a range of bibliographic databases from the earliest possible study date to January 2022.

Results

From 925 identified records, 15 studies were selected for inclusion: 10 hospital-based registries, three community-based registries and two utilizing combined hospital and community-based ascertainment. Studies represented nine African countries: three in Tanzania, two each from Libya, Egypt, Mozambique, Nigeria, and one each from Zimbabwe, Uganda, Cameroon and the Gambia.

The total population denominator was 3,638,304 and 5,104 (mean 365 SD 254) people were identified with incident stroke, 1948 (42%) female. Crude incidence of stroke ranged from 25 to 250/100,000 people per year. Crude prevalence was only reported in two studies ranging from 560 to 655/100,000 people per year and one-month case fatality rates from 4% to 50%.

Conclusions

There is a dearth of high-quality evidence in Africa, and a lack of resources (stroke registries, availability of imaging) impacts study quality. Future studies should consider the World Health Organisation STEPwise approach to Surveillance (STEPS) framework, including a combination of hospital-registry and comprehensive community ascertainment strategies to ensure complete stroke identification.

Background and Aims

Safe and efficient acute stroke care services, effective training and and context -sensitive research and advocacy are key to reducing the high stroke burden in Africa. However, quantitative data are sparse on stroke care services, training and research priorities in Africa. We describe the status of acute stroke care services and unmask training and research needs in Africa.

Methods

A 56-item, pre-tested, multi-lingual online survey tool adapted from the World Stroke Organization (WSO) Roadmap to delivering quality stroke care was sent to stroke experts in each African country through e-mail directories of national stroke organizations, the African Stroke Organization (ASO), the African Academy of Neurology (AFAN) and the WSO-Future Leaders African fellows. Data on stroke services, management guidelines, stroke research, stroke education and training were collected and analyzed using descriptive statistics.

Results

We surveyed 54 but had responses from 45 (83%)African countries covering 95% of the population of Africa. Only 4% of respondent countries reported having a national stroke registry or national stroke surveillance system. Thrombolysis was available in 49% of countries, at an estimated 255 centres. 16% of countries had access to endovascular thrombectomy at 69 centres. National stroke-specfic training programmes were available for 11% of consultants, 9% of general medical practitioners and 4% of nurses. Reperfusion therapy was selected as the most important training need and national stroke registries as the top research priority.

Conclusions

Our study highlights core needs for stroke services improvement, capacity building, context - sensitive research and multi-level advocacy in Africa