Development of an inclusive and cost-effective Afrocentric predictive model for stroke: A novel approach

Abstract Background: Prediction of stroke is indispensable for the initiation of the necessary preventive and prophylactic measures. The conspicuous omission of African data in most of the validated prediction models questions their appropriateness for the region. This study therefore aimed to develop an inclusive and cost-effective Afrocentric predictive model for stroke (CAPMS). Methods and Analyses: We employed an evidence synthesis approach namely meta-analysis structured as per the Preferred Reporting Item for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We searched PubMed, Scopus, African Journals, Medline, Cochrane Library, Web of Science and Cumulative Index for Nursing and Allied Health Literature, from inception to date. Case-control and cohort studies that reported the risk factors of stroke and corresponding risk estimates were included. Screening of the titles and abstracts was undertaken by two independent reviewers. We conducted meta-analyses using Comprehensive Meta-analysis (CMA) version 3. Result: Majority of the eligible studies (>50%) investigated both ischemic and haemorrhagic stroke. In Africa, more than 20 risk factors of stroke were identified however only 18 met the eligibility for meta-analysis. Our findings shows that homocysteine (Rw = 13.9, Ri = 0.67), hypertension (Rw = 5.6, Ri =0.94) and cardiac events (Rw =3.1, Ri = 0.8) were the three most powerful independent predictors of stroke in Africa. Low consumption of green vegetables (Rw =2.4, Ri = 1.0), stress (Rw = 1.76, Ri =1.0) and hypertension were the most clinically responsive risk factors of stroke. All biomarkers except homocysteine were cost-effective having an investigative price of less than $13.6. Critical risk point was fitted at the 90th percentile being 12.7. The cumulative Rw and investigative costs of CAPMS 1 (15.8 and $2.4) and CAPMS 2 (14.9 and $7.2) showed good performance index and cost-effectiveness. Conclusion: Targeted screening with the CAPMS 1 & CAPMS 2 model represents cost-effective innovation in practice of stroke screening in African clinics and communities. We recommend immediate validation of CAPMS to ascertain its performance, feasibility and acceptability in the region.