Abstract
Stroke is the leading neurological emergency and the leading cause of death in neurology departments in the Republic of Congo, notably at the Brazzaville University Hospital (CHUB). No consolidated national synthesis existed prior to this work. To identify, evaluate and synthesized all available epidemiological data on stroke in the Republic of the Congo published between January 2010 and December 2025. A systematic review following the PRISMA 2020 protocol was conducted, prospectively registered on PROSPERO (CRD420261409995). The research question was structured using the PICOS framework. Seven databases were searched. Methodological quality of cross-sectional studies was assessed with the STROBE checklist (threshold ≥ 12/21) and that of cohort/case-control studies with the Newcastle-Ottawa Scale (threshold ≥ 5/9). Results: Sixteen studies were included following the PRISMA 2020 selection process (263 records identified, 215 after de-duplication, 46 full-text assessments). Hospital frequency of stroke among neurology admissions ranged from 47.7% to 71.8%, a specialized-service indicator that cannot be extrapolated nationally in the absence of a registry. Haemorrhagic strokes remain frequent but are no longer uniformly predominant once the largest general hospital series are considered (32.1–59.2% of CT-confirmed cases across series), contrasting with the pattern seen in high-income countries (15–20%); this finding is sensitive to ward-level recruitment and should not be generalized to the Congolese population. Hypertension is the leading risk factor (78.6–92.9% of patients). Hospital mortality ranged from 10.1% to 55.6% depending on ward, stroke type and follow-up window. Mean age of onset ranged from 55.9 to 62.7 years, with HIV and sickle cell disease as emerging aetiological factors specific to the African context. The hospital burden of stroke in Congo is substantial, worsened by diagnostic delays and limited access to specialized care. Strengthening epidemiological surveillance and establishing a national multisite registry are the most urgent priorities.
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