Mapping the economic burden of stroke across Africa: a scoping review

Stroke is the second leading cause of death globally, with nearly 90% of stroke-related deaths and disability-adjusted life years occurring in low- and middle-income countries. In Africa, healthcare financing remains heavily dependent on out-of-pocket expenditure, placing stroke-affected households at substantial risk of financial hardship. This scoping review maps and synthesises available evidence on the direct costs, indirect costs, and caregiver burden associated with stroke across Africa. Conducted in accordance with the Joanna Briggs Institute framework and reported following PRISMA-ScR, searches were performed across six electronic databases and multiple grey literature sources from inception to April 2026. Findings were synthesised narratively and presented using descriptive tables. Fourteen eligible studies from ten African countries were included. Evidence was geographically sparse, concentrated in West and Central Africa, with no eligible studies identified from North Africa. Reported direct costs ranged from approximately US$157 in Senegal to over US$4,800 in private settings in Nigeria, frequently exceeding local monthly wages by substantial multiples. Only two studies assessed productivity losses, and none formally examined catastrophic health expenditures or household impoverishment attributable to stroke. Caregiver burden was consistently reported as high and disproportionately affecting women, though no included study quantified caregiver costs using standard health economic methods. The economic burden of stroke in Africa is substantial but critically underexplored. Major gaps persist in catastrophic health expenditure analysis, caregiver cost quantification, indirect cost estimation, and evidence from North Africa. Standardized, longitudinal, and geographically inclusive research is urgently needed to inform equitable stroke care financing and the design of universal health coverage policies across African health systems.