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BACKGROUND: Understanding the determinants of stroke prognosis and outcomes is crucial for guiding treatment decisions and recovery expectations. This systematic review aimed to synthesise the key determinants of health outcomes for stroke survivors (SSVs) in low- and middle-income countries (LMICs), with a particular focus on Africa. METHODS: This review adhered to the PRISMA guidelines and was registered on PROSPERO (CRD42025629244). Literature search was conducted using EBSCOhost, Scopus, and Web of Science databases for studies published from inception to April 14, 2025. Original researches on SSVs in Africa were included. Methodological quality was assessed using the Newcastle-Ottawa Scale. Data was analysed using a narrative synthesis and summarised in tables and texts. A random-effects meta-analysis was conducted to quantitatively synthesise the findings from the included reviews. RESULTS: The literature search identified 979 articles published between October 1987 and April 2025. Of these, 52 studies conducted in seven African countries met the inclusion criteria. Clinical determinants were reported in 40 studies, while 12 studies assessed psychosocial factors. Risks of bias were classified as low in 47 of the studies and moderate in the remaining five. The key clinical determinants of health outcomes were stroke severity/neurological status (n = 19), biomarkers and blood parameters (n = 18), and abnormal radiological/imaging findings (n = 10). The psychosocial determinants were mental health and emotional well-being, especially from social support (n = 6) and quality-of-life domains (n = 5). The overall pooled estimates of clinical risk factors among SSVs indicated a statistically significant association, with an odds ratio (OR) of 1.446 (95% CI: 1.202-1.739, P < 0.001) based on 11 studies. CONCLUSION: The determinants of health outcomes among SSVs in Africa are multifactorial. The significance of these findings highlights the critical importance of comprehensive management approaches that target key factors to enhance health outcomes and reduce the burden of stroke in Africa.
Odetunde et al. (Wed,) studied this question.