Over the past couple of decades, the reasons for ill-health and disease have seen a rapid transition globally, and more so in India, where studies have shown an increase in the proportion of deaths contributed by Noncommunicable Diseases (NCDs) over infectious diseases, maternal and child health conditions.
One of the diseases that has seen a significant increase is stroke. Stroke is a leading cause of death and disability across the world.
In India, it is the fifth leading cause of death among all causes. Its burden has increased by 12.2% from 1990 to 2016. Increase in life expectancy and exposure to risk factors are linked to the increasing prevalence of this disease, and it continues to have significant socioeconomic consequences for both patients and caregivers, and consequently, on our health services. Yet, what we often forget, is that stroke is largely preventable and curable, if timely action is taken.
Risk Factors and Treatment
So, what exactly is a stroke? Stroke is recognised as a sudden onset disease characterised by a weakness of limbs; angulation of the face and mouth; slurring of speech; difficulty in swallowing and, sometimes, loss of consciousness. There are regional variations within the country regarding its occurrence, types (more haemorrhagic types in eastern and north eastern parts and thrombotic type in southern parts), age groups, survival and outcomes. Usually a disease of the elderly, it is now being seen increasingly in young adults below 40 years of age.
Stroke is driven by a cluster of risk factors – high blood pressure, diabetes, high cholesterol, obesity, tobacco and alcohol use, air pollution, etc. – all of which can, over a period of time, contribute to the sudden onset of a stroke. Despite its suddenness, there is a golden period of approximately 4.5 hours after the onset where, through early detection and immediate medical care, the disease can potentially be treated.
Prevention Through a Public-Health Lens
As with many other NCDs, a holistic approach to reducing stroke needs to incorporate a public health lens. First, and foremost, in this regard is gathering data. Without robust data on the clinical and epidemiological aspects of stroke from different parts of the country, covering the diversities of age, gender, socioeconomic classes and residence, we cannot plan and design effective preventive strategies.
To this end, ICMR has established stroke registries to gather data on stroke magnitude, types, quality of care, outcome and survival across different geographies and populations to ensure better monitoring and surveillance.
Second, we need to strengthen measures for appropriate management of patients suffering from the disease. For instance, mobile stroke clinics are being piloted by ICMR in Tezpur, Assam, to respond to emergencies quickly and efficiently. If successful, they can be expanded to more areas. District-level stroke care units are also being augmented to provide clotting busting (thrombolytic therapy) facilities to improve survival rates of patients. Additionally, standard treatment guidelines for different levels of healthcare systems will also enable improved stroke care, and so will integration of health care services through the Ayushman Bharat Health and Wellness centres for reaching out to the rural and underserved populations. The present pandemic has also thrown up new challenges. Strengthening telemedicine services to provide remote medical assessments, referral and management advice can go a long way in overcoming this new barrier.
Finally, we need to create more awareness. Tackling risk factors early on and throughout the course of one’s life is critical to prevent the disease, and that can only be done if the public is adequately informed. This will require partnerships and collaboration of society, families, healthcare professionals, caregivers, academia, researchers, media, policy and decision makers. Effective adoption of existing policies, programs and campaigns – such as Fit India, Eat Right India, Measure Your Blood Pressure, FAST (Facial drooping, Arm weakness, Speech difficulties and Time), NCD screening programs, etc. – can also contribute significantly in reducing the disease.
Only by implementing programmatic changes through a public-health approach can we fight this silent killer. On World Stroke Day, let us join hands to ensure that we can improve the quality of life of citizens everywhere by taking collective action.
Dr Prashant Mathur is Scientist G & Director, ICMR National Center for Disease Informatics and Research (NCDIR), Bengaluru.
Dr Sukanya Rangamani is Scientist, ICMR National Center for Disease Informatics and Research (NCDIR), Bengaluru.
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