The state of stroke services across the globe: Report of World Stroke Organization–World Health Organization surveys
Mayowa Owolabi, Amanda G. Thrift, Sheila Cristina Ouriques Martins, Walter D. Johnson, Jeyaraj Pandian, Foad Abd-Allah, Cherian Varghese, Ajay Mahal, Joseph Yaria, Hoang Phan, Gregory A. Roth, Seana Gall, Richard Beare, Thanh G. Phan, Robert Mikulík, Bo Norrving, Valery L. Feigin, Semaw Ferede Abera, Adamu Addissie, Adeniyi Adeleye, Yerzhan Adilbekov, B. Adilbekova, Thierry Adoukonou, de Aguiar, З Б Ахметжанова, Rufus Akinyemi, Albert Akpalu, Sebastián F. Ameriso, Silva Andonova, Carlos Abanto, Folorunso E Awoniyi, Moiz Bakhiet, Helmi Hasan Basri, Philip M. Bath, Dániel Bereczki, Simone Beretta, Aaron L. Berkowitz, Julie Bernhardt, Guna Bērziņa, Bhavan Bhavsar, Mher S Bisharyan, Pascal Bovet, Michael Brainin, Hrvoje Budinčević, Norberto L. Cabral, Dominique A. Cadilhac, Valeria Caso, Christopher Chen, Joong Hyoun Chin, Hanne Christensen, Kamil Chwojnicki, Adriana Bastos Conforto, Vítor Tedim Cruz, Marco D’Amelio, Kristine Danielyan, Stephen M. Davis, Vida Demarin, Robert J. Dempsey, Martin Dichgans, Dokova, Geoffrey A. Donnan, Juan Carlos Durán, Marcelo Elizondo, Mitchell S Elkind, Matthias Endres, I. Etedal, MoezAlIslam E. Faris, Urs Fischer, Fortuné Gbètoho Gankpé, Martín Gavidia, A. Gaye-Saavedra, Maurice Giroud, Fernando Góngora‐Rivera, Vladimir Hachinski, Werner Hacke, Randah R Hamadeh, Talhatu K. Hamzat, Graeme J. Hankey, Mirjam R. Heldner, Norlinah Mohamed Ibrahim, Manami Inoue, Sun Ha Jee, Jeng Jiann-Shing, S. Claiborne Johnston, Yogeshwar Kalkonde, Saltanat Kamenova, Peter J. Kelly, Tariq Khan, Stefan Kiechl, Аida Kondybayeva, Janika Kõrv, Maksim Kravchenko, Rita Krishnamurthi, Peter Langhorne, Zijian Kang, Jera Kruja, Pablo M. Lavados, Dmytro Lebedynets, Thomas Leung, David S Liebeskind
Abstract
BACKGROUND: 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.