Factors associated with delayed hospital presentation following stroke in Senegal: a mixed methods study

Abstract

Timely presentation to specialized stroke centers after a stroke is crucial for stroke outcomes and long-term prognosis. In developing countries like Senegal, several barriers may hinder timely presentation after stroke but have not been extensively studied. Analyzing the factors contributing to delayed presentation will allow for the development of context-informed interventions to reduce the time to treatment and improve outcomes for stroke patients. We conducted a hospital-based mixed-methods study in the neurology departments in Dakar, Senegal, from January 2023 to January 2025. A cross-sectional study was conducted to gather quantitative data, while semi-structured qualitative interviews were conducted to collect qualitative data. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with delayed presentation. Qualitative data were analyzed using thematic analysis following a grounded theory approach. A total of 265 participants were included in the study with a mean age of 57.0642 ± 16.8786 [IQR 15–94]. Ischemic stroke was the most common type of stroke. Most patients (72.8%) presented outside the 4h30 minute time window. Factors associated with late presentation were stroke onset between 18:00–00:01 am (p = 0.001, OR 5.6, CI 2.1–15) and 12:00 and 17:59 pm (p = 0.012, OR 3.1, CI 1.3–7), arriving from a health center (p = 0.009, OR 3, CI 1.3–6.8), and arriving from another stroke-treating center (p = 0.027, OR 2.9, CI 1.1–7.6). Barriers to early presentation that emerged from the semi-structured interviews included limited awareness of stroke symptoms, traditional healers, lack of transportation means, severity of stroke, socioeconomic challenges, safety concerns, cultural beliefs, and healthcare system-related barriers. There are significant delays in presentation to stroke centers after a stroke in Senegal. These delays are influenced by the complex interplay of individual, sociocultural, and healthcare system-related factors. Addressing these multifaceted challenges requires a comprehensive approach involving patients, healthcare providers, policymakers, and communities.