Management and neuromarkers of glioblastoma in Sub-Saharan Africa: A narrative review of published literature and regional data

Glioblastoma is the most common and aggressive primary brain malignancy in adults. While therapeutic advances have improved outcomes in high-income countries, the situation in Sub-Saharan Africa remains challenging. Limited diagnostic infrastructure, restricted access to neurosurgical and radiotherapy facilities, and high treatment costs contribute to poor survival and quality of life. This narrative review synthesises published literature and regional data on glioblastoma management and neuromarkers in Sub-Saharan Africa, drawing on peer-reviewed studies, institutional reports, and relevant policy documents. The review explores current diagnostic and therapeutic practices, workforce capacity, and emerging innovations, including the potential role of artificial intelligence in improving care delivery. Precise epidemiological data on glioblastoma burden in Sub-Saharan Africa are unfortunately limited, owing to underdeveloped cancer registration systems and diagnostic gaps; this substantially constrains the evidence base available. Diagnostic delays are common due to inadequate access to advanced neuroimaging and neuropathology services. Surgical resection remains the cornerstone of management, but most patients present with advanced disease and receive incomplete treatment. Radiotherapy and chemotherapy availability are limited, with marked regional disparities. High costs, equipment shortages, and workforce constraints further restrict adherence to international treatment standards. Multidisciplinary and palliative care services are underdeveloped, although telemedicine and artificial intelligence-supported approaches show emerging potential to bridge gaps in expertise and access. The immediate priorities for improving care in the region are expansion of neurosurgical capacity with improved operative outcomes, radiotherapy infrastructure development, and access to at least a minimum panel of molecular markers, particularly MGMT promoter methylation testing, to guide evidence-based use of temozolomide. Glioblastoma management in Sub-Saharan Africa remains severely constrained, but progress is achievable through targeted health system strengthening and responsible adoption of digital innovation. A realistic and phased regional strategy, centred on hub-and-spoke service delivery models and grounded in infrastructure development, workforce training, and multidisciplinary collaboration, offers the most practical path toward improved outcomes and equity in neuro-oncology care across the continent. Artificial intelligence and telemedicine, while promising, are best viewed as complementary tools within this broader strategy rather than primary solutions.