Kehinde Alare

Title: National and Regional Burden of Stroke in Nigeria, 1990–Temporal Analysis of Prevalence, Incidence, Mortality, and Disability Indicators.

Abstract

Background: Stroke remains a leading cause of mortality and long-term disability globally, with a disproportionate burden in low- and middle-income countries. Nigeria, the most populous country in Africa, has experienced rapid demographic and epidemiologic transitions that may have substantially altered the burden of stroke over recent decades. However, comprehensive national and subnational temporal assessments are lacking.

Objective: To systematically review and synthesize evidence on the national and regional burden of stroke in Nigeria from 1990 to 2025, with a focus on trends in prevalence, incidence, mortality, and disability indicators.

Methods: A systematic review was conducted in accordance with PRISMA guidelines. Multiple electronic databases and grey literature sources were searched for population-based studies, hospital-based registries, surveillance reports, and modeled estimates reporting stroke burden in Nigeria between 1990 and 2025. Outcomes included prevalence, incidence, mortality rates, case fatality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Data were synthesized narratively and quantitatively where feasible. Temporal trends and regional variations across Nigeria’s geopolitical zones were analyzed.

Results: A total of 60 studies were included with a sample population of 142,810; 14,008 stroke cases, with male accounting for 54.01%. Estimated National stroke prevalence from population based studies  was 5.1 per 1000 (95% CI: 1.9 - 9.7 per 1000), while stroke accounted for 20.47% (95% CI: 13.29% - 28.73%) of total hospital admission, North-western region had the highest stroke admission rate of 26.74% while south-west region has the least of 9.51%. Estimated National stroke incidence of 70 per 100,000 person-years, 24-hours mortality rate of 8.35% (95% CI: 6.36% - 10.56%), 30-days mortality rate of 29.27% (95% CI: 23.08% - 35.86%), while the overall case fatality rate of 28.97% (95% CI: 24.70% - 33.43%). The estimated means DALYs of 1.873.2(± 1,596.2) years per study, YLL of 935.8 years, and YLD 937.2 years

Conclusion: The burden of stroke in Nigeria has increased significantly from 1990 to 2025, with pronounced regional inequalities and sustained high mortality and disability. These findings underscore the urgent need for strengthened stroke prevention strategies, equitable access to acute and rehabilitative care, and region-specific health policies to mitigate the growing stroke burden in Nigeria.