Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.

Center for Genomic and Precision Medicine College of Medicine University of Ibadan Ibadan Nigeria

Department of Clinical Sciences and Department of Neurology Skåne University Hospital Lund University Lund Sweden

Department of Neurology Hospital de Clínicas de Porto Alegre Porto Alegre Brazil; Department of Neurology Universidade Federal do Rio Grande do Sul Rio Grande do Sul Brazil; Department of Neurology Hospital Moinhos de Vento Porto Alegre Brazil; Brazilian Stroke Network São Paulo Brazil

Department of Neurology Kasr Alainy School of Medicine Cairo University Cairo Egypt

Department of Neurology Monash University Melbourne VIC Australia; Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia

Department of Neurology University College Hospital Ibadan Nigeria

Department of Neuroscience and Preventive Medicine Danube University Krems Krems an der Donau Austria

Institute for Advanced Medical Research and Training College of Medicine University of Ibadan Ibadan Nigeria

Institute for Health Metrics Evaluation University of Washington Seattle WA USA

Institute for Health Metrics Evaluation University of Washington Seattle WA USA; National Institute for Stroke and Applied Neurosciences School of Clinical Sciences Faculty of Health and Environmental Sciences Auckland University of Technology Auckland New Zealand; Scientific and Educational Department Research Centre of Neurology Moscow Russia

International Clinical Research Center Neurology Department St Anne's University Hospital Masaryk University Brno Czech Republic

Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia

Monash Health and Peninsula Clinical School Monash University Melbourne VIC Australia; Developmental Imaging Group Murdoch Children's Research Institute Melbourne VIC Australia

Nossal Institute for Global Health University of Melbourne Melbourne VIC Australia

School of Public Health Christian Medical College Ludhiana Punjab India

School of Public Health Loma Linda University Loma Linda CA USA

Stroke and Ageing Research Department of Medicine School of Clinical Sciences Monash University Melbourne VIC Australia

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Lancet Public Health. 2022 Jan;7(1):e14. doi: 10.1016/S2468-2667(21)00281-4. PubMed

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