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Publications

Journal Article Scoping Review Epublish

PubMed: 40405122 DOI: 10.1186/s12913-025-12920-5

A scoping review of the utilization of mobile stroke units in low and lower middle-income countries: current evidence, implications and future direction.

BMC Health Serv Res 25(1):742

Authors: Priscilla Abrafi Opare-Addo, Elliot Koranteng Tannor, Emily Brennan, Minas Aikins, Serwaa Asare Bediako, Teri Lynn Herbert, Kojo Awotwi Hutton-Mensah, Emmanuel Ofori, Kwadwo Faka Gyan, Solomon Gyabaah, Emmanuel Acheamfour-Akowuah, Fred Stephen Sarfo

Affiliations

  • Directorate of Medicine, Komfo Anokye Teaching Hospital, P. O. Box 1934, Bantama, Kumasi, Ghana.
  • Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
  • Directorate of Medicine, Komfo Anokye Teaching Hospital, P. O. Box 1934, Bantama, Kumasi, Ghana.
  • Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
  • Medical University of South Carolina, Charleston, SC, USA.
  • Department of Family Medicine, Dalhousie University, Yarmouth, NS, Canada.

Abstract

BACKGROUND

Low and Lower-Middle-Income Countries (LMICs) have the highest stroke incidence, prevalence, and case fatality rates globally. Current evidence suggests Mobile Stroke Units (MSUs) outperform traditional Emergency Medicine Services (EMS) in time metrics, cost-effectiveness, and long-term outcomes. MSUs could potentially improve stroke outcomes in resource-constrained settings by addressing critical challenges related to prehospital delays, health-seeking behavior, and access to expertise.

PURPOSE

This scoping review aims to assess the existing literature and knowledge gaps on the utilization of mobile stroke units in LMICS, their impact on stroke outcomes, and cost-effectiveness.

MATERIALS AND METHODS

We conducted a detailed search of PubMed, Scopus, CINAHL, African Index Medicus, and Publicly Available Content Database (ProQuest) inception to April 15, 2024. Google Scholar and TRIP Pro were also searched to identify Grey literature. African Journals Online, references were also hand-searched.

RESULTS

Seven hundred and eighty-five studies were screened; only two met the eligibility criteria. Cherian et al. report the first use of a mobile stroke unit (MSU) in India, detailing its operations during the first year and the challenges encountered. According to the authors, fewer patients utilize MSUs in India compared to other parts of the world due to challenges such as a lack of awareness and affordability. Osuegbu et al. also report the absence of both fixed and mobile stroke units in Rivers State, Nigeria.

CONCLUSION

There is currently very limited data to support the contextual suitability of MSU or implementation strategies to guide its integration into stroke care systems in LMICs. Further research is needed to examine the utilization, barriers, impact, and cost-effectiveness of Mobile Stroke Units (MSUs) in low- and middle-income countries. This could inform stakeholders and policymakers about the potential role and value of MSUs within stroke care systems in these settings.

MeSH

Stroke, Income, Health Services Research