{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:54:40Z","timestamp":1785779680588,"version":"3.56.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014718","name":"Innovative Research Group Project of the National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72274110"],"award-info":[{"award-number":["72274110"]}],"id":[{"id":"10.13039\/100014718","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MUHAS-Higher Education for Economic Transformation in Tanzania, World Bank funded project"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stroke is a leading cause of death and disability worldwide, with the greatest burden occurring in in low- and middle-income countries. In Tanzania, delayed hospital presentation, weak referral systems, high out-of-pocket costs, shortages of stroke-ready facilities, and limited rehabilitation services contribute to preventable deaths and long-term disability. Although previous qualitative studies have described barriers to accessing stroke care services, there remains limited evidence on strategies for improving access across the continuum of stroke care. Therefore, this study explored strategies to ensure equitable access to stroke care services in Tanzania, focusing on the perspectives of healthcare providers, stroke survivors, and family caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A descriptive qualitative study was conducted at Muhimbili National Hospital\u2013 Mloganzila, a national tertiary referral hospital and designated stroke center in Tanzania. A purposive sample of 45 participants was recruited, including 15 healthcare providers, 15 stroke survivors, and 15 caregivers. In-depth semi-structured interviews were conducted between June and September 2024. Interviews were transcribed verbatim and analyzed using thematic analysis guided by the WHO health system building blocks framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thematic analysis identified six themes aligned with the WHO health system building blocks. These include: (1) raise public awareness on stroke risks, prevention and treatment; (2) strengthen stroke care resources and infrastructures at primary care facilities; (3) increase healthcare financing and stroke services insurance coverage; (4) integrate health information systems in stroke care; (5) train multidisciplinary teams in stroke care and effective communication; and (6) improve stroke care services delivery across care continuum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Improving access to stroke care requires both patient-centered and health system\u2013level interventions across the continuum of care. Strengthening public awareness, healthcare infrastructures, referral pathways, service delivery, rehabilitation access, workforce capacity, and health insurance coverage may reduce inequities in accessing stroke care services in Tanzania.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0328334","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:21:46Z","timestamp":1785777706000},"page":"e0328334","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perspectives of stroke survivors, caregivers and healthcare providers on improving access to stroke care services in Tanzania: A qualitative study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4539-6515","authenticated-orcid":true,"given":"Nyagwaswa Athanas","family":"Michael","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian Teddy","family":"Mselle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costansia Anselim","family":"Bureta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjuan","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"issue":"10","key":"pone.0328334.ref001","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"GBD 2021 Stroke Risk Factor Collaborators","year":"2024","journal-title":"Lancet Neurol"},{"issue":"10","key":"pone.0328334.ref002","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1038\/s41582-021-00542-4","article-title":"Stroke in Africa: profile, progress, prospects and priorities","volume":"17","author":"RO Akinyemi","year":"2021","journal-title":"Nat Rev Neurol"},{"issue":"3","key":"pone.0328334.ref003","doi-asserted-by":"crossref","first-page":"108571","DOI":"10.1016\/j.jstrokecerebrovasdis.2026.108571","article-title":"Early insights from a multi-centre national stroke surveillance initiative in Tanzania","volume":"35","author":"SS Matuja","year":"2026","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"pone.0328334.ref004","article-title":"Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association\/American Stroke Association","author":"S Prabhakaran","year":"2026","journal-title":"Stroke"},{"issue":"1","key":"pone.0328334.ref005","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1177\/17474930241262936","article-title":"A scoping review of stroke registers in Sub-Saharan Africa","volume":"20","author":"D Youkee","year":"2025","journal-title":"Int J Stroke"},{"issue":"1","key":"pone.0328334.ref006","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1159\/000545954","article-title":"Implementing Acute Stroke Services in Sub-Saharan Africa: Steps, Progress, and Perspectives from the Tanzania Stroke Project","volume":"15","author":"SS Matuja","year":"2025","journal-title":"Cerebrovasc Dis Extra"},{"issue":"1","key":"pone.0328334.ref007","doi-asserted-by":"crossref","first-page":"1927507","DOI":"10.1080\/16549716.2021.1927507","article-title":"The characteristics of stroke and its rehabilitation in Northern Tanzania","volume":"14","author":"EM Mkoba","year":"2021","journal-title":"Glob Health Action"},{"issue":"10","key":"pone.0328334.ref008","doi-asserted-by":"crossref","DOI":"10.1161\/STROKEAHA.114.005446","article-title":"Norrving, and S. 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