title: Stroke risk factors in an incident population in urban  and rural Tanzania: a prospective, community-based,  case-control study.
abstract: BACKGROUND
  The burden of stroke on health systems in low-income and middle-income countries is increasing. However, high-quality data for modifiable stroke risk factors in sub-Saharan Africa are scarce, with no community based, case-control studies previously published. We aimed to identify risk factors for stroke in an incident population from rural and urban Tanzania.
  
  
  METHODS
  Stroke cases from urban Dar-es-Salaam and the rural Hai district were recruited in a wider study of stroke incidence between June 15, 2003, and June 15, 2006. We included cases with fi rst-ever and recurrent stroke. Community-acquired controls recruited from the background census populations of the two study regions were matched with cases for age and sex and were interviewed and assessed. Data relating to medical and social history were recorded and blood samples taken.
  
  
  RESULTS
  We included 200 stroke cases (69 from Dar-es-Salaam and 131 from Hai) and 398 controls (138 from Dar-es-Salaam and 260 from Hai). Risk factors were similar at both sites, with previous cardiac event (odds ratio [OR] 7.39, 95% CI 2.42-22.53; p<0.0001), HIV infection (5.61, 2.41-13.09; p<0.0001), a high ratio of total cholesterol to HDL cholesterol (4.54, 2.49-8.28; p<0.0001), smoking (2.72, 1.49-4.96; p=0.001), and hypertension (2.14, 1.09-4.17; p=0.026) identified as significant independent risk factors for stroke. In Hai, additional risk factors of diabetes (4.04, 1.29-12.64) and low HDL cholesterol (9.84, 4.06-23.84) were also significant.
  
  
  CONCLUSIONS
  We have identified many of the risk factors for stroke already reported for other world regions. HIV status was an independent risk factor for stroke within an antiretroviral-naive population. Clinicians should be aware of the increased risk of stroke in people with HIV, even in the absence of antiretroviral treatment.
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D055812:Community-Based Participatory Research; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013636:Tanzania / Q000453:epidemiology; D014505:Urban Population
references.citation: Acta Neurol Scand. 2009 Feb;119(2):81-7
references.pmid: 18638038
references.citation: Arch Neurol. 1997 Sep;54(9):1150-3
references.pmid: 9311359
references.citation: Stroke. 2004 Jul;35(7):1562-7
references.pmid: 15192251
references.citation: Neurology. 2005 Sep 13;65(5):759-61
references.pmid: 16157915
references.citation: Lancet. 2010 Jul 10;376(9735):112-23
references.pmid: 20561675
references.citation: Lancet Neurol. 2010 Aug;9(8):786-92
references.pmid: 20609629
references.citation: Infect Disord Drug Targets. 2010 Apr;10(2):105-11
references.pmid: 20166970
references.citation: J Hum Hypertens. 2013 Jun;27(6):374-80
references.pmid: 23235367
references.citation: AIDS. 2011 Aug 24;25(13):1637-46
references.pmid: 21646903
references.citation: J Neurol Neurosurg Psychiatry. 2000 Jun;68(6):744-9
references.pmid: 10811698
references.citation: J Neurovirol. 2000 Jun;6(3):229-36
references.pmid: 10878712
references.citation: J Hum Hypertens. 2006 Sep;20(9):704-6
references.pmid: 16738685
references.citation: East Afr Med J. 1983 Mar;60(3):190-5
references.pmid: 6617561
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: N Engl J Med. 2007 Apr 26;356(17):1723-35
references.pmid: 17460226
references.citation: Cerebrovasc Dis. 2012;33(3):209-18
references.pmid: 22261608
references.citation: Stroke. 1988 Dec;19(12):1497-500
references.pmid: 3201508
references.citation: Am J Prev Med. 2007 Aug;33(2):172-3
references.pmid: 17673107
references.citation: Neuroepidemiology. 2010;35(1):12-6
references.pmid: 20339306
references.citation: Lancet. 2000 May 13;355(9216):1684-7
references.pmid: 10905244
references.citation: ISRN Cardiol. 2011;2011:897908
references.pmid: 22347662
references.citation: Lancet. 2012 Dec 15;380(9859):2197-223
references.pmid: 23245608
references.citation: J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1320-4
references.pmid: 17470469
references.citation: Stroke. 2001 Aug;32(8):1725-31
references.pmid: 11486097
references.citation: J Acquir Immune Defic Syndr. 2012 Aug 1;60(4):351-8
references.pmid: 22580566
references.citation: Bull World Health Organ. 2001;79(10):947-53
references.pmid: 11693977
references.citation: S Afr Med J. 2011 May;101(5):338-44
references.pmid: 21837879
references.citation: Atherosclerosis. 1998 Aug;139(2):391-9
references.pmid: 9712347
references.citation: Arch Intern Med. 1993 Jan 25;153(2):154-83
references.pmid: 8422206
references.citation: J Med Assoc Thai. 2012 Feb;95 Suppl 2:S227-34
references.pmid: 22574554
references.citation: Lancet Neurol. 2012 Oct;11(10):878-90
references.pmid: 22995692