OBJECTIVES: Despite the increasing burden of stroke and its effects in sub-Saharan Africa, there is a paucity of empirical studies on the burden of stroke and its risk factors to help guide targeted interventions in the region. This study examines the incidence, trends and some factors associated with stroke cases in Ghana. STUDY DESIGN: Retrospective analysis of observational routinely collected data. METHODS: Empirical data of confirmed stroke cases from all government-affiliated healthcare facilities were extracted from the District Health Information Management Systems of the Ghana Health Service spanning 2016-2021. Variables include stroke case counts by sex, age group and location. Cartographic geospatial mapping of stroke case density and negative binomial regressions were employed to assess trends and factors associated with stroke. RESULTS: Stroke cases increased by more than two-fold in just six years (from 10,732 to 23,009). The rates for people 35-59years (IRR = 5.06, 95% CI: 4.04-6.63) and those above 60 years (IRR = 6.29, 95% CI: 5.01-7.88) were 5 and 6 times higher compared with 0-35year old. The rate of stroke in the year 2021 was 61 % higher than in 2016 (IRR = 1.61, 95% CI: 1.18-2.21). People in the northern savannah ecological zone had 77 % lower rate of stroke compared with those in the coastal zone of Ghana (IRR = 0.23, 95% CI: 0.18-0.30). CONCLUSIONS: The incidence of stroke in Ghana is rising across all age groups, sexes and locations with a trajectory of early onset within the life course. There is an urgent need for the implementation of public health interventions for early detection, prevention and management of stroke cases in the country.