Quality of stroke guidelines in low- and middle-income countries: a systematic review

Joseph Yaria, Artyom Gil, Akintomiwa Makanjuola, Richard Oguntoye, J. Jaime Miranda, Maria Lazo-Porras, Puhong Zhang, Xuanchen Tao, Jhon Álvarez Ahlgren, Antonio Bernabe-Ortiz, Miguel Moscoso-Porras, German Malaga, Irina Svyato, Morenike Osundina, Camila Gianella, Olamide Bello, Abisola Lawal, Ajagbe Temitope, Oluwadamilola Adebayo, Monkol LakkhanaloetMichael Brainin, Walter Johnson, Amanda G. Thrift, Jurairat Phromjai, Annabel S. Mueller-Stierlin, Sigiriya Aebischer Perone, Cherian Varghese, Valery Feigin, Mayowa O. Owolabi, on behalf of the Stroke Experts Collaboration Group

Research output: Contribution to journalReview ArticleResearchpeer-review

23 Citations (Scopus)


Objective To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low-and middle-income countries. Methods We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. Findings We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low-and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low-and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. Conclusion Guidelines on stroke in low-and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
Original languageEnglish
Pages (from-to)640-652E
Number of pages18
JournalBulletin of the World Health Organization
Issue number9
Publication statusPublished - Sept 2021

Cite this