WSO - July 2023 - 634

1147164
WSO
International Journal of StrokeOkekunle et al.
Review
Stroke in Africa: A systematic
review and meta-analysis of the
incidence and case-fatality rates
Akinkunmi Paul Okekunle1,2 , Stephanie Jones3
Olaleye Adeniji4, Caroline Watkins3*
Gian Luca Di Tanna5,6, Mayowa Owolabi1,7,8*
Rufus Akinyemi1,7,8*
,
, Maree Hackett3,5*
and
,
International Journal of Stroke
2023, Vol. 18(6) 634 -644
© 2023 World Stroke Organization
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DOI: 10.1177/17474930221147164
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930221147164
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 (PoissonNormal
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
Stroke, epidemiology, incidence, case fatality, Africa, systematic review, meta-analysis
Received: 30 August 2022; accepted: 28 November 2022
1 Department of Medicine, College of Medicine, University of Ibadan,
Ibadan, Nigeria
2 Research Institute of Human Ecology, Seoul National University, Seoul,
Republic of Korea
3University of Central Lancashire, Preston, UK
4 Neurology Unit, Department of Medicine, Federal Medical Centre,
Abeokuta, Nigeria
5 The George Institute for Global Health, University of New South
Wales, Sydney, NSW, Australia
6 Department of Innovative Technologies, University of Applied Sciences
and Arts of Southern Switzerland, Lugano, Switzerland
7 Centre for Genomic and Precision Medicine, College of Medicine,
University of Ibadan, Ibadan, Nigeria
International Journal of Stroke, 18(6)
8 Neuroscience and Ageing Research Unit, Institute for Advanced
Medical Research and Training, College of Medicine, University of
Ibadan, Ibadan, Nigeria
*Senior authors of this work.
Corresponding author:
Rufus Akinyemi, Neuroscience and Ageing Research Unit, Institute
for Advanced Medical Research and Training, College of Medicine,
University of Ibadan, 200212 Ibadan, Nigeria.
Email: rufusakinyemi@yahoo.com
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