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Background The epidemiology of stroke in sub-Saharan African populations and variation of subtypes between communities are not well understood. Our aim was to ascertain prospectively the incidence of first-ever stroke and ischemic stroke subtypes in an urban city population of Southwestern Nigeria. Methods A community-based stroke registry was set up to enroll hospitalized and nonhospitalized first-ever stroke cases at all health care facilities located in the assigned community. The study was conducted between November 1, 2010, and October 31, 2011, in Akure North and South Local Government Areas of Ondo State, Southwestern Nigeria. Results We identified 298 incidents of strokes in patients presenting for the first time ever. Pathologic diagnosis was confirmed in 75% of the cases. Adjusted age-standardized incidence rate was 60.67 per 100,000 per year after adjustment to the World Health Organization World Population. Incidence of cerebral infarction and intracerebral hemorrhage increased with age in both men and women. Conclusions The incidence of stroke in our population-based study ranks low compared with high-income countries. However, when incidence rates were compared by pathologic type, our rates for intracerebral hemorrhage and that of subarachnoid hemorrhage are comparable with those of high-income countries. [ABSTRACT FROM AUTHOR]