Risk Factors for Hemorrhagic and Ischemic Stroke in Sub-Saharan Africa

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