Original Article
Prevalence and Risk Factors for Stroke in an Adult Population in a Rural Community in the Niger Delta, South-South Nigeria

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.010Get rights and content

Sub-Saharan Africa is experiencing an epidemiologic transition with stroke contributing to the disease burden. However, community-based stroke prevalence studies are sparse. This study aimed to determine the prevalence of stroke in a rural population in the Niger Delta region in south–south Nigeria and to describe known risk factors for stroke among them. A door-to-door stroke prevalence study was conducted in 2008 among randomly selected adults of 18 years or older in rural Kegbara-Dere community in Rivers State, south–south Nigeria. We administered a modified screening tool by the World Health Organization, a stroke-specific questionnaire, and conducted a physical/neurological examination (on persons screening positive) in 3 stages of assessments. The crude prevalence of stroke was 8.51/1000 (95% confidence interval [CI] = 3.9-16.1) representing 9 of 1057 participants. The age-adjusted prevalence was 12.3/1000 using the US Population 2000. Men had higher unadjusted prevalence than women (12.9/1000 versus 5.1/1000) but were not at more risk (unadjusted relative risk = .99; 95% CI = .98-1.00). Stroke prevalence increased with age (Mantel–Haenszel χ2 P = .00). Hypertension (blood pressure ≥140/90 mm Hg) was present in all stroke cases and diabetes mellitus (fasting blood sugar >126 mg/dL) in 1 person, but none had hypercholesterolemia, obesity (body mass index >30 kg/m2), or a history of alcohol intake or smoking. Stroke prevalence was found to be high, commoner among men and the elderly population, and likely to be predisposed by hypertension, in rural south–south Nigeria. The need to conduct follow-up studies on the burden and outcomes of stroke among this study population is acknowledged.

Introduction

Developing countries carry about 90% of the global disease burden.1 Of these, cerebrovascular disease (stroke) ranks fourth after perinatal conditions, respiratory infection, and ischemic heart disease.2 Many countries in sub-Saharan Africa (sSA), including Nigeria, are experiencing an epidemiological transition of disease burden, from communicable to noncommunicable diseases (NCDs), with stroke being the forerunner. Most often, the threat posed by the emergence of NCDs is underestimated and often denied.3, 4 Typically, communities in resource-constraint settings struggle to cope with the direct effects of poverty, ethnoreligious conflicts, fragile social and economic structures, and HIV/AIDS.4 Meanwhile, the impact of NCDs appears insidious and less direct, but little reliable evidence is available.3

A rural, community-based study of neurological disorders in southwest Nigeria, which was conducted about 3 decades ago, reported a stroke prevalence of .58/1000.5 More recently, a stroke prevalence study in an urban, mixed-income community in Lagos, also in the southwest, gave a prevalence rate of 1.14/1000.6 However, the current status of stroke is unknown in rural populations in the Niger Delta region in south–south Nigeria. Population differences in the prevalence of stroke usually follow sociocultural and geographical distinctions, and are important to highlight, in view of conducting focused interventions. Such information guides resource allocation and the development of local plans for strategies to address the problem of stroke. Apparent shifts in population characteristics are what account for the epidemiological transition being experienced by the third world communities such as those in Nigeria.3, 4

The Center for Disease Control report on the prevalence of stroke in the United States in 2005 showed that a substantial difference existed in the prevalence of stroke among States and by areas of residence.7 For instance, many States with high estimates were concentrated in the southeast of United States and corresponded with high rate of stroke mortality in the region that has been traditionally called the “stroke belt.”7, 8 Similarly, in India, stroke in Calcutta showed a low prevalence rate of 1.5/1000,9 whereas it was substantially high at a prevalence rate of 8.4/1000 in Parsis, Mumbai.10 These divergent rates could be because of innate factors such as widely different age composition, differences in the prevalence of stroke risk factors, or ethnicity.4, 8, 11 It could also be possibly because of extrinsic factors such as variation in the amount of trace elements in the environment,12 migration patterns, or inaccuracy of records owing to weak health systems.11

This study aimed to determine the prevalence of stroke in a rural population in the Niger Delta region in south–south Nigeria and to describe known risk factors for stroke among them.

Section snippets

Materials and Methods

A cross-sectional study of the prevalence of stroke and its risk factors among adults aged 18 years and older was conducted in Kegbara-Dere (K-Dere) community in July 2008, along with a study of hypertension prevalence.13 Both were part of an annual door-to-door community enumeration of health status indicators that was organized by the Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt. K-Dere is a rural farming settlement in Ogoniland of an estimated

Results

The results presented are on 1057 eligible persons who were screened during the house-to-house study for the first stage of stroke screening and had complete sociodemographic data. The sociodemographic characteristics of the study participants were as reported in Onwuchekwa et al.13 The mean age was 35.8 ± 14.8 years, there were more women (56.0%, χ2 P = .00), the difference in the mean ages between the sexes was not statistically significant at 35.2 ± 14.6 years in women compared with

Discussion

The crude prevalence of stroke in this community was found to be high at 8.5/1000 and even higher at an age-adjusted rate of 12.3/1000. These levels of stroke prevalence may be a manifestation of the health transition in sSA that has resulted primarily from lifestyle changes along with other social and economic shifts that have characterized many nations of the third world in recent decades.3, 4, 11, 18, 19 The recent prominence of stroke among cardiovascular disorders has been described in the

Acknowledgment

The authors thank the Department of Preventive and Social Medicine of the University of Port Harcourt, Port Harcourt, for the logistical and financial support. We are also grateful to the Council of Chiefs and the people of Kegbara-Dere community, especially all the study participants. We are indebted to Drs E. G. Asekomeh, M. M. Mezie-Okoye, and Bliss Moore for their contributions and to all the final-year medical students and staff of the health center for their assistance with the data

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    Conflict of interest: The authors declare none.

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