Stroke or cerebrovascular disease (CVD) has been a worldwide concern for many years, affecting people from all walks of life and costing high-income, middle-income, and low-income countries a significant amount of money to cover the medical expenses. In 2015, stroke ranked 2nd in the World Health Organization’s (WHO) top 10 causes of death worldwide. Together with ischemic heart disease, these two were responsible for the death of 15 million people in the said year.
WHO 2015 data shows that stroke was the 2nd leading cause of mortality in both high-income and middle-income economies. However, it ranked 3rd in low-income economies, where respiratory infections and diarrheal diseases were the 1st and 2nd leading causes of death, respectively.
Basic Facts About Stroke
Stroke is a fatal medical condition that can turn your whole life around. The disease mainly affects the arteries in your brain, which are responsible for supplying your brain tissues with oxygen-rich blood and nutrients. These brain tissues will die if the supply is cut or diminished, either due to a blood clot in the artery (ischemic stroke) or a ruptured brain artery (hemorrhagic stroke). Approximately 87% of stroke cases in the United States are ischemic in nature.
The disease is both debilitating and deadly because it affects your brain, the command center of your body. If it occurs on the right side of your brain, you are likely to experience vision problems, left-sided paralysis of the body, and loss of memory. On the other hand, if the left side is affected, you might present with speech problems, memory loss, and right-sided paralysis. If your brainstem is affected, bilateral signs and symptoms might manifest. It might also leave you in a state of coma.
The prognosis of stroke cases generally depends on the severity of the attack, the extent of the brain damage, and the areas of the brain affected. Aside from these, the availability of medications and medical interventions also play an important role in the road to recovery.
Stroke in Developing Countries
Researchers have been conducting studies in an effort to determine the factors contributing to the increasing prevalence of stroke in the developing countries. A 2017 study published in the Journal of Neurological Sciences came to the conclusion that compared to high-income countries, low-income countries have a lesser quantity and quality of stroke prevention guidelines. The study highlights the need to do significant improvements on prevention efforts to reduce the cases of stroke.
According to Professor Lloyd-Sherlock of the University of East Anglia, stroke prevention measures in the developing countries must be given appropriate attention. Health programs in these countries are greatly focused on communicable diseases despite the rising number of cases related to lifestyle diseases. Although the prevention of lifestyle diseases are easy and affordable, the rising statistics calls for more comprehensive and targeted strategies to ensure that these preventive measures are disseminated and well enforced.
In addition to this, the availability and accessibility of emergency treatments in developing countries, particularly in the rural areas, remain limited. He encouraged the implementation of a targeted screening process since it is a relatively cheaper form of prevention and allow for early detection of cases.
Teo and Dokainish conducted a study on cardiovascular risk factors and atherosclerotic diseases as emerging epidemics in developing countries. Their research has shown that the fatality of cardiovascular diseases is higher in low-income countries compared to high-income countries, despite the latter having the highest cardiovascular risk. Their study also found that adherence to medication is poor in high and middle-income countries. An even lower adherence rate was observed in low-income countries due to unavailability and unaffordability of medications. Lifestyle modifications and control of risk factors for cardiovascular diseases are also poorly observed in low-income countries, contributing to the high mortality rate of stroke patients.
An article published in Jama Neurology has stated that stroke services in developing countries are either nonexistent or unaffordable, making it available only to a few individuals who can afford these costly treatment offered by private hospitals. In government hospitals, it has been shown that although thrombolytic therapy is available, it is not being offered for free and patients are still asked to shoulder a portion of the treatment cost, which they are unable to afford. These circumstances make it more prudent to focus the initiatives toward stroke prevention instead, which has a cheaper medical cost, to combat the rising number of stroke cases in developing countries.
Although certain risk factors for stroke cannot be modified like age, sex, and family history, controlling the modifiable risk factors can achieve positive results in the worldwide fight against stroke. Home blood pressure monitoring is widely encouraged for it has been shown that regular use of home BP monitoring for professional and home use can greatly reduce your blood pressure over time. Smoking cessation and diet modification (low salt and low fat) should also be emphasized to the public.