Background: In Africa, approximately 80% of individuals with stroke experience pre-hospital delays, contributing to preventable morbidity and mortality. Despite this, factors influencing stroke care‑seeking behaviours have not been comprehensively examined. We aimed to systematically identify and map the factors influencing pre-hospital stroke care-seeking behaviours in African populations.
Methods: We searched five electronic databases from inception to September 2025 to identify studies on pre-hospital stroke care-seeking behaviours in African populations. Google Scholar was also searched for grey literature. We followed the Joanna Briggs Institute methodological framework for scoping reviews. Covidence was used to facilitate screening and extraction. Paired reviewers independently screened and extracted the data, with a third reviewer resolving discrepancies.
Results: We included 44 studies, of which 69% were published within the last five years. The included studies originated from 17 African countries and the United States. Multiple factors were identified as barriers to pre-hospital stroke care-seeking behaviours. These included: belief in witchcraft and demons; belief in supernatural and divine causality of stroke; preference for traditional and faith-based healing rituals; fear and mistrust of biomedical care; stigma; stroke knowledge deficits; symptom misattribution; caregiver burden; societal and family pressure to pursue herbal treatments first; and shortages of and high costs associated with medicines and diagnostic imaging.
Conclusion: Prehospital stroke care‑seeking behaviours are influenced by interconnected cultural and social structures that influence health beliefs and responses to stroke. In Africa, community‑led approaches that integrate traditional health systems with formal emergency medical services, supported by low‑cost technologies and context‑appropriate policies, are essential.