Stroke profile in Afghanistan, Nepal, and India

Abstract

Introduction.– Stroke is a major health issue in semi-industrialized countries (SIC). We reviewed stroke profile of three SICs: Afghanistan, Nepal, India. Methods.– We searched PUBMED,BVNA (http://www-ient.unilim.fr/), SCOPUS, www.ajol.info, WHO InfoBase, using several relevant keywords. Results.– For Afghanistan, no prevalence or incidence data was found. Age-standardised mortality and disability adjusted life years (DALY) (/100,000) is 118.6 and 908.0 respectively. Overweight/obesity (≥25 kg/m2) occurred in 1.8-11.5% stroke-free subjects (SFS) and ≥30 kg/m2 in 16.1% of SFS. Hypertension (>130/85 mmHg) occur in 11.2-14.3% in Kabul SFS. Tobacco use in SFS varied from 15.4% to 82.0% among males and 5.4-17.0% among Women. Hypercholesterolemia was reported in 44% in a hospital-based survey. Nepal does not have any incidence data. Hospital-based study showed 150 stroke occurrences (42% hemorrhagic) over one year (as young as 7 years age). Its mortality and DALY (/100,000) is 107.5 and 543.0 respectively. Hypertension among hospital-based cases varied from 40-60% cases and tobacco use among such cases varied from 40.6-61.0%. Alcoholism and atrial fibrilation (AF) among such cases was 41.4% and 12.5%, respectively. Diabetes occurred among 11.1% hospital cases, 4.1-9.5% in semi-urban SFS and 19.0% among urban SFS. For India, incidence (/100,000/yr) is 36-145 in urban and 13-124 in rural populations. Prevalence (/100,000) is 44-842 in urban and 52-165 in rural populations. Mortality and DALY (/100,000) are 60 and 597.6 respectively. Population-based data on SFS shows high prevalence of obesity (6-49%), hypertension (12-40%), tobacco use (46% men, 13% women), hypercholesterolemia (7-32%), alcoholism (22.5%), AF (7%), diabetes (3-12%). History of stroke provides highest attributable risk. Males have 7-times higher risk for stroke. Conclusions.– Stroke is inadequately studied in Afghanistan and Nepal. High mortality and DALY rates are seen and so is the prevalence of risk factors. Most risk factors are lifestyle related, therefore modifiable.