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

Martinsixtus C Ezejimofor; Yen-Fu Chen; Ngianga-Bakwin Kandala; Benedeth C Ezejimofor; Aloysius C Ezeabasili; Saverio Stranges; Olalekan A Uthman

doi:10.1016/j.jns.2016.03.016

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

J Neurol Sci. 2016 May 15:364:68-76. doi: 10.1016/j.jns.2016.03.016. Epub 2016 Mar 10.

Authors

Martinsixtus C Ezejimofor¹, Yen-Fu Chen², Ngianga-Bakwin Kandala³, Benedeth C Ezejimofor⁴, Aloysius C Ezeabasili⁵, Saverio Stranges⁶, Olalekan A Uthman⁷

Affiliations

¹ Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK. Electronic address: m.c.ezejimofor@warwick.ac.uk.
² Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK.
³ Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK; Department of Mathematics and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Department of Population Health, Luxembourg Institute of Health (LIH), 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg.
⁴ Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK.
⁵ School of the Built Environment, University of Salford, M5 4WT, UK.
⁶ Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK; Department of Population Health, Luxembourg Institute of Health (LIH), 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg.
⁷ Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK; Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Centre for Evidence-Based Health Care, Stellenbosch University, Tygerberg 7505, South Africa.

PMID: 27084220
DOI: 10.1016/j.jns.2016.03.016

Abstract

Purpose: To provide an up-to-date estimate on the changing prevalence of stroke survivors, and examines the geographic and socioeconomic variations in low and middle-income countries (LMICs).

Methods: We searched MEDLINE, EMBASE, SCOPUS and Web of Science databases and systematically reviewed articles reporting stroke prevalence and risk factors from inception to July 2015. Pooled prevalence estimates and secular trends based on random-effects models were conducted across LMICs, World Bank regions and income groups.

Results: 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 10years increase in participants' mean age, the prevalence of stroke survivors increases by 62% (95% CI 6% to 147%).

Conclusion: The prevalence estimates of stroke survivors are significantly different across LMICs in both magnitude and secular trend. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed.

Keywords: Low- and middle-income countries; Prevalence; Secular trends; Stroke survivors; World Bank regions.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Databases, Bibliographic / statistics & numerical data
Delivery of Health Care
Developing Countries*
Humans
Hypertension / epidemiology
Prevalence
Stroke / epidemiology*
Stroke / mortality*
Survivors / statistics & numerical data*