Pediatric Stroke in Asia and Africa: Epidemiology, Etiology, and Resource-Stratified Care Across Geographic and System-Level Disparities

Pediatric stroke is a rare but serious cause of morbidity and mortality, with disproportionately high burden in low- and middle-income countries (LMICs). Asia and Africa report the highest global incidence and prevalence, driven by region-specific risk factors such as sickle cell disease (SCD), moyamoya disease (MMD), and infectious etiologies. Despite this substantial burden, data from these regions remain limited and fragmented, hindering effective clinical care and policy development. Incidence rates across Asia and Africa consistently exceed those in high-income countries. Western Sub-Saharan Africa, Southeast Asia, and Central Asia present some of the world’s highest age-standardized rates. The most common etiologies include infections, particularly tuberculous meningitis, hematologic disorders such as SCD, and vasculopathies including MMD. Clinical features resemble those in high-income settings; however, children in LMICs experience delays in diagnosis due to limited diagnostic modalities, shortages of pediatric stroke expertise, and lack of standardized protocols. Management practices vary widely, consistent with global challenges due to lack of clinical data. LMICs are further constrained by resource limitations. Pediatric stroke care disparities in Asia and Africa reflect both geographic inequities between LMICs and HICs and system-level inequities within LMICs, where tertiary urban centers may provide advanced care while rural and secondary facilities remain limited. Emerging initiatives, including resource-adapted diagnostic algorithms, community screening tools, educational programs, and multicenter prevention trials, highlight growing efforts to strengthen pediatric stroke care. Improving outcomes require strengthening epidemiological surveillance, expanding regional and national stroke registries, developing resource-adapted diagnostic and treatment guidelines, and increasing access to preventive and therapeutic interventions. This review synthesizes available literature on pediatric stroke across Asian and African regions using the Global Burden of Disease (GBD) regional framework. Countries within Sub-Saharan Africa, North Africa and the Middle East, East Asia, High-Income Asia Pacific, South Asia, and Southeast Asia were examined. Key themes include epidemiology, etiologies, clinical presentations, and management strategies within these regions.