UN millennium development goals: Can we halt the stroke epidemic in India?

India will soon have to bear an enormous socioeconomic burden due to the costs of the rehabilitation of stroke survivors; this is because the population is now surviving through the peak years (age 55-65) for the occurrence of stroke or cerebrovascular accident (CVA). Community surveys from many regions show crude prevalence rates for stroke (presumed to be of vascular origin) in the range of 90-222 per 100,000 persons. In India, the major risk factors identified have been hypertension (>95 mm Hg diastolic), hyperglycemia, tobacco use, and low levels (<10 gm%) of hemoglobin. The Global Burden of Disease (GBD) Study, in 1990, reported 9.4 million deaths in India, of which 619,000 deaths were due to stroke, suggesting a mortality rate of 73 per 100,000 persons. This mortality rate was almost 22 times greater, and the disability adjusted life years lost was nearly six times higher, than that due to malaria. For effective prevention strategies, the existing mass media must be used to build up public awareness and impart health education on the warning symptoms of hypertension and stroke. In the absence of facilities such as computerized tomography in rural areas, primary health care doctors should receive training on the nomenclature and clinical diagnosis of stroke. Community surveys to detect 'stroke-prone' subjects should be undertaken wherever feasible and medico-social workers should remain in contact with such patients to ensure intake of preventive medicines. Changes in lifestyle and dietary habits, and intensive campaigns against tobacco use, will prove rewarding. National councils should interact with various agencies (health, industry, finance, etc.) to coordinate activities at all levels.