THE AFRICAN STROKE ORGANIZATION CONFERENCE 2021: BUILDING CAPACITY, CAREERS, COLLABORATIONS, AND CONTRIBUTIONS

Abstract

The inaugural African Stroke Organization Conference (ASOC) aimed to create a forum to discuss the latest stroke science, highlight opportunities to address the high burden of stroke in Africa, develop a viable pipeline of emerging African stroke researchers, honor leading scientists and policy makers, and provide networking avenues to bolster future collaboration. Using a virtual platform, ASOC was held from Nov 3–4, 2021, and was attended by 236 participants. ASOC 2021 sessions included: (1) Osuntokun Award Lecture delivered by Prof. Richard Walker of Newcastle University; (2) Distinguished Policy Maker Lecture delivered by Dr. Raj Tajudeen of the African Centers for Disease Control and Prevention; (3) Invited presentations by prominent global stroke academicians on acute stroke, vascular malformations, vascular brain injury, Covid-19, nursing/allied care, rehabilitation/recovery, health services, imaging, pediatric stroke, precision medicine, and unusual causes of stroke; (4) six oral scientific abstract presentations; and (5) fifteen moderated oral poster presentations. Other sessions were (i) Vascular Brain Trust where early career African scholars presented manuscripts and grant proposals under development for feedback from seasoned researchers (ii) Moving on Up during which presentations were given to early career scholars about pathways for success in funding and advancement. A capstone event was the Frontiers of Research in Africa session which showcased the work and capabilities of 20 scientists and sites in Africa. All the ASOC sessions were lively and post-conference feedback from attendees showed high levels of satisfaction for the conference platforms and content. The ASOC marks a new dawn in the era of an escalating stroke burden in Africa, and it is anticipated to serve as a catalyst for exponentially building the capacity, careers, collaborations, and contributions of Africans to ameliorating stroke within and beyond the continent.

INTRODUCTION

Stroke remains a leading cause of death, disability, dementia and depression across the globe.^1,2 This burden is most severe in the lower and middle-income countries (LMIC) which accounts for 80%−89% of the share.³ The rise in the burden of stroke is most alarming in Africa where the rise is dramatic with the highest age-standardized stroke incidence rate of up to 316 per 100,000,prevalence up to 14.6 per 1,000 population⁴, and a 3-year mortality of up to 84%^5,6. On the other hand, over the last four decades, the incidence of stroke has declined in high-income countries because of heightened awareness and better control of vascular risk factors^4,7–9.

The African Stroke Organization Conference (ASOC) aims to address disparities in stroke research and research output, stroke services and foster a capable academic/professional workforce in Africa. ASOC has: 1) firm commitment from a team of mostly African distinguished academicians experienced with stroke research & practice within Africa; 2) robust professional development networking activities through in-person & online platform; 3) comprehensive program evaluation methods; 4) focus on stroke, a single major disease entity which substantially burdens Africans & can be studied from a variety of scientific and professional disciplines; 5) close collaboration with several prominent global & regional nongovernmental & governmental agencies, to provide an enrichment of events geared at facilitating discourse during ASOC & broadening the exposure of African trainees to important opportunities designed to lead to a successful research career in stroke research.

AFRICAN STROKE ORGANIZATION CONFERENCE 2021 PROCEEDINGS

The inaugural ASOC (The African Stroke Organization Conference) 2021 is the first-ever held annual transcontinental African stroke conference with an overarching goal to advance the quality and quantity of stroke research in Africa by creating a cross-national multidisciplinary scientific forum focused on progress and priorities of cerebrovascular disease research and management in Africa, which could have an impact on lessening the overall societal toll of stroke and reducing the disproportionate burden of stroke in Africa compared to the rest of the world.¹⁰ ASOC was organized with the intent of bringing together key stakeholders, identifying gaps in knowledge, setting priorities for stroke care delivery, research and accelerating translation of research findings to improve stroke outcomes in the region.¹⁰ ASOC is a collaborative initiative with the World Stroke Organization, World Federation of Neurology, Global Alliance for Chronic Diseases, World Hypertension League, African Academy of Sciences, & African governmental agencies, local academic institutions and local teaching hospitals (Table 1). The 2-day virtual conference focused on stroke epidemiology, community awareness, and stakeholder engagement in Africa.¹⁰ and was planned for implementation after the launch of the ASO in October 2020,^11,12 ASOC 2021 was held as a 2-day virtual African-wide conference on a vFairs online integrated pre-recorded and live platform. The conference took place on November 3–4, 2021.

Table 1.

African Stroke Organization 2021 Partner Organizations

Name	Description
African Academy of Neurology (AFAN)	• Represents and unifies all African Neurologists through their National Neurological Societies, towards optimal neurological education and advancement of Neurosciences.
Society of Neuroscientists of Africa (SONA)	• Umbrella organization for regional and national neuroscience societies in Africa. Mandate is to promote research & teaching in neuroscience in Africa.
World Stroke Organization (WSO)	• >4000 individual members & >60 society members from 85 different countries. Mission is to reduce global burden of stroke through prevention and, treatment.
World Federation for Neurorehabilitation (WFNR)	• Aims to advance quality of neurological rehabilitation across the world, stimulate collaboration, & facilitate exchange of knowledge and scientific research.
World Hypertension League (WHL)	• 60 national & regional hypertension organizations dedicated to prevention & control of hypertension, especially healthy environment & knowledge translation

1. Conference Planning Committee

Drs Ovbiagele (chair) and Owolabi (Co-chair) led the Conference Planning Committee (CPC). The ASOC chairs have conducted successful conferences (e.g. International Stroke Conference, African Neurorehab Conference) in the past & both have extensive research and leadership experience. Drs. Ovbiagele & Owolabi have an established working relationship in authoring peer-reviewed publications, co-leading NINDS grants (6 together), as well as a long track record of mentoring trainees & junior faculty on published papers & funded trainee research. In addition, members of the CPC (Ovbiagele, Owolabi, Akinyemi, Sarfo and Gebreyohanns) have extensive stroke research experience in Africa with outstanding publication records. Each CPC member is an established scientist with complementary expertise and experience in key areas of advancing stroke research and practice in Africa. The CPC and its members developed the conference agenda and designed its implementation, identified scholars, graded submitted abstracts, reviewed evaluation reports, made recommendations, facilitated discussions, and led individual fora at the conference. Additional individuals were sought to serve as ASOC collaborators and facilitators throughout the planning process.

2. Conference Announcement and Dissemination

ASOC was publicized via an extensive network of communication including a Letter to the Editor in scientific journals¹³, electronic mailings, the ASO Website, ASO quarterly webinars, and social media networks such as Facebook, WhatsApp and Twitter where dedicated ASO and ASOC 2021 accounts were created. The CPC members also used their wide network of affiliations with professional societies and academic institutions to disseminate the announcements. Members of Cross-National Associations in Table 2 received announcements of the meeting. Notice of meeting was included in Fogarty International Center newsletter. Announcements of the meeting were sent to teaching hospitals throughout Africa via emails and local societies as identified. ASOC 2021 also partnered with the Journal of Stroke & Cerebrovascular Diseases, which will be publishing a manuscript written by Dr. Richard Walker, the pioneer recipient of the Osuntokun Award Lecture. Other abstracts accepted for oral presentation at the conference will also be published in a special edition of the journal. The ASOC 2021 website URL is: https://asoc2021.vfairs.com/.

Table 2.

Plenary Presentations and Invited Lectures at the African Stroke Organization 2021

Name/Affiliation	Title
Raj Tajudeen African Centers for Disease Control and Prevention	“Tackling Non-Communicable Diseases during COVID-19 Pandemic and beyond: The Role of Regional Health Organizations”
Richard Walker Newcastle University, United Kingdom	“The challenges of measuring the burden of stroke in sub-Saharan Africa: personal reflections”
Pooja Khatri University of Cincinnati, USA	“Treatment of Acute Stroke in 2021: Practical Considerations and Future Directions”
Babu Welch University of Texas, Southwestern, USA	“Aneurysms and Vascular Malformations: Surgical and Endovascular Therapies Relevant to Low to Middle Income Countries”
David Good Penn State University, USA	“Delivering State of the Art Rehabilitation Services With Limited Resources”
Stephanie Debette University Paris Diderot, France	“Genomics, integrative Multi-omics and Precision Stroke Medicine: Relevance to Low- to Middle Income Countries”
Shehu Umar Bayero University, Nigeria	“Primary stroke prevention in children with sickle cell anemia: the result of the SPRING randomized controlled trial”
Mark Alberts Hartford HealthCare Neuroscience Institute, USA	“Formation and Challenges of Stroke Systems of Care in Developing Countries”
David Liebeskind University of California, Los Angeles, USA	“Collateral Blood Flow in Acute Ischemic Stroke”
Philip Gorelick Northwestern University, USA	“Vascular Risks and Brain Health Across the Life Course”
Carolyn Jenkins Medical University of South Carolina, USA	“Learning and Working with Communities to Improve Stroke Outcomes—Messages from our Communities”
Luciano Sposato Western University, Ontario, Canada	“COVID-19 and Stroke”
Jose Biller Loyola University, Chicago, USA	“Uncommon Causes of Stroke: Non-Atherosclerotic Cerebral Vasculopathies Potpourri”
Richard Benson and Kathleen Michels National Institutes of Health, USA	Global Health Funding Opportunities
Bamidele Tayo Loyola University, Chicago, USA	Finding the Right Mentor or Collaborator

3. Symposium Agenda

A. Invited Speakers

The ASOC speakers were selected from among the most productive and relevant scientists in the relevant fields covered by the conference (Table 2). With lectures given to all attendees, there were many opportunities for cross-pollination. Meeting attendees networked via a virtual lounge chat room, posted questions and poster sessions, participated in the Q&A after scientific presentations and interacted during career development sessions. Thus, each of the invited speakers was available on several occasions for networking and stayed throughout the entire meeting.

B. The Osuntokun Award Lecture

The Osuntokun award recognizes lifetime contribution to stroke research in Africa., This award is appropriately named after the preeminent African Scholar and Neuroepidemiologist, Professor Benjamin Oluwakayode Osuntokun who was a founding member of the Pan African Association of Neurological Sciences who led some of the earliest epidemiological studies of stroke in Africa.^14,15 The inaugural lecture was delivered by Professor Richard Walker who has published the largest ever incidence study of stroke in Africa.¹⁶

C. Travel Awards

The original proposal for the conference envisioned awarding travel scholarships to 20 Young Investigators from the African Continent. However, that was not possible because of the emergence of the COVID-19 pandemic, which made large live gatherings and transnational travel impossible. The CPC envisions future conferences to feature hybrid versions of live and virtual platforms allowing for travel and face-to-face interactions. We received 40 abstracts eligible for consideration from early career African investigators with the overwhelming majority residing in Africa, with very few from residents outside the continent. The abstracts were evaluated by the CPC for scientific rigor, innovation and relevance and ranked accordingly. The top six presented full oral presentations; the next 15 were oral presentations in poster format; and the last 16 were Posters on Parade displayed in the virtual conference hall viewed at any time.

D. Moderated Oral Abstract Sessions

Two thirty minutes sessions over the consecutive 2 days were held, featuring 3 presenters each day and a moderator. The sessions were open to everyone, and the presenters responded to questions collected from the audience by the moderators through the chat box.

E. Moderated Sessions for Oral Presentations in Poster Form

Two sixty minutes sessions over the consecutive 2 days were held, featuring 7–8 presenters each day and a moderator. The sessions were open to everyone, and the presenters responded to questions collected from the audience by the moderators through the chat box.

F. Frontiers of Research in Africa Session: Showcase of Scientists and Sites

Stroke researchers in Africa delivered 5-minute overviews about their research personnel, infrastructure/resources, capabilities, accomplishments, current/previous investigations, interests and opportunities at their institutions/sites. The session was facilitated by Dr. Bruce Ovbiagele and provided an opportunity for various scientists largely working independently to see what others in Africa were doing and identify avenues for intracontinental collaboration. Already within a month of ASOC 2021 completion an opportunity to collaborate on a registry is being explored. Other opportunities are anticipated.

G. Networking Sessions

Vascular Brain Trust:

Early Career African scholars presented manuscripts or grants in development and receive feedback from established stroke researchers. The session was moderated by Drs Fred Sarfo and Rufus Akinyemi. The presenters found the feedback particularly very helpful in further shaping the development of the ideas presented.

Moving On Up:

Early Career Development Presentations and Discussions led by funding agency leaders and seasoned mentors. ‘Finding the Right Mentor and Collaborator’ was discussed by Bamidele Tayo of Loyola University; and ‘NIH Global Health Opportunities’ was discussed by Richard Benson and Kathleen Michels of the NIH. The session was co-sponsored by the World Hypertension League and moderated by Drs. Daniel Lackland and Mehari Gebreyohanns (Table 3).

Table 3.

Career Development and Networking Sessions at the African Stroke Organization 2021

Title	Overview
“Abstract Presentations	• Oral Presentations in Slide and Poster format by early career scholars selected through a competitive review process
“Vascular Brain Trust”	• Early Career African scholars present manuscripts or grants in development and receive feedback from established stroke researchers
“Moving on Up”	• Early Career Development Presentations and Discussions led by funding agency leaders and seasoned mentors
“Frontiers of Stroke Research in Africa: Showcase of Scientists and Sites”	• Presenters in Africa will deliver 5 minute overviews about their stroke research personnel, infrastructure/resources, capabilities, accomplishments, current/previous investigations, interests and opportunities at their institutions/sites.
“Posters on Parade”	• Dedicated Section on Conference website where attendees can view accepted posters of studies led by early career African scholars at any time

H. Conference Attendance and Feedback

Of the 236 registered attendees at ASOC 2021, 76 were female (32%), 118 were male (50%) and 42 preferred not to respond (18%). Physician participants: 76; Nursing participants: 9; Researchers: 8; Other healthcare professionals: 11; Health Administration/Faculty: 47; Residents/Fellows: 12; Medical School//Masters/PhD Student: 13; Other Professionals: 18

DISCUSSION

Tackling the rapidly increasing burden of stroke in Africa is at the heart of the African Stroke Organization (ASO) vision.^11,12 ASOC 2021 has proven to be a successful vehicle towards the actualization of this central goal by debuting the scholarly work of African researchers, clinicians, and other health-care professionals.¹¹ The ASOC 2021 activities were consistent with ASO’s conceptual framework which has four key operational pillars ‘(1) stroke research, (2) capacity building, (3) development of stroke services, and (4) advocacy and collaboration with all stakeholders’. Future annual ASOC meetings will build on the success of this year’s event and strive to attract more collaborators in designing even better programming. Possible areas of focus in subsequent years include 2022: Clinical Trials & Implementation Science; 2023: Systems of Care, Capacity Building, Policymaking, Scaling Up and Surveillance. If situations with the state of the pandemic improve enough, we envision future live meetings in Africa as originally planned.¹¹

According to current projections, over the coming decades the burden of stroke in Africa will increase because of adoption of western lifestyles, increasing urbanization, lack of risk awareness and poor healthcare infrastructure⁵. It is also estimated that there will be an increase by 68% from 75 million in 2008 to 126 million people in Africa with hypertension in 2025 ⁹. Therefore research conducted in Africa is a top priority in developing interventions to fight the growing burden of stroke¹⁰. A lack of appropriate guideline-based treatment plans by providers was found to be a major reason for not adhering to antihypertensive medications in Nigeria, according to a study¹⁷. This health maintenance demand and the overall workload it creates is not matched by trained health workers to care for chronic diseases such as stroke in African countries where the ratio of those workers to the population is 0.8 per 10,000. In Africa, the neurologist to population ratio ranges from 1 per 162,885 persons to zero in 11 countries. This is in contrast to the US with 1 per 29,200 persons¹⁸,while the ratio for physiotherapists and occupational therapists per 100,000 people served is 2.5 and 2 respectively. The shortage of trained work force in Africa is further exacerbated by brain drain¹⁹ leaving stroke prevention and treatment to fewer providers^9,20,21.

The gap in knowledge about risk factors for stroke among people in Africa is a barrier in designing appropriate guidelines that are geared to the population.

Despite the enormity of the burden in Africa from non-communicable diseases (NCDs), the research output from scholars in the region is abysmally low; for a global population share of 12% producing only <1% of the world’s research output; low even when compared to those from countries such as Vietnam and Malaysia²². This is evidenced by the severely low proportion of research by African scholars at (3.9%), over 70% from collaborators in western countries.

Furthermore, the intra- and inter-African collaborative research is a mere 0.9–2.9% of the total research output from the continent resulting in lack of implementation of evidence-based practices for the region. It has been proposed that fostering career pathways is an important and practical solution for augmenting research capacity in Africa, by the Global Forum for Health Research, Council on Health Research for Development and UNICEF/UNDP/ World Bank/WHO Special Program for Research and Training in Tropical Diseases²³.

African scholars continue to strive to develop culturally appropriate stroke education tools in native languages^24–26 and publish important information about the unique characteristics of stroke in the region^27,28 in order to design appropriate interventions.

ASOC 2021 has been successful in highlighting the future success of addressing stroke in Africa is through capacity building, utilizing the scholarship of Africans and their collaborators throughout the world. It made the scientific contributions by African researchers, giving vigor and energy to scholarship, which is needed to be produced in the continent. It effectively leveraged the talents and resources in the continent as a forum where the challenges of addressing the rising burden of stroke are front and center. Connections were made by bringing together African scholars in the continent and opportunities to collaborate among researchers within the continent and across the globe were enhanced. The networking opportunities in this conference provided mechanisms especially on career development by introducing funding opportunities and introducing potential collaborators to ongoing stroke research in the continent. The role of social networking, especially in dedicated forums is crucial in reducing social isolation among scientists and creating opportunities to discuss science.²⁹ Such forums also provide an effective medium for teaching and mentoring.²⁹ Indeed, it is a new dawn for stroke in Africa.¹²