Stroke survivors in low- and middle-income countries: A meta-analysis of prevalence and secular trends

Abstract

Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University's research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners. Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page. The content must not be changed in any way. Full items must not be sold commercially in any format or medium without formal permission of the copyright holder. The full policy is available online: http://nrl.northumbria.ac.uk/policies.html This document may differ from the final, published version of the research and has been made available online in accordance with publisher policies. To read and/or cite from the published version of the research, please visit the publisher's website (a subscription may be required.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Overall, 101 eligible community-based studies were included in the meta-analysis.The pooled crude prevalence of stroke survivors was highest in Latin America and Caribbean (21.2 per 1000, 95% CI 13.7 to 30.29) but lowest in sub-Saharan Africa (3.5 per 1000, 95% CI 1.9 to 5.7). Steepest increase in stroke prevalence occurred in low-income countries, increasing by 14.3% annually while the lowest increase occurred in lower-middle income countries (6% annually), and for every 10 years increase in participants' mean age, the prevalence of stroke survivors increases by 62% (95% CI 6% to 147%). ConclusionThe prevalence estimates of stroke survivors are significantly different across LMICs in both magnitude and secular trend. Improved stroke surveillance and care, as well as for better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed. Though there are existing reviews that had looked at prevalence of stroke in LMICs and regions such as Africa and Latin America [6][7][8][9], to the best of our knowledge there is no recent attempt to compile studies on stroke prevalence across different geographic regions in LMICs. Since the publication of these reviews, there have been an increasing number of new studies from these regions. This study therefore, aimed to provide more accurate estimates on the prevalence of stroke survivors and secular trends in LMICs in order to inform decision regarding policy responses and public health intervention across many geographic regions, socioeconomic and populations' subgroups. Methods Protocol and registrationThis systematic review rational and methods were specified ...

Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region

“…2). This is comparable to other studies carried out in Nigeria [4], [8], [9], [10], [11], [12] and [13] and in other LMICs as shown in the reviewed literature evidence [2], [6] and [7]. The only important difference is that most studies in upper-middle-income countries were sampled from urban rather than rural settings like the current study and from an area with high life expectancy (aging population) driven by high standard of living and quality…”

“…The fact that the result from this current study was comparable with the current estimates reported in most LMICs particularly in Latin America, South East Asia, Europe and Central Asia [2] further underpins the size of the problem in relation to the associated socioeconomic burden among the population in the rural Niger Delta in Nigeria.…”

“…persons among elderly (70 years and over), this is the highest age-adjusted rate recorded in any community-based study previously conducted anywhere in Nigeria (Table 4) and in African region [2]. The fact that the result from this current study was comparable with the current estimates reported in most LMICs particularly in Latin America, South East Asia, Europe and Central Asia [2] further underpins the size of the problem in relation to the associated socioeconomic burden among the population in the rural Niger Delta in Nigeria.…”

“…Despite the infectious disease scourge, it has been predicted that about 80% of all stroke will occur in LMICs by the year 2030 particularly in sub-Saharan Africa where the pooled estimates is currently 3.5 per 1,000 population and with the annual increase of 12.0% [2] and [3]. Evidence also found that the risk of death is higher in LMICs compared high income countries.…”

“…Due to the current epidemiological transition driven by rapid economic development and combined effects of population growth and aging, and sociocultural changes, there is huge concern of continuous increase in the prevalence of stroke in LMICs including Nigeria, and among relatively younger populations [2]. Recent systematic review of population-based studies revealed a consistent evidence that the prevalence of stroke and its major risk factors particularly high blood pressure were now higher in LMICs compared to high income countries and that young adults who present with stroke were unaware of their high blood pressure [2], [5], [6] and [7]. These important revelations were poorly known or underexplored in the rural areas of most LMICs such as in the Niger Delta region in Nigeria.…”