The purpose of the World Stroke Day which is commemorated every year on 29 October is to increase awareness and drive actions on stroke around the world. In addition, this day provides opportunities to advocate for actions by decision makers to improve prevention of stroke, increase access to emergency medical care and provide support for survivors and caregivers. World Stroke Day 2022 campaign on “save #precioustime”, focuses on the recognition of stroke signs using the “FAST” and stressing the need for immediate treatment to prevent death or permanent disability.
Stroke is the leading cause of disability worldwide and the second leading cause of death. The Global Stroke Factsheet released in 2022 reveals that lifetime risk of developing a stroke has increased by 50% over the last 17 years and now 1 in 4 people is estimated to have a stroke in their lifetime. From 1990 to 2019, there has been a 70% increase in stroke incidence, 43% increase in deaths due to stroke, 102% increase in stroke prevalence and 143% increase in Disability Adjusted Life Years (DALY). The most striking feature is that the bulk of the global stroke burden (86% of deaths due to stroke and 89% of DALYs) occur in lower and lower-middle-income countries. This disproportionate burden experienced by lower and lower-middle income countries has posed an unprecedented problem to families with less resources.
In Sri Lanka, there are no national level data on stroke incidence and the annual health statistics of the Ministry of Health records approximately 60,000 stroke admissions to state hospitals annually with around 4000 deaths in hospitals. Furthermore, stroke which was the 3rd leading cause of hospital deaths in 2014 has now become the 7th leading cause in 2019.
Source: Medical Statistics Unit, Ministry of Health, Sri Lanka
Source: Medical Statistics Unit, Ministry of Health, Sri Lanka
One of the main clinical risk factors for stroke is a high blood pressure. Other risk factors include tobacco use, physical inactivity, unhealthy diet, use of alcohol, atrial fibrillation, raised blood lipid levels, obesity, genetic disposition, stress, and depression. Stroke survivors may live with impacts which include physical disability, communication difficulties, loss of work, income, and social networks. Fast access to treatment saves lives and improves recovery.
The key signs of stroke are facial drooping, arm weakness on one side, and speech difficulties - slurring or not making sense. People may also experience changes in their vision and loss of balance/dizziness. Knowing the signs of stroke and seeking immediate emergency medical care can save lives and improve the outcome for survivors. “FAST” stroke recognition helps any person to identify a stroke quickly and take immediate action to transfer the patient to the nearest hospital.
WHO has collaborated with the National Stroke Association Sri Lanka (NSASL) and Ministry of Health by hosting of the Asia Pacific Stroke Conference in 2011 and commemorating World Stroke Day during last few biennia. WHO Sri Lanka partnered with Sri Lanka Medical Association to develop a manual on “Stroke Rehabilitation” and to train the Consultant Physicians and Consultant Neurologists on stroke rehabilitation. Currently, WHO South-East Asia Region has launched a programme to provide ‘Technical Support for Mentoring of Stroke Care Improvement Program’ in six countries in South-East Asia Region in collaboration with Christian Medical College (CMC), Ludihana, Punjab, India. Sri Lanka is also engaged in the above programme with the National Stroke Association and Non-communicable diseases unit of the MoH and WHO Sri Lanka office is providing technical support. As an initial step of the project, an appraisal of stroke care delivery in Sri Lanka was done in May to December 2022.
WHO will continue to support Ministry of Health and all stakeholders to reduce the burden of stroke through primordial, primary and secondary prevention and rehabilitation.
References
- World Stroke Campaign. WSD2022_Campaign_Toolkit_LR.pdf.
- Global Stroke Factsheet. International Journal of Stroke. 2022, Vol. 17(1) 18–29
- Annual Health Bulletin 2019, Ministry of Health, Sri Lanka.
- Know the Facts About Stroke
- Feigin VL, Stark BA, Johnson CO, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795–820.