Ericka Samantha Teleg, MD

World Stroke Congress
October 28–29, 2021

Plenary Session: “Stroke in Low to Middle Income Countries”

While the landscape of stroke changes in terms of innovations, pathways and technology, there is a continuing increase of stroke burden in the low to middle income countries (LMICs). This session was moderated by Dr. Norlinah Ibrahim and Dr. Mayowa Owolabi.

Dr. Owolabi opened the discussion by giving an overview of the Lancet Commission in giving evidence-based recommendations that are pragmatic in nature extending to primary, secondary, and tertiary prevention, keeping in mind that these regions bear a burden due to limited resources. He emphasized the Stroke Quadrangle that includes epidemiological surveillance, acute care, rehabilitation, palliative care, health promotion, and disease prevention. He set the stage by reiterating that there is scarcity of funding for primary stroke prevention, particularly in LMICs. There is indeed an absence of an integrative approach. Regional and national differences in policymaking are also a variable. 

Dr. Nijasri Suwanwela, from Thailand, followed with her discussion on the “Changing of the World Landscape in Stroke Epidemiology.” She reiterated the dual burden of stroke. She also emphasized that stroke care is a continuum that begins with primary prevention, which must encompass public awareness even at an early age despite stroke being a disease of the elderly, as well as policy and promotion of a healthy lifestyle.

A second aspect of the continuum is primary prevention that includes risk assessment. Dr. Valery Feigin presented that a motivational approach can be implemented in this aspect. While each stroke landscape differs globally, Dr. Feigin encouraged adaptation of technology through Stroke Risk Assessment apps that may be applicable.

The difference in stroke landscape and applicability of strategies was shown in Dr. Jeyaraj Pandian’s talk in which he said that although some countries can do stroke pre-hospital care, in other regions, this is not possible. There are two components of analyzing barriers in stroke care; they include the patient component and the health care system component. The presence of stroke units, stroke neurologists, and more so, stroke interventionalists are among the elements that Dr. Pandian emphasized.

To change policy, there must be knowledge of the economic burden of stroke, presented by Dr. Ajay Mahal. He emphasized that there is an economic burden of stroke in the household, namely, there is loss of income, costs of living, and longer run burdens to disabled persons. As there is scarcity of medical costs data from low-income countries, there is insufficient data to calculate medical costs comparing high income countries versus LMICs. Loss of income from a stroke disability, in a household on the individual level, carries a fulminant impact and carries implications to the national cost, overall.

While we, overall, benefit from stroke innovations, with several paradigm-shifting trials and research in stroke care, LMICs experience allocation resource scarcity. This plenary session has prompted us to analyze the need to broaden our delivery of stroke health care to include LMICs.