Stroke in Africa: profile, progress, prospects and priorities.
Stroke in Africa: profile, progress, prospects and priorities.
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DOI：
10.1038/s41582-021-00542-4
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Owolabi MO
中科院分区：
文献类型：
--
作者：
Akinyemi RO;Ovbiagele B;Adeniji OA;Sarfo FS;Abd-Allah F;Adoukonou T;Ogah OS;Naidoo P;Damasceno A;Walker RW;Ogunniyi A;Kalaria RN;Owolabi MO
中风是全世界导致残疾、痴呆症和死亡的主要原因。大约70%的中风死亡和87%的中风相关残疾发生在低收入和中等收入国家。在世纪之交，非洲最常见的疾病是传染病，而包括中风在内的非传染性疾病被认为是罕见的，特别是在撒哈拉以南非洲。然而，有证据表明，今天，非洲的中风发病率和中风患病率可能是西欧和美国的2-3倍。在非洲，过去十年公布的数据显示，中风的年发病率高达每10万人中有316人，患病率高达每10万人中有1460人，3年死亡率超过80%。此外，许多非洲人在40至60岁之间中风，对个人、家庭和社会造成严重影响。这一年龄特征尤其重要，因为与老年人相比，年轻人中风往往会导致更大的自我价值和社会经济生产力的损失。对中风流行病学、遗传学、预防、护理和结果的研究的新见解为解决非洲大陆日益沉重的中风负担提供了巨大的前景。在这篇文章中，我们回顾了非洲中风的独特概况，并总结了目前关于中风流行病学、遗传学、预防、急性护理、康复、结果、护理费用和意识的知识。我们还为生活在非洲的10多亿人讨论了中风医学的知识差距、新出现的优先事项和未来方向。在这篇综述中，Akinyemi和他的同事提供了非洲中风的概述，包括流行病学、风险因素、遗传学和可用的中风服务。作者还讨论了非洲中风护理的未来，强调了生物库和新的领导倡议的前景。非洲每年的中风发病率高达每100,000人中有316人，属于世界上发病率最高的地区之一，而尼日利亚西非一个地区报告的发病率为1,460/100,000人，显然是世界上最高的之一。在非洲，高血压仍然是中风最重要的可改变的危险因素，但其他因素包括糖尿病、血脂异常、肥胖、压力、吸烟、饮酒、缺乏运动和不健康的饮食。与世界其他地区相比，非洲与小血管疾病相关的中风和脑出血损害的优势略大一些。第一个关于中风的非洲全基因组关联研究的结果预计很快就会出来，但已知的改变非洲人群中风风险的基因包括IL6、APOE、APOL1、CYB11B2和CDKN2A/2B。改善非洲中风护理的务实办法包括定期监测风险因素和保健服务，实施预防战略，改善急性护理和康复服务，并鼓励分担任务；一些北非和撒哈拉以南国家出现了独立的中风护理和中风单位，这是令人鼓舞的。中风医学在非洲面临着许多挑战，但人们的意识以及通过非洲中风组织、世界中风组织和世卫组织等组织为更多中风研究和服务提供支持的协调努力大有可为。
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. In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives. The annual incidence rate of stroke in Africa is up to 316 per 100,000 individuals, which is within the highest incidence rates in the world, and the prevalence rate of 1,460 per 100,000 reported in one region of Nigeria, western Africa, is clearly among the highest in the world. Hypertension remains the most important modifiable risk factor for stroke in Africa but others include diabetes mellitus, dyslipidaemia, obesity, stress, smoking, alcohol use, physical inactivity and an unhealthy diet. Africa has a slightly greater preponderance of small vessel disease-related stroke and intracerebral haemorrhagic lesions than elsewhere in the world. The results of the first African genome-wide association study on stroke are expected soon but genes already known to modify stroke risk in African populations include IL6, APOE, APOL1, CYB11B2 and CDKN2A/2B. Pragmatic approaches to improving stroke care in Africa include regular monitoring of risk factors and health services, implementation of prevention strategies, improving acute care and rehabilitation services, and encouraging task sharing; the emergence of standalone stroke care and stroke units in some North African and sub-Saharan countries is encouraging. Numerous challenges face stroke medicine in Africa but awareness and the concerted efforts towards securing support for more stroke research and services via organizations such as the African Stroke Organization, World Stroke Organization and WHO hold much promise.
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DOI：
10.1177/1747493019897871
发表时间：
2021-01
期刊：
International journal of stroke : official journal of the International Stroke Society
影响因子：
--
作者：
Akinyemi R;Sarfo F;Abd-Allah F;Ogun Y;Belo M;Francis P;Mateus MB;Bateman K;Naidoo P;Charway-Felli A;Akpalu A;Wahab K;Napon C;Arulogun O;Ebenezer AA;Ekeng G;Scola G;Hamzat K;Zimba S;Ossou-Nguiet PM;Ademokoya J;Adebayo P;Ayele BA;Vaz DC;Ogbole G;Barasukan P;Melifonwu R;Onwuekwe I;Belson S;Damasceno A;Okubadejo N;Njamnshi AK;Ogeng'o J;Walker RW;Diop AG;Ogunniyi A;Kalaria R;Sandercock P;Davis S;Brainin M;Ovbiagele B;Owolabi M
通讯作者：
Owolabi M
影响因子：
3.7
作者：
Adeloye D
通讯作者：
Adeloye D
影响因子：
6.7
作者：
Akinyemi, Rufus O.;Sarfo, Fred S.;Ovbiagele, Bruce
通讯作者：
Ovbiagele, Bruce
影响因子：
0.7
作者：
Akinyemi RO;Ovbiagele B;Akpalu A;Jenkins C;Sagoe K;Owolabi L;Sarfo F;Obiako R;Gebreziabher M;Melikam E;Warth S;Arulogun O;Lackland D;Ogunniyi A;Tiwari H;Kalaria RN;Arnett D;Owolabi MO;SIREN Investigators as Members of the H3Africa Consortium
通讯作者：
SIREN Investigators as Members of the H3Africa Consortium
影响因子：
5.7
作者：
Akpalu A;Sarfo FS;Ovbiagele B;Akinyemi R;Gebregziabher M;Obiako R;Owolabi L;Sagoe K;Jenkins C;Arulogun O;Adamu S;Appiah LT;Adadey MA;Agyekum F;Quansah JA;Mensah YB;Adeoye AM;Singh A;Tosin AO;Ohifemen O;Sani AA;Tabi-Ajayi E;Phillip IO;Isah SY;Tabari NA;Mande A;Agunloye AM;Ogbole GI;Akinyemi JO;Akpa OM;Laryea R;Melikam SE;Adinku D;Uvere E;Burkett NS;Adekunle GF;Kehinde SI;Azuh PC;Dambatta AH;Ishaq NA;Arnett D;Tiwari HK;Lackland D;Owolabi M;SIREN as part of the H3Africa Consortium
通讯作者：
SIREN as part of the H3Africa Consortium