Rising stroke burden in Uganda: A national time-series analysis and forecasts, 2016–2028
7 affiliations
- 1Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- 2Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda
- 3African Population and Health Research Centre, Nairobi, Kenya
- 4Institute of Mathematical Sciences, Strathmore University, Nairobi, Kenya
- 5College of Computing and Information Sciences, Makerere University, Kampala, Uganda
- 6Infectious Diseases Institute, Makerere University, KampalaUganda
- 7Committee on Data of the International Science Council – CODATA, Paris, France
Abstract
Introduction: Stroke is a leading cause of mortality and disability globally, with a disproportionate and growing burden in low- and middle-income Countries. However, evidence on national temporal trends and potential impacts in Uganda remains limited. This study examined trends in stroke cases and deaths in Uganda and forecast of future stroke burden through December 2028. Methods: We conducted a retrospective time-series analysis of District Health Information System (DHIS2) from 2016 to 2025. Monthly stroke cases, and deaths were analyzed. Monthly populations of Uganda were estimated using exponential growth interpolation and incorporated as an offset term in Bayesian negative binomial regression models to estimate incidence rate ratios (IRR) at 95% confidence interval (CI). Decomposition analysis using the Kitagawa method was applied to derive contributions from population growth and epidemiological change, based on model estimates. Stationarity and autocorrelation were assessed using the unit root and Ljung–Box tests. Forecasting was performed using the exponential smoothing state-space (ETS) model at 80% prediction intervals (PI). Results: Trend analysis showed sustained monthly increases in stroke incidence and mortality with IRR; 1.005 (95% CI: 1.004–1.006), and 1.006 (95% CI: 1.005–1.007), respectively (all p < 0.001). The epidemiological effect was approximately twice as large as the population effect, indicating that the majority of the increase in stroke cases and deaths is attributable to rising incidence rates rather than population growth alone. ETS model demonstrated that by December 2028, monthly cases and deaths are projected to reach approximately 927 (80% PI: 709–1,156) and 126 (80% PI: 94–160), respectively. Conclusion: Stroke burden in Uganda is projected to continue increase further over the next years in the absence of effective prevention measures. Strengthened primary prevention, expanded acute stroke care capacity, and improved surveillance systems are urgently needed to mitigate the growing health system impact.
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BibTeX
@article{nakasendwa2026rising,
title = {{Rising stroke burden in Uganda: A national time-series analysis and forecasts, 2016–2028}},
author = {Suzan Nakasendwa and Joan Nankya Mutyoba and Alex Riolexus Ario and Evans Omondi and Brenda Birungi Bashemera and Francis Kakooza and Letisha Najjemba and Joyce Nakatumba Nabende and David Guwatudde and Agnes Kiragga},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0360963},
url = {https://doi.org/10.1371/journal.pone.0360963},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Rising stroke burden in Uganda: A national time-series analysis and forecasts, 2016–2028
AU - Suzan Nakasendwa
AU - Joan Nankya Mutyoba
AU - Alex Riolexus Ario
AU - Evans Omondi
AU - Brenda Birungi Bashemera
AU - Francis Kakooza
AU - Letisha Najjemba
AU - Joyce Nakatumba Nabende
AU - David Guwatudde
AU - Agnes Kiragga
PY - 2026
DA - 2026/10/16
JO - PLOS One
DO - 10.1371/journal.pone.0360963
UR - https://doi.org/10.1371/journal.pone.0360963
AB - Introduction: Stroke is a leading cause of mortality and disability globally, with a disproportionate and growing burden in low- and middle-income Countries. However, evidence on national temporal trends and potential impacts in Uganda remains limited. This study examined trends in stroke cases and deaths in Uganda and forecast of future stroke burden through December 2028. Methods: We conducted a retrospective time-series analysis of District Health Information System (DHIS2) from 2016 to 2025. Monthly stroke cases, and deaths were analyzed. Monthly populations of Uganda were estimated using exponential growth interpolation and incorporated as an offset term in Bayesian negative binomial regression models to estimate incidence rate ratios (IRR) at 95% confidence interval (CI). Decomposition analysis using the Kitagawa method was applied to derive contributions from population growth and epidemiological change, based on model estimates. Stationarity and autocorrelation were assessed using the unit root and Ljung–Box tests. Forecasting was performed using the exponential smoothing state-space (ETS) model at 80% prediction intervals (PI). Results: Trend analysis showed sustained monthly increases in stroke incidence and mortality with IRR; 1.005 (95% CI: 1.004–1.006), and 1.006 (95% CI: 1.005–1.007), respectively (all p < 0.001). The epidemiological effect was approximately twice as large as the population effect, indicating that the majority of the increase in stroke cases and deaths is attributable to rising incidence rates rather than population growth alone. ETS model demonstrated that by December 2028, monthly cases and deaths are projected to reach approximately 927 (80% PI: 709–1,156) and 126 (80% PI: 94–160), respectively. Conclusion: Stroke burden in Uganda is projected to continue increase further over the next years in the absence of effective prevention measures. Strengthened primary prevention, expanded acute stroke care capacity, and improved surveillance systems are urgently needed to mitigate the growing health system impact.
SN - 1932-6203
ER -