Association between post-stroke psychological disorders, activity limitations and health-related quality of life in chronic stroke survivors in Benin

PURPOSE

To evaluate the association between depression/anxiety and activity limitations and health-related quality of life (HRQoL) in chronic stroke survivors in Benin.

MATERIALS AND METHODS

One hundred and seventy-six chronic stroke survivors (113 males; mean age (±SD): 56.5 (±10.5) years old) were included. We used the Barthel index (BI) to assess activity limitations. Participants were screened for depression and anxiety symptoms using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). Euroqol-5 Dimensions-3 Levels (EQ-5D-3L) including a Visual Analog Scale (EQ-VAS) was used to assess HRQoL. Multivariate linear regressions were performed to determine the impact of psychological disorders on activity limitations and HRQoL.

RESULTS

Depression (β=-0.54; p < 0.0001) and anxiety (β=-0.35; p < 0.0001) were negatively associated with activity limitations (R²=0.60). Similar patterns of association were observed with HRQoL (β≤-0.28; p < 0.0001; R² ≥0.40). Inversely, occupational status showed positive association with EQ-5D-3L summary index scores (β = 0.21; p = 0.015).

CONCLUSIONS

Depression and anxiety had a negative impact on activity limitations and HRQoL in Beninese chronic stroke survivors. This call for action to integrate psychological interventions as part of rehabilitation programs in low and middle-income countries.Implications for rehabilitationPost-stroke depression and anxiety are quite common among stroke survivors in sub-Saharan Africa.Post-stroke depression and anxiety negatively impact activities and health-related quality of life in chronic stroke survivors in sub-Saharan Africa.Managing these post-stroke psychological disorders is necessary to promote the functional recovery and social reintegration of stroke survivors in their communities.

Prevalence and factors associated with stroke risk factors in an urban community of Parakou, Northern Benin, 2016

Sub-Saharan Africa faces a heavy burden of stroke due to the growth of its risk factors. We aimed to estimate the prevalence of stroke risk factors and identify the factors associated with metabolic risk factors in the district of Titirou, in Parakou (northern Benin) in 2016. A cross-sectional study was conducted. It included people aged at least 15 years, living in Titirou for at least 6 months, and who had given their written consent to participate in the study. A door-to-door survey was performed from 15 march to 15 July 2016 in each neighborhood until the pre-determined number was reached. Sociodemographic data, medical histories, anthropometric and blood pressure measures were recorded using the WHO STEPS approach. The prevalence of stroke risk factors was calculated, and a multivariable logistic regression was done to identify the factors associated with metabolic risk factors for stroke. A total of 4671 participants were included with a mean age of 27.7±12.9 years and a sex ratio of 0.98. Concerning the behavioral risk factors for stroke, 17.2% were alcohol consumers, 3.5% were smokers, 21.5% had low fruit and vegetable intake, and 51.1% had low physical activity practice. The prevalence of metabolic risk factors for stroke was respectively of 8.7% for obesity, 7.1% for high blood pressure, 1.7% for self-reported diabetes, and 2.2% for dyslipidemia. Age (p<0.001), sex (p<0.001), marital status (p<0.001) and professional occupation (p = 0.010) were associated with obesity. Age was also associated with high blood pressure (p<0.001) and diabetes (p<0.001). Dyslipidemia varied according to smoking (p = 0.033) and low physical activity practice (p = 0.003). The study revealed a significant prevalence of some stroke risk factors. Targeted local interventions for primary prevention of stroke should be promoted in this community.

Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study

Background

Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life.

Objective

To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou.

Method

This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests.

Results

A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments.

Conclusion

Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments.

Clinical implications

[AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.

Reducing stroke burden through a targeted self-management intervention for reducing stroke risk factors in high-risk Ugandans: A protocol for a randomized controlled trial

INTRODUCTION

Stroke burden is rapidly increasing globally. Modifiable risk factors offer an opportunity to intervene, and targeting hypertension is a key actionable target for stroke risk reduction in sub-Saharan Africa. This 3-site planned randomized controlled trial builds on promising preliminary data.

METHODS

A total of 246 Ugandan adults will be recruited randomized to experimental intervention vs. enhanced treatment control. Intervention participants will receive six weekly group-format stroke risk reduction self-management training sessions, and the controls will receive information on cardiovascular risk. The primary study outcome is systolic B.P. measured at baseline, 13-week, 24 weeks (6 months). Secondary outcomes include other biological and behavioral stroke risk factors.

DISCUSSION

The curriculum-guided self-management TargetEd MAnageMent Intervention (TEAM) program is anticipated to reduce the stroke burden in Uganda.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020.

Stroke case fatality in sub-Saharan Africa: Systematic review and meta-analysis

Background

The burden of stroke is high in sub-Saharan Africa; however, few data are available on long-term mortality.

Objective

To estimate over one-month stroke case fatality in sub-Saharan Africa.

Methods

A systematic review and meta-analysis were performed according to meta-analysis of observational studies in epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42020192439), on five electronic databases (PubMed, Science direct, AJOL, EMBASE, and Web of Sciences). We searched all studies on stroke case fatality over one month in sub-Saharan Africa published between 1st January 2000 and 31st December 2019.

Results

We included 91 studies with a total of 34,362 stroke cases. The one-month pooled stroke case-fatality rate was 24.1% [95% CI: 21.5–27.0] and 33.2% [95% CI: 23.6–44.5] at one year. At three and five years, the case-fatality rates were respectively 40.1% [95% CI: 20.8–63.0] and 39.4% [95% CI: 14.3–71.5] with high heterogeneity. Hemorrhagic stroke was associated with a higher risk of mortality at one month, but ischemic stroke increased the risk of mortality over six months. Diabetes was associated with poor prognosis at 6 and 12 months with odds ratios of 1.64 [95% CI: 1.22–2.20] and 1.85 [1.25–2.75], respectively.

Conclusion

The stroke case fatality over one month was very high, compared to case fatalities reported in Western countries and can be explained by a weak healthcare systems and vascular risk factors.

Stroke prevalence in a medium-sized Swedish municipality

OBJECTIVES

Many patients who have had stroke survive with functional disability for years. Stroke prevalence is a fundamental measure of the impact of stroke in society. Stroke prevalence has never been evaluated in Sweden.

MATERIALS & METHODS

In this study, we use a registry-based method, using three overlapping Swedish registers, namely, the Swedish Stroke Register (Riksstroke), the National Patient Register, and a primary healthcare-based patient register. Data were gathered from these registers and cross-checked with the population register as per December 31st, 2019, with respect to stroke survivors (ICD-10 I60-I69) living in Kumla (population 21,738), a municipality well representative of Sweden.

RESULTS

A total of 330 individuals with stroke were found, of which 42% were women. The mean age was 74.1 years in men and 75.1 years in women. 11.5% of the patients had more than one stroke. The mean duration since the first stroke was 8.3 years. The crude prevalence per 100,000 was 1754 in men, 1281 in women, and 1518 in both sexes. Adjusted to the European population, the ratio was 1570 per 100,000, and to the World population 936 per 100,000.

CONCLUSIONS

In spite of a declining stroke incidence in Sweden, the stroke prevalence in Kumla, Sweden, is relatively high. Comparisons with other studies indicate that a decline in prevalence may have occurred since the early 2000s. Modern registers can support data collection, but the index stroke may have occurred almost forty years back in time.

Knowledge of Stroke Risk Factors and Signs in Parakou, a Northern City of Benin in West Africa

INTRODUCTION

We aimed to determine knowledge of stroke risk factors and signs in an urban population of northern Benin.

METHODS

A door-to-door purposeful sampling survey was conducted in resident population (age ≥15 years) of the district of Titirou in the city of Parakou (N = 255,478) in Benin between March 15 and July 15, 2016. In-person interviews were conducted with data collection on structured questionnaires with close and open questions, according to standard definitions. Multivariable logistic regression was used to assess predictors of good knowledge, defined by provision of a correct response in pre-defined set of questions on stroke risk factors and warning signs.

RESULTS

Of 4,671 participants (mean age 27.7 ± 12.9 years; females 50.6%), only 404 (8.6%) knew at least 1 stroke risk factor. Knowledge level of stroke risk factors (odds ratio, 95% confidence interval) was related to age (1.37, 1.27-1.48), level of education (2.54, 1.73-3.72), and family history of stroke (3.01, 2.08-4.26). Only 230 (4.9%) were able to cite at least 1 stroke symptom, and this knowledge was great with increasing age (1.04, 1.02-1.06), family (3.63, 2.41-5.49) and personal history of stroke (3.71, 1.86-7.42), and high level of education (4.35, 2.68-7.07).

CONCLUSION

Knowledge of stroke risk factors and signs is low in northern Benin. Greater public education and awareness campaigns are required to address the burden of stroke.

Stroke in Africa: profile, progress, prospects and priorities

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.

Natural Products for the Treatment of Neurodegenerative Diseases

Neurodegenerative diseases are a heterogeneous group of disorders characterized by the progressive degeneration of the structure and function of the central nervous system or peripheral nervous system. Alzheimer's Disease (AD), Parkinson's Disease (PD) and Spinal Cord Injury (SCI) are the common neurodegenerative diseases, which typically occur in people over the age of 60. With the rapid development of an aged society, over 60 million people worldwide are suffering from these uncurable diseases. Therefore, the search for new drugs and therapeutic methods has become an increasingly important research topic. Natural products especially those from the Traditional Chinese Medicines (TCMs), are the most important sources of drugs, and have received extensive interest among pharmacist. In this review, in order to facilitate further chemical modification of those useful natural products by pharmacists, we will bring together recent studies in single natural compound from TCMs with neuroprotective effect.

Prevalence of the major neurological disorders in a semi-urban community in northern Benin

BACKGROUND

Neurological disorders are some of the most disabling diseases. Epidemiological data on their incidence in Benin are scarce.

OBJECTIVE

The prevalence of major neurological diseases among people older than 15 years was investigated in Titirou.

METHODS

It was a cross-sectional study and door-to-door survey which took place from June 10 to August 30, 2014, in the district of Titirou and included 1094 persons. The diagnosis of migraine, tension-type headaches, epilepsy, peripheral neuropathies, stroke, parkinsonism, Parkinson's disease and dementia were conducted using a validated screening questionnaire, neurological examination and standard diagnostics criteria.

RESULTS

They were aged from 16 to 85 with a mean age of 29.8 +/- 12.9 years. Forty five percent (492/1094) were males. Among the 1094 respondents, 497 (45.4% 95%CI 42.5-48.4) had at least one neurological disorder. The raw prevalences of the conditions were: tension-type headaches (26.9%), migraine (14.3%); peripheral neuropathies (5.6%); epilepsy (1.9%); stroke (1.3%), parkinsonism (0.1%). No case of dementia or Parkinson's disease was found. Socio-demographic factors associated with these conditions were as follows: tension-type headaches: age (p = .020); peripheral neuropathies: age (p = 0. 000); sex (p = .006); profession (p = .004); marital status (p = .032); and level of education (p = .003); stroke: age (p = .000) and marital status (p = .000).

CONCLUSION

These results point to a high prevalence of neurological disorders in Titirou.

Prevalence of stroke survivors in Parakou in northern Benin: A door-to-door community survey

INTRODUCTION

Stroke is a major public health problem with a high burden in Sub-Saharan Africa. We aimed to determine the prevalence of stroke in Titirou in Parakou.

METHODS

It was a cross-sectional study using a door-to-door survey in Titirou (Parakou) from 15 march to 15 October 2016 and included 4671 adults. We did a two stages survey. In the first stage the World Health Organization (WHO) tool for the diagnosis of stroke in community was used. In the second phase all suspected cases underwent neurological exam and sometimes brain CT-scan. The WHO definition was used for the diagnosis of stroke. We recorded the socio-demographic data and the vascular risk factors. The prevalence was standardized on age according to the WHO type population. Multiple logistic regression was done to identify associated factors and estimate the adjusted prevalence ratio (aPR) and their 95% confidence interval (CI).

RESULTS

The mean age of the subjects was 27.7±12.9 years with a sex ratio of 0.97. After screening 161 were suspected and 54 confirmed cases, the overall prevalence of stroke in Titirou was 1.156 per 100,000 inhabitants [95% CI: 0.850 to 1.426]. The age-standardized prevalence of stroke was 3223 cases per 100,000 inhabitants. The associated factors were age (aPR 1.7 [1.5-1.9] for 10 years), history of hypertension (aPR: 64.8 [46.1-108.9]), diabetes mellitus (aPR: 4.5 [1.6-12.3]), low consumption of fruits and vegetables (aPR: 2.3 [1.2-4.4]), history of heart disease (aPR: 6.0 [2.6-13.7]), family history of stroke (PR: 4.6 [2.1-10.0]). Among the 54 subjects who had a stroke 10 were able to perform the brain CT-Scan: 40% were hemorrhagic and 60% ischemic stroke.

CONCLUSION

Our study showed a high prevalence of stroke in Titirou and suggested urgent action for prevention.

Long-Term Mortality of Stroke Survivors in Parakou: 5-Year Follow-Up

BACKGROUND

The burden of stroke is high in Africa, but few data are available on the long-term outcome of strokes in this area.

AIM

We aimed to study the long-term outcome of stroke survivors in Parakou from 2012 to 2018.

METHODS OF STUDY

It was a cohort study and included 247 stroke patients admitted to the University Hospital of Parakou from January 1, 2012 to April 30, 2018. Each patient was followed up for at least 1 year. The modified RANKIN scale was used to evaluate patients. Verbal autopsy was used to ascertain the cause of death. The survival probability was estimated using the Kaplan-Meier method. Predictors of mortality were estimated using the Cox proportional model and the hazard ratio (HR) and their 95% confidence intervals were determined. The data were analyzed using Stata Software.

RESULTS

The mean age was 58.1 ± 13.4 years with a sex ratio of 1.12. Among stroke survivors, the mortality was 10.1% at 3 months, 11.7% at 6 months, 15.4% at 1 year, 21.5% at 3 years, and 23.5% at 5 years. The probability of survival after a stroke was 66.5% at 5 years. Factors associated with mortality were age with adjusted HR 1.4 (1.2-1.7) for each 10 years, male sex with aHR 2.3 (1.2-4.6), history of hypertension with aHR 2.0 (1.0-4.1) and the severity of the initial neurological impairment National Institute of Health Stroke Scale with aHR 1.1 (1.0-1.2) for each 1 point. The main causes of death were recurrent stroke, infectious diseases, and cardiac disease. The proportion of patients with functional disability was 53.8% at 1 year. The quality of life was generally impaired in terms of physical health, personal environment, and finances.

CONCLUSIONS

The long-term prognosis of stroke patients in Parakou is poor. It requires urgent action to reduce this burden.

The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and/or diabetes: a systematic review

BACKGROUND

Cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are noncommunicable diseases (NCDs) that cause extensive social and economic burden worldwide, particularly in low-income and middle-income countries. There is growing recognition of the importance of the disabilities that individuals experience as a consequence of these NCDs.

OBJECTIVES

This systematic review examined the prevalence of disabilities associated with cancer, CVD, chronic respiratory disease and diabetes.

METHODS

A comprehensive literature search was conducted in PubMed, CINAHL, Embase, Web of Science, PsycINFO, CIRRIE, WHO database, LILACS and AIM. Studies were included if their samples were representative of people with at least one of these four conditions and if prevalence estimates of disability were provided. As random sampling was not feasible in the majority of cases, studies were included where they offered evidence that their sample was representative of the general population being investigated.

RESULTS

A total of 105 articles were included in the review. Most studies were conducted in high-income countries. The prevalence of difficulties with activities of daily living (i.e. eating, bathing, dressing) was reported to be 10.4-34.5% amongst cancer survivors, 21.1-64.1% in those with CVD, 7.4-49.8% in those with chronic respiratory disease and 12.2-54.5% for those with diabetes. The prevalence of a range of other physical, cognitive and psychological impairments (systemic or structural) was additionally described for each disease.

CONCLUSION

Substantial proportions of people with cancer, CVD, chronic respiratory disease or diabetes experience some form of disability - although there was great variance in prevalence and definitions. The findings of this review support the evidence base of global impact associated with NCD, indicate frequency measures for specific disabilities and inabilities associated with each NCD and provide direction for future systematic reviews.

WHAT IS KNOWN ABOUT THE TOPIC

WHAT THIS ARTICLE ADDS.

The impact of stroke on people living in central Uganda: A descriptive study

Background

Knowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions.

Objectives

To explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda.

Method

A cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation.

Results

The mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample.

Conclusion

People with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.

Feasibility of a cardiovascular cohort in a Sub-Saharan Africa community: preliminary report of the pilot project TAHES (Tanvè Health Study) in Benin

BACKGROUND

Faced with the growing burden of cardiovascular disease (CVD) including atherosclerotic in Sub-Saharan Africa (SSA), the development of appropriate prediction tools, based on large cohorts, appears useful for prevention.

OBJECTIVE

The objective of the pilot project TAHES (Tanvè Health Study) was to explore the feasibility of a large cohort study focused on CVD and risk factors in Benin.

METHODS

We implemented a prospective cohort over 2 years. The sample consisted of all people aged 25 years or older who had lived for at least the previous 6 months in the villages of Tanvè or Dékanmè. At baseline in February 2015, behaviours and medical histories were recorded using a standardized questionnaire adapted from the WHO Steps instrument; screening questionnaires for angina, claudication, congestive heart failure, and stroke were applied; anthropometric measures and fasting capillary blood glucose were taken. All participants were included in the follow-up phase. Surveillance of target CVD and deaths was implemented through a medical and a community network.

RESULTS

A total of 1,195 participants were enrolled at baseline; women represented 65.5% and the median age was 39 years. The high participation rate (91.4%), the quality of baseline data, and the functionality of the events surveillance network over 8 months indicated good perspective for the feasibility of a large cohort. We recorded a 3.8% prevalence of daily smoking, 3.6% of harmful use of alcohol, 10.7% of obesity, 25.5% of high blood pressure, and 3.5% of diabetes. Prevalence of angina pectoris (2.7%), intermittent claudication (2.0%), congestive heart failure (0.9%), and stroke survival with motor impairment (3‰) were also recorded. Ten deaths occurred during the first 8 months, all within households; a cardiovascular cause was suspected in four cases.

CONCLUSION

These preliminary results support the feasibility of establishing a cohort in Benin. It would require technical and resource support.

Stroke burden in Egypt: data from five epidemiological studies

PURPOSE

Accurate data on the epidemiology of stroke in Egypt is scarce. The aim of this review is to address this issue based on available community-based studies and compare the resulting findings to those of other regional and international studies.

METHOD

A systematic literature search was conducted to identify population-based epidemiological studies of stroke in Egyptians. Original articles published in English between 1990 and 2016 were included. Five studies from five different governorates in southern Egypt fulfilled the study criteria (Qena, Sohag, Assiut, New Valley and Red Sea).

RESULTS

The mean and median crude prevalence rates (CPRs) across the five studies, which were conducted in southern Egypt were 721.6/100,000 and 655/100,000, respectively. The mean and median crude incidence rates (CIRs) were 187/100,000 and 180.5/100,000, respectively. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000.

CONCLUSION

The incidence and prevalence of stroke in Egypt are high. More population-based studies are urgently needed in northern Egypt and in Cairo - the capital of Egypt.

Cardiovascular disease in Africa: epidemiological profile and challenges

From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. In this Review, we provide a contemporary picture of the epidemiology of CVD in Africa, highlight key regional discrepancies among populations, and emphasize what is currently known and, more importantly, what is still unknown about the CVD burden among the >1 billion people living on the continent.

Prevalence and incidence of neurological disorders among adult Ugandans in rural and urban Mukono district; a cross-sectional study

Background

The burden of neurological diseases is increasing in developing countries. However, there is a prominent scarcity of literature on the incidence of neurological diseases in sub-Saharan Africa. This study was therefore undertaken to determine the prevalence and incidence of neurological diseases in this setting to serve as a baseline for planning and care for neurological disorders in Uganda.

Methods

The study was conducted within rural and urban Mukono district, east of Kampala city of Uganda, central region. Over a period of six months, a cross sectional survey was conducted and screening was performed using a standardized questionnaire. All subjects with neurological symptoms and signs were reviewed by a team of neurologists and neurological diagnoses made.

Results

Of the 3000 study subjects, 50.3% (1510/3000) were from the rural setting. Out of the participants screened, 67.4% were female, with a median age of 33 years. Among the 98 subjects with confirmed neurological disorders, the frequency of diseases was as follows; peripheral neuropathy (46.2%), chronic headaches (26.4%), and epilepsy (8.5%), followed by pain syndromes (7.5%), stroke (6.6%) and tremors/Parkinson disease (3.8%). The crude prevalence rates of these disorders (95% CI) were 14.3% (8.5–24.1); 13.3% (7.7–22.8); 33.7% (23.9–47.4) for stroke, epilepsy and peripheral neuropathy respectively. Peripheral neuropathy followed by chronic headaches had the highest estimated incidence/1000 years. Stroke had an estimated incidence of 3.6 new cases with 95% CI of (2.1–6.1)/1000 years.

Conclusion

Peripheral neuropathy, chronic headaches and epilepsy disorders are major causes of morbidity in Sub-Saharan settings. There is an urgent need of more robust and powered studies to determine the incidence of these diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s12883-016-0732-y) contains supplementary material, which is available to authorized users.

Impact of libido at 2 weeks after stroke on risk of stroke recurrence at 1-year in a chinese stroke cohort study

Background:

There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year.

Methods:

It is a multi-centered, prospective cohort study. The 14^th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of former neurological functional deficit, new local or overall symptoms, or stroke diagnosed at re-admission.

Results:

Among 2341 enrolled patients, 1757 patients had completed follow-up data, 533 (30.34%) patients had decreased libido at 2 weeks, and 166 (9.45%) patients had recurrent stroke at 1-year. Multivariate logistic regression analysis showed that, compared with patients with normal libido, the odds ratio (OR) of recurrent stroke in patients with decreased libido was reduced by 41% (OR = 0.59, 95% confidence interval [CI]: 0.40–0.87). The correlation was more prominent among male patients (OR = 0.52, 95% CI: 0.31–0.85) and patients of ≥60 years of age (OR = 0.57, 95% CI: 0.35–0.93).

Conclusions:

One out of three stroke patients in mainland China has decreased libido at 2 weeks after stroke. Decreased libido is a protective factor for stroke recurrence at 1-year, which is more prominent among older male patients.

The burden of stroke in Africa: a glance at the present and a glimpse into the future

Objective

Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa.

Methods

We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures.

Results

Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown.

Conclusions

While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.

Magnitude of cardiovascular risk factors in rural and urban areas in Benin: findings from a nationwide steps survey

Data on variations in the frequency of cardiovascular risk factors (CVRF) in sub-Saharan populations are limited, particularly with regard to Benin.

Prevalence of stroke in three semi-urban communities in middle-belt region of Nigeria: a door to door survey

Introduction

The burden of stroke has been projected to increase for developing countries, but data are limited, especially in sub-Saharan Africa. This necessitated this study to determine the stroke prevalence in a semi urban community in middle-belt region of Nigeria.

Methods

A two-phase door-to-door study was performed in three semi-urban communities of Kwara state; in the first phase 12,992 residents were screened and probable stroke cases were identified by trained health care workers. In the second phase individuals adjudged to be positive for stroke were screened with a stroke-specific questionnaire and made to undergo a complete neurological examination by a neurologist. Stroke diagnosis was based on clinical evaluation using WHO criteria.

Results

Out of the numbers that were screened, 18 probable stroke cases were identified in the first stage, and of these, 17 fulfilled WHO criteria for stroke, giving a crude prevalence rate of 1.31/1000 population. The prevalence of stroke was higher among the males than the females (1.54/1000 vs. 1.08/1000) with a ratio 1.4: 1. Sixteen subjects (94.1%) had one or more risk factors for stroke. Uncontrolled systemic hypertension (82.4%) was the commonest risk factors for stroke followed by transient ischaemic attack (TIA) (41.2%).

Conclusion

Stroke is a condition that is prevalent in our environment; especially in older adults and men. Uncontrolled systemic hypertension and previous transient ischaemic attacks were the commonest risk factors for stroke in our community.

An estimate of the incidence and prevalence of stroke in Africa: a systematic review and meta-analysis

BACKGROUND

Stroke is increasingly becoming a challenging public health issue in Africa, and the non-availability of data has limited research output and consequently the response to this burden. This study aimed to estimate the incidence and prevalence of stroke in Africa in 2009 towards improved policy response and management of the disease in the region.

METHODS

A systematic search of Medline, EMBASE and Global Health for original population-based or hospital-based studies on stroke was conducted. A random effect meta-analysis was conducted on crude stroke incidence and prevalence rates, and a meta-regression-like epidemiological model was applied on all data points. The fitted curve generated from the model was used to estimate incident cases of stroke and number of stroke survivors in Africa at midpoints of the United Nation population 5-year age groups for the year 2009.

RESULTS

The literature search yielded a total of 1227 studies. 19 studies from 10 African countries were selected. 483 thousand new stroke cases among people aged 15 years or more were estimated in Africa in 2009, equivalent to 81.2 (13.2-94.9)/100,000 person years. A total of 1.89 million stroke survivors among people aged 15 years or more were estimated in Africa in 2009, with a prevalence of 317.3 (314.0-748.2)/100,000 population. Comparable figures for the year 2013 based on the same rates would amount to 535 thousand (87.0-625.3) new stroke cases and 2.09 million (2.06-4.93) stroke survivors, suggesting an increase of 10.8% and 9.6% of incident stroke cases and stroke survivors respectively, attributable to population growth and ageing between 2009 and 2013.

CONCLUSION

The findings of this review suggest the burden of stroke in Africa is high and still increasing. There is need for more research on stroke and other vascular risk factors towards instituting appropriate policy, and effective preventive and management measures.

Assessing locomotion ability in West African stroke patients: validation of ABILOCO-Benin scale

OBJECTIVE

To calibrate and validate the Benin version of ABILOCO, a Rasch-built scale developed to assess locomotion ability in stroke patients.

DESIGN

Prospective study and questionnaire development.

SETTING

Rehabilitation centers.

PARTICIPANTS

Stroke patients (N=230; mean age ± SD, 51.1±11.6 y; 64.3% men).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Participants completed a preliminary list of 36 items including the 13 items of ABILOCO. Items were scored as "impossible," "difficult," or "easy." The mobility subdomain of FIM (FIM-mobility), the Functional Ambulation Classification (FAC), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT) were used to evaluate and elucidate the validity of the ABILOCO-Benin scale.

RESULTS

Successive Rasch analyses led to the selection of 15 items that define a unidimensional, invariant, and linear measure of locomotion ability in stroke patients. This modified version of the ABILOCO scale, named ABILOCO-Benin, showed an excellent internal consistency, with a Person Separation Index of .93, and excellent test-retest reliability with high intraclass correlation coefficients of .95 (P<.001) for item difficulty and .93 (P<.001) for subject measures. It also presented good construct validity compared with FAC, FIM-mobility, 6MWT, and 10MWT (r≥.75, P<.001).

CONCLUSIONS

ABILOCO-Benin presents good psychometric properties. It allows valid, reliable, and objective measurements of locomotion ability in stroke patients.

[Direct hospital cost of stroke in Parakou in northern Benin]

Introduction

Les accidents vasculaires cérébraux constituent un véritable problème de santé publique en Afrique avec une charge importante. Les données fiables sur sa réelle charge économique sont rares en Afrique. L'objectif de cette étude était d’évaluer le coût direct hospitalier des AVC à Parakou au Bénin.

Méthodes

Il s'agissait d'une étude transversale économique ayant inclus des patients hospitalisés pour un AVC à l'hôpital de Parakou entre le 1^er Juin 2010 au 31Mai 2011. Les données concernant les différents postes de consommation ont été collectées selon la méthode dite bottom-up. Le coût était envisagé du point de vue de la société et du patient. L'unité du coût était le franc CFA (valeur en 2011). Une régression linéaire multiple était utilisée pour déterminer les meilleurs prédicteurs du coût.

Résultats

Ils étaient 78 patients dont 52 hommes, âgés en moyenne de 57 ans ± 10.9. Le NIHSS moyen était de 14,4. Le taux de mortalité était de 20,5%. Le coût direct moyen était de 316.810,3 (±230.774,8) F CFA (environ 704 ± 512 Euros). Les grands postes de consommation étaient les explorations paracliniques (34.3%) les soins et médicaments (28.4%) et les frais d'hospitalisation (17.9%). Les meilleurs prédicteurs du coût élevé étaient un AVC hémorragique, un NIHSS élevé à l'admission et une longue durée d'hospitalisation.

Conclusion

Cette étude suggère un coût élevé de la prise en charge actuelle des AVC à Parakou.

Prevalence and risk factors for stroke in an adult population in a rural community in the Niger Delta, south-south Nigeria

Sub-Saharan Africa is experiencing an epidemiologic transition with stroke contributing to the disease burden. However, community-based stroke prevalence studies are sparse. This study aimed to determine the prevalence of stroke in a rural population in the Niger Delta region in south-south Nigeria and to describe known risk factors for stroke among them. A door-to-door stroke prevalence study was conducted in 2008 among randomly selected adults of 18 years or older in rural Kegbara-Dere community in Rivers State, south-south Nigeria. We administered a modified screening tool by the World Health Organization, a stroke-specific questionnaire, and conducted a physical/neurological examination (on persons screening positive) in 3 stages of assessments. The crude prevalence of stroke was 8.51/1000 (95% confidence interval [CI] = 3.9-16.1) representing 9 of 1057 participants. The age-adjusted prevalence was 12.3/1000 using the US Population 2000. Men had higher unadjusted prevalence than women (12.9/1000 versus 5.1/1000) but were not at more risk (unadjusted relative risk = .99; 95% CI = .98-1.00). Stroke prevalence increased with age (Mantel-Haenszel χ(2) P = .00). Hypertension (blood pressure ≥140/90 mm Hg) was present in all stroke cases and diabetes mellitus (fasting blood sugar >126 mg/dL) in 1 person, but none had hypercholesterolemia, obesity (body mass index >30 kg/m(2)), or a history of alcohol intake or smoking. Stroke prevalence was found to be high, commoner among men and the elderly population, and likely to be predisposed by hypertension, in rural south-south Nigeria. The need to conduct follow-up studies on the burden and outcomes of stroke among this study population is acknowledged.

Recent advances in the epidemiology, outcome, and prevention of myocardial infarction and stroke in sub-Saharan Africa

The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority. Stroke caused predominantly by hypertension is now a major cause of disability and premature death. Third, the burden of risk factors for atherosclerosis is increasing rapidly in most urban and some rural regions. A concerted effort to understand the primary drivers of this increase in cardiac risk factors is required to prevent a future epidemic of atherosclerosis and its sequelae.

Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study

BACKGROUND

Because there have been no epidemiological studies of stroke in Egypt, a community-based survey was conducted in the Assiut Governorate to estimate the prevalence and risk factors of stroke in our community.

METHODS

A three-phase door-to-door study was performed in which 6,498 participants were chosen by random sampling from 7 districts in Assiut (first phase). Out of this sample, 578 dropped out leaving 3,066 males (51.8%) and 2,854 females (48.2%). There were 3,660 (61.8%) urban residents and 2,260 (38.2%) from the rural community. In the second phase participants were screened using the questionnaire for stroke, while the third phase involved medical evaluation of all suspected cases, with diagnosis of stroke confirmed by evaluation of CT scans. The Mini Mental State Examination and Hamilton Depression Scale were evaluated for each patient.

RESULTS

65 participants were identified as positive on the survey questionnaire, but only 57 patients were found to have stroke, giving a crude prevalence rate of 963/100,000 inhabitants with an age-adjusted local prevalence rate of 699.2/100,000 and an age-adjusted prevalence relative to the standard world population of 980.9/100,000. The prevalence among males was higher than females (1174/100,000 vs. 736/100,000) with a ratio 1.7:1. There was a significantly higher prevalence of ischemic (895/100,000) than hemorrhagic (68/100,000) stroke. Stroke prevalence was the same in rural and urban areas and in males and females. There was, however, a significantly higher prevalence in illiterate (2413/100,000) than literate participants (357/100,000). Forty-two patients (73.7%) had one or more risk factors for stroke, hypertension being the commonest (66%) and diabetes mellitus second (38.6%). Nine cases had poststroke dementia (15.8%) and 14 cases (24.6%) had mild depression.

CONCLUSIONS

The overall prevalence rate of stroke is high, especially in older adults, men and illiterate individuals. A higher prevalence of ischemic than hemorrhagic stroke was recorded, with hypertension and diabetes mellitus being the commonest risk factors in our community.

Quality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study

BACKGROUND

Data concerning quality of acute stroke care and outcome are scarce in developing countries.

OBJECTIVE

This study aimed to evaluate quality of acute stroke care and stroke outcomes in Thailand.

METHODS

We performed a multicenter countrywide prospective cohort study. Consecutive patients with an acute ischemic stroke admitted to the participating institutions between June 2008 and November 2010 were included. Baseline characteristics, process measures including thrombolysis use, acute stroke unit admission, initiation of aspirin within 48 hours, and antithrombotic and/or anticoagulation medication at discharge were recorded. Main outcome measures were death and disability at discharge as well as in-hospital complications.

RESULTS

A total of 1222 patients were included with a mean (±SD) age of 65.0 ± 13 years, and 55.0% were men. Median National Institutes of Health Stroke Scale score was 6.5. Patients were given aspirin within 48 hours, admitted to acute stroke unit, and given thrombolytic therapy in 71.1%, 24.6%, and 3.8%, respectively. Good recovery at discharge (modified Rankin scale score 0-1) was found in 26.1%, and 3.2% of patients died during hospitalization. The median length of stay was 4 days. Factors predicting poor outcome (modified Rankin scale score 5-6) at discharge included: age (by 10-year increments: adjusted odds ratio [OR] 1.23; 95% confidence interval [CI], 1.06-1.43), female sex (adjusted OR 1.52; 95% CI, 1.05-2.19), initial National Institutes of Health Stroke Scale score (adjusted OR 1.35; 95% CI, 1.27-1.43), and in-hospital complications (adjusted OR 3.16; 95% CI, 1.58-6.35).

CONCLUSIONS

Limited access to acute ischemic stroke care interventions were observed in many domains especially thrombolysis and stroke unit admission. These findings emphasize an urgent need for strategies to improve standard acute stroke care among developing countries.