At this year’s Global Health Scholars Symposium, students and early‑career researchers showcased a powerful range of studies addressing urgent neurological and health systems challenges in Zambia. The event was sponsored by the Institute for Global Health and Infectious Diseases and the Gillings School of Global Public Health. Neurologist Monica Diaz, MD, MS, led the breakout session “Stroke and Neurological Care Systems and Outcomes.” Find an overview of the event here.
Zambia: Core Themes
Collectively, student research showed how stroke care, clinical diagnostics, patient experiences, and health‑seeking behaviors intersect in a setting where rapid response, accurate classification, and long‑term management can mean the difference between life and death. From analyzing door‑to‑CT times and echocardiogram utility to exploring discharge readiness and fever-related outcomes, students illuminated the realities of stroke care in Zambia’s hospitals—revealing both the progress made and the gaps that persist.
Across the presentations, a set of core themes emerged: the essential role of accurate diagnosis, the importance of timely acute care, the influence of environmental and social factors, and the growing need for evidence‑based, low-resource interventions. Together, these projects reflect a maturing research ecosystem in Zambia—one shaped by strong mentorship, close clinical partnerships, and a commitment to improving outcomes for patients facing neurological disease. Among these contributions, one project stood out for its depth, scope, and potential to inform clinical practice across the region: Dr. Nana Boakye Agyeman Badu’s pioneering work on non‑traditional risk factors and stroke mortality.
Research Spotlight: Shaping Stroke Survival
In his oral presentation, Dr. Nana Boakye Agyeman Badu, a neurology resident and recent MPH graduate, reframed how clinicians understand stroke mortality in Zambia. While hypertension, diabetes, and smoking are well‑known contributors to stroke burden, Badu recognized how traditional risk factors alone could not fully explain the devastating outcomes he observed during his clinical rotation in Lusaka. Inspired by real‑world experiences, working closely with his mentor neurologist Deanna Saylor, MD, MHS (member of the Institute for Global Health and Infectious Diseases), Badu launched a prospective cohort study to evaluate how diet, household air pollution, and physical activity affect survival after stroke—an essential but largely understudied question in Sub-Saharan Africa.
His study followed 532 adults admitted with stroke between 2019 and 2022, tracking both in‑hospital and one‑year mortality. The findings were striking. Patients with high pre‑stroke physical activity experienced a 41% reduction in the risk of dying during hospitalization, highlighting how routine movement may build physiological resilience that carries into the acute recovery period. High vegetable consumption, especially leafy greens, emerged as one of the strongest protective factors, associated with a roughly 50% reduction in in‑hospital mortality and a 46% reduction at one year. In contrast, high red meat consumption was linked to nearly double the risk of death at one year—echoing global concerns about red meat and vascular health, but grounding these concerns in locally generated evidence.
Just as important were the structural insights: patients whose stroke type could not be confirmed, due to lack of imaging, faced almost four times higher in‑hospital mortality, and those with severe disability at baseline were at dramatically greater risk both immediately and over the long term. These findings underscore a dual reality: lifestyle and environmental factors shape recovery, but health system capacity—from imaging to rehabilitation—remains equally critical for survival.
Badu’s portrayal of stroke care in Zambia showed a complex interplay between individual behaviors, household environments, and structural health system constraints. His study not only expands the evidence base on stroke mortality but also identifies practical, context‑appropriate opportunities for intervention—from dietary promotion and physical activity campaigns to investments in diagnostic capacity and early rehabilitation.
Participating Scholars
Following is a listing of participating scholars and their topics.
- Evaristo Kunka, MMed – “Accuracy of Optic Nerve Sheath Diameter and Optic Disc Elevation for Discrimination Between Patients with Hemorrhagic and Ischemic Stroke at the Adult Hospital of The University Teaching Hospitals in Lusaka, Zambia”
- Theresa Shankanga, MBCHB
“Impact of fever on outcomes of stroke patients in Lusaka, Zambia” - Madalitso Nthere, MBBS, Research Fellow
–“Evaluating the Utility of Echocardiogram in the Diagnostic Work Up of Stroke Patients in Resource-Limited Settings” and
–“Gaps in Evidence-Based Stroke Care in Zambia: Opportunities For Low-Resource Interventions to Improve Outcomes” - William Tembo, Research Coordinator
–“Door-to-CT Intervals in Acute Stroke Care in Sub-Saharan Africa: A Scoping Review Protocol with Preliminary Findings” and
–“An Evidence-Based Approach to Stroke Unit Development in Zambia” - Diwell Mwansa, BMBS, UNC Project-Zambia Research Coordinator
“Patients’ Perceptions of Their Readiness for Hospital Discharge From Zambia’s First Stroke Unit.” - Yohanna Gebreyohanns, Medical Student
“Health-Seeking Behaviors and Outcomes Among Hospitalized Adults with Stroke in Lusaka, Zambia” - Malya Sahu, PhD, Postdoctoral Fellow
“Narrative Inquiry to Explore Delays to Care-Seeking for Symptoms of Multiple Sclerosis Among Healthy Individuals in Zambia”
Together, Zambia-focused projects showed a health system in transition—one where clinicians, researchers, and trainees are collaboratively defining what high-quality stroke and neurological care can look like in low‑resource settings. Whether improving diagnostic accuracy, reducing critical delays, evaluating care pathways, or identifying modifiable predictors of survival, these studies collectively point toward a future in which care decisions are increasingly informed by local data and lived patient experience.