Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria.
Epidemiology and Prevention Division, Stroke and Ageing Research (STAR), School of Clinical Sciences, Monash University, Melbourne, Australia.
Int J Stroke. 2021 Oct;16(8):889-901. doi: 10.1177/17474930211019568. Epub 2021 May 27.
Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization- Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries.
Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019.
Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ∼ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol.
There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.
改善卒中服务对于降低全球卒中负担至关重要。世界卒中组织-世界卫生组织卒中委员会对中低收入国家（LMICs）与高收入国家的卒中服务现状进行了调查。
使用经过验证的世界卒中组织综合问卷，我们收集并比较了 84 个国家在卒中四方（监测、预防、急性卒中和康复）四个支柱方面的卒中服务数据，这些国家分布在世界卫生组织各区域和经济阶层。世界卫生组织还于 2019 年对 194 个国家的非传染性疾病进行了调查。
低收入国家的监测活动（包括登记处的存在、近期危险因素调查的存在以及参与研究）比高收入国家少。预防的总体全球得分为 40.2%。卒中单元在 91%的高收入国家存在，而在 18%的低收入国家存在（p<0.001）。在高收入国家，约有 60%提供急性卒中治疗，而在低收入国家，这一比例为 26%（p=0.009）。与高收入国家相比，中低收入国家提供的康复服务较少，包括住院康复、家庭评估、社区康复、教育、早期出院计划以及康复方案的存在。
全球，尤其是在中低收入国家，急需改善卒中单元和服务的可及性。卒中服务较少的国家可以借鉴服务较好的国家的策略。这可能包括建立定期监测卒中负担和服务的框架，实施综合预防活动和基本的急性卒中护理服务，以及提供卒中康复的跨学科护理。
