Stroke treatment costs can swallow several months’ earnings and push African families into financial hardship, with patients often relying on relatives to pay hospital bills because of inadequate health insurance, a study published in Health Economics Review has found.

The review found that direct medical costs ranged from about $157 per patient in Senegal to approximately $4,860 in a private hospital in Nigeria, highlighting the financial pressure stroke care places on households.

The researchers, Nicholas Aderinto, Temitomi Jane Oyedele and Faith Adedayo Adejumo, said the economic burden of stroke in Africa remains poorly understood because research largely focuses on hospital bills, overlooking lost earnings, unpaid caregiving and the risk of poverty.

Titled Mapping the economic burden of stroke across Africa: a scoping review, the study examined evidence on medical expenses, productivity losses and the financial impact on households.

It searched six electronic databases and other sources for relevant studies published up to April 2026, covering Nigeria, Senegal, Benin, Togo, Gabon, Congo, Cameroon, South Africa, Tanzania and Mozambique.

Costs varied considerably across countries. In Benin, one study reported expenses ranging from about $145 to more than $9,300 per patient, averaging approximately $1,030. In Cameroon, mean annual direct costs were $1,600 for ischaemic stroke and $1,400 for haemorrhagic stroke.

In Togo, hospitalisation costs were equivalent to about 19 times the minimum monthly salary of civil servants, while costs in Congo were approximately 3.6 times the guaranteed minimum wage.

Hospital stays, brain imaging, diagnostic tests, medicines and healthcare personnel were major cost drivers. More severe strokes and longer hospital stays generally increased expenses, while haemorrhagic stroke was associated with higher direct costs than ischaemic stroke in studies comparing the two.

In Togo, 70 per cent of patients in one study had no insurance and paid out of pocket. In Congo, families reportedly covered about 78 per cent of inpatient stroke care costs, with community associations contributing another 2.8 per cent.

The review also found that private hospital care in Nigeria cost about eight times as much as treatment in a government hospital over a 36-week follow-up period.

Only two studies formally assessed productivity losses. Research from Tanzania estimated an average loss of about $213 per patient over six months, with urban losses more than twice those in rural areas.

In Mozambique, informally employed patients experienced the greatest productivity losses, partly because they lacked paid sick leave and employment protections.

None of the studies formally quantified caregiver costs using standard health economics methods, despite relatives often bearing the financial and practical demands of care. Family members may lose working hours, leave jobs or sacrifice income to support stroke survivors. Although women may be particularly affected, the studies did not quantify caregiving costs by gender.

The review also identified major research gaps. No eligible studies were found from North Africa, and none of the included studies formally measured catastrophic health expenditure or household impoverishment using established methods.

Most studies were conducted in urban tertiary hospitals, limiting their ability to reflect the experiences of rural communities and people unable to access specialist care. Differences in costing methods, currencies and follow-up periods also made comparisons difficult.

The researchers urged African governments to include comprehensive stroke services in universal health coverage and national health insurance packages. They recommended improving access to affordable brain imaging, medicines, hospital treatment, rehabilitation and long-term follow-up care.

They also called for more community-based and long-term research to measure lost earnings, unpaid caregiving and the risk of financial hardship.

The authors said stronger economic evidence is essential for developing fairer health financing policies and ensuring stroke survivors can access treatment and rehabilitation without exposing their families to severe financial hardship. (Nigerian Tribune)