article · Equity Neuroscience
Sub-Saharan Africa faces very high stroke mortality, with Nigeria reporting estimated one- and three-year mortality rates of 40% and 80%. A focus group study involving 35 healthcare professionals, stroke patients, and caregivers in Kano, Nigeria, examined gaps across stroke prevention, acute management, and rehabilitation to inform the development of a low-resource stroke unit. Combined with a literature search of regional barriers, the assessment identified five primary challenges: delays in accessing care, significant resource limitations, financial and sociocultural barriers, gaps in rehabilitation services, and opportunities for system-wide improvements. These findings mirror broader patterns across sub-Saharan Africa. Addressing these gaps requires prioritising feasible, system-level interventions, with low-resource stroke units highlighted as a potentially cost-effective pathway to enhance acute treatment, prevention, and rehabilitation.
Stroke is a leading cause of severe disability and mortality in sub-Saharan Africa, where long-term survival rates remain exceptionally low. Identifying the specific operational, financial, and cultural obstacles faced by clinicians, patients, and families helps healthcare providers and policymakers design realistic interventions. Cost-effective models like low-resource stroke units offer a practical approach to improving patient survival and long-term outcomes in settings with limited healthcare infrastructure.
The findings support the design and deployment of low-resource stroke unit models tailored for hospitals in developing health systems. Intended users include hospital administrators, clinical care teams, and public health planners looking for cost-effective care pathways. Based on the abstract, the research represents an early-stage qualitative assessment intended to inform the implementation phase of a low-resource stroke unit study.
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Background Globally, sub-Saharan Africa (SSA) has some of the highest stroke mortality rates. In Nigeria, for example, 1- and 3-year stroke death rates are estimated at 40% and 80%, respectively. Purpose To explore perceptions of acute stroke care barriers among healthcare professionals, patients, and caregivers in Kano, Nigeria, and to contextualize these findings within the literature from SSA. Methods We carried out focus groups to determine gaps in acute stroke treatment, management, prevention, and rehabilitation. The current study was carried out as part of a larger study to inform the low-resource stroke unit (LRSU) phase of the study. A moderator and translator attended each of 5 group sessions, and tailored, open-ended questions were answered by the participants. In addition, we carried out a literature search of barriers to acute stroke care in SSA. Results A convenience sample of 35 participants including 2 consulting neurologists of which 1 doubled as an administrator and 5 resident physicians, 7 nurses, 7 physiotherapists, 7 patients who had a stroke, and 6 caregivers, participated in focus group discussions. Five main overlapping themes regarding gaps in acute stroke care emerged: delays in access to care, significant resource limitations, financial and sociocultural barriers, gaps in rehabilitative services, and opportunities for system-wide improvements. Our main findings about barriers to stroke care share many similarities to other recent studies in SSA. Conclusion The findings support the prioritization of feasible, system-level strategies to improve stroke prevention, acute stroke treatment, and rehabilitation services in Kano and similar low-resource settings. LRSUs may provide a cost-effective pathway to help achieve this end.
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DOI: 10.1016/j.neuros.2026.100068
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