Why we do it

Stroke is not only the third leading cause of death with 10% of all deaths in Nepal, but is also associated with a drastic reduction in quality of life. Although national data on the prevalence of stroke in Nepal are not yet available, it is expected that the incidence of stroke in Nepal is increasing. As a national register of stroke data is not yet available, we can draw conclusions from numerous local surveys and comparable data from other South-Asian countries. We have to assume a crude stroke incidence of 117 per 100,000 persons (according to stroke incidence in LMIC). With a population of 28 million, roughly 33,000 persons are estimated to suffer a stroke in Nepal per year. 

Stroke, an acute disease of the brain,  is caused by an interruption of the blood supply in the brain supporting vessels and without an immediate restore of blood support leading to an irreversible damage of brain tissue. Most strokes are ischemic caused by a blood clot in the brain supporting vessels (ischemic stroke), still approximately one third of all strokes in Nepal are caused by a bleeding (hemorrhagic stroke). In South Asia the most common risk factors for stroke are high systolic blood pressure, high cholesterol, diet low in fruits and vegetables, household air pollution and smokingStroke is a preventable disease as many of the vascular risk factors for stroke can be modified by healthy lifestyle or medication. Still, the awareness of stroke risk factors is low in Nepal.

While strokes were an incurable disease many years ago, in recent years a number of therapeutic options for acute treatment and secondary prevention have been developed. Acute therapeutic strategies for ischemic stroke are aiming to restore the blood flow in the brain vessels by dissolving the blood clot (thrombolytic therapy or Intravenous thrombolysis or IVT) or mechanical removal of the blood clot in an angiography (endovascular therapy or endovascular treatment or EVT). While EVT is offered only at a few tertiary care centers, IVT is being administered safely in many secondary health centers worldwide. The backbone of any acute stroke treatment, either ischemic or hemorrhagic, is to treat these patients by an expert team for stroke care (so called stroke unit care) which is proven to be superior in reducing stroke associated complications and preventing recurrent stroke for both stroke subtypes – hemorrhagic and ischemic stroke. Nowadays, an acute stroke can be treated effectively and safely with systemic thrombolysis in clinical routine within the first 4.5 hours after onset. However, this requires rapid recognition of symptoms, rapid transport to a trained hospital, and rapid diagnosis and therapy there. Even outside this narrow time window, clarification of the cause of the stroke and initiation of targeted secondary prevention is essential. 

Timely access to emergency care is one of the most relevant aspects in acute stroke treatment, as preclinical delays impede the chance of successful recanalization. A major barrier to rapid presentation at a stroke center is the lack of awareness and knowledge of stroke symptoms and of the time window for acute treatment options.

If you want to learn more about the burden of stroke worldwide and in Nepal, you can have a look at the references: 

Thapa L et al, Prevalence of Stroke and Stroke Risk Factors in a South-Western Community of Nepal. J Stroke Cerebrovasc Dis. 2021 

Nepal G et al. Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal. BMC Neurol. 2019 

Chandra A, Rajbhandari P, Pant B. Acute stroke management: The plight of Nepal. Neurology. 2019

Thapa L et al. Knowledge, attitude, and practice of stroke among high school students in Nepal. J Neurosci Rural Pract. 2016 

Lindsay P, Furie KL, Davis SM, Donnan GA, Norrving B. World Stroke Organization global stroke services guidelines and action plan. Int J Stroke. 2014 

Feigin VL et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016 

Feigin VL et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009 

James SL et al. Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study. Inj Prev. 2020


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