Govt-aided policies and programmes, including PPP, are needed to effectively manage stroke
Stroke is the third leading cause of death in India and the sixth major cause of Disability Adjusted Life Years (DALYs). The incidences of stroke have doubled in the past five decades and roughly 87 per cent of these are ischemic strokes — where a clot disrupts blood supply to a part of the brain — while 13 per cent are haemorrhagic strokes when an artery ruptures to cause a bleed in the brain. With around 17 lakh new stroke cases occurring in India annually, the projected economic loss attributable to it is estimated to be Rs 2.34 lakh crore. That’s over three times the total allocation for the healthcare sector for the Financial Year 2020-21! Yet, the problem is not drawing the attention it needs from the Government even as its prevalence has increased by over 50 per cent from 1990-2019 in India, according to the Global Burden of Diseases Study, 2019.
The number of cases has been on the rise not just in India but across the globe, especially in the developing countries. It is the second leading cause of death and fourth leading cause of disability worldwide, causing functional impairments, with 20 per cent of survivors requiring institutional care even after three months and 15-30 per cent being permanently disabled. Other than the economic loss and disabilities, the high incidence and prevalence of stroke has a massive impact on societal well-being as well. According to conventional treatment protocols, patients need to be treated within a little over four hours from the time of onset. A delay in seeking the right treatment can lead to lifelong disability and may even be fatal in some cases. One of the bigger challenges that exist in our country is accessibility, affordability and availability of the optimal, timely care needed to patients who suffer stroke. These constraints are due to the enormous geographic, economic and social challenges across the length and breadth of the Indian subcontinent. A prompt affirmative action from policymakers is imperative for ensuring corrective measures to overcome these hurdles. Given the resource constraints in terms of infrastructure, transport, awareness besides other limitations, the chances of getting a stroke affected patient to a certified facility in time is difficult. In fact, studies estimate that the average time taken by a patient to reach a hospital is above seven hours in urban areas while in rural areas it is 34 hours. The delay in treatment increases the chances of permanent disability or even the death of a patient. Advanced therapies such as mechanical thrombectomy can play a crucial role in such cases because it has been shown to be effective in some patient upto 24 hours post symptom onset. However, the question remains, when will the Government take cognisance of the available technology and extend support to make it accessible and affordable for all? Currently, the most frequently used treatment available is Intravenous Tissue Plasminogen Activator (IV-tPA) injection which may be helpful if the patient is able to get to the nearest hospital within a little over four hours. Mechanical thrombectomy, on the other hand, can be effective upto 24 hours after symptom onset and in combination with IV-tPA has shown to be upto 60 per cent effective in the long-term.
Paucity of trained healthcare professionals and the lack of awareness is one of the major reasons for mechanical thrombectomy not finding its due place. The Government-aided policies and programmes, including public-private partnerships, may be needed to effectively manage stroke, rehabilitate patients and alleviate the concerns of the patients and their caregivers. Undoubtedly, there is a need to have a comprehensive integrated approach to address this public health crisis.
(The writer is Head, Department of Neurology, AIIMS. The views expressed are personal.)
