Community-level fatal and non-fatal stroke surveillance: providing the tools for evaluating interventions in hypertension and stroke in sub-Saharan Africa. (360G-Wellcome-103418_Z_13_Z)

It is thought that stroke is particularly common in sub-Saharan Africa (SSA), possibly due to a high prevalence of hypertension, but there is remarkably little accurate data. Determining and evaluating optimal strategies to reduce the burden of stroke in SSA requires validated tools to assess incidence, mortality and the contribution of modifiable risk factors. In a recent national survey in Malawi 1/3 of adults had hypertension, 94% previously undiagnosed. We have already shown, in the rura l demographic surveillance site (DSS) that is one of the settings for this study, that stroke was a leading cause of adult mortality, at 9%. I will: 1) Undertake a detailed assessment of, immediate and delayed mortality from stroke and the relative importance of risk factors for stroke mortality (including hypertension) by linking data from multiple settings in SSA. 2) Provide the most accurate estimates to date from SSA of the age specific incidence of transient ischaemic attacks, fatal an d non-fatal stroke, recurrent stroke and the short- and longer-term mortality from stroke by establishing and evaluating the validity of community and health clinic stroke surveillance at the rural DSS and urban site (where only hospital surveillance will be implemented) in Malawi.