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Pathan NM, Saxena R, Kumar C, Kamlakar S, Yelikar A. Stroke Rehabilitation in India: Addressing Gender Inequities. J Lifestyle Med 2024; 14:94-97. [PMID: 39280941 PMCID: PMC11391334 DOI: 10.15280/jlm.2024.14.2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/04/2024] [Accepted: 07/16/2024] [Indexed: 09/18/2024] Open
Abstract
Gender inequality has a significant and complex impact on stroke recovery and rehabilitation outcomes. Moreover, the influence of gender on post-stroke recovery is multifactorial, primarily biological, social, and behavioral issues. The recovery paths for men and women may have different outlines in relation to stroke occurrence, injury sites, and hormonal effects. These collectively influence the effective summarization of recovery strategies and outcomes. Furthermore, societal and cultural elements play a significant role in shaping access to resources, social support networks, and participation in rehabilitation programs, which consequently affect the outcomes. Considering the gender-specific nuances is important in developing effective rehabilitation strategies. Furthermore, effective stroke rehabilitation programs are needed to achieve equitable and improved recovery outcomes for all stroke survivors and to create inclusive interventions that consider these differences.
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Affiliation(s)
- Nawaj Mehtab Pathan
- Department of Neurophysiotherapy, MGM Institute of Physiotherapy, Maharashtra, India
- Department of Physiotherapy, School of Allied Health Sciences (SAHS), Sharda University, Greater Noida, India
| | - Rahul Saxena
- Department of Biochemistry, School of Allied Health Sciences (SAHS), Sharda University, Greater Noida, India
| | - Chandan Kumar
- Department of Physiotherapy, Galgotias University, Greater Noida, India
| | - Sampada Kamlakar
- Department of Neurophysiotherapy, Royal College of Physiotherapy, Malegaon, India
| | - Ankita Yelikar
- Department of Neurophysiotherapy, Royal College of Physiotherapy, Malegaon, India
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Rangamani S, Huliyappa D, Kulothungan V, Saravanan S, Murugan P, Mahadevan R, Rachel Packiaseeli C, Bobby E, Sunitha K, Mallick AK, Nayak SD, Swain SK, Behera M, Nath BK, Swami A, Kalwar AK, Difoesa B, Sardana V, Maheshwari D, Bhushan B, Mittal D, Chaurasia RN, Meena L, Vinay Urs KS, Koli RR, Suresh Kumar N, Mathur P. Stroke incidence, mortality, subtypes in rural and urban populations in five geographic areas of India (2018-2019): results from the National Stroke Registry Programme. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100308. [PMID: 38404513 PMCID: PMC10884975 DOI: 10.1016/j.lansea.2023.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 02/27/2024]
Abstract
Background Increasing stroke burden in India demands a long-term stroke surveillance framework. Earlier studies in India were urban-based, short term and provided limited data on stroke incidence and its outcomes. This gap is addressed by the establishment of five population-based stroke registries (PBSRs) of the National Stroke Registry Programme, India. This paper describes stroke incidence, mortality and age, sex, and subtypes distribution in the five PBSRs with urban and rural populations. Methods First-ever incident stroke patients in age group ≥18 years, resident for at least one year in the defined geographic area, identified from health facilities were registered. Death records with stroke as the cause of death from the Civil Registration System (CRS) were included. Transient ischemic attack (TIA) was excluded. Three PBSRs (Cuttack, Tirunelveli, Cachar) included urban and rural populations. PBSRs in Kota and Varanasi were urban areas. The crude and age-standardized incidence rate (ASR) by age, sex, and residence (urban and rural), rate ratios of ASR, case fatality proportions and rates at day 28 after onset of stroke were calculated for years 2018-2019. Findings A total of 13,820 registered first-ever stroke cases that included 985 death certificate-only cases (DCOs) were analysed. The pooled crude incidence rate was 138.1 per 100,000 population with an age-standardized incidence rate (ASR) of 103.4 (both sexes), 125.7 (males) and 80.8 (females). The risk of stroke among rural residents was one in seven (Cuttack), one in nine (Tirunelveli), and one in 15 (Cachar). Ischemic stroke was the most common type in all PBSRs. Age-standardized case fatality rates (ASCFR) per 100,000 population for pooled PBSRs was 30.0 (males) and 18.8 (females), and the rate ratio (M/F) ranged from 1.2 (Cuttack) to 2.0 (Cachar). Interpretation Population-based registries have provided a comprehensive stroke surveillance platform to measure stroke burden and outcomes by age, sex, residence and subtype across India. The rural-urban pattern of stroke incidence and mortality shall guide health policy and programme planning to strengthen stroke prevention and treatment measures in India. Funding The National Stroke Registry Programme is funded through the intramural funding of the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, India.
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Affiliation(s)
- Sukanya Rangamani
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Deepadarshan Huliyappa
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Vaitheeswaran Kulothungan
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | | | - P.K. Murugan
- Tirunelveli Medical College, Tirunelveli, 627011, India
| | | | | | - Esakki Bobby
- Tirunelveli Medical College, Tirunelveli, 627011, India
| | | | - Ashok Kumar Mallick
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Soumya Darshan Nayak
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Santosh Kumar Swain
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Manoranjan Behera
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Bhaskar Kanti Nath
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Abhijit Swami
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Amit Kumar Kalwar
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Bijush Difoesa
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Vijay Sardana
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Dilip Maheshwari
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Bharat Bhushan
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Deepika Mittal
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - L.P. Meena
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - K S Vinay Urs
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Rahul Rajendra Koli
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Natesan Suresh Kumar
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Prashant Mathur
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
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Kalkonde YV, Rangamani S, Suwanwela NC, Mathur P, Injety RJ, Sebastian IA, Vijayanand PJ, Chawla NS, Sylaja P, Sharma M, Pandian JD. Surveillance of stroke: a South-East Asia Region (SEAR) perspective. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100286. [PMID: 37849929 PMCID: PMC10577148 DOI: 10.1016/j.lansea.2023.100286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023]
Abstract
Surveillance of stroke is critical to track its burden and assess progress in prevention and treatment. We reviewed the literature to evaluate stroke surveillance efforts in the South-East Asia Region (SEAR) countries, identify progress and assess gaps. Epidemiological data on all the major parameters such as the incidence, prevalence and mortality of stroke were available for India and Thailand but for none of the other SEAR countries. Most of the epidemiological data came from investigator-initiated studies. National stroke surveillance was present only in India in the form of a National Stroke Registry Programme and Thailand has a national database that was used to obtain epidemiological data for stroke. Research on novel methods for stroke registration, such as using information technology, was absent. This review identified serious gaps in the monitoring and surveillance of stroke in SEAR countries. Systematic efforts are needed to fill those gaps.
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Affiliation(s)
| | - Sukanya Rangamani
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Nijasri C. Suwanwela
- Division of Neurology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Ranjit J. Injety
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Ivy A. Sebastian
- Consultant Neurologist, St. Stephen's Hospital, New Delhi, India
| | - Pranay J. Vijayanand
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Nistara S. Chawla
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - P.N. Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Meenakshi Sharma
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Jones SP, Baqai K, Clegg A, Georgiou R, Harris C, Holland EJ, Kalkonde Y, Lightbody CE, Maulik PK, Srivastava PMV, Pandian JD, Kulsum P, Sylaja PN, Watkins CL, Hackett ML. Stroke in India: A systematic review of the incidence, prevalence, and case fatality. Int J Stroke 2022; 17:132-140. [PMID: 34114912 PMCID: PMC8821978 DOI: 10.1177/17474930211027834] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of stroke is increasing in India; stroke is now the fourth leading cause of death and the fifth leading cause of disability. Previous research suggests that the incidence of stroke in India ranges between 105 and 152/100,000 people per year. However, there is a paucity of available data and a lack of uniform methods across published studies. AIM To identify high-quality prospective studies reporting the epidemiology of stroke in India. SUMMARY OF REVIEW A search strategy was modified from the Cochrane Stroke Strategy and adapted for a range of bibliographic databases from January 1997 to August 2020. From 7717 identified records, nine studies were selected for inclusion; three population-based registries, a further three population-based registries also using community-based ascertainment and three community-based door-to-door surveys. Studies represented the four cities of Mumbai, Trivandrum, Ludhiana, Kolkata, the state of Punjab, and 12 villages of Baruipur in the state of West Bengal. The total population denominator was 22,479,509 and 11,654 (mean 1294 SD 1710) people were identified with incident stroke. Crude incidence of stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per year, and one-month case fatality rates from 18% to 42%. CONCLUSIONS Further high-quality evidence is needed across India to guide stroke policy and inform the development and organization of stroke services. Future researchers should consider the World Health Organization STEPwise approach to Surveillance framework, including longitudinal data collection, the inclusion of census population data, and a combination of hospital-registry and comprehensive community ascertainment strategies to ensure complete stroke identification.
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Affiliation(s)
| | - Kamran Baqai
- University of Central Lancashire, Preston, Lancashire, UK
| | - Andrew Clegg
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Cath Harris
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health, Gadchiroli, India
| | | | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Manipal University, Manipal, India
| | | | | | - Patel Kulsum
- University of Central Lancashire, Preston, Lancashire, UK
| | - PN Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Maree L Hackett
- University of Central Lancashire, Preston, Lancashire, UK
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia
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Vijayan B, Ramanathan M, Rangamani S, Joe W, Gopinathan S, Mishra US. Treatment and rehabilitation of stroke patients in India: A gendered analysis based on repeated cross-sectional national sample surveys on health, 2014 and 2019. Health Care Women Int 2021; 42:1237-1254. [PMID: 34125652 DOI: 10.1080/07399332.2021.1931226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We attempt a gendered inspection of sex differentials in care following stroke in India using data from two rounds of NSSO. While almost all men and women receive allopathic care, a higher percentage of women (51.8%) were treated in public hospitals compared to men (32.6%) in 2014 and 2017-18 (45.8% vs 41.4%). Men were preponderantly treated in private hospitals (67.4%) compared to women (48.2%) in 2014 and 2017-18 (58.6% vs 54.2%). We provide evidence that for rehabilitation, at the highest decile for expenditure, men spend more than women. This preliminary exploration is indicative of a gendered dimension in care-seeking for stroke.
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Affiliation(s)
- Bevin Vijayan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Mala Ramanathan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sukanya Rangamani
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
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