STS Hospital-level stroke surveillance in Lilongwe, Malawi: providing tools for evaluating interventions in hypertension and stroke in sub-Saharan Africa Lilongwe

Stroke is the second most cause of death worldwide and a disproportionate number of these deaths occur in low income countries. In Sub-Saharan Africa(SSA) with effective antiretroviral treatment (ART)programmes, life expectancy has improved and more adults are now dying from non-communicable diseases (NCD) than HIV/AIDS. In 2004 around 1.2 million deaths were thought to be attributable to cardiovascular disease(CVD) alone in this region. The figure is expected to double by 2030.The population living with co-morbidities of HIV and NCD is growing, with detrimental social and economic impacts, creating an unsustainable burden on constrained health systems.
It is thought that stroke is particularly common in sub-Saharan Africa (SSA), possibly due to high prevalence of hypertension, but there is remarkably little accurate data. Determining and evaluating optimal strategies to reduce the burden of stroke in SSA requires validated tools to assess incidence, mortality and the contribution of modifiable risk factors.
This study involved urban health facility level stroke surveillance, which in combination with our rural community surveillance, gave the first estimates of incidence of transient ischaemic attack(TIA) and fatal and non-fatal stroke in Malawi, and their determinants, including HIV infection and ART. The study also built on our existing collaboration with the Ministry of Health 's NCD department.

NHSRC number : 1431