Are usual concussion tools universally applicable? Challenges in concussion management in West African football - a qualitative study

Objectives: To explore how sport-related concussions are recognised and managed in West African football, and to examine the applicability of international concussion tools in local contexts. Design: Qualitative study using a grounded theory method. Methods: Semi-structured interviews were conducted with eight physicians working in high-level football teams and national teams across Senegal, Mali and Gambia. Interviews were audio-recorded, transcribed, and then analysed through open, axial and selective coding. Results: Six overarching categories emerged in the analysis: (1) the concussion burden is unclear due to under-reporting and lack of awareness, with concussion risks often overshadowed by other conditions perceived as more serious (e.g. cardiac); (2) protocols and tools such as SCAT are not applied; (3) organisational and resource gaps limit care; (4) clinical decisions are shaped by external pressures and absence of federation structures; (5) training remains insufficient and mostly theoretical; and (6) cultural norms (toughness, gender, mystical beliefs, and crowd influence) strongly affect practice. Conclusions: Concussion management in West Africa is marked by under-recognition, limited applicability of international tools, organisational deficiencies and cultural pressures. Current guidelines remain largely theoretical in this context. Broader access to context-sensitive and local education, federation-level structures such as concussion leads, as well as culturally adapted strategies are needed to improve recognition and management of sport-related concussion in this context.