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Background: Stroke registers are recommended as a key priority by the Lancet Neurology World Stroke Organization Commission for Stroke, 2023, and the African Stroke Leaders' Summit, 2022., Aims: This scoping review aims to map where stroke registers have been implemented in Sub-Saharan Africa (SSA). The article then compares and critiques the methods and definitions used and summarizes key results from the registers. The scoping review searched EMBASE, MEDLINE, and CABI Global Health databases and included all studies with a prospective longitudinal design in SSA, where adult acute stroke was the primary condition studied. Articles were screened against inclusion and exclusion criteria independently by two authors., Summary: We identified 42 unique stroke registers from 48 individual studies. The registers were located in 19 countries, with 19 from East Africa, 15 West Africa, 6 Central Africa, and 2 from Southern Africa. Cumulatively, the registers recruited 12,345 participants with stroke, the median number of participants was 183 (interquartile range (IQR): 121-312), and the range was 50-1018. Only one study was a population-based register, and 41 were hospital-based registers. Of the hospital-based registers, 29 were single site, 10 were conducted at two sites, and 2 at three sites. Twenty-three (54.7%) of the registers were located in the capital city of their respective country, and only one of the hospital-based registers was in a self-described rural area. Length of recruitment ranged from 4 months to 6 years; the median length of recruitment was 12 months. Methodology and definitions were heterogenous between the registers. Only seven (19.4%) registers referenced the WHO STEPwise approach to implementing stroke registers. Twenty-seven (64.3%) registers used the WHO definition of stroke. The mean neuroimaging rate was 84%, and ranged from 0% to 100%. Stroke severity was measured using the National Institute of Health Stroke Scale (NIHSS) in 22 (52.4%) registers, four registers used the Glasgow Coma Scale (GCS), two registers used the miniNIHSS, one used the Scandinavian Stroke Scale, one modified Rankin Scale (mRS), and 11 registers did not report a stroke severity measure. Seventeen (40.5%) registers used the mRS to measure function, six registers used Barthel Index alone, and three registers used both mRS and Barthel Index. Only two registers included a quality-of-life measure, the EQ-5D. Eight registers included a quality-of-care measure, and 26 (61.9%) registers recorded socioeconomic status or a socioeconomic status proxy, most frequently educational attainment., Conclusions: This scoping review found high heterogeneity of methods and definitions used by stroke registers, with low uptake of the WHO stepwise method of stroke surveillance. A drive to standardize methodology would improve the comparability of stroke data in SSA. The shared use of educational attainment by registers in our review may enable future meta-analyses of inequities in stroke in SSA. Incorporating health-related quality-of-life measures, such as EQ-5D, into stroke registers should be encouraged, bringing a patient perspective, and allow the estimation of quality-adjusted life years lost to stroke. Agreement on a standardized register methodology or further promotion and uptake of the WHO stepwise method is essential to produce comparable data to improve stroke prevention and care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients' homes., Aim: We aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available., Methods: We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and case-control studies that reported on non-pregnant individuals diagnosed with T2DM in SSA, who received a substantial part of care in the community. Only studies which reported at least one of our outcomes of interest were included. A narrative analysis was done, and comparisons made between community-based and facility-based models, where within-study comparison was reported., Results: We retrieved 5,335 unique studies, four of which met our inclusion criteria. Most studies were excluded because interventions were facility-based; community care interventions described in the studies were only add-on features of a primarily facility-based care; and studies did not report outcomes of interest. The included studies reported on a total of 383 individuals with T2DM. Three different community care models were identified. 1) A community-initiated model where diagnosis, treatment and monitoring occurred primarily in the community. This model reported a higher linkage and engagement in care at 9 months compared to the corresponding facility model, but only slight reductions of average blood glucose levels at six months compared to baseline. 2) A facility-originated community model where after treatment initiation, a substantial part of follow-up was offered at community level. Two studies reported such a model of care, both had as core component home-delivery of medication. Acceptability of this approach was high. But neither study found improved T2DM control when compared to facility care 3) An eHealth model with high acceptability scores for both patients and care providers, and an absolute 1.76% reduction in average HbA1c levels at two months compared to baseline. There were no reported outcomes on end-organ damage. All four studies were rated as being at high risk for bias., Conclusion: Evidence on models of care for persons with T2DM in SSA where a substantial part of care is shifted to the community is scant. Whereas available literature indicates high acceptability of community-based care, we found no conclusive data on their effectiveness in controlling blood sugar and preventing complications. Evidence from larger scale studies, ideally randomized trials with clinically relevant endpoints is needed before roll-out of community-based T2DM care can be recommended in SSA., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Firima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)