Sudden cardiac arrest preparedness in African football: evidence from Cameroon and implications for global sport

Abstract

OBJECTIVE: Sudden cardiac arrest (SCA) remains the leading cause of sport-related death worldwide, yet survival outcomes in Africa are critically poor. We conducted a formative assessment of the knowledge, attitudes and practices of professional football stakeholders in Cameroon as a model for identifying system-level gaps in SCA preparedness in low-resource sport settings. METHODS: We conducted a cross-sectional survey during the 2024/2025 season across five pre-competition medical centres in Cameroon. Eligible participants were players, referees, coaches and physiotherapists from Elite 1, Elite 2 and the Female Super League who had two or more seasons of professional experience. A validated questionnaire, adapted from international guidelines, was used to assess sociodemographic data, knowledge, attitudes and practices. Data were analysed descriptively with subgroup comparisons using SPSS V.20. RESULTS: A total of 745 participants were enrolled: 536 players, 90 referees, 84 coaches and 35 physiotherapists. Most (66.4%) demonstrated poor knowledge of SCA, only 12% reported confidence in cardiopulmonary resuscitation (CPR) or automated external defibrillator (AED) use and referees showed the lowest preparedness scores despite their critical first-responder role. While one-third expressed positive attitudes, self-reported barriers to providing CPR included fear of harm (66.3%) and legal concerns (78.3%). Only 33.4% reported good practices, with significant gaps in AED access, CPR training and emergency action plan awareness. CONCLUSION: This assessment identified critical gaps in SCA preparedness in Cameroonian football, exposing gaps that likely extend across Africa and similar environments. Compulsory CPR/AED training, AED availability and enforceable emergency action plans are urgently needed to align African football with international best practice and strengthen the survival chain.