Published in PLOS One on 2026-08-03, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Nyagwaswa Athanas Michael, Lilian Teddy Mselle, Costansia Anselim Bureta, Yingjuan Cao, Shashank Shekhar
Source: PLOS One • DOI 10.1371/journal.pone.0328334
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Stroke is a leading cause of death and disability worldwide, with the greatest burden occurring in in low- and middle-income countries. In Tanzania, delayed hospital presentation, weak referral systems, high out-of-pocket costs, shortages of stroke-ready facilities, and limited rehabilitation services contribute to preventable deaths and long-term disability. Although previous qualitative studies have described barriers to accessing stroke care services, there remains limited evidence on strategies for improving access across the continuum of stroke care. Therefore, this study explored strategies to ensure equitable access to stroke care services in Tanzania, focusing on the perspectives of healthcare providers, stroke survivors, and family caregivers.
A descriptive qualitative study was conducted at Muhimbili National Hospital– Mloganzila, a national tertiary referral hospital and designated stroke center in Tanzania. A purposive sample of 45 participants was recruited, including 15 healthcare providers, 15 stroke survivors, and 15 caregivers. In-depth semi-structured interviews were conducted between June and September 2024. Interviews were transcribed verbatim and analyzed using thematic analysis guided by the WHO health system building blocks framework.
Thematic analysis identified six themes aligned with the WHO health system building blocks. These include: (1) raise public awareness on stroke risks, prevention and treatment; (2) strengthen stroke care resources and infrastructures at primary care facilities; (3) increase healthcare financing and stroke services insurance coverage; (4) integrate health information systems in stroke care; (5) train multidisciplinary teams in stroke care and effective communication; and (6) improve stroke care services delivery across care continuum.
Improving access to stroke care requires both patient-centered and health system–level interventions across the continuum of care. Strengthening public awareness, healthcare infrastructures, referral pathways, service delivery, rehabilitation access, workforce capacity, and health insurance coverage may reduce inequities in accessing stroke care services in Tanzania.
Introduction
Stroke is a leading cause of death and disability worldwide, with significant burden in World Bank low- and middle-income countries (LMICs). Globally, more than 12 million new stroke cases and over 6.5 million stroke-related deaths occur annually, with nearly 86% of deaths and 90% of stroke-related disabilities occurring in LMICs [1]. Sub-Saharan Africa (SSA) carries a disproportionately high burden due to rapid urbanization, increasing prevalence of hypertension and diabetes, and weak healthcare infrastructure. The incidence and prevalence of stroke in SSA are estimated to be 316 and 1,460 per 100,000 people respectively, while the case fatality is more than 80% [2]. In Tanzania, in-hospital mortality rate is more than 30% especially among survivors who present late to tertiary care facilities [3].
Timely access to acute stroke care and rehabilitation services is essential for reducing mortality and improving functional outcomes. Emergency treatments such as thrombolysis can significantly reduce secondary brain injury and improve recovery when delivered within 4.5 hours of symptom onset [4]. Studies show that fewer than 10% of survivors with acute ischemic stroke in SSA receive treatment within the recommended 4.5 hours window, and only 19 countries have stroke units [5]. Recent surveys of stroke services in Tanzania found that only 2 hospitals had active stroke registries, 8 hospitals had dedicated stroke units, and only 5% of survivors present at the tertiary hospitals within 4.5 hours of symptom onset [3,6]. Furthermore, more than 30% of stroke survivors do not receive formal rehabilitation services after hospital discharge leading to poor recovery outcomes [7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Nyagwaswa Athanas Michael, Lilian Teddy Mselle, Costansia Anselim Bureta, Yingjuan Cao, Shashank Shekhar. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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