title: MS incidence and prevalence in Africa, Asia, Australia and New Zealand: A systematic review.
abstract: OBJECTIVE
  Studies of multiple sclerosis (MS) incidence and prevalence from Africa, Asia, Australia and New Zealand are relatively scarce. We systematically reviewed MS incidence and prevalence in these regions including a standardized evaluation of study quality.
  
  
  METHODS
  We searched MEDLINE and EMBASE databases for studies of MS prevalence or incidence in Africa, Asia, Australia and New Zealand published in English or French between January 1, 1985 and January 31, 2011. Study quality was assessed using a standardized tool. All steps of the review were performed in duplicate.
  
  
  RESULTS
  Of 3925 citations identified, 28 studies met inclusion criteria and 21 of these were from Asia. Quality scores ranged from 1/8 to 8/8; the lowest scores were observed in studies from Asia (median 4/8, IQR 3,6). Prevalence was lowest in South African Blacks (0.22/100,000) and highest amongst Australian-born individuals in Australia (125/100,000). Prevalence increased over time in many countries. MS prevalence increased with increasing latitude only in some regions, and prevalence varied significantly with ethnicity. Eight studies reported incidence, which ranged from 0.67/100,000/year in Taiwan to 3.67/100,00/year in Australia.
  
  
  CONCLUSIONS
  This comprehensive study provides an update of MS epidemiology in Africa, Asia, Australia, and New Zealand. Incidence and prevalence were lowest in Africa and Asia and highest in Australia, but many Asian studies were of poor quality. Use of consistent case ascertainment methods, standardized data collection tools, and similar outcomes would all improve study quality and comparability. The underlying basis of observed ethnic differences is an important area for future study.
authors: Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada. Electronic address: naila.makhani@sickkids.ca.
authors: N
authors: N
authors: Makhani
authors: Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
authors: S A
authors: SA
authors: Morrow
authors: Department of Psychiatry, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada.
authors: J
authors: J
authors: Fisk
authors: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
authors: C
authors: C
authors: Evans
authors: Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada.
authors: S G
authors: SG
authors: Beland
authors: Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada.
authors: S
authors: S
authors: Kulaga
authors: Division of Neurology, University of British Columbia, Vancouver, Canada.
authors: E
authors: E
authors: Kingwell
authors: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
authors: J J
authors: JJ
authors: Marriott
authors: Department of Community Health Sciences, University of Calgary, Calgary, Canada.
authors: J
authors: J
authors: Dykeman
authors: Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Institute for Public Health, University of Calgary, Calgary, Canada.
authors: N
authors: N
authors: Jetté
authors: Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Institute for Public Health, University of Calgary, Calgary, Canada; Department of Pediatrics, University of Calgary, Calgary, Canada.
authors: T
authors: T
authors: Pringsheim
authors: Division of Neurology, University of British Columbia, Vancouver, Canada; Department of Epidemiology & Biostatistics, McGill University, Canada; Department of Medicine, McGill University, Canada.
authors: C
authors: C
authors: Wolfson
authors: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
authors: R A
authors: RA
authors: Marrie
authors: Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Institute for Public Health, University of Calgary, Calgary, Canada.
authors: M W
authors: MW
authors: Koch
keywords: Asia, Africa; Epidemiology; Incidence; Multiple sclerosis; Prevalence