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- Pandian, Jeyaraj Durai, et al.
(author)
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Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries : A Systematic Review
- 2017
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In: Neuroepidemiology. - : S. Karger AG. - 0251-5350 .- 1423-0208. ; 49, s. 45-61
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Research review (peer-reviewed)abstract
- Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
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2. |
- Thrift, Amanda G., et al.
(author)
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Global stroke statistics
- 2017
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In: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 12:1, s. 13-32
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Research review (peer-reviewed)abstract
- Background: Up to date data on incidence, mortality, and case-fatality for stroke are important for setting the agenda for prevention and healthcare. Aims and/or hypothesis: We aim to update the most current incidence and mortality data on stroke available by country, and to expand the scope to case-fatality and explore how registry data might be complementary. Methods: Data were compiled using two approaches: (1) an updated literature review building from our previous review and (2) direct acquisition and analysis of stroke events in the World Health Organization (WHO) mortality database for each country providing these data. To assess new and/or updated data on incidence, we searched multiple databases to identify new original papers and review articles that met ideal criteria for stroke incidence studies and were published between 15 May 2013 and 31 May 2016. For data on case-fatality, we searched between 1980 and 31 May 2016. We further screened reference lists and citation history of papers to identify other studies not obtained from these sources. Mortality codes for ICD-8, ICD-9, and ICD-10 were extracted. Using population denominators provided for each country, we calculated both the crude mortality from stroke and mortality adjusted to the WHO world population. We used only the most recent year reported to the WHO for which both population and mortality data were available. Results: Fifty-one countries had data on stroke incidence, some with data over many time periods, and some with data in more than one region. Since our last review, there were new incidence studies from 12 countries, with four meeting pre-determined quality criteria. In these four studies, the incidence of stroke, adjusted to the WHO World standard population, ranged from 76 per 100,000 population per year in Australia (2009–10) up to 119 per 100,000 population per year in New Zealand (2011–12), with the latter being in those aged at least 15 years. Only in Martinique (2011–12) was the incidence of stroke greater in women than men. In countries either lacking or with old data on stroke incidence, eight had national clinical registries of hospital based data. Of the 128 countries reporting mortality data to the WHO, crude mortality was greatest in Kazhakstan (in 2003), Bulgaria, and Greece. Crude mortality and crude incidence of stroke were both positively correlated with the proportion of the population aged ≥ 65 years, but not with time. Data on case-fatality were available in 42 studies in 22 countries, with large variations between regions. Conclusions: In this updated review, we describe the current data on stroke incidence, case-fatality and mortality in different countries, and highlight the growing trend for national clinical registries to provide estimates in lieu of community-based incidence studies.
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3. |
- Thrift, Amanda G., et al.
(author)
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Global stroke statistics : An update of mortality data from countries using a broad code of “cerebrovascular diseases”
- 2017
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In: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 12:8, s. 796-801
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Journal article (peer-reviewed)abstract
- Background: Current information on mortality attributed to stroke among different countries is important for policy development and monitoring prevention strategies. Unfortunately, mortality data reported to the World Health Organization by different countries are inconsistent. Aims and/or hypothesis: To update the repository of the most recent country-specific data on mortality from stroke for countries that provide data using a broad code for “cerebrovascular disease.” Methods: Data on mortality from stroke were obtained from the World Health Organization mortality database. We searched for countries that provided data, since 1999, on a combined category of “cerebrovascular disease” (code 1609) that incorporated International Classification of Diseases (10th edition) codes I60–I69. Using population denominators provided by the World Health Organization for the same year when available, or alternatively estimates obtained from the United Nations, we calculated crude mortality from “cerebrovascular disease” and mortality adjusted to the World Health Organization world population. We used the most recent year reported to the World Health Organization, as well as comparing changes over time. Results: Since 1999, seven countries have provided these mortality data. Among these countries, crude mortality was greatest in the Russian Federation (in 2011), Ukraine (2012), and Belarus (2011) and was greater in women than men in these countries. Crude mortality was positively correlated with the proportion of the population aged ≥65 years but not with time. Age-adjusted mortality was greatest in the Russian Federation and Turkmenistan, and greater in men than women. Over time, mortality declined, with the greatest decline per annum evident in Kazakhstan (8.7%) and the Russian Federation (7.0%). Conclusions: Among countries that provided data to the World Health Organization using a broad category of “cerebrovascular disease,” there was a decline in mortality in two of the countries that previously had some of the largest mortality rates for stroke.
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