Taming the burgeoning stroke epidemic in Africa: stroke quadrangle to the rescue.

OBJECTIVES: Globally, stroke is the second leading cause of death. This is a systematic review of the existing literature to examine the burden and profile of stroke in the World Health Organization (WHO) African region and proffer coordinated and responsive means to tackle the epidemic.
METHODS: A systematic review of the literature was conducted according to the Centre for Reviews and Dissemination Guidelines using Pubmed, African Journals On-Line and Google Scholar databases. Over 1300 articles were obtained. All abstracts were screened, and every article that might have contained relevant information was read in full. Their heterogeneity made meta-analysis impossible. So a critical assessment of the data with a narrative review was conducted.
RESULTS: Stroke has an annual incidence rate of up to 316 per 100 000, a prevalence rate of up to 315 per 100 000 and a three-year fatality of up to 84% in Africa. In 2002, model-based estimated age-adjusted stroke mortality rates ranged between 168 and 179 per 100 000 population for countries in the African region. There is severe scarcity of facilities and human resources for prevention, investigations, acute care and rehabilitation of stroke patients in Africa.
CONCLUSIONS: Africa bears a heavy burden of stroke. This author proposes a stroke quadrangle comprising a concerted network of four pillars: demographic surveillance and stroke research network, integrated community-based primary and secondary prevention programmes, easily accessible and well-equipped acute stroke care services, and neuro-rehabilitation centres and services. This network could be reinforced using information and communication technologies, telemedicine facilities and linked health information systems.