Delays in the Stroke Care Pathway in a Low-Income Setting: An Audit Study from Mozambique

Helena Buque (), Lee Smith, Dino Lopes, Damiano Pizzol, Elder Lorenzo, Nachan Arroz, Lazara Bacallau, Mohsin Sidat, Evangelina Namburete Bauaze and Hipólito Nzwalo ()
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Helena Buque: Neurology Department, Maputo Central Hospital, Maputo 1100, Mozambique
Lee Smith: Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
Dino Lopes: Emergency Department, Maputo Central Hospital, Maputo 1100, Mozambique
Damiano Pizzol: Health Unit, Eni, Maputo 1100, Mozambique
Elder Lorenzo: Neurology Department, Maputo Central Hospital, Maputo 1100, Mozambique
Nachan Arroz: Neurology Department, Maputo Central Hospital, Maputo 1100, Mozambique
Lazara Bacallau: Neurology Department, Maputo Central Hospital, Maputo 1100, Mozambique
Mohsin Sidat: Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo 1100, Mozambique
Evangelina Namburete Bauaze: Faculty of Health Sciences, Catholic University, Beira 821, Mozambique
Hipólito Nzwalo: Ageing and Cerebrovascular Research Group, ABC Research Institute, Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal

IJERPH, 2025, vol. 22, issue 7, 1-9

Abstract: Background: The burden of stroke is on the rise in low-income countries (LICs). Organized stroke care (OSC) is crucial for improving outcomes in LICs and is the very first step to reducing delays in diagnosis and treatment. We aim to evaluate delay times (DT) in accessing OSC at the national reference hospital of Mozambique, a LIC from southern Africa. Methods : An observational study based on consecutive case series of 59 stroke patients confirmed by computed tomography (CT) scans over a period of 3 months (May–July 2023). The total DT (from stroke onset to inward hospitalization) was the main outcome. Other specific DTs were analyzed including initial symptoms to arrival and admission (DT0), arrival to CT scans (DT1), arrival of laboratory results (DT2), and arrival to inward hospitalization (DT3). Results: The mean age was 61.9 (min 30–max 90) and 45.8% were female. The median total DT was 20 h. The median time DT0 was 10.6 h (interquartile range (IQR): 16.48). The median DT1 and DT2 were 4 h (IQR: 3.5) and 5 h (IQR: 2.6), respectively. The median DT3 was 10 h (IQR: 4). None of the patients were treated under a stroke code. Conclusions: This study reveals an unacceptable prehospital and in-hospital DT. Waiting for the CT scan contributed to a large proportion of the total DT, which among other factors can be explained by the absence of a stroke code and limited imaging capacity. These findings mirror disparities in stroke care seen in other LICs, where late presentation, scarce imaging, and limited specialized protocols are common. The urgent implementation of organized prehospital and in-hospital stroke pathways is needed in Maputo to improve outcomes.

Keywords: stroke care; treatment delays; low income; Mozambique (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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