Stroke Recurrence Rate and Risk Factors Among Stroke Survivors in Sub-Saharan Africa: A Systematic Review

Figures & data

Figure 1 Papers screened.

Table 1 Summary of the Articles Included in the Review

Lead Author, Year, and Country	Study Design	Sample Size	Reported Incidence of Stroke Recurrence	Reported Mortality Rates	Time Interval Between Strokes
Akpalu A et al 2022 Ghana^Citation25	Multi-center case control study	3553	335(9.4%)	In patient mortality rate was 20.5% among those with recurrent strokes compared to 21.4 in first time strokes.	NA
Dabilgou A, A et al 2021 Burkina Faso^Citation24	Cross-sectional observational study	266	44 (16.4%)	No mortality rates reported	The mean interval time between initial and second stroke was 24 ± 24.34 months, ranges (3 months-10 years). The majority of patients (59.5%) had their stroke after 12 months. This time was 5.85 years between second stroke and third stroke.
Walker RW et al 2013 Tanzania^Citation26	Case control study	201	4 (1.99%)	No mortality rates reported	NA
Mbonda, PC Cameroon 2021^Citation29	Retrospective study Cross sectional prospective study	528	75 (14.20%)	23% deaths occurred among those with recurrent strokes	The time between the first stroke and recurrence was 1 to 2 years in 37.8% of patients, more than 3 years in 28.4% of patients, and 14.9% of patients had recurrence within six months of the first stroke
Kamgang, J Cameroon 2021^Citation27	Case control study Retrieved data from patient records at a hospital	100	25(25%)	No mortality rates	The median time from the index stroke event to the second stroke was 16.0 (95% CI = 3.36–28.64) months in right-handed patients, 19.0 (95% CI = 3.76–34.25) months in patients with heart failure, and 15.0 (95% CI = 0.78–29.22) months in patients with hypertension.
Lekoubou, A et al Cameroon 2017^Citation28	Retrospective study Admission and discharge registries, and patient files for the period 1999–2012	1678	243 (14.5%) had recurrent stroke	20.6% deaths occurred among those with recurrent strokes 95% CI (1.43 (1.03–1.99) compared to deaths among first ever strokes. Known risk factors like diabetes mellitus, history of hypertension did not alter the association between recurrent stroke and death.	NA

Table 2 Weighted Risk Factors for Stroke Recurrence in SSA Studies. Odds Ratio; 95% (Confidence Interval)

Study	Hypertension	Alcohol Abuse/Excessive Consumption	Diabetes Mellitus	Medication non-Adherence	Older Age	History of Stroke
Akpalu et al^Citation25 *	50.73; (6.55–392.7); p=<0.001	NA	4.04 (2.12–7.69); p<0.001	NA	2.10 (0.37–11.96); P=0.399	2.12 (1.07–4.21); p=0.031
Kamgang et al^Citation27	1.40 (0.50–3.97)	2.26 (0.89–5.77)	2.21(0.89–5.77)	NA	NA	NA
Walker et al^Citation26	2.14 (1.09–4.17); p=0.026	1.62 (0.69–3.78); p=0.268	1.38 (0.35–5.39); p=0.644	NA	NA	7.39 (2.42–22.53); p<0.0001
Mbonda et al^Citation29	2.68 (1.4756–4.8692); p=0.001	NA	0.973 (0.421–2.251); p=0.95	0.399 (0.160–0.992); P=0.042	NA	NA
Lekoubou et al^Citation28	NA	NA	NA	NA	NA	NA
Dabilgou A et al^Citation24	NA	NA	NA	NA	NA	NA

Notes: *Study reported adjusted Odds Ratio(OR), while others reported unadjusted OR.

Akpalu A, Sarfo FS, Akinyemi J, et al. Frequency & factors associated with recurrent stroke in Ghana and Nigeria. J Neurol Sci. 2022;439:120303. doi:10.1016/j.jns.2022.120303

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Dabilgou AA, Drave A, Kyelem JMA, et al. Frequency of recurrent stroke in Burkina Faso: an observational hospital based study of 6 months. Pan Afr Med J. 2021;40:108. doi:10.11604/pamj.2021.40.108.23098

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Walker RW, Jusabani A, Aris E, et al. Stroke risk factors in an incident population in urban and rural Tanzania: a prospective, community-based, case-control study. Lancet Glob Health. 2013;1(5):e282–8. doi:10.1016/S2214-109X(13)70068-8

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Mbonda PC, Mafo D, Doumbe J, Kuate C. Recurrence of strokes and associated factors at laquintinie hospital in douala. Clinical Neur Neuro sci. 2021;5:3. doi:10.11648/j.cnn.20210503.12

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Kamgang J, Tetinou F, Zolo Y, et al. Recurrent ischemic and hemorrhagic stroke in Cameroon: a case-control study. Neurol Res Int. 2021;2021:9948990. doi:10.1155/2021/9948990

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Lekoubou A, Nkoke C, Dzudie A, Kengne AP. Recurrent stroke and early mortality in an urban medical unit in Cameroon. J Stroke Cerebrovasc Dis. 2017;26(8):1689–1694. doi:10.1016/j.jstrokecerebrovasdis.2017.03.031

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