International Stroke Conference
Deepak Gulati, MD
Stroke is a leading cause of morbidity and mortality among children with sickle cell disease. It was an interesting discussion by national and international speakers during one of the dedicated sessions at ISC 2018 on epidemiology of stroke, genetics, use of transcranial Doppler and hydroxyurea trial in sickle cell disease. Sickle cell disease is an inherited monogenetic disorder with a polygenic phenotype. Stroke affects 10–30% of children with sickle cell disease.
Dr. Rufus Akinyemi, MBBS, from the University of Ibadan in Nigeria, provided an update on the epidemiology of stroke in Africa. Non-communicable diseases contribute as much as 80% to medical admissions in some African hospitals. There are numerous studies providing varying number for stroke prevalence in Africa, ranging from 58 to 1,331/100,000. In one of the studies (Interstroke study), the one-month case fatality rate for stroke was 22% in Africa. Hemorrhagic strokes are reported to be more common in Africa. There has also been observed a relationship between HIV infection and stroke, but the pathogenesis is not entirely clear. One of the major concerns is the gaps in the stroke knowledge in health care workers and treatment choice influenced by cultural and religious beliefs. Because of various challenges, no study fulfilled the criteria for an excellent stroke incidence study. The relatively few stroke epidemiology studies in Africa have significant methodological flaws. ARISES (African Rigorous Innovative Stroke Surveillance) aims to conduct a 3-year surveillance of stroke cases in selected urban and rural sites in Nigeria, which have an existing demographic surveillance system. There is a great need for rigorous and reliable data to inform implementation efforts for prevention and control of stroke in Africa.