Can we stop the stroke epidemic in Pakistan

摘要: Pakistan has the world’s 6th largest population with a growth rate of about 2% per year. Most recent national health survey conducted by Medical and Research Council reported that 33% Pakistani above age 45 years is suffering from hypertension.4 About one-third these hypertensives were unaware their hypertension. A large proportion diabatic, 5.2 million in year 2000 projected to be 13.9 2020.5 14-21% adolescents adults are given smoking tobacco, majority being male.6 Exact prevalence may higher because number smokers especially women do not report habits. There no well-designed, population- based published studies related stroke Pakistan. The estimated annual incidence 250/100,000, which an estimate 350,000 new cases every year.7 Some potential risk factors unique our remain unstudied include huqqa (water-pipe) smoking, orally chewed tobacco (naswar, pan, mishri, ghutka, bajjar, ghundi), different forms clarified butter hydrogenated oils, rheumatic heart disease, high hepatitis B C.2 Younger at first particularly among women, haemorrhagic some alarming features available known epidemiology.1,2 85% all deaths registered low- middle-income countries, also account for 87% total losses due terms disability-adjusted life (DALYs).8 Although often neglected, informal care paramount relevance maintain survivors community, valuable economic resource systems. Indirect costs both frequency, i.e. crude numbers expressed as prevalence, severity mortality, morbidity functional impairment. An effective optimization starts primary prevention treatment vascular factors, admission patients dedicated wards multidisciplinary approach, adherence guidelines acute phase management, early rehabilitation availability treatments, such thrombolysis, selected patients.8 Assessing direct cost retrospective analysis tertiary teaching hospital Pakistan, authors concluded was extremely compared average income most important determinant length stay.9 burden