World Stroke Day | High time India had a national-level stroke registry

Representative image.

Launched in 2006, the World Stroke Day is observed on October 29 under the aegis of World Stroke Organization, with the objective to stress the need for early recognition of stroke. This year, the theme is ‘Recognise stroke symptoms early and save #precious time’.

The Indian Stroke Association proposes the theme ‘ACT FAST, STRIKE@STROKE’. Joint effort by the policymakers, administrators, and medical community is the need of hour to address this stealthy predator. Any delay will only escalate the risks of disability, and even mortality. These losses, like many medical setbacks, impair the country’s economy to a great extent.

Stroke or brain attack is fast emerging as a serious health hazard that causes significant morbidity, even mortality. Worldwide, it is the second-most common cause of mortality, and around 5.6 million people succumb to it every year. Stroke occurs either due to blockage of blood vessel (thrombotic stroke) to the brain, or due to haemorrhage into the brain (cerebral haemorrhage). About 85 percent of stroke patients have thrombotic stroke, and the remaining 15 percent brain haemorrhage.

In India, which accounts for about 60 percent of stroke patients globally, the incidence of stroke is about 135-150 per 100,000 population, while the mortality caused by it is about 30 percent. The disability rate is about 40 percent. The remaining 30-40 percent patients survive without significant disability, and carry out their daily activities without being dependent.

However, the incidence of this disease differs between rural and urban areas. What is a matter of concern is that infrastructure, skilled human resources, and awareness among the public are woefully low when it comes to the stroke care.

The current guidelines of management of acute ischaemic stroke requires an Intensive Care Unit, brain imaging facilities (a minimum CT scan), and trained stroke physicians and nurses. Patients reaching the hospitals within four-and-a-half hours of onset of symptoms can only be given clot dissolving medication (thrombolytic agent). In case of large blood pipe blockage, a patient who reaches the hospital within six hours can undergo endovascular treatment (catheter-based clot removing treatment, or mechanical thromboectomy).

India’s national programme on prevention of non-communicable disease stresses the importance of risk factors for stroke and heart attacks. However, it must be backed by a definite programme to address the acute care of stroke patients. This is very important to reduce disability, and death rate, thus reducing the economic burden a debilitating stroke can induce.

Improve Stroke Care

A string of measures have to be launched on a war-footing to bridge the gap in stroke management across India. Establishment of adequate facilities in medical colleges and district hospitals for acute stroke management is an immediate step to be taken. Trained physicians, nursing staffs, and physiotherapists are required for acute stroke management. Brain imaging facilities such as CT scan and MRI are the need of hour. Stroke ICU/ICU beds need to be established in designated medical ICUs. Thrombolytic agents should be made available in all district hospitals, and medical colleges.

A national-level stroke registry to estimate the burden of the disease must be made mandatory. This will help identify the incidence and prevalence of stroke in various states, and also in planning and budgeting to run a concerted programme. Training for ASHA workers, health inspectors, and public health nurses regarding symptoms of stroke will empower them to identify patients with brain attacks early, and, thus, can refer them to the respective hospitals where treatment facilities are available.

It is also imperative to include chapters on stroke awareness in school curriculum to make students understand the importance of early recognition of brain attack.

According to the Census 2011 India has about 8.6 percent of its population above 60 years of age. In the years ahead its young population is set to become old, and stroke is largely associated with the elderly. That India is aging fast is clear from decadal data available. Given this, it is imperative that we focus on healthcare infrastructure right now to cater to a stroke patient load which is likely to increase in the near future.

The World Stroke Day is a reminder that we have a silent healthcare threat in our midst—and we must prepare to tackle it.

VG Pradeep Kumar is the President of the Indian Stroke Association. Views are personal, and do not represent the stand of this publication.