WSC 2025 | Barriers to acute stroke services in Sub-Saharan Africa

We all know that stroke is the second leading cause of death and the third leading cause of death and disability adjusted life years combined. And actually more than 80% of the burden of stroke is seen in low and middle-income countries. Staggering numbers are seen in Sub-Saharan Africa. Now there are so many challenges that are seen in terms of implementing acute stroke services in the region. One of it is beginning to establish systems. But what we know through the Tanzania Stroke Project is that it is possible. It’s not impossible. It’s very possible and it’s actually very impactful. So some of the challenges that we have is lack of stroke units, together with continuity of care and pathways to manage patients presenting with acute stroke. But this is an initiative that we’ve currently just begun. We’ve just recently launched stroke units through our project. And the plan is to scale up because there’s limited access to organized stroke unit care which is very essential in improving outcomes and reducing the number of deaths. The other major challenge we see is the delayed hospital presentation. So we need to really promote community advocacy because people do not understand when to refer patients. They probably don’t understand stroke symptoms and signs. So this needs to be addressed by extensive community advocacy because majority of our patients arrive after 24 hours from stroke symptoms and we all know that time is brain. So if you don’t intervene early, it means that there’s high risk of deaths but also poor functional outcomes leading to permanent disabilities which eventually leads to impaired quality of life because majority of strokes that occur in Sub-Saharan Africa affect younger individuals between 40 to 60 years of age and this age is prime and considered a prime age for the nation’s economy. So it’s taking a toll on countries in Sub-Saharan Africa. And the other issue we have is challenges to imaging because to make a diagnosis of stroke it’s a clinical diagnosis but to confirm it you need to have imaging as simple as CT scan. Now there’s limited access to CT scanners within the region of Sub-Saharan Africa. I know there are local initiatives from each country to address this by trying to scale up availability of CT scans and MRIs. But yeah those are some of the major challenges. But in terms of acute care we are also lacking enough human staff that comprise the stroke multi-disciplinary teams so we need to advocate for capacity building efforts to train stroke nurses, neurologists, physicians, who comprise the stroke part teams together with rehabilitation, which is very primed and a very important component in improving acute stroke services. The other challenge is the lack of data. So in order to improve practice or to improve systems you need to have evidence of where the problem is the magnitude of disease. So we are lacking surveillance systems such as registries to give us real-time data to guide policy changes and decision making. So at the moment these are some of the areas that need we need to focus on and majority of strokes that occur in sub-Saharan Africa or globally are preventable. 80% of these strokes are preventable. So we need to also advocate for primary preventive strategies to ensure early detection of modifiable risk factors such as hypertension, diabetes, which are a leading cause of strokes within the region.

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