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VOLUME 15 NUMBER 1 • JULY 2018
29
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
Cerebrovascular disease in Sudan: a huge gap
to be bridged
Muwada Bashir Awad Bashir, Samuel Nambile Cumber
Correspondence to: Samuel Nambile Cumber
Section for Epidemiology and Social Medicine, Department of Public
Health, Institute of Medicine (EPSO), Sahlgrenska Academy, University of
Gothenburg, Sweden
e-mail:
samuelcumber@yahoo.comMuwada Bashir Awad Bashir
Discipline of Medicine and Surgery, Faculty of Medicine, University
of Khartoum, Sudan, and Discipline of Public Health and Community
Medicine, Department of Public Health and Community Medicine,
University of Gothenburg, Sweden
S Afr J Diabetes Vasc Dis
2018;
15
: 29–31
Abstract
Organised national structural and research efforts are
crucial to minimising the high morbidity and mortality
burdens attributed to cerebrovascular disease in Sudan.
The dearth of quality research evidence to guide decision
making in neurological services, and the lack of political
will and resources have accounted for the uncertainty
regarding this major health problem in Sudan. This article
reviews the research efforts on cerebrovascular diseases in
Sudan from an epidemiological and health-service point
of view, highlighting areas of information deficiency
and recommending health-system and research-based
interventions to improve cerebrovascular disease status in
Sudan.
Keywords:
cerebrovascular diseases, Sudan
Introduction
Cerebrovascular disease is defined by the World Health Organisation
as ‘rapidly developing clinical signs of focal (or global) disturbance
of cerebral function, with symptoms lasting 24 hours or longer or
leading to death, with no apparent cause other than of vascular
origin’.
1
Cerebrovascular diseases have contributed to 5.5 million
deaths globally in 2000, two-thirds of which were recorded in low-
and middle-income countries, and 40% of the subjects were less
than 70 years of age.
1
Results from recent studies in Africa indicate
the increasing burden from various types of cerebrovascular disease
and their risk factors.
2
Sudan is an African country with a population of 37 million
inhabitants. The majority of this population lives in the rural areas,
with only one-third living in urban areas. Sudan has a young
population, 29.1% of subjects are 30 to 70 years of age, of whom
16.4% are estimated to be younger than five years old and 42%
under 15 years. In Sudan, life expectancy at birth is 64.1 years and
its age-standardised mortality rate for non-communicable diseases
per 100 000 population is 551.
3
Such figures reflect the low health
standards experienced in all parts of Sudan, which are expected to
be worse in the poor and remote regions.
This article aims at providing a glimpse at the current situation
of cerebrovascular diseases in Sudan, based on relevant retrieved
and reviewed data from studies and reports, highlighting areas
of information deficiency and recommending health-system,
service and research actions for improving the health status and
outcomes of cerebrovascular diseases in Sudan.
Economic and social burden
Sudan is a low-income country with limited facilities and services
devoted to neurological healthcare. Cerebrovascular diseases, with
their consequent physical dependency and disability outcomes,
inflict high social and economic costs on people in Sudan.
4
A treatment requiring surgical intervention can be very
expensive, costing $1 000–2 000 on average. In the capital city,
Khartoum, where most secondary and tertiary services are located,
admission costs for intensive medical care range from $50 to $450
per day, including private and public care options. Rehabilitative
care is mainly provided by privately operated bodies who do not
offer free services. Besides, the facilities are limited and difficult to
access by those in the rural areas due to geographical challenges
and political instability in Sudan.
5
Disabilities caused by cerebrovascular diseases cause a serious
psychosocial burden in patients and their families. In Sudan,
families are large and all members shoulder the responsibilities
when any member of the family is ill. If the father, who is the
income earner, is ill, the family is more affected than if the mother
is indisposed. Medical handicaps in the bread winner may have
catastrophic consequences on the economic status of the family,
not to mention the time and energy needed from other family
members to care for the patient.
6
Epidemiology
Stroke is the main cause of cardiovascular disability-adjusted life
years (DALYs) in sub-Saharan Africa, with figures increasing from
5 930 040 (39.5%) in 1990 to 7 824 920 (52.0%) in 2010.
2
In
Sudan, cerebrovascular diseases contribute to one-third (31%) of
the medical admissions of elderly adults, with a DALY of 1 143.2
for ischaemic stroke.
4,7
Most of the studies aimed at identifying
risk factors among stroke patients report mortality rates that
are higher than in Western and wealthier countries.
4
Males are
more affected than females,
4,7
and the peak frequency of stroke is
45.8% in the age group from 61 to 80 years and above.
4
Despite the absence of statistics and studies on the prevalence
of cerebrovascular accidents (CVAs) in young Sudanese adult
patients, a systematic review on stroke in Arab countries, including
Sudan, revealed that six to 20% of patients with stroke are young.
8
Another study from Sudan’s western state, Darfur, reported 8%
of stroke cases among study subjects, including young patients,
were not fully investigated and diagnosed.
6
Considering the different types of CVAs, ischaemic stroke is