India has made phenomenal strides in its healthcare sector, but many areas remain to be addressed. What is particularly disconcerting is that like cancer and heart disease, stroke is developing into a potentially explosive public health issue across the country. This warrants a national programme for combating and managing stroke. Essentially, it would involve robust governmental interventions for putting in place parameters and protocols for patient safety, reduction of morbidity and mortality and effective rehabilitation.

World Stroke Day is observed on October 29, and the message for this year is ‘Up Again after Stroke’. In the Indian context, such a call reiterates the need for both the Central and State governments to initiate programmes to create awareness among public about early recognition and treatment of stroke and also provide facilities for acute stroke management in all medical colleges and district hospitals.

The only specific treatment available for stroke is thrombolytic therapy, which is expensive. This drug is given free only in a few States. The government should ensure that this lifesaving drug is given free in all the States. Also, mechanical thrombectomy devices are currently unaffordable for majority of the people. Restriction needs to be imposed on cost of ‘stentrievers’ for acute ischemic stroke therapy, similar to cardiac stents.

Insurance cover

Ayushman Bharat, the world’s biggest health insurance scheme for families based on income criteria, must be leveraged to provide cover for treatment of stroke that affects both the urban and rural populace.

Besides developing inexpensive and judicious treatment systems, hospitals across the country should be well-equipped with ambulance services, trained paramedical and nursing personnel, and access to swift radiology and rehabilitation facilities to treat various types of stroke. It would be a great idea if properly-equipped hospitals have signboards saying ‘stroke-ready’, similar to trauma care.

Stroke management needs a multi-disciplinary approach that is not limited to neurology. Though training of physicians for stroke treatment and management is being done by neurologist in a few States, this needs to be done at a national level. Continuing Medical Education (CME) programmes for doctors, nurses and paramedics should be organised across the country. A crucial component would be developing a national monitoring framework to instil confidence among stroke patients for a renewed lease of life.

Recognition and treatment of stroke in the early stage will reduce morbidity and mortality. Blood clots in the brain can be dissolved using injectable medications, if presented within 4.5 hours of onset of symptoms. FAST (Face, Arm, Speech, Time) mnemonic will help to remember the early signs of stroke. Incidence of stroke varies in different countries. In India, the estimated incidence is about 119-145/100,000 population, whereas in the US around eight lakh people suffer stroke each year. A recent study in The Lancet reveals that heart disease and stroke in India have increased by over 50 per cent from 1990 to 2016.

These diseases together contributed to 28.1 per cent of total deaths in India in 2016 — compared with 15.2 per cent in 1990. The severity of stroke and the mortality are higher among women. Stroke is no longer a silent epidemic in India, and the response to mitigate it brooks no further delay.

The writers are President and Secretary, respectively, Indian Stroke Association .

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