Stroke in Africa: profile, progress, prospects and priorities
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-...
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| Published in | Nature reviews. Neurology Vol. 17; no. 10; pp. 634 - 656 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
Nature Publishing Group UK
01.10.2021
Nature Publishing Group |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1759-4758 1759-4766 1759-4766 |
| DOI | 10.1038/s41582-021-00542-4 |
Cover
| Abstract | Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2–3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives.
Key points
The annual incidence rate of stroke in Africa is up to 316 per 100,000 individuals, which is within the highest incidence rates in the world, and the prevalence rate of 1,460 per 100,000 reported in one region of Nigeria, western Africa, is clearly among the highest in the world.
Hypertension remains the most important modifiable risk factor for stroke in Africa but others include diabetes mellitus, dyslipidaemia, obesity, stress, smoking, alcohol use, physical inactivity and an unhealthy diet.
Africa has a slightly greater preponderance of small vessel disease-related stroke and intracerebral haemorrhagic lesions than elsewhere in the world.
The results of the first African genome-wide association study on stroke are expected soon but genes already known to modify stroke risk in African populations include
IL6
,
APOE
,
APOL1
,
CYB11B2
and
CDKN2A/2B
.
Pragmatic approaches to improving stroke care in Africa include regular monitoring of risk factors and health services, implementation of prevention strategies, improving acute care and rehabilitation services, and encouraging task sharing; the emergence of standalone stroke care and stroke units in some North African and sub-Saharan countries is encouraging.
Numerous challenges face stroke medicine in Africa but awareness and the concerted efforts towards securing support for more stroke research and services via organizations such as the African Stroke Organization, World Stroke Organization and WHO hold much promise. |
|---|---|
| AbstractList | Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa. Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2–3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives. Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2–3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa. In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives. Key points The annual incidence rate of stroke in Africa is up to 316 per 100,000 individuals, which is within the highest incidence rates in the world, and the prevalence rate of 1,460 per 100,000 reported in one region of Nigeria, western Africa, is clearly among the highest in the world. Hypertension remains the most important modifiable risk factor for stroke in Africa but others include diabetes mellitus, dyslipidaemia, obesity, stress, smoking, alcohol use, physical inactivity and an unhealthy diet. Africa has a slightly greater preponderance of small vessel disease-related stroke and intracerebral haemorrhagic lesions than elsewhere in the world. The results of the first African genome-wide association study on stroke are expected soon but genes already known to modify stroke risk in African populations include IL6 , APOE , APOL1 , CYB11B2 and CDKN2A/2B . Pragmatic approaches to improving stroke care in Africa include regular monitoring of risk factors and health services, implementation of prevention strategies, improving acute care and rehabilitation services, and encouraging task sharing; the emergence of standalone stroke care and stroke units in some North African and sub-Saharan countries is encouraging. Numerous challenges face stroke medicine in Africa but awareness and the concerted efforts towards securing support for more stroke research and services via organizations such as the African Stroke Organization, World Stroke Organization and WHO hold much promise. Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa. Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa. In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives. Key points The annual incidence rate of stroke in Africa is up to 316 per 100,000 individuals, which is within the highest incidence rates in the world, and the prevalence rate of 1,460 per 100,000 reported in one region of Nigeria, western Africa, is clearly among the highest in the world. Hypertension remains the most important modifiable risk factor for stroke in Africa but others include diabetes mellitus, dyslipidaemia, obesity, stress, smoking, alcohol use, physical inactivity and an unhealthy diet. Africa has a slightly greater preponderance of small vessel disease-related stroke and intracerebral haemorrhagic lesions than elsewhere in the world. The results of the first African genome-wide association study on stroke are expected soon but genes already known to modify stroke risk in African populations include IL6, APOE, APOL1, CYB11B2 and CDKN2A/2B. Pragmatic approaches to improving stroke care in Africa include regular monitoring of risk factors and health services, implementation of prevention strategies, improving acute care and rehabilitation services, and encouraging task sharing; the emergence of standalone stroke care and stroke units in some North African and sub-Saharan countries is encouraging. Numerous challenges face stroke medicine in Africa but awareness and the concerted efforts towards securing support for more stroke research and services via organizations such as the African Stroke Organization, World Stroke Organization and WHO hold much promise. Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2–3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa. In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives. The annual incidence rate of stroke in Africa is up to 316 per 100,000 individuals, which is within the highest incidence rates in the world, and the prevalence rate of 1,460 per 100,000 reported in one region of Nigeria, western Africa, is clearly among the highest in the world. Hypertension remains the most important modifiable risk factor for stroke in Africa but others include diabetes mellitus, dyslipidaemia, obesity, stress, smoking, alcohol use, physical inactivity and an unhealthy diet. Africa has a slightly greater preponderance of small vessel disease-related stroke and intracerebral haemorrhagic lesions than elsewhere in the world. The results of the first African genome-wide association study on stroke are expected soon but genes already known to modify stroke risk in African populations include IL6 , APOE , APOL1 , CYB11B2 and CDKN2A/2B . Pragmatic approaches to improving stroke care in Africa include regular monitoring of risk factors and health services, implementation of prevention strategies, improving acute care and rehabilitation services, and encouraging task sharing; the emergence of standalone stroke care and stroke units in some North African and sub-Saharan countries is encouraging. Numerous challenges face stroke medicine in Africa but awareness and the concerted efforts towards securing support for more stroke research and services via organizations such as the African Stroke Organization, World Stroke Organization and WHO hold much promise. |
| Audience | Academic |
| Author | Ogah, Okechukwu S. Owolabi, Mayowa O. Kalaria, Rajesh N. Sarfo, Fred S. Adoukonou, Thierry Damasceno, Albertino Naidoo, Pamela Adeniji, Olaleye A. Ogunniyi, Adesola Ovbiagele, Bruce Abd-Allah, Foad Walker, Richard W. Akinyemi, Rufus O. |
| Author_xml | – sequence: 1 givenname: Rufus O. orcidid: 0000-0001-5286-428X surname: Akinyemi fullname: Akinyemi, Rufus O. email: roakinyemi@com.ui.edu.ng organization: Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Department of Neurology, University College Hospital, Neurovascular Research Group, Translational and Clinical Research Institute, Newcastle University – sequence: 2 givenname: Bruce surname: Ovbiagele fullname: Ovbiagele, Bruce organization: Department of Neurology, University College Hospital, Department of Neurology, University of California, Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital – sequence: 3 givenname: Olaleye A. orcidid: 0000-0002-3402-7768 surname: Adeniji fullname: Adeniji, Olaleye A. organization: Department of Medicine, Federal Medical Centre Abeokuta – sequence: 4 givenname: Fred S. surname: Sarfo fullname: Sarfo, Fred S. organization: Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital – sequence: 5 givenname: Foad surname: Abd-Allah fullname: Abd-Allah, Foad organization: Department of Neurology, Kasr Alainy School of Medicine, Cairo University – sequence: 6 givenname: Thierry surname: Adoukonou fullname: Adoukonou, Thierry organization: Department of Neurology, University Teaching Hospital – sequence: 7 givenname: Okechukwu S. surname: Ogah fullname: Ogah, Okechukwu S. organization: Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Department of Medicine, University College Hospital/College of Medicine, University of Ibadan – sequence: 8 givenname: Pamela surname: Naidoo fullname: Naidoo, Pamela organization: Heart and Stroke Foundation South Africa/University of the Western Cape – sequence: 9 givenname: Albertino surname: Damasceno fullname: Damasceno, Albertino organization: Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University – sequence: 10 givenname: Richard W. surname: Walker fullname: Walker, Richard W. organization: Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Department of Medicine, North Tyneside General Hospital, Population Health Sciences Institute, Newcastle University – sequence: 11 givenname: Adesola surname: Ogunniyi fullname: Ogunniyi, Adesola organization: Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Department of Neurology, University College Hospital – sequence: 12 givenname: Rajesh N. orcidid: 0000-0001-7907-4923 surname: Kalaria fullname: Kalaria, Rajesh N. organization: Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Neurovascular Research Group, Translational and Clinical Research Institute, Newcastle University – sequence: 13 givenname: Mayowa O. surname: Owolabi fullname: Owolabi, Mayowa O. organization: Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Department of Neurology, University College Hospital |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34526674$$D View this record in MEDLINE/PubMed https://unilim.hal.science/hal-03411874$$DView record in HAL |
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| Title | Stroke in Africa: profile, progress, prospects and priorities |
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