Abstract
Introduction. In sub-Saharan Africa (SSA), there is a signifcant burden of ischemic stroke (IS) and hemorrhagic stroke (HS),
although data on risk factors for each type are sparse. In this systematic review we attempt to characterize the risk factors. Methods.
We systematically reviewed (PubMed, EMBASE, WHOLIS, Google Scholar, Wiley online, and the Cochrane Central Register of
Controlled Trials (CENTRAL)) case-control studies and case series from 1980 to 2016 that reported risk factors for IS and/or HS
in SSA. For each risk factor we calculated random-efects pooled odds ratios (ORs) for case-control studies and pooled prevalence
estimates for case series. Results. We identifed 12 studies, including 4,387 stroke patients. Pooled analysis showed that patients who
had diabetes (OR = 2.39; 95% CI: 1.14–5.03) and HIV (OR = 2.46 (95% CI: 1.59–3.81) were at a signifcantly greater risk of sufering
from all stroke types. Tere were insufcient data to examine these factors by stroke type. Among case series, the pooled prevalence
of hypertension was higher for HS than for IS (73.5% versus 62.8%), while diabetes mellitus (DM) and atrial fbrillation (AF) were
more prevalent among IS compared to HS (15.9% versus 10.6% and 9.6% versus 2.3%, respectively). Conclusions. Tere remain too
few data from SSA to reliably estimate the efect of various factors on the risk of IS and HS. Furthermore, the vast majority of cases
were identifed in hospital and so are unlikely to be representative of the totality of stroke cases in the community
although data on risk factors for each type are sparse. In this systematic review we attempt to characterize the risk factors. Methods.
We systematically reviewed (PubMed, EMBASE, WHOLIS, Google Scholar, Wiley online, and the Cochrane Central Register of
Controlled Trials (CENTRAL)) case-control studies and case series from 1980 to 2016 that reported risk factors for IS and/or HS
in SSA. For each risk factor we calculated random-efects pooled odds ratios (ORs) for case-control studies and pooled prevalence
estimates for case series. Results. We identifed 12 studies, including 4,387 stroke patients. Pooled analysis showed that patients who
had diabetes (OR = 2.39; 95% CI: 1.14–5.03) and HIV (OR = 2.46 (95% CI: 1.59–3.81) were at a signifcantly greater risk of sufering
from all stroke types. Tere were insufcient data to examine these factors by stroke type. Among case series, the pooled prevalence
of hypertension was higher for HS than for IS (73.5% versus 62.8%), while diabetes mellitus (DM) and atrial fbrillation (AF) were
more prevalent among IS compared to HS (15.9% versus 10.6% and 9.6% versus 2.3%, respectively). Conclusions. Tere remain too
few data from SSA to reliably estimate the efect of various factors on the risk of IS and HS. Furthermore, the vast majority of cases
were identifed in hospital and so are unlikely to be representative of the totality of stroke cases in the community
| Original language | English |
|---|---|
| Article number | 4650851 |
| Number of pages | 11 |
| Journal | Journal of Tropical Medicine |
| Volume | 2018 |
| DOIs | |
| Publication status | Published - 31 May 2018 |