Strengthening stroke registries for trial readiness and research equity in Sub-Saharan Africa

Sub-Saharan Africa carries one of the highest stroke burden globally, yet contributes fewer than 6% of participants to trials to inform international secondary stroke prevention guidelines. Although stroke registries across the region have expanded in numbers, they have not yet provided the trial-ready infrastructure required to support clinical research, quality improvement, and policy-relevant evidence generation. This commentary examines how existing stroke registries can evolve into platforms capable of supporting locally relevant clinical research and participation in multinational clinical studies. Recent studies identified more than 40 stroke registries across sub-Saharan Africa; however, most are characterised by heterogeneous data elements, variable follow-up, limited alignment with international standards, and incomplete population coverage. These structural limitations restrict comparability across sites, impede regional data pooling, and constrain participation in collaborative research. We propose a three-pillar pathway toward trial readiness comprising harmonised core data standards, operational capacity development through regional mentorship networks, and sustainable funding supported by coordinated national and international leadership. Harmonisation should be accompanied by broader registry coverage to improve representativeness and trial recruitment. Beyond supporting research participation, mature registries can also facilitate quality improvement, benchmarking, and health-system planning alongside clinical research. Transforming stroke registries into trial-ready platforms is both feasible and necessary to strengthen secondary prevention, improve research equity, and ensure that international stroke guidelines better reflect the epidemiological realities and research priorities of sub-Saharan Africa.