Published Online
on February 12, 2004

A more recent version of this article appeared on March 1, 2004

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Submitted on October 28, 2003
Accepted on November 21, 2003

Prevalence of Stroke Survivors in Rural South Africa. Results From the Southern Africa Stroke Prevention Initiative (SASPI) Agincourt Field Site

The SASPI Project Team

From the Department of Epidemiology, University of Warwick, Warwick, UK (M.T.); Division of Neurology, Department of Neurosciences (M.D.C.) and Clinical Research Fellow (B.C., C.D.), University of the Witswatersrand, Johannesburg, South Africa; and Department of Neurology, University of Edinburgh, Edinburgh, UK (C.P.W.).

Background and Purpose--The importance of stroke in low-income regions such as sub-Saharan Africa has recently been emphasized. However, little is known about the burden of stroke in sub-Saharan Africa. We investigated the prevalence of stroke survivors in the Agincourt Health and Population Unit, a demographic surveillance site in the rural northeast of South Africa.

Methods--Census workers asked household informants 2 screening questions for stroke during the annual census. If either question was answered positively, a clinician visited individuals aged 15 years to confirm the likely diagnosis of stroke. We performed a detailed assessment and defined stroke according to the World Health Organization criteria.

Results--A total of 42 378 individuals were aged 15 years. There were 982 positive responses to the questionnaire, and we examined 724 individuals (74%). We identified 103 strokes (crude prevalence, 243/100 000). After adjustment for those we did not examine, the prevalence was 300/100 000 (95% CI, 250 to 357). Sixty-six percent of stroke survivors needed help with at least 1 activity of daily living (Segi age-standardized prevalence, 200/100 000).

Conclusions--Stroke prevalence in rural South Africa is higher than previously documented in Africa but lower than in high-income countries. However, the prevalence of stroke survivors requiring help with at least 1 activity of daily living is already at high-income country levels. South Africa suffers from a huge burden of HIV/AIDS and diseases of poverty and violence and now faces the challenge of adapting its health systems to face the coming epidemic of vascular disease.

Key words: cause of death • censuses • epidemiology • population surveillance • prevalence • rural population • South Africa • stroke

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