Stroke is a major cause of disability and death globally that disproportionately affects people in low- and middle-income countries. Worldwide, stroke is the second leading cause of death and the third leading cause of disability.
Around 70% of strokes occur in low- and middle-income countries, where the incidence of stroke has more than doubled over the last four decades, and where, on average, stroke occurs to people 15 years earlier than it does in high-income countries. Up to 84% of stroke patients in low- and middle-income countries die within three years of diagnosis, as compared with 16% in high-income countries. For stroke survivors, lifelong sequalae and disabilities, including mental health problems, are common, and can be a source of financial hardship.
To help achieve the Sustainable Development Goal (SDG) target of a one-third reduction in premature mortality from noncommunicable diseases (NCDs) by 2030, WHO will continue to support countries in the South-East Asia Region to address the primary causes of stroke – including hypertension, diabetes and tobacco use – and will continue to promote the development of quality stroke services that are accessible to all.
Countries in the Region have in recent years implemented a series of high-impact “best buys” aimed at preventing stroke, in line with the Region’s Flagship Priority on preventing and controlling NCDs. All countries are implementing multisectoral NCD action plans, with a specific focus on enhancing services to detect and treat NCDs at the primary level. Region-wide, tobacco control initiatives continue to be strengthened, with five Member States – namely, India, Nepal, Maldives, Thailand and Timor-Leste – among the world’s top ten countries with the largest graphic warnings on tobacco packaging. WHO continues to work with countries in the Region to promote healthy lifestyles, including greater physical activity, for which the strategies outlined in WHO’s ACTIVE toolkit are of immense value.
To advance progress on the Region’s Flagship Priorities and applicable SDG targets, WHO will continue to support all countries to sustain and accelerate the implementation of interventions that prevent and control NCDs. But as new regional guidance highlights, increased efforts are required to scale up the quality and reach of services that can deliver stroke care. Region-wide, countries have great potential to improve and streamline stroke services, for example by increasing the availability of CT scanners, enhancing health workers’ knowledge and skills, implementing evidence-based clinical practice guidelines, and adopting continuous quality improvement programmes. Health services at all levels must have the capacity to provide fast-track referrals and coordinated emergency stroke care, in addition to ongoing support and rehabilitation for people living with stroke.
Amid the Region’s ongoing battle against COVID-19, WHO has provided hands-on technical support to Bhutan, Maldives, Myanmar and Timor-Leste to improve stroke services, and has also conducted online workshops with key partners to scale up core competencies along the stroke care continuum. Maintaining and strengthening essential health services, including for NCDs, has been – and will continue to be – a strategic priority within the Region’s pandemic response, as underscored by the Declaration on the Collective Response to COVID-19, adopted at the Seventy-third Session of the WHO Regional Committee for South-East Asia. Throughout the response and into the recovery and beyond, WHO is committed to providing Member States its full technical support in improving access to quality stroke services to reduce preventable morbidity and mortality and associated financial hardships.
On World Stroke Day, WHO reiterates the critical need to address the disproportionate burden of disability and death that stroke is responsible for in low- and middle-income countries globally, including in the South-East Asia Region. To do that, efforts to prevent and control NCDs such as hypertension and diabetes must continue to be strengthened, in addition to the provision of resource-linked, evidence-based stroke services that span the continuum of care, from stroke recognition to acute care, rehabilitation and community reintegration. Together we can realize a Region in which stroke is more effectively prevented and managed, with fewer stroke-related disabilities and deaths, and greater health, well-being and productivity. Let us achieve our vision, for a healthier and more sustainable future for all.
Singh is WHO Regional Director for South-East Asia.
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