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Advanced Neurology

REVIEW ARTICLE
Stroke care in sub-Saharan Africa: Evaluating the

present landscape and proposing strategies for
improving outcomes

Felix E. Chukwudelunzu * and Amir A. Mbonde 2
1
1 Department of Neurology Mayo Clinic Health System, Eau Claire, Wisconsin, United States of America
2 Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
(This article belongs to Special Issue: Advances in stroke research and therapy)

Abstract

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
*Corresponding author:
Felix E. Chukwudelunzu anemia and human immunodeficiency virus infection. However, the interpretation of
(chukwudelunzu.felix@mayo.edu) mortality rates warrants caution due to methodological limitations. Both modifiable
and non-modifiable risk factors significantly contribute to stroke risk in SSA. Notably,
Citation: Chukwudelunzu FE,
Mbonde AA. Stroke care in sub- stroke occurs at a younger age in SSA compared to Western countries. Hypertension,
Saharan Africa: Evaluating the diabetes, dyslipidemia, and lifestyle factors are among the major modifiable risk
present landscape and proposing factors. The availability of organized stroke care varies significantly across SSA, with
strategies for improving outcomes.
Adv Neuro. 2024;3(2):2804. more advanced care typically found in higher-level health-care centers. However,
doi: 10.36922/an.2804 efforts to improve access and quality of care are ongoing. The challenges in advancing
Received: January 23, 2024 stroke care in SSA include cultural beliefs, limited access to care, and prohibitive costs.
A “5 Ps” framework involving collaboration among policymakers, payers, partners
Accepted: March 20, 2024
in health care, providers, and patients is proposed to improve stroke care. This
Published Online: May 30, 2024 review underscores the urgent need for enhanced public health strategies, medical
Copyright: © 2024 Author(s). interventions, and collaborative efforts to address the escalating stroke burden in SSA.
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution Keywords: Sub-Sahara Africa; Stroke care; Epidemiology; Stroke burden; Review article
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited.
1. Introduction
Publisher’s Note: AccScience
Publishing remains neutral with Stroke is a common neurological disorder associated with high morbidity and mortality
regard to jurisdictional claims in
published maps and institutional rates. The 2019 Global Burden of Disease Study estimated that there were more than
1
affiliations 12 million new stroke cases globally. There were six and half million stroke-related
Volume 3 Issue 2 (2024) 1 doi: 10.36922/an.2804