The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study.
BACKGROUND
The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan.


METHODS
Individuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pre-tested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by neurological examination of suspected cases. Anthropometric measurements and random blood glucose levels were recorded. Multivariable logistic regression was used to determine the association of vascular risk factors with prevalence of stroke.


RESULTS
Five hundred and forty five individuals (49.4% females) participated in the study with a response rate of 90.8%. One hundred and four individuals (19.1%) were observed to have a prior stroke while TIA was found in 53 individuals (9.7%). Overall, 119 individuals (21.8% with 66.4% females) had stroke and/or TIA. Female gender, old age, raised random blood glucose level and use of chewable tobacco were significantly associated with the prevalence of cerebrovascular disease.


CONCLUSIONS
This is the first study demonstrating an alarmingly high life-time prevalence of cerebrovascular disease in Pakistan. Individual and public health interventions in Pakistan to increase awareness about stroke, its prevention and therapy are warranted.
Kamal
Ayeesha Kamran
AK
Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. ayeesha.kamal@aku.edu
Itrat
Ahmed
A
Murtaza
Muhammed
M
Khan
Maria
M
Rasheed
Asif
A
Ali
Amin
A
Akber
Amna
A
Akber
Zainab
Z
Iqbal
Naved
N
Shoukat
Sana
S
Majeed
Farzin
F
Saleheen
Danish
D
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires