Stroke in South Asian countries

• Published in: Nature reviews. Neurology Vol. 10; no. 3; pp. 135 - 143
• Main Authors: Wasay, Mohammad, Khatri, Ismail A., Kaul, Subhash
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2014; Nature Publishing Group
• Subjects: 692/499; 692/699/375/534; 692/700/228; Asia, Western - epidemiology; Cardiovascular disease; Coronary vessels; Diabetes; Distribution; Epidemiology; Hospitals; Humans; Hypertension; Medicine & Public Health; Mortality; Neurology; Population-based studies; Prevalence; Prevalence studies (Epidemiology); review-article; Risk factors; Stroke; Stroke (Disease); Stroke - epidemiology; Vein & artery diseases; Asia, Western; South Asia; Bangladesh; Afghanistan; Pakistan; Sri Lanka; Karachi Pakistan; India
• ISSN: 1759-4758; 1759-4766
• DOI: 10.1038/nrneurol.2014.13

Key Points The South Asian region, which includes India, Pakistan, Sri Lanka and Bangladesh, has a high prevalence of stroke, especially in younger individuals, and short-term mortality from stroke is also high In addition to traditional risk factors for stroke, nontraditional factors including chewing tobacco are widespread in this region South Asia accounts for the largest proportion of the global burden of stroke in pregnancy and cerebral venous thrombosis Acute stroke care, including thrombolysis and stroke units, is limited in South Asia, and stroke prevention strategies are nonexistent at the national level Cost-effective interventions are needed owing to financial constraints Important areas of intervention include public awareness and physician training, as well as strong advocacy efforts and implementation research South Asia is thought to be the highest contributor to stroke mortality in the world, probably accounting for more than 40% of global stroke deaths. Wasay et al . review stroke epidemiology and management issues in four South Asian countries: India, Pakistan, Sri Lanka and Bangladesh. The authors highlight the prevalence of traditional and nontraditional stroke risk factors in this region, and consider the barriers to effective implementation of stroke prevention and treatment strategies. Three of the world's top 10 most populous countries are located in South Asia. The health-care problems of this region are different from those in the developed world, and the rapidly changing socioeconomic scenario, fast-increasing urbanization and longevity, changes in dietary patterns, and decrease in mortality from infectious diseases has made chronic illnesses of old age, such as coronary artery disease and stroke, an important area of focus. This article reviews stroke epidemiology and management issues in four South Asian countries: India, Pakistan, Sri Lanka and Bangladesh. The available literature is limited and mostly hospital-based, and differing study methodologies make direct comparisons difficult. The high prevalence of traditional risk factors, including hypertension, diabetes, dyslipidaemia and smoking, in these countries is alarming, and several nontraditional risk factors, such as water-pipe use, desi ghee, chewable tobacco, and infectious causes of stroke, are understudied. Access to tertiary stroke care is limited, and the use of tissue plasminogen activator is scarce. In addition, public and caregiver awareness of stroke risk factors and management is disappointing, and the interest of governments and policy makers in stroke is suboptimal. Interventions to reduce stroke burden and stroke-related mortality in South Asia should have a substantial impact at the global level.