Stroke Services in São Tomé and Príncipe: Assessing the Quality of Care using the World Stroke Organization Roadmap

Reducing the burden of stroke in Sub-Saharan Africa is an urgent public health priority. São Tomé and Príncipe is a low and middle-income country in Sub-Saharan Africa, situated in the Gulf of Guinea off the west coast of Africa. Yet, no studies have been conducted on stroke care in São Tomé and Príncipe, nor has data about stroke care from the country been included in existing research on stroke in Africa. This quality improvement initiative aimed to assess the quality of stroke care in São Tomé and Príncipe, using the World Stroke Organization (WSO) Roadmap as a framework. From February to December 2024, we held virtual meetings to assess the provision of stroke and identify if recommended stroke standards were being met in the local context. We supported our data collection with publicly available, administrative health data and additional informal discussions with key local healthcare professionals in São Tomé and Príncipe. Data collection and analysis occurred simultaneously. Despite existing strengths in São Tomé and Príncipe’s healthcare system, our analysis indicated that the current level of health service capacity for stroke care is minimal, with pre-hospital and emergency care, acute inpatient stroke care, secondary stroke prevention, stroke rehabilitation, community reintegration and long-term recovery failing to meet the minimum standards set by the WSO. We propose immediate and long-term strategies to strengthen and guide the improvement of stroke care in São Tomé and Príncipe.