The Epidemiology of Stroke in Pakistan: Past, Present, and Future

Abstract

Stroke is a major public health problem in developing countries of South Asia. In this paper, we review the epidemiology of stroke in Pakistan. Most of the available data are based on hospital-centred case series addressing established stroke risk factors, stroke-related mortality and disability, functional status, and case fatality rates. There are limited population-based data regarding the prevalence of established stroke risk factors in the general population, and no epidemiologic studies have been conducted to specifically identify potential stroke risk factors unique to the region. The limited data that are available from Pakistan indicate that stroke epidemiology differs between Pakistan and Western populations - in Pakistan first stroke occurs at a younger age, particularly among women, and there is a higher proportion of haemorrhagic strokes. Besides the established stroke risk factors (e.g. hypertension, smoking, and diabetes) some potentially unique stroke risk factors related to life style and dietary habits such as huqqa smoking, use of dalda and desi ghee, and orally consumed forms of tobacco, may exist in Pakistan, and warrant further investigation. The shortage of trained stroke epidemiologists is a major limiting factor to the conduct of epidemiological stroke studies in Pakistan. Epidemiologic data are essential to guide health policy development aimed at decreasing the mortality and morbidity from stroke in Pakistan. To facilitate this process, medical professionals in Pakistan could participate in the World Health Organization's STEPwise approach to stroke surveillance, which provides a framework for data collection and comparison between and within populations.