The state of stroke services across the globe: Report of World Stroke Organization–World Health Organization surveys
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Published:2021-05-27
Issue:8
Volume:16
Page:889-901
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ISSN:1747-4930
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Container-title:International Journal of Stroke
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language:en
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Short-container-title:International Journal of Stroke
Author:
Owolabi Mayowa O1, Thrift Amanda G2ORCID, Martins Sheila3, Johnson Walter4, Pandian Jeyaraj5ORCID, Abd-Allah Foad6, Varghese Cherian7, Mahal Ajay8, Yaria Joseph9ORCID, Phan Hoang T10, Roth Gregory11, Gall Seana L10, Beare Richard12, Phan Thanh G13ORCID, Mikulik Robert14, Norrving Bo15, Feigin Valery L16ORCID, Abera S.F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T.A., Aguiar de Sousa D., Akhmetzhanova Z., Akinyemi R.O., Akpalu A., Ameriso S.F., Andonova S., Abanto C., Awoniyi F.E., Bakhiet M., Basri H., Bath P.M., Bereczki D., Beretta S., Berkowitz A.L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M.S., Bovet P., Brainin M., Budincevic H., Cabral N.L., Cadilhac D A., Caso V., Chen C., Chin J.H., Christensen H, Chwojnicki K., Conforto A.B., Cruz V.T., D'Amelio M., Danielyan K.E., Davis S., Demarin V, Dempsey R.J., Dichgans M., Dokova , Donnan G., Duran J., Elizondo M.A.B., Elkind M.S., Endres M., Etedal I., Faris M.E., Fischer U., Gankpe F., Gavidia M., Gaye-Saavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R.R., Hamzat T.K., Hankey G.J., Heldner M.R., Ibrahim N.M., Inoue M., Jee S., Jiann-Shing J., Johnston S., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Kõrv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z.L., Kruja J., Lavados P.M., Lebedynets D., Leung T.W., Liebeskind D.S., Lindsay P., Liu L., López-Jaramillo P., Lotufo P.A., Machline-Carrion J.M., Markus H.S., Marquez-Romero J.M., Medina M.T., Medukhanova S., Mehndiratta M.M., Mirrakhimov E., Mohl S., Murphy S., Musa K.I., Nasreldein A., Nogueira R., Nolte C.H., Norrving B., Noubiap J.J., Novarro-Escudero N., O'Donnell M., Ogun V., Oraby M.I., Ovbiagele B., Ōrken D.N., Ōzdemir A.O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F.A., Roth G., Sacco R.L., Sahathevan R., Santos I.C., Saposnik G., Sarfo F.S., Sharma M., Sheth K.N., Shobhana A., Silva S.N., Suwanwela N., Sylaja P.N., Thakur K., Toni D., Topcuoglu M.A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J.N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K.W., Wang W., Wijeratne T., Wolfe C, Yifru M.Y., Yock-Corrales A., Yonemoto N., Yperzeele L.,
Affiliation:
1. Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria 2. Epidemiology and Prevention Division, Stroke and Ageing Research (STAR), School of Clinical Sciences, Monash University, Melbourne, Australia 3. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento & Brazilian Stroke Network 4. Loma Linda Hospital, Murrieta, CA, USA 5. Christian Medical College, Ludhiana, Punjab, India 6. Department of Neurology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt 7. Non-communicable Disease Department, World Health Organization, Geneva, Switzerland 8. Nossal Institute of Global Health, University of Melbourne, Australia 9. Department of Neurology, University College Hospital, Ibadan, Nigeria 10. Menzies Institute for Medical Research, University of Tasmania, Australia 11. NUI Galway Health Research Board, Clinical Research Coordination, Galway, Ireland 12. Peninsula Clinical School, Monash University, and Developmental Imaging Group, Murdoch Children’s Research Institute, Melbourne, Australia 13. Department of Neurology, Monash Health and School of Clinical Sciences, Monash University, Melbourne, Australia 14. International Clinical Research Center and Neurology Department of St. Anne’s, University Hospital and Masaryk University, Brno, Czech Republic 15. Department of Clinical Sciences, Lund University, Sweden 16. National Institute for Stroke and Applied Neurosciences (NISAN), School of Clinical Sciences, Auckland University of Technology, New Zealand
Abstract
Background Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization–World Health Organization– Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Methods Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Results Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ∼ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. Conclusions There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.
Publisher
SAGE Publications
Cited by
64 articles.
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