Abstract Number: Esoc2026a1284 Are Onset-to-Door Times Delayed in Adults With Stroke Living in Africa? - A Systematic Review

Abstract Background and aims Stroke incidence in Africa is among the highest worldwide. Early hospital presentation improves outcomes, but delays are common. However,there is no comprehensive review of studies characterizing onset-to-door times in Africa. This review aimed to evaluate onset-to-door times for stroke patients in Africa to inform public health strategies and interventions. Methods Multiple (ten) electronic databases were searched for studies published from 2000 onward, with no language restrictions. Title, abstract, and full-text screenings and data abstraction were conducted independently by two reviewers, with disagreements resolved by discussion or a third reviewer. Reasons for study exclusions were documented. Results Out of 4,449 studies identified, 57 met inclusion criteria, covering 16 African countries across all regions. The combined sample size was 19,093 (53.5% male, mean age 59.6 years ± 11.76). Onset-to-door time reporting was inconsistent: 40 studies reported mean times ranging from 3 to 125 hours, and 17 reported median times between 8 and 72 hours. Imaging was reported in 52 studies with mean time to imaging being 28 hours. 38 studies reported reasons for delays. Most common reasons were low awareness and recognition of stroke symptoms, limited literacy, and poor access to transportation. Conclusions There was considerable heterogeneity in studies however, substantial delays in presentation to health facilities were consistently observed, with many patients arriving outside the recommended therapeutic window for acute interventions. These findings highlight the urgent need for targeted interventions to improve early stroke recognition, strengthen referral systems, and optimize in-hospital stroke management pathways in Africa. Conflict of interest Sylvia Tawiah-Eshun. nothing to disclose