The Burden of Stroke in Pakistan

Khealani, Bhojo A; Wasay, Mohammad

doi:10.1111/j.1747-4949.2008.00214.x

Cited by 54 publications

(78 citation statements)

References 13 publications

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“…The fact that brain tissue is viable to be salvaged within a given period of time is the key concept in understanding why the time frame for delivering thrombolysis or intervention is so crucial in acute ischaemic stroke as shown in figure 4. [28][29][30][31][32][33][34][35][36][37][38][39][40] …”

Section: Transit Timesmentioning

confidence: 99%

Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives

et al. 2017

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Ischaemic stroke is a major cause of neurological morbidity and mortality. The objective of this review article is to summarise facts pertaining to acute ischaemic stroke and its various aspects in a developing country like Pakistan, where resources are limited and the healthcare system is underdeveloped. No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. We reviewed the available literature on stroke from Pakistan and through this article we primarily aim to present the current acute ischaemic stroke management in Pakistan in juxtaposition to that of the developed world. We also intend to highlight areas for future development and improvement in management. The routine practice in Pakistan is that of using stat dose of aspirin in emergency (ER) at large with only a handful of centres offering thrombolytic therapy with recombinant tissue plasminogen activator for acute ischaemic stroke. This too is faced with the problem of long window periods before the patient reaches a proper stroke care centre. The facilities of interventional therapies like arterial thrombolysis and endovascular surgery are non-existent and rehabilitation facilities limited. The opportunities for training physicians in acute stroke are also scarce. Stroke in children is underdiagnosed and that in women not availing facilities at stroke care centres. While basic research has gained pace regarding local demographic data, advanced research and genetic studies are extremely limited. The field of stroke neurology needs to grow at a substantial pace in Pakistan to be at par with the developed world.

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Section: Transit Timesmentioning

confidence: 99%

Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives

et al. 2017

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“…The frequency of smokers ranged from 11% to 53% in previously published studies related to stroke in Pakistan. 2 This low frequency of reported smoking could be related to poor documentation or poor reporting from patients. There are several limitations to our study.…”

Section: Discussionmentioning

confidence: 97%

“…A recent review of various stroke studies from Pakistan showed that the proportion of hemorrhagic stroke varied from 21% to 39% among all stroke sufferers. 2 A Chinese communitybased study carried out in 1985 reported a 44% incidence of ICH, 3 while a relatively recent study (2007) from the same country reported a higher proportion of hemorrhagic stroke (up to 55%) in the Chinese population. 4 During the last 20 years, substantial changes in stroke risk factors, stroke subtypes, hospitalization trends, and outcomes have been reported around the globe.…”

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confidence: 97%

Temporal Trends in Risk Factors and Outcome of Intracerebral Hemorrhage Over 18 Years at a Tertiary Care Hospital in Karachi, Pakistan

Wasay

Khatri

Khealani

et al. 2012

Journal of Stroke and Cerebrovascular Diseases

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“…The prevalence of stroke is very high because of hypertension, diabetes, and tobacco use. 6 Tetanus, rabies, and polio are still prevalent with high mortality. …”

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“…The prevalence of stroke is very high because of hypertension, diabetes, and tobacco use. 6 Tetanus, rabies, and polio are still prevalent with high mortality. 7 General physicians and patients are realizing that a neurologist is better trained to manage the complex neurologic diseases.…”

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Neurology in Pakistan: Growing burden, low on priority, and a hope to keep alive

Wasay

Khatri

2013

Neurology

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Neurology is one of the most underrecognized and underappreciated specialties in Pakistan. 1 The beginnings of clinical and academic neurology in Pakistan can be traced to the 1960s when 3 neurology departments were established in 2 major cities of Pakistan: 2 in Karachi and 1 in Lahore.2,3 One of the 2 departments in Karachi was a combined neurology and psychiatry department. 2From the onset, neurology was given the status of an optional specialty by the Pakistan Medical and Dental Council (PMDC) for undergraduate medical colleges. This implied that it was not mandatory for medical colleges to have a separate department of neurology for the purpose of recognition by the PMDC.3 Unfortunately, this still holds true even after almost 50 years of building a foundation for clinical and academic neurology. Many of Pakistan's premier medical colleges do not have a separate neurology department.2 Only 15 of the 72 medical colleges have a neurology department or neurology faculty. Most of the medical students graduating from these medical colleges do not go through structured neurology teaching by a neurologist. 4 Currently, there are 15 programs in 7 cities accredited by the College of Physicians and Surgeons of Pakistan for postgraduate training in neurology. These programs are both in public and private sector hospitals and are primarily adult neurology training programs. The programs are not uniform and the trainees do not get equal opportunities and exposure to various aspects of training. The availability of advanced technology, expertise in neurophysiology, neuroradiology, and other specialized areas varies from program to program. The patient population and disease spectrum is also quite different in public and private sector hospitals. The hierarchal supervision, and gradual transition from supervised to independent, differs greatly from institution to institution. The subspecialties of neurology are not realized even among some neurology circles-and only 1 training program offers training in neurophysiology, child neurology, and stroke neurology. The remaining subspecialties are not only underserved but also underacknowledged. Retaining neurologists in Pakistan is an important issue as an alarming number of neurologists are moving out of the country after training because of lack of jobs.Except for some work on the epidemiology of epilepsy in the Pakistani population in 1980s and 1990s, no large-scale epidemiologic studies have been done on regional neurologic disorders. The incidence or prevalence of major neurologic diseases is not known 5 and this lack of data translates into a governmental health policy with little focus on neurologic disease. 5 The burden of stroke, epilepsy, and CNS infections (especially tuberculous meningitis) is a shared experience across all neurology departments and services in the country. The prevalence of stroke is very high because of hypertension, diabetes, and tobacco use. 6 Tetanus, rabies, and polio are still prevalent with high mortality. 7General physicians and patients ar...

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The Burden of Stroke in Pakistan

Cited by 54 publications

References 13 publications

Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives

Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives

Temporal Trends in Risk Factors and Outcome of Intracerebral Hemorrhage Over 18 Years at a Tertiary Care Hospital in Karachi, Pakistan

Neurology in Pakistan: Growing burden, low on priority, and a hope to keep alive

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