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The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys

MO. Owolabi, AG. Thrift, S. Martins, W. Johnson, J. Pandian, F. Abd-Allah, C. Varghese, A. Mahal, J. Yaria, HT. Phan, G. Roth, SL. Gall, R. Beare, TG. Phan, R. Mikulik, B. Norrving, VL. Feigin, Stroke Experts Collaboration Group

. 2021 ; 16 (8) : 889-901. [pub] 20210527

Language English Country United States

Document type Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc22003592

Grant support
001 World Health Organization - International
R01 NS107900 NINDS NIH HHS - United States
R01 NS115944 NINDS NIH HHS - United States
R01 NS114045 NINDS NIH HHS - United States

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.

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$a 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.
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$a Thrift, Amanda G $u Epidemiology and Prevention Division, Stroke and Ageing Research (STAR), School of Clinical Sciences, Monash University, Melbourne, Australia
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$a Martins, Sheila $u Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento & Brazilian Stroke Network
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$a Johnson, Walter $u Loma Linda Hospital, Murrieta, CA, USA
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$a Pandian, Jeyaraj $u Christian Medical College, Ludhiana, Punjab, India
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$a Phan, Hoang T $u Menzies Institute for Medical Research, University of Tasmania, Australia
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$a Roth, Gregory $u NUI Galway Health Research Board, Clinical Research Coordination, Galway, Ireland
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$a Gall, Seana L $u Menzies Institute for Medical Research, University of Tasmania, Australia
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