aDepartment of Neurology, Institute for Paediatric Neurodisorder & Autism, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshbRaffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore

Bangladesh, with a population of 165.6 million people, is located in the northwest region of South Asia, bordered on the west, north, and east by India, southeast by Myanmar, và south by the bay of Bengal <1>. The per-capita income is USD 1,909, poverty rate is 20.5%, literacy (7+ years) is 73.2%, và life expectancy is 72.3 years; 74% live in rural areas.

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Stroke is a major cause of death and disability in the region, with an age- & sex-standardized mortality rate of 54.8 per 100,000 & disability-adjusted life years lost of 888.1 per 100,000 in Bangladesh <2>. The prevalence of stroke at approximately 1–2% of those aged over trăng tròn years <3> is similar in males and females, & urban and rural areas <4>, but increases with age such that the ratio of infarction khổng lồ hemorrhage is 2.91 in the community <5>. Stroke incidence has not been studied in adequate epidemiological studies. In a large multicenter hospital study, 72% had ischemic stroke, và the frequency of hypertension, smoking, diabetes mellitus, ischemic heart disease, and dyslipidemia was 58%, 45%, 23%, 17%, và 5%, respectively <6>; these are not from population-based studies. Small-vessel “lacunar” disease was the most common type of ischemic stroke, và there is a clear seasonal variation in the frequency of hemorrhagic stroke <7, 8>. The high stroke mortality among Bangladeshi populations may be due lớn the high frequency of the conventional atherosclerotic risk factors, especially of hypertension & diabetes mellitus <9>; there is a strong belief over the importance of betel nut chewing, squatting and straining during defecation, chronic infection, vitamin D deficiency, và the combined effect of smoking and tobacco chewing <10>. Stroke mortality might be related lớn stroke severity, delayed diagnosis, & stroke care gaps discussed further below.

Medical services are không lấy phí in the community <11>. Community clinics are available at villages at ward levels, while small hospital services are located at the union and upazila levels. Secondary màn chơi care is provided at district hospitals; tertiary màn chơi care is provided at medical college hospitals and super-specialty hospitals.

There are 2,213 hospitals with 45,723 registered physicians, but only 160 trained neurologists through training programs only provided at Dhaka Medical College (DMC) and Bangabandhu Sheikh Mujib Medical University (BSMMU). There are 2,300 technologists operating 250 CT scans and 80 MRIs in Bangladesh.

Acute care for stroke patients is available in 2 government & 5 private hospitals, all situated in Dhaka, the capital city, while subacute care provided by neurologists is available in 23 government hospitals located in most parts of the country và 7 private hospitals. Stroke is the most common condition among neurology in-patients (48%) <12> và out-patients (24%) <13>.

The Bangladesh Rehabilitation Assistance Committee (BRAC), a nongovernmental organization (NGO), provides stroke rehabilitation services to patients who cannot afford treatment and conducts education programs to lớn raise awareness about the signs and symptoms of stroke <14>. Another NGO, the Centre for the Rehabilitation of the Paralysed (CRP), provides physiotherapy, speech và language therapy, and occupational therapies to lớn stroke patients, as well as educating the public on the symptoms of stroke <15>. The few other stroke care services are mostly based in Dhaka, with in-patient beds in government & private resources combined, such as the National Institute of Neurosciences & Hospital, BSMMU; Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine và Metabolic Disorders (BIRDEM); Holy Family Medical Collage Hospital; DMC Hospital; và Bangladesh Medical College Hospital. Rehabilitation costs approximately USD 328 per month <16>, và early rehabilitation is helpful in certain populations <17>.

There are a few instances where lay volunteers provide community service for stroke patients, particularly in assisting family members in the provision of care for those who are disabled và infirm.

The main primary preventive approaches being promoted during public education involve maintaining a healthy lifestyle, blood pressure control, not smoking (and smoking cessation for smokers), being physically active, và a healthy diet characterized by adequate fruit and vegetable intake, and reduced intake of salt & trans-fats.

The Society of Neurologists of Bangladesh (SNB) at present organizes all stroke-related training, awareness programs, and tư vấn programs <18> (Fig. 1, 2). There are several private nonmedical tư vấn groups established by therapists or social workers such as the Bangladesh Stroke Association (BSA) <19>. This stroke tư vấn group supports patients across the country. Their main motto is that “No stroke survivor shall die untreated & un-rehabilitated even if he/she is poor.” BSA started its operations in early 2014.

World Stroke Day 2018, co-organized by the SNB & BSMMU. Reprinted with kind permission of the SNB. SNB, Society of Neurologists of Bangladesh; BSMMU, Bangabandhu Sheikh Mujib Medical University.


Attendees at a continuing medical education program. Reprinted with kind permission of the SNB. SNB, Society of Neurologists of Bangladesh.


More needs to be done for stroke care in Bangladesh. More stroke physicians and rehabilitation services, especially in the rural areas, are needed <20>. Community resources need khổng lồ be strengthened for stroke survivors. Effective public education programs aimed at stroke prevention must continue. With these measures, the burden of stroke in Bangladesh can be reduced.

Statement of Ethics

The Society of Neurologist of Bangladesh (SNB) gave the authors the permission to lớn use the photographs of the celebration of World Stroke Day all around Bangladesh in different institutions under our supervision and/or our member’s supervision. All our members very willingly gave their verbal permission to use their photographs along with the study “Stroke Burden and Stroke Services in Bangladesh.” SNB will bear all responsibility if there are any future disputes regarding the use of the photos.

Conflict of Interest Statement

The authors have no conflicts of interest to lớn declare.

Funding Sources

The authors did not receive any funding.

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Author Contributions

M.M. And N.V. Both conceptualized the study, wrote the manuscript, approved the final manuscript.