Epidemiology of Stroke in the MENA Region: A Systematic Review.

Abstract

Introduction: Stroke is a major burden on the health system due to high fatality and major disability in survivors. Whilst Stroke incidence has declined in the developed world, it continues to increase in developing nations, including the MENA (Middle East and North Africa) region. This may reflect different risk factors and strategies to treat and manage patients prior to and after Stroke. Methods: We have conducted a systematic review of the prevalence, incidence and mortality of Stroke in the 23 countries of MENA region following the PRISMA guidelines. Results: 8,874 published papers were retrieved through both PubMed and Embase. Of those, 38 studies were found to be eligible for inclusion in this review. Only thirteen countries in the MENA region had data points for the critical stroke parameters. Of these qualified studies, 14 were prospective, population-based studies. In the age-adjusted studies, incidence ranged widely between 16/100,000 in a prospective population-based in Iran to 162/100,000 in Libya. Age-adjusted prevalence was available only from Tunisia at 184/100,000. Mortality for all strokes from the eight countries reporting this measure found the 30 day-case fatality ranged from 9.3% in Qatar to 30% in Pakistan. Most stroke studies in the MENA region were small sized, hospital-based, lacked confidence intervals and did not provide prevalence and mortality figures. Conclusion: National policymakers, public health and medical care stakeholders need more reliable epidemiologic studies on Stroke from the MENA region to plan more effective preventive and therapeutic strategies.