When someone has a stroke, every second delayed is critical

Dr Praveen Aggarwal

&

Dr Manorama Bakshi

(The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.)

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

Out of all the NCDs, neurological disorders and neurological injuries contribution to the total disease burden has more than doubled between 1990 and 2019 as published in The Lancet Global Health by the India State-Level Disease Burden Initiative. Some of the non-communicable neurological disorders include (stroke, headache disorders, epilepsy, cerebral palsy, Alzheimer's disease and other dementias, brain and central nervous system cancer, Parkinson's disease, multiple sclerosis, motor neuron diseases, and other neurological disorders and injury-related neurological disorders (traumatic brain injuries and spinal cord injuries). Within SDG3 are specific targets related to tackling non-communicable diseases - including stroke - which pose a major challenge to sustainable development in all countries of the world.

This year 14.5 million people will have a stroke, 5.5 million people will die as a result and 80 million people have survived stroke worldwide. The world stroke organization has declared stroke a public health emergency in 2010. According to the Global Burden of Disease study, there is an increase of 30 per cent of stroke patients in India since 2014. The number of stroke patients annually in India is over 17 lakh, the third largest cause of death and disability in India. The economic burden to the country is estimated at 2.34 lakh crore (nearly 3.4 times the total annual health budget of India) can be substantially brought down. The most common type of stroke is Ischemic Stroke, accounting for almost 87 per cent of all strokes in India, and is caused by a clot or other blockage within an artery in the brain. Rest 13 per cent of strokes are Hemorrhagic Strokes which are caused by bleeding of an aneurysm in the brain artery. In India, Stroke only caused 6,99,000 deaths in India in 2019, which was 7.4% of the total deaths in the country, which has one-fifth of the world's population.

Understanding the gravity of this public health challenge, our former health Minister said on World Stroke Day on October 29, 2020: "Stroke or Brain attack is the leading cause of disability worldwide. Globally one in four adults can have a stroke in their lifetime."

Department of Health and Family Welfare's Website, Institute for Health Metrics and evaluation (for Global Burden of Diseases); Global Burden of Diseases study 2019 India Compare data.

Dr Rajinder Dhar, Professor at NIMS Medical College and Hospital said: "When somebody has a stroke, every second that goes by is critical. As brain tissue and millions of neurons begin to fade away, time could not be more precious."

As the old adage said, "A stitch in time saves nine" the immediate need is to raise awareness of stroke signs and the benefits of timely access to emergency medical care. Some of the challenging factors for providing treatment to Stroke patients are Geographic and Transportation Barriers to Healthcare Access. The average time taken by the patient to reach the hospital in urban areas is 7.6 hours and that in rural areas is 34 hours, then we have only a Paucity of healthcare professionals to address stroke (mere 300 healthcare professionals for 1 crore patients). Also, the absence of standard treatment protocols and the lack of affordable treatment add to the burden. Delay in seeking the right treatment leads to the loss of about 20 lakh brain cells per minute. This is where advanced technologies and medical procedures such as Mechanical Thrombectomy have displayed proven results and higher success rates by increasing the treatment window to up to 24 hours. Niti Aayog has claimed that India's healthcare industry is ripe for innovations and investment, yet the challenge is the acceptance of new technologies in the case of treating stroke with respect to mechanical thrombectomy.

This increase in strokes can be attributed to many lifestyle factors such as High BP, stress, sedentary lifestyle, smoking, high cholesterol, etc., which is contributing to strokes. However, medically, there are two main causes of stroke, the first is a blocked artery, the second is a ruptured blood vessel. A blocked artery causes ischemic stroke, it is the most common form of stroke. It usually happens when fat deposit in a blood vessel. A haemorrhagic stroke happens when a blood vessel burst to result in a brain haemorrhage. There are various reasons for the bursting of an artery such as stress, uncontrolled BP, using blood thinners in excess, deposition of protein on blood vessel walls. A severe increase in blood pressure that can lead to a stroke is called a hypertensive crisis. Extremely high BP can damage blood vessels and weaken arteries in the brain, increasing the risk of stroke. Economic evidence commissioned by India Consensus, a collaboration between Tata Trusts and the Copenhagen Consensus, quantified the Benefit-Cost Ration (BCR) of hypertension screening and treatment intervention to be exceedingly high and 31 and 23 in the two states of Andhra Pradesh and Rajasthan, respectively (Seshadri and Hebbare, 2017A; Seshadri and Hebbare, 2017b). As per PubMed study Hypertension prevalence in India is high, but the proportion of adults with hypertension who are aware of their diagnosis, are treated, and achieve control is low.

Stroke survivors face significant challenges that include physical disability, communication disabilities, changes in how they think and feel, loss of work and income, as well as caregiver burden. Not only does disease impact the wellbeing of an individual, but it also burdens family and public resources, weakens societies, and dissipates potential. Despite being the second biggest killer globally, public awareness of stroke risks and how to manage them is still low. The need is to highlight stroke risk and prevention, call for commitment to continued national campaigns that raise awareness of how to reduce and manage individual stroke risks. Support NGOs and policy-makers, supporting public awareness campaigns that have the potential to deliver significant gains in stroke prevention. India can develop a public healthcare framework for Stroke Management and achieve UN Sustainable Development Goal 3 (SDG 3.4). (IANS)