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GLOBAL NEUROLOGY REPORT

STROKE IN THE DEVELOPING WORLD

· Neurology,stroke,air pollution,Brain Day,Dr James C Johnston

Dr. James C. Johnston is a board-certified neurologist holding Fellowship or membership status in a number of professional organizations and societies including the American Academy of Neurology (AAN). The AAN publishes several journals and newsletters including NeurologyToday, which discusses pressing current topics such as the recent article entitled “Most Strokes Worldwide Caused by Modifiable Lifestyle factors; Air Pollution Is to Blame for One-Third of Cases.”

Dr. Johnston published a Letter to the Editor noting the importance of this insight into the relationship between stroke and air pollution, but also raising another crucial point. The core of his letter is reproduced as follows: The new Global Burden of Disease analysis probably underestimates the extent of stroke risk worldwide due to the paucity of data in many developing regions. This is particularly true of sub-Saharan Africa. In Ethiopia, for example, there are a mere handful of studies reporting that stroke patients constitute a significant minority of hospital admissions, and recent clinical data demonstrates that almost one-fifth of outpatients present with stroke or stroke-related issues, but few other details are available. More research is unquestionably needed to define the true extent of stroke and formulate effective preventive and management protocols appropriate for these regions. In the intervening time, the most reasonable approach is to focus on capacity building to initiate new or improve existing stroke management services but resource limitations often preclude these efforts.

In many regions of sub-Saharan Africa, the dearth of neurologists, limited imaging facilities and absence of stroke centers combined with overwhelming infrastructural challenges, barriers to access, lack of drugs and adherence to traditional beliefs, all in a setting of abject poverty with food and water insecurity, remain significant impediments to medical care including preventive stroke management. This abysmal situation is aggravated by the lack of treatment options for stroke, high morbidity secondary to post-stroke complications, limited secondary stroke intervention, and absence of meaningful rehabilitation. It quickly becomes clear why there is a ten-fold difference in rates of stroke mortality and disability adjusted life year loss between the most affected and least affected nation.

There must be a sustainable, comprehensive, ethically congruent, multimodality approach to concurrently address stroke prevention, treatment, and rehabilitation in these developing nations, setting realistic priorities that are commensurate to local resources. Stroke prevention, however, is of the upmost importance and desperately needed funding should be allocated accordingly. Dr. Johnston is particularly focused on this area in his role as Director of Global NeuroCare, a non-profit organization dedicated to improving neurological services in sub-Saharan Africa.

It is unlikely there will be any significant improvement in air pollution in the foreseeable future, especially in the developing regions that continue to use solid fuel during a period of unprecedented industrial growth, but there is a real urgency to treat hypertension and related risk factors, which will have an immediate effect on improving population health.

Of note, this press release corresponds with the World Federation of Neurology Brain Day and we hope the additional attention to the desperate needs of the sub-Saharan African populations will draw support through www.GlobalNeuroCare.org a nonprofit organization dedicated to advancing neurological care in this region.

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