title: Door-to-door capture of incident and prevalent stroke cases in Durango, Mexico: the Brain Attack Surveillance in Durango Study.
abstract: OBJECTIVE
  Stroke incidence and prevalence estimates in developing countries should include stroke cases not presenting to hospital. We performed door-to-door stroke case ascertainment in Durango Municipality, Mexico, to estimate stroke incidence and prevalence and to determine the error made by only ascertaining hospital cases.
  
  
  METHODS
  Between September 2008 and March 2009, 1996 housing units were randomly sampled to screen for stroke in Durango Municipality residents 35 years of age and older. Field workers utilized a validated screening tool. Those screening positive were referred to a neurologist for history and examination and a head CT scan. Prevalence and cumulative incidence from the door-to-door surveillance were calculated and compared with previously reported hospitalization rates during the same defined time.
  
  
  RESULTS
  Respondents included 2437 subjects from 1419 homes. The refusal rate was 3.8%. Twenty subjects had verified or probable stroke. The prevalence of probable or verified stroke was 7.7 per 1000 (95% CI, 4.3 per 1000-11.2 per 1000). Five patients had a stroke during the time of the hospital surveillance, yielding a cumulative incidence of 232.3 per 100 000 (95% CI, 27.8-436.9). Two of the 5 cases were captured by door-to-door surveillance but not by hospital surveillance.
  
  
  CONCLUSIONS
  This study provides the first community-based stroke prevalence and incidence estimates in Mexico. The wide confidence intervals, despite the large number of surveyed housing units, suggest the need for more advanced sampling strategies for stroke surveillance in the developing world.
authors.affiliation: Stroke Program, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Neurology, Mexico City, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cantu-Brito
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Majersik
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sánchez
authors.forename: Angel
authors.initials: A
authors.lastname: Ruano
authors.forename: Daniela
authors.initials: D
authors.lastname: Becerra-Mendoza
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Wing
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*