The sub-standardized approach to stroke management in low and middle-income countries including Pakistan: limitations and suggested options to overcome some of the shortcomings via teleneurology/telestroke application

Abstract

Background and objective:Ischemic stroke still poses a significant health concern throughout the world. However, low and middle-incomecountries (LMIC) in Asia have more devastating outcome. The vascular risk factors are prevalent in most parts of Asia, contributing to increasing incidence. The recommended approved treatment for acute stroke is limited to a few areas in these countries. We aimed to identify stroke risk factors, its incidence and prevalence; treatment opportunities offered in various parts of the region and utilizing the alternate pathways to improve the disease recognition and management outcome.Method:A comprehensive search using PubMed, MEDLINE, Medline Plus, PubMed Central and Pak Medinet, including the various key words was performed.Results:Two-hundred-fifty-five articles of potential interest were found through the initial search. The studies were analyzed in detail in order to obtain relevant information according to the objectives of the review. Most of the literature was regarding the stroke risk factors. Only few articles regarding the current status of stroke services and management options in LMIC were available.Conclusion:Some of the factors identified in previous studies preventing the utilization of recent advancement in the diagnosis and management of stroke in LMIC, including Pakistan, were lack of awareness of stroke symptoms among general population and physicians, poor knowledge of management options, unavailability of trained stroke neurologists, poor infrastructure, cost effectiveness and patients’ trust more on homeopathic physicians, quacks and spiritual healers instead of medical doctors. Stroke is still managed conservatively in most part of these countries. There is strong need of alternate means to overcome these shortcomings in managing this highly morbid condition. As only few studies specifying the prevalence and management outcome in LMIC including Pakistan are available, a strong database is needed to quantify the real burden.