Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates

Abstract

Background: The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking.

Aim: To determine the incidence and 1-month case-fatality rates from high-quality studies of stroke epidemiology among Africans.

Summary of review: We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (MEDLINE, ScienceDirect, Google Scholar, and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle-Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, 14 studies were eligible for inclusion. The total number of stroke cases was 2568, with a population denominator (total sample size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,384,102. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% confidence interval (CI) = 58.59-193.55), I² = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI = 56.31-220.12), I² = 99.2%, than females, 91.14 (95% CI = 47.09-176.37), I² = 98.9%. One-month case-fatality rate was 24.45 (95% CI = 16.84-35.50), I² = 96.8%, with lower estimates among males, 22.68 (95% CI = 18.62-27.63), I² = 12.9%, than females, 27.57 (95% CI = 21.47-35.40), I² = 51.6%.

Conclusion: The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.

Keywords: Africa; Stroke; case fatality; epidemiology; incidence; meta-analysis; systematic review.

Figure 1.

PRISMA flowchart of study selection.

Figure 2.

Location of studies assessing the crude incidence (a) and case-fatality rate—CFR (b) of stroke in Africa.

Figure 3.

Forest plots on the pooled crude annual incidence of stroke per 100,000 persons in the overall population (a), among males (b) and females (c) in Africa.

Figure 4.

Forest plots on the pooled crude annual incidence rates of stroke per 100,000 persons stratified by study setting (community-based, hospital-based, community-based, and hospital-based).

Figure 5.

Forest plots on the pooled 30-day case fatality rate of stroke per 100,000 events in the overall population (a), among males (b) and females (c) in Africa.