AccScience Publishing / AN / Online First / DOI: 10.36922/an.2804
Submit to AN
Cite this article
97
Download
1342
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
REVIEW

Stroke care in sub-Saharan Africa: Evaluating the present landscape and proposing strategies for improving outcomes

Felix E. Chukwudelunzu1* ,  Amir A. Mbonde2
Show Less
1 Department of Neurology Mayo Clinic Health System, Eau Claire, Wisconsin, United States of America
2 Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
Advanced Neurology 2024, 3(2), 2804 https://doi.org/10.36922/an.2804
Submitted: 23 January 2024 | Accepted: 20 March 2024 | Published: 30 May 2024
(This article belongs to the Special Issue Advances in stroke research and therapy)
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

The burden of stroke is alarmingly high in sub-Saharan Africa (SSA), characterized by increasing trends in stroke incidence, prevalence, and mortality. This review details the landscape of stroke care in SSA, encompassing epidemiology, risk factors, care availability, and challenges in advancing stroke care, along with a proposed strategic framework for improvement. Epidemiological studies in SSA indicate a rising trend in stroke incidence and prevalence, with significant variability attributable to differences in study methodologies. Crude incidence rates have risen from an average of 53 (range: 26 – 101) cases/100,000 population between 1973 and 1991 to 88 (range: 25 – 149) cases/100,000 population between 2003 and 2011. Similarly, prevalence rates have shown an upward trend. Stroke mortality in SSA remains high, with variability across studies. Key predictors of mortality include hemorrhagic stroke, gender, National Institute of Stroke Scale score at presentation, and comorbidities such as anemia and human immunodeficiency virus infection. However, the interpretation of mortality rates warrants caution due to methodological limitations. Both modifiable and non-modifiable risk factors significantly contribute to stroke risk in SSA. Notably, stroke occurs at a younger age in SSA compared to Western countries. Hypertension, diabetes, dyslipidemia, and lifestyle factors are among the major modifiable risk factors. The availability of organized stroke care varies significantly across SSA, with more advanced care typically found in higher-level health-care centers. However, efforts to improve access and quality of care are ongoing. The challenges in advancing stroke care in SSA include cultural beliefs, limited access to care, and prohibitive costs. A “5 Ps” framework involving collaboration among policymakers, payers, partners in health care, providers, and patients is proposed to improve stroke care. This review underscores the urgent need for enhanced public health strategies, medical interventions, and collaborative efforts to address the escalating stroke burden in SSA.

Keywords
Sub-Sahara Africa
Stroke care
Epidemiology
Stroke burden
Review article
Funding
None.
Conflict of interest
The authors declare no conflicts of interest.
References
  1. World Stroke Organization: Global Stroke Fact Sheet; 2022. Available from: https://ghdx.healthdata.org/gbd-results-tool [Last accessed on 2023 Oct 21].

 

  1. Feigin V. Stroke epidemiology in the developing world. Lancet. 2005;365(9478):2160-2161. doi: 10.1016/S0140-6736(05)66755-4

 

  1. World Bank Country and Lending Groups. Available from: https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html [Last accessed on 2023 Nov 10].

 

  1. Sub-Saharan Africa, Demographic-Population. Available from: https://en.wikipedia.org/wiki/sub-saharan_africa [Last accessed on 2023 Oct 21].

 

  1. Osuntokun BO, Bademosi O, Akinkugbe OO, Oyediran AB, Carlisle R. Incidence of stroke in an African city: Results from the stroke registry at Ibadan, Nigeria 1973–1975. Stroke. 1979;10(2):205-207. doi: 10.1161/01.str.10.2.205

 

  1. Rosman KD. The epidemiology of stroke in an urban black population. Stroke. 1986;17(4):667-669. doi: 10.1161/01.str.17.4.667

 

  1. Matenga J. Stroke incidence rates among black residents of Harare-a prospective community-based study. S Afr Med J. 1997;87(3):606-609.

 

  1. Danesi MA, Okubadejo NU, Ojini FI, Ojo OO. Incidence and 30-day case fatality rate of first ever stroke in urban Nigeria: The prospective community-based epidemiology of stroke in Lagos (EPISIL) phase 11 results. J Neurol Sci. 2013;331:43-47. doi: 10.1016/j.jns.2013.04.026

 

  1. Okon M, Adebobola NI, Julius S, et al. Stroke incidence and case fatality rate in an urban population. J Stroke Cerebrovasc Dis. 2015;24(4):771-777. doi: 10.1016/j.jstrokecerebrovasdis.2014.11.004

 

  1. Damasceno A, Gomes J, Azevedo A, et al. An epidemiological study of stroke hospitalizations in Maputo, Mozambique: A high burden of disease in a resource-poor country. Stroke. 2010;41(11):2463-2469. doi: 10.1161/STROKEAHA.110.594275

 

  1. Walker R, Whiting D, Unwin N, et al. Stroke incidence in rural and urban Tanzania: A prospective community-based study. Lancet Neurol. 2010;9(8):786-792. doi: 10.1016/S1474-4422(10)70144-7

 

  1. Osuntokun BO, Adeuja AOG, Schoenberg BS, et al. Neurological disorders in Nigerian Africans: A community-based study. Acta Neurol Scand. 1987;75(1):13-21. doi: 10.1111/j.1600-0404.1987.tb07883.x

 

  1. Connor MD, Thorogood M, Casserly B, Dobson C, Warlow CP, SASPI Project Team. Prevalence of stroke survivors in rural South Africa: Results from the southern stroke prevention initiative (SASPI) Agincourt Field site. Stroke. 2004;35(3):627-632. doi: 10.1161/01.Str.0000117096.61838.C7

 

  1. Tekle-Haimanot R, Abebe M, Gebre-Mariam A, et al. Community-based study of Neurological disorders in rural Central Ethiopia. Neuroepidemiology. 1990;9(5):263-277. doi: 10.1159/000110783

 

  1. Walker RW, McLarty DG, Masuki G, et al. Age specific prevalence of impairment and disability relating to hemiplegic stroke in the Hai district of Northern Tanzania: Adult morbidity and mortality project. J Neurol Neurosurg Psychiatry. 2000;68(6):744-749. doi: 10.1136/jnnp.68.6.744

 

  1. Onwuchekwa AC, Tobin-West C, Babatunde S. Prevalence, and risk factors for stroke in an adult population in a rural community in the Niger Delta, South-South Nigeria. J Stroke Cerebrovasc Dis. 2014;23(3):505-510. doi: 10.1016/j.jstrokecerebrovasdis.2013.04.010

 

  1. Ejimofor MC, Uthman OA, Maduka O, et al. Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region. J Neurol Sci. 2017;372:262-269. doi: 10.1016/j.jns.2016.11.059

 

  1. Sanya EO, Desalo OO, Adepoju F, Aderibigbe SA, Shittu A, Olaosebikan O. Prevalence of stroke in three semi-urban communities in middle-belt region of Nigeria: A door-to-door survey. Pan Afr Med J. 2015;20(33):4594. doi: 10.11604/pamj.2015.20.33.4594

 

  1. Dewhurst F, Dewhurst MJ, Gray WK, et al. Prevalence of Neurological disorders in older people in Tanzania. Acta Neurol Scand. 2013;127(3):198-207. doi: 10.1111/j.1600-0404.2012.01709.x

 

  1. Adoukonou T, Yahouedeou B, Agbetou M, et al. Prevalence of stroke survivors in Parakou in Northern Benin: A door-to-door community survey. Rev Neurol. 2020;176(10):839-845. doi: 10.1016/j.neurol.2020.02.005

 

  1. Enwereji KO, Nwosu MC, Ogunniyi A, Nwani PO, Asomugha AL, Enwereji EE. Epidemiology of stroke in a rural community in Southeast Nigeria. Vasc Health Risk Manag. 2014;10:375-388. doi: 10.2147/VHRM.S57623

 

  1. Cossi MJ, Gobron C, Preux PM, Niama D, Chabriat H, Houinato D. Stroke: Prevalence and disability in Cotonou, Benin. Cerebrovasc Dis. 2012;33(2):166-172. doi: 10.1159/000334195

 

  1. Adeloye D, Ezejimofor M, Auta A, et al. Estimating morbidity due to stroke in Nigeria: A systematic review and meta-analysis. J Neurol Sci. 2019;402:136-144. doi: 10.1016/j.jns.2019.05.020

 

  1. Aeloye D. An estimate of the incidence and prevalence of stroke in Africa: A systematic review and meta-analysis. PLoS One. 2014;9(6):e100724. doi: 10.1371/journal.pone.0100724

 

  1. Maredza M, Bertram MY, Tollman SM. Disease burden of stroke in rural South Africa: An estimate of incidence, mortality and disability adjusted life years. BMC Neurol. 2015;15:54. doi: 10.1186/s12883-015-0311-7

 

  1. Walker RW, McLarty DG, Kitange HM, et al. Stroke mortality in urban and rural community in Tanzania. Lancet. 2000;355:1684-1687. doi: 10.1016/s0140-6736(00)02240-6

 

  1. Walker RW, Jusabani A, Aris E, et al. Post-stroke case fatality within an incident population in rural Tanzania. J Neurol Neurosurg Psychiatry. 2011;82:1001-1005. doi: 10.1136/jnnp.2010.231944

 

  1. Olum S, Muyingo A, Wilson TL, et al. Stroke mortality outcomes in Uganda. J Stroke Cerebrovasc Dis. 2021;30(5):105661. doi: 10.1016/j.jstrokecerebrovasdis

 

  1. Adoukonou T, Kossi O, Mefo PF, et al. Stroke case fatality in Sub-Sahara Africa: Systematic review and meta-analysis. Int J Stroke. 2021;16(8):902-916. doi: 10.1177/1747493021990945

 

  1. Okong OK, Chillo P, Gray WK, Walker RW, Matuja W. Early mortality and associated factors among patients with stroke admitted to a large teaching hospital in Tanzania. J Stroke Cerebrovasc Dis. 2017;26:871-878. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.037

 

  1. Russell JBW, Charles E, Conteh V, Lisk DR. Risk factors, clinical outcomes, and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study. Ann Med Surg (Lond). 2020;60:293-300. doi: 10.1016/j.amsu.2020.10.060

 

  1. Gomes J, Damasceno A, Carrilho C, et al. Determinants of early case-fatality among stroke patients in Maputo, Mozambique, and impact of in-hospital complications. Int J Stroke. 2013;8:69-75. doi: 10.1111/j.1747-4949.2012.00957.x

 

  1. GBD 2016 Lifetime Risk of Stroke Collaborators, Feigin VL, Nguyen G, et al. Global, regional and country-specific lifetime risk of stroke, 1990 and 2016. N Engl J Med. 2018;379(25):2429-2437. doi: 10.1056/NEJMoa1804492

 

  1. Akyea RK, Vinogradova Y, Qureshi N, et al. Sex, age, and socioeconomic differences in nonfatal stroke incidence and subsequent major adverse outcome. Stroke. 2021;52:396-405. doi: 10.1161/STROKEAHA.120.031659

 

  1. Owolabi M, Sarfo F, Howard VJ, et al. Stroke in Indigenous Africans, African Americans, and European Americans: Interplay of racial and geographic factors. Stroke. 2017;48(5):1169-1175. doi: 10.1161/STROKEAHA.116.015937

 

  1. Owolabi MO, Ugoya S, Platz T. Racial disparity in stroke risk factors: Berlin-Ibadan experience, a retrospective study. Acta Neurol Scand. 2009;119:81-87. doi: 10.1111/j.1600-0404.2008.01077.x

 

  1. Edzie EKM, Gorleku PN, Dzefi-Tettey K, et al. Incidence rate and age of onset of first stroke from CT scan examination in Cape Coast Metropolis. Heliyon. 2021;7(2):e06214. doi: 10.1016/j.heliyon.2021.e06214

 

  1. Tribelhorn S, Motara F, Lewis CM. Stroke: A retrospective review of the incidence and epidemiology in a South African academic hospital emergency department. S Afr Med J. 2021;111(12):1205-1210. doi: 10.7196/SAMJ.2021.v111i12.15682

 

  1. Sarfo FS, Ovbiagele B, Gebregziabher M, et al. Stroke among young West Africans Evidence from the SIREN (Stroke Investigative Research and Education Network) large multisite case-control study. Stroke. 2018;49(5):1116-1122. doi: 10.1161/STROKEAHA.118.020783

 

  1. Aigwe OP, Onoja SO, Onavbavba G. A critical review of sickle cell disease burden and challenges in Sub-Sahara Africa. J Blood Med. 2023;14:367-376. doi: 10.2147/JBM.S406196

 

  1. Naibiap JJ, Mengnjo MK, Nicastro N, Kamtchum- Tatuene J. Neurologic complications of sickle cell disease in Africa: A systematic review and meta-analysis. Neurology. 2017;89(14):1516-1524. doi: 10.1212/WNL.0000000000004537

 

  1. Isa H, Adegoke S, Madu A, et al. Sickle cell disease clinical phenotypes in Nigeria: A preliminary analysis of the Sickle Pan Africa Research Consortium Nigeria database. Blood Cells Mol Dis. 2020;84:102438. doi: 10.1016/j.bcmd.2020.102438

 

  1. Fatunde OJ, Adamson FG, Ogunseyinde O, Sodeinde O, Familusi JB. Stroke in Nigerian children with sickle cell disease. Afr J Med Sci. 2005;34(2):157-160.

 

  1. O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischemic and intracerebral hemorrhagic stroke in 22 countries (the INTERSTATE study): A case-control study. Lancet. 2010;376:112-123. doi: 10.1016/S0140-6736(10)60834-3

 

  1. Walker RW, Jusabani A, Aris E, et al. Stroke risk factors in an incident population in urban and rural Tanzania: A prospective, community-based, case-control study. Lancet Glob Health. 2013;1(5):e282-e288. doi: 10.1016/S2214-109X(13)70068-8

 

  1. Okokhere PO, Bankole IA, Erohubie CA. Characteristics, risk factors and case fatality rate of stroke in hospitalized patients in semi-urban South-South Nigeria. Sage Open Med. 2013;1. doi: 10.1177/2050321113516112

 

  1. Nakibuuka J, Abwooli N, Namale A, Blondin NA, Ddumba E. A descriptive epidemiological study on stroke in Kampala, Uganda: A hospital-based study. Afr J Neurol Sci. 2012;31(1): 41-48.

 

  1. Geldsetzer P, Manne-Goehler J, Marcus ME, et al. The state of hypertension care in 44 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level data from 1.1 million adults. Lancet. 2019;394:652-662. doi: 10.1016/S0140-6736(19)30955-9

 

  1. GBD 2017 HIV Collaborators. Global regional and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030 for 195 countries and territories: A systematic analysis for the Global Burden of Disease, injuries, and risk factors study. Lancet HIV. 2019;6(12):e831-e859. doi: 10.1016/S2352-3018(19)30196-1

 

  1. Corbett C, Brey N, Pitcher RD, et al. Prevalence and characteristics of HIV-associated stroke in a tertiary hospital setting in South Africa. Neurology. 2022;99(9):e904-e915. doi: 10.1212/WNL.0000000000200780

 

  1. Benjamin LA, Bryer A, Emsley HCA, Khoo S, Solomon T, Connor MD. HIV infection and stroke: Current perspectives and future directions. Lancet Neurol. 2012;11:878-890. doi: 10.1016/S1474-4422(12)70205-3

 

  1. Abdallah A, Chang JL, O’Carroll CB, et al. Stroke in human immunodeficiency virus-infected individuals in Sub-Saharan Africa (SSA): A systematic review. J Stroke Cerebrovasc Dis. 2018;27(7):1828-1836. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.016

 

  1. Qureshi AI, Janssen RS, Karon JM, et al. Humman immunodeficiency virus infection and stroke in young patients. Arch Neurol. 1997;54:1150-1153. doi: 10.1001/archneur.1997.00550210078016

 

  1. Lindsay P, Furie KL, Davis SM, Donnan GA, Norrving B. World Stroke Organization global stroke services guidelines and action plan. Int J Stroke. 2014;9 Suppl A100:4-13. doi: 10.1111/ijs.12371

 

  1. Jørgensen JMA, Christensen DL, Nielsen KK, et al. Incidence, and characteristics of stroke in Zanzibar-a hospital-based prospective study in a low-income island population. Front Neurol. 2022;13:931915. doi: 10.3389/fneur.2022.931915

 

  1. Moshi B, Yongolo N, Biswaro SM, et al. Trends of frequency, mortality and risk factors among patients admitted with stroke from 2017 to 2019 to the medical ward at Kilimanjaro Christian Medical Centre hospital: A retrospective observational study. BMJ Open. 2023;13(7):e071918. doi: 10.1136/bmjopen-2023-071918

 

  1. Mbonde AA, Chang J, Musubire A, et al. An analysis of stroke risk factors by HIV serostatus in Uganda: Implications for stroke prevention in Sub-Saharan Africa. J Stroke Cerebrovasc Dis. 2022;31(7):106449. doi: 10.1016/j.jstrokecerebrovasdis.2022.106449

 

  1. Nkusi AE, Muneza S, Nshuti S, et al. Stroke burden in Rwanda: A multicenter study of stroke management and outcome. World Neurosurg. 2017;106:462-469. doi: 10.1016/j.wneu.2017.06.163

 

  1. Nampogo AM, Musubire AK, Bagasha P, et al. Thirty-day mortality rates among young adult stroke patients and their characteristics at Kiruddu and Mulago hospitals in Uganda: A prospective observational cohort study. PLoS Glob Public Health. 2023;3(10):e0001892. doi: 10.1371/journal.pgph.0001892

 

  1. Ekenze OS, Onwuekwe IO, Ezeala Adikaibe BA. Profile of neurological admissions at the University of Nigeria Teaching Hospital Enugu. Niger J Med. 2010;19(4):419-422. doi: 10.4314/njm.v19i4.61967

 

  1. Arabambi B, Oshinaike O, Ogun SA, et al. Stroke units in Nigeria: A report from a nationwide organizational cross-sectional survey. Pan Afr Med J. 2022;42:140. doi: 10.11604/pamj.2022.42.140.35086

 

  1. Sykes L, Akpalu A, Gordon C, Cullen L, Fullbrook- Scanlon C, Johnson L. Developing stroke care services in West Africa. Lancet Neurol. 2022; 21(9):778-779. doi: 10.1016/S1474-4422(22)00308-8

 

  1. Akpalu A, Sykes L, Nkromah K, et al. Experiences of Multidisciplinary Working: Perspectives from the Wessex Ghana Stroke Partnership. West Afr J Med. 2022;39(6):641-645.

 

  1. Burton A. South Africa: Stroke units out of the blue. Lancet Neurol. 2016;15(4):359-60. doi: 10.1016/S1474-4422(16)00073-9

 

  1. Smit S, Hagemeister DT, Van Rooyen C. Clinical review of stroke care at National District Hospital, Bloemfontein. S Afr Fam Pract (2004). 2023;5;65(1):e1-e7. doi: 10.4102/safp.v65i1.5608

 

  1. Cisse FA, Damien C, Bah AK, et al. Minimal setting stroke unit in a Sub-Saharan African public hospital. Front Neurol. 2019;10:856. doi: 10.3389/fneur.2019.00856

 

  1. Kissani N, Liqali L, Hakimi K, et al. Why does Africa have the lowest number of Neurologists and how to cover the Gap? J Neurol Sci. 2022;434:120119. doi: 10.1016/j.jns.2021.120119

 

  1. Limbole EB, Magne J, Lacroix P. Stroke characterization in Sun Saharan Africa: Congolese population. Int J Cardiol. 2017;240:392-397. doi: 10.1016/j.ijcard.2017.04.063

 

  1. Roushdy T, Aref H, Kesraoui S, et al. Stroke services in Africa: What is there and what is needed. Int J Stroke. 2022;17(9):972-982. doi: 10.1177/17474930211066416

 

  1. Musung JM, Kakoma PK, Bugeme M, et al. Risk factors for hemorrhagic stroke among adults in the democratic republic of the Congo: A hospital-based study in a limited resource setting. Stroke Res Treat. 2022;2022:7840921. doi: 10.1155/2022/7840921

 

  1. Baatiema L, Chan CKY, Sav A, Somerset S. Interventions for acute stroke management in Africa: A systematic review of the evidence. Syst Rev. 2017;6(1):213. doi: 10.1186/s13643-017-0594-4

 

  1. Bryer A, Wasserman S. Thrombolysis for acute ischemic stroke in South Africa. Int J Stroke. 2013;8 Suppl A100:112-3. doi: 10.1111/ijs.12059

 

  1. Gillum RF. Stroke in blacks. Stroke. 1998;19:1-9.

 

  1. Murray CJL, Lopez AD. Mortality by cause for eight regions of the world: Global burden of disease study. Lancet. 1997;349:1269-1276. doi: 10.1016/S0140-6736(96)07493-4

 

  1. Wiredu EK, Nyame PK. Stroke-related mortality at Korle B Teaching Hospital, Accra Ghana. East Afr Med J. 2001;78:180-184. doi: 10.4314/eamj.v78i4.9059

 

  1. Walker RW, Rolfe M, Kelly PJ, George MO, James OFW. Mortality and recovery after stroke in Gambia. Stroke. 2003;34:1604-1609. doi: 10.1161/01.STR.0000077943.63718.67

 

  1. Urimubenshi G, Cadilhac DA, Kagwiza JN, Wu O, Langhorne P. Stroke care in Africa: A systematic review of literature. Int J Stroke. 2018;13(8):797-805. doi: 10.1177/1747493018772747

 

  1. Chukwudelunzu FE, Okwu-Delunzu VU, Dzissah J. Knowledge of stroke signs and symptoms among residents in rural Southeastern Nigerian Community. J Stroke Cerebrovasc Dis. 2018;27(11):3306-3310. doi: 10.1016/j.jstrokecerebrovasdis.2018.07.038

 

  1. Nakibuuka J, Sajatovie M, Katabira E, Ddumba E, Byakika- Tusiime J, Furlan AJ. Knowledge, and perception of stroke: a population-based survey in Uganda. ISRN Stroke. 2014;2014. doi: 10.1155/2014/309106

 

  1. Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. N Engl J Med. 1995;333:1392-1400. doi: 10.1056/NEJM199511233332106

 

  1. MacMahon S, Petro R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: Prospective observational studies corrected for the regression bias. Lancet. 1990;335:765-774. doi: 10.1016/0140-6736(90)90878-9

 

  1. Collins R, Petro R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 11. Short-term reduction in blood pressure: Overview of the unconfounded randomized drug trials in their epidemiological context. Lancet. 1990;335:827-838. doi: 10.1016/0140-6736(90)90944-z

 

  1. Staessen JA, Wand JG, Thijs I. Cardiovascular prevention, and blood pressure reduction: A meta-analysis. Lancet. 2001;358:1305-1315. doi: 10.1016/S0140-6736(01)06411-X

 

  1. Edwards R, Unwin N, Mugusi F, et al. Hypertension prevalence and care in an urban and rural area of Tanzania. J Hypertens. 2000;18:145-152. doi: 10.1097/00004872-200018020-00003

 

  1. Adeloye D, Owolabi EO, Ojji DB, et al. Prevalence, awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence. J Clin Hypertens (Greenwich). 2021;23:963-979. doi: 10.1111/jch.14220

 

  1. Amoah AGB. Hypertension in Ghana: A cross-sectional community prevalence study in greater Accra. Ethn Dis. 2003;13:310-315.

 

  1. Matenja JA, Allain TJ, Wilson AO, et al. Hypertension management in Zimbabwe-awareness, treatment, and blood pressure control. A community-based study. S Afr Med J. 1997;87:1371-1373.

 

  1. Steyn K, Gaziano TA, Bradshaw D, Laubscher R, Fourie J, South African Demographic and Health Coordinating Team. Hypertension in South African adults: Results from the demographic and health survey 1998. J Hypertens. 2001;19(10):1717-1725. doi: 10.1097/00004872-200110000-00004

 

  1. Hajj I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1998-2000. JAMA. 2003;290:199-206. doi: 10.1001/jama.290.2.199

 

  1. Biqi P, Xiao J, Liu J, et al. The relationship between smoking and stroke. A meta-analysis. Medicine (Baltimore). 2019;98(12):e14872. doi: 10.1097/MD.0000000000014872

 

  1. The World Bank. Prevalence of Current Tobacco Use (% of adults)-Sub-Sahara Africa. Available from: https://www.data. worldbank.org/indicator/SH.PRV.SMOK?/location=ZG [Last accessed on 2023 Dec 23].

 

  1. Sreeramareddy CT, Acharya K. Trends in prevalence of tobacco use by sex and socioeconomic status in 22 Sub-Sahara African countries, 2003-2019. JAMA Netw Open. 2021;4(12):e2137820. doi: 10.1001/jamanetworkopen.2021.37820

 

  1. Asma S, Blanton C, Eriksen MP, et al. Tobacco use among Youths: A cross-country comparison. Tob Control. 2002;11:252-270.

 

  1. Nishio A, Saito J, Tomokawa S, et al. Systematic review of school tobacco prevention programs in African countries from 2000-2016. PLoS One. 2018;13(2):e0192489. doi: 10.1371/journal.pone.0192489

 

  1. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes, and cardiovascular disease: A statement for healthcare professional from American Heart Association. Circulation. 1999;100:1134-1146. doi: 10.1161/01.cir.100.10.1134

 

  1. MacWalter RS. Secondary prevention of stroke. Thromb Haemost. 1999;82(Suppl 1):95-103.

 

  1. Report of the Expert Committee on diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20(7):1183-1197. doi: 10.2337/diacare.20.7.1183

 

  1. Diawara A, Coulibaly DM, Hussain TYA, et al. Type 2 diabetes prevalence, awareness and risk factor in rural Mali: A cross-sectional study. Sci Rep. 2023;13:e3718. doi: 10.1038/s41598-023-29743-1

 

  1. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guidelines for the prevention of stroke in patients with stroke and Transient Ischemic Attack. A Guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467.

 

  1. Sarfo FS, Ovbiagele B, Akassi J, Kyem G. Baseline prescription and one-year persistence of secondary prevention drugs after an index stroke in Central Ghana. eNeurologicalSci. 2017;6:68-73. doi: 10.1016/j.ensci.2016.12.003

 

  1. Mugwano I, Kaddumukasa M, Mugenyi L, et al. Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala Uganda: A cross-sectional study. BMC Res Notes. 2016;9:3. doi: 10.1186/s13104-015-1830-4

 

  1. Wasserman S, de Villiers Lx, Bryes A. Community-based care of stroke patients in a rural South African setting. S Afr Med J. 2009;99:579-583.

 

  1. WHO. Rehabilitation 2030 Initiative: A Call for Action; 2017. Available from: https://www.who.int/initiatives/ rehabilitation-2030 [Last accessed on 2023 Dec 23].

 

  1. Climatiro GL, Rhoda AJ. Scoping review of acute stroke care management and rehabilitation in low and middle-income countries. BMC Health Serv. 2019;19:789. doi: 10-1186/s12913-019-4654-4

 

  1. Tawa N, Rhoda A, Brink Y, et al. Stroke rehabilitation services in Africa-challenges and opportunities: A scoping review of literature. In: Louw Q, editor. Collaborative Capacity Development to Complement Stroke Rehabilitation in Africa (Human Functioning Technology and Health Services). Vol. 1. Cape Town: AOSIS; 2020. p. 3-54. doi: 10.4102/aosis.2020.BK85.01

 

  1. Bernhardt J, Urimubenshi G, Gandhi DBC, Eng JJ. Stroke rehabilitation in low-income and middle-income countries. A call to action. Lancet. 2020;396:1452-1462. doi: 10.1016/S0140-6736(20)31313-1

 

  1. The ATTEND Collaborative Group. Family-led rehabilitation after stroke in India (ATTEND): A randomized controlled trial. Lancet. 2017;390:588-599. doi: 10.1016/S0140-6736(17)31447-2

 

  1. Sarfo FS, Adusei N, Ampofo M, Kpeme FK, Ovbiagele B. Pilot trial of a tele-rehab intervention to improve outcomes after stroke in Ghana: A feasibility and user satisfaction study. J Neurol Sci. 2018;387:94-97. doi: 10.1016/j.jns.2018.01.039

 

  1. Owolabi MO, Thrift AG, Martins S, et al. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys. Int J Stroke. 2021;16(8):889-901. doi: 10.1177/17474930211019568

 

  1. Ekeh BC. Challenges of the management of stroke in Sub- Sahara Africa: Evaluating Awareness, Access, and Action. J Pediatr Neurol Med. 2017;2:128. doi: 10.4172/2472-100x.1000128

 

  1. Akiyemi RO, Ogah OS, Ogundipe RF, et al. Knowledge, and perception of stroke among hospital workers in an African Community. Eur J Neurol. 2009;16:998-1003. doi: 10.1111/j.1468-1331.2009.02666.x

 

  1. Hundt GL, Stuttaford M, Ngoma B, SASPI Team. The social diagnostics of stroke-like symptoms: Healers, doctors and prophets in AgrinCourt, Limpopo Province, South Africa. J Biosoc Sci. 2004;36:433-443. doi: 10.1017/s0021932004006662

 

  1. Risenga PR, Botha A, Tjallinks JE. Shangaan patients and traditional healers’ management strategies of hypertension in Limpopo Province. Curations. 2007;30:77-84.

 

  1. Wahab KW, Kayode OO, Musa OI. Knowledge of stroke risk factors among Nigerians at high risk. J Stroke Cerebrovasc Dis. 2015;24:125-129. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.053

 

  1. African Summit on HIV/AIDS/Tuberculosis and other Infectious diseases Abuja Nigeria. Abuja Declaration; 2001. Available from: https://au.int/sites/default/files/ pages/32894-file-2001-abuja-declaration.pdf [Last accessed: November 25, 2023].

 

  1. Ocampo AR. Health Funding in Africa. How close is the AU to Meeting Abuja Target? Devex; 2013. Available from: https://devex.com/news/health-funding-in-africa-how-close-is-the-au-to-meeting-abuja-traget-81567# [Last accessed: November 25, 2023].

 

  1. Adebisi YA, Alaran A, Badmos A, et al. How West African countries prioritize health. Trop Med Health. 2021;49:87. doi: 10.1186/s41182-021-00380-6

 

  1. SAIIA. SADC and the Abuja Declaration: Honoring the Pledge; 2021. Available from: https://saiia.org.za/research/ sadc-and-the-abuja-declaration-honouring-the-pledge [Last accessed on 2023 Dec 31].

 

  1. Ohlere N, Gatome-Munyua A. Public Financing for Health in Africa: 15% of an Elephant is not 15% of a Chicken. African Renewal; 2020. Available from: https://www. un.org/africarenewal/magazine/october-2020/public-financing-health-africa-when-15-elephant-not-15- chicken [Last accessed: December 31, 2023].

 

  1. WHO. Universal Health Coverage; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/ universal-health-coverage-(uhc) [Last accessed on 2023 Dec 31].

 

  1. Ifeagwu SC, Yang JC, Parkers-Ratanshi R, Brayne C. Health financing for universal health coverage in Sub- Sahara Africa: A systematic review. Glob Health Res Policy. 2021;6(1):8. doi: 10.1186/s41256-021-00190-7

 

  1. Ponsar F, Tayler-Smith K, Philips M, et al. No cash, no care: How user fees endanger health - lesson learnt regarding financial barriers to health care services in Burundi, Sierra Leone, Democratic Republic of Congo, Chad, Haiti and Mali. Int Health. 2011;3(2):91-100. doi: 10.1016/j.inhe.2011.01.002

 

  1. Eze P, Lawani LO, Agu UJ, Acharya Y. Catastrophic health expenditure in Sub-Sahara Africa: A systematic review and meta-analysis. Bull World Health Organ. 2022;100(5):337-351. doi: 10.2471/BLT.21.287673

 

  1. Iseko O, Adeniji F, Osungbade K, Iseko I. Analysis of direct medical cost of acute stroke among patients in a tertiary hospital in Ibadan, South-West Nigeria. Afr J Health Econ. 2018;7(2):1-9.

 

  1. Nyassinde J, Toure K, Gams D, et al. Hospital direct cost of stroke in Sub-Sahara Africa: The case of Senegal. J Neurol Sci. 2021;429:119348. doi: 1016/j-jns.2021.119348

 

  1. Yap A, Olatunji BT, Negash S, et al. Out-of-pocket costs and catastrophic health care expenditure for families of children requiring surgery in SSA. Surgery. 2023;174:567-573. doi: 10.1016/j.surg.2023.05.010

 

  1. Birabi BN, Oke KI, Dienye PO, Okafor UC. Cost burden of post stroke condition in Nigeria: A pilot study. Glob J Health Sci. 2012;(6):17-22. doi: 10.5539/gjhs.v4n6p17

 

  1. Maredza M, Chola L. Economic burden of stroke in rural South African setting. eNeurologicalSci. 2016;3:26-32. doi: 10.1016/j.ensci.2016.01.001

 

  1. Feign V, Owolabi MO, World Stroke Organization-Lancet Neurology Commission Stroke Collaboration Group. Pragmatic solutions to reduce the global burden of stroke: A World Stroke Organization-Lancet Neurology Commission. Lancet. 2023;22:1160-1206. doi: 10.1016/S1474-4422(23)00277-6
Share
Back to top
Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept