Stroke care in sub-Saharan Africa: Evaluating the present landscape and proposing strategies for improving outcomes

The burden of stroke is alarmingly high in sub-Saharan Africa (SSA), characterized by increasing trends in stroke incidence, prevalence, and mortality. This review details the landscape of stroke care in SSA, encompassing epidemiology, risk factors, care availability, and challenges in advancing stroke care, along with a proposed strategic framework for improvement. Epidemiological studies in SSA indicate a rising trend in stroke incidence and prevalence, with significant variability attributable to differences in study methodologies. Crude incidence rates have risen from an average of 53 (range: 26 101) cases/100,000 population between 1973 and 1991 to 88 (range: 25 149) cases/100,000 population between 2003 and 2011. Similarly, prevalence rates have shown an upward trend. Stroke mortality in SSA remains high, with variability across studies. Key predictors of mortality include hemorrhagic stroke, gender, National Institute of Stroke Scale score at presentation, and comorbidities such as anemia and human immunodeficiency virus infection. However, the interpretation of mortality rates warrants caution due to methodological limitations. Both modifiable and non-modifiable risk factors significantly contribute to stroke risk in SSA. Notably, stroke occurs at a younger age in SSA compared to Western countries. Hypertension, diabetes, dyslipidemia, and lifestyle factors are among the major modifiable risk factors. The availability of organized stroke care varies significantly across SSA, with more advanced care typically found in higher-level health-care centers. However, efforts to improve access and quality of care are ongoing. The challenges in advancing stroke care in SSA include cultural beliefs, limited access to care, and prohibitive costs. A 5 Ps framework involving collaboration among policymakers, payers, partners in health care, providers, and patients is proposed to improve stroke care. This review underscores the urgent need for enhanced public health strategies, medical interventions, and collaborative efforts to address the escalating stroke burden in SSA.