Over the last four decades, rates of stroke occurrence in low-and middle-income countries (LMIC) have roughly doubled, whereas they have substantively decreased in high income countries (HIC). The majority of these LMIC are in Sub-Saharan Africa (SSA) where the burden of stroke will probably continue to rise over the next few decades due to an ongoing epidemiological transition. Moreover, SSA is circumstantially distinct: socioeconomic obstacles, cultural barriers, under-diagnosis, uncoordinated care, and shortage of physicians impede the ability of SSA countries to implement CVD prevention among people with DM in a timely and sustainable manner. Reducing the burden of stroke in SSA may necessitate an initial emphasis on high-risk individuals motivated to improve their health, multidisciplinary care coordination initiatives with clinical decision support, evidence-based interventions tailored for cultural relevance, task shifting from physicians to nurses and other health providers, use of novel patient-accessible tools, and a multi-level approach that incorporates individual- and system- level components.

This article proposes a theory-based integrated blood pressure self-management intervention called Phone-based Intervention under Nurse Guidance after Stroke (PINGS) that could be tested among hospitalized stroke patients with poorly controlled HTN encountered in SSA. PINGS would comprise the implementation of nurse-run BP control clinics and administration of health technology (personalized phone text messaging and home telemonitoring), aimed at boosting patient self-efficacy and intrinsic motivation for sustained adherence to antihypertensive medications.