J Korean Med Sci.  2015 Nov;30(Suppl 2):S139-S142. 10.3346/jkms.2015.30.S2.S139.

Development-assistance Strategies for Stroke in Low- and Middle-income Countries

• Lee H
• Nam YS
• Lee KM

• KMID: 2351151
• DOI: http://doi.org/10.3346/jkms.2015.30.S2.S139

Abstract

While communicable diseases still pose a serious health threat in developing countries, previously neglected health issues caused by non-communicable diseases such as stroke are rapidly becoming a major burden to these countries. In this review we will discuss the features and current status of stroke in low- and middle-income countries (LMICs). Overall the global burden of hemorrhagic stroke is larger than ischemic stroke, with a disproportionately greater burden, measured in incidence and disability-adjusted life-years, regionally localized in LMICs. Patients in poorer countries suffer due to insufficient primary care needed to control risk factors such as hypertension, and inadequate emergency care systems through which sudden events should be managed. In light of these situations, we emphasize two strategic points for development assistance. First, assistance should be provided for bolstering, integrating, and coordinating both the primary health and emergency care systems, in order to prevent stroke and strengthen stroke management, respectively. Second, the assistance needs to focus on programs at the community level, to reduce life-style risks of stroke in a more sustainable manner, and to improve stroke outcomes more effectively.

Keyword

Cerebrovascular Disorder; Global Health Burden; Non-communicable Diseases; Primary Health Care; Emergency Care System; Community-based Approach

MeSH Terms

Delivery of Health Care/*organization & administration
Developing Countries/*economics
*Economic Development
Global Health
Health Promotion/*organization & administration
Humans
Incidence
International Cooperation
Models, Organizational
Prevalence
Risk Factors
Stroke/economics/*epidemiology/*prevention & control

Reference

1. Hankey GJ. The global and regional burden of stroke. Lancet Glob Health. 2013; 1:e239–e240.

2. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009; 8:355–369.

3. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2095–2128.

4. Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson LM, Truelsen T, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013; 1:e259–e281.

5. Lawes CM, Vander Hoorn S, Rodgers A. International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008; 371:1513–1518.

6. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, Rangarajan S, Islam S, Pais P, McQueen MJ, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376:112–123.

7. Turnbull F, Woodward M, Anna V. Effectiveness of blood pressure lowering: evidence-based comparisons between men and women. Expert Rev Cardiovasc Ther. 2010; 8:199–209.

8. Kim AS, Johnston SC. Global variation in the relative burden of stroke and ischemic heart disease. Circulation. 2011; 124:314–323.

9. Jung JM, Choi J, Eun MY, Seo WK, Cho KH, Yu S, Oh K, Hong S, Park KY. Prestroke antiplatelet agents in first-ever ischemic stroke: clinical effects. Neurology. 2015; 84:1080–1089.

10. Koton S, Molshatzki N, Bornstein NM, Tanne D. Low cholesterol, statins and outcomes in patients with first-ever acute ischemic stroke. Cerebrovasc Dis. 2012; 34:213–220.

11. Ludwig J, Sanbonmatsu L, Gennetian L, Adam E, Duncan GJ, Katz LF, Kessler RC, Kling JR, Lindau ST, Whitaker RC, et al. Neighborhoods, obesity, and diabetes--a randomized social experiment. N Engl J Med. 2011; 365:1509–1519.

12. Hernandez R, Kershaw KN, Prohaska TR, Wang PC, Marquez DX, Sarkisian CA. The cross-sectional and longitudinal association between perceived neighborhood walkability characteristics and depressive symptoms in older Latinos: the "inverted exclamation markCaminemos!" study. J Aging Health. 2015; 27:551–568.

13. Rasella D, Harhay MO, Pamponet ML, Aquino R, Barreto ML. Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data. BMJ. 2014; 349:g4014.