title: Stroke survivors in low- and middle-income countries: A meta-analysis of prevalence and secular trends.
abstract: OBJECTIVE
  To provide an up-to-date estimate on the changing prevalence of stroke survivors, and examines the geographic and socioeconomic variations in low and middle-income countries (LMICs).
  
  
  METHODS
  We searched MEDLINE, EMBASE, SCOPUS and Web of Science databases and systematically reviewed articles reporting stroke prevalence and risk factors from inception to July 2015. Pooled prevalence estimates and secular trends based on random-effects models were conducted across LMICs, World Bank regions and income groups.
  
  
  RESULTS
  Overall, 101 eligible community-based studies were included in the meta-analysis. The pooled crude prevalence of stroke survivors was highest in Latin America and Caribbean (21.2 per 1000, 95% CI 13.7 to 30.29) but lowest in sub-Saharan Africa (3.5 per 1000, 95% CI 1.9 to 5.7). Steepest increase in stroke prevalence occurred in low-income countries, increasing by 14.3% annually while the lowest increase occurred in lower-middle income countries (6% annually), and for every 10years increase in participants' mean age, the prevalence of stroke survivors increases by 62% (95% CI 6% to 147%).
  
  
  CONCLUSIONS
  The prevalence estimates of stroke survivors are significantly different across LMICs in both magnitude and secular trend. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed.
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK. Electronic address: m.c.ezejimofor@warwick.ac.uk.
authors.forename: Martinsixtus C
authors.initials: MC
authors.lastname: Ezejimofor
authors.affiliation: Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK.
authors.forename: Yen-Fu
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK; Department of Mathematics and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Department of Population Health, Luxembourg Institute of Health (LIH), 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg.
authors.forename: Ngianga-Bakwin
authors.initials: NB
authors.lastname: Kandala
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK.
authors.forename: Benedeth C
authors.initials: BC
authors.lastname: Ezejimofor
authors.affiliation: School of the Built Environment, University of Salford, M5 4WT, UK.
authors.forename: Aloysius C
authors.initials: AC
authors.lastname: Ezeabasili
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK; Department of Population Health, Luxembourg Institute of Health (LIH), 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg.
authors.forename: Saverio
authors.initials: S
authors.lastname: Stranges
authors.affiliation: Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK; Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Centre for Evidence-Based Health Care, Stellenbosch University, Tygerberg 7505, South Africa.
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003695:Delivery of Health Care; D003906:Developing Countries; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015995:Prevalence; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality*; D017741:Survivors / Q000706:statistics & numerical data*
keywords: Low- and middle-income countries; Prevalence; Secular trends; Stroke survivors; World Bank regions