Timeliness of acute stroke care and predictors of delays in three referral hospitals in Douala, Cameroon: a multicenter cross-sectional study

Abstract Background Timely access to evidence-based acute stroke care is essential for reducing disability and mortality, yet substantial delays persist in many low- and middle-income countries. Data on the timing of acute stroke care in Cameroon remain scarce. This study assessed the timeliness of acute stroke care and identified factors associated with delays in the care pathway in three referral hospitals in Cameroon. Methods We conducted a multicenter cross-sectional study from January to May 2025 in three referral hospitals in Douala. Adults with imaging-confirmed acute stroke were consecutively and exhaustively recruited. Sociodemographic, clinical, vascular risk factor, care pathway, and treatment data were collected. Three process-of-care intervals were assessed: onset-to-door (OTD), door-to-neurologist (DTNe), and door-to-imaging (DTI) times. Delays were defined as OTD > 4.5h, DTNe > 1h, DTI > 25 min. Univariable and multivariable logistic regression analyses were performed. Associations were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results A total of 126 patients were included. The mean age was 62.3 ± 13.3 years, and 51.6% were men. Hypertension was the most frequent vascular risk factor (54.0%). Ischemic stroke accounted for 60.3% cases. The median OTD time was 16.7h (45.4), with 75.4% of patients arriving > 4.5h after symptom onset or last known well, while 88.9% of patients experience a DTNe > 1h, and 71.4% exceeding the 25 minutes DTI target. In multivariable analysis, not considering stroke symptoms alarming (aOR = 7.02, 95% CI: 2.13–23.22, p = 0.001) and initially targeting a non-specialized healthcare facility (aOR = 2.97, 95% CI: 1.16–7.59, p = 0.023) were independently associated with delayed OTP. Ischemic stroke was associated with delayed DTI (aOR = 2.66, 95% CI: 1.14–6.17, p = 0.023), while MRI rather than CT scan was associated with delayed DTNe (aOR = 10.33, 95% CI: 2.38–44.71, p = 0.002). Conclusion Acute stroke care in these three referral hospitals in Douala was characterized by substantial delays in prehospital arrival, neurological assessment, and brain imaging. Perception of stroke symptoms and the initial point of healthcare contact were determinants of delayed hospital arrival.