Background: In the near future, a majority of strokes are projected to occur in developing countries. However, population-level information on the prevalence of stroke from rural areas of developing countries, including India, is rare. We estimated the prevalence of stroke in a rural area of one of the most underdeveloped districts of India. Methods: Trained surveyors conducted a house-to-house survey using a validated screening questionnaire in a well-defined population of 45,053 living in 39 villages in a demographic surveillance site in Gadchiroli district. A trained physician and a neurologist evaluated screen-positive patients and diagnosed stroke using the World Health Organization's criteria. Results: In the screened population, 175 patients had stroke. The mean age of patients with stroke was 60.9 ± 14.7 years and 32.5% were women. The crude prevalence rate of stroke was 388.43 (95% CI 335.04-450.33) and the age-standardized prevalence rate of stroke was 535.58 (95% CI 492.41-583.01) per 100,000 population. The crude prevalence rate of stroke was significantly higher among men than among women (520 vs. 255/100,000 population, p < 0.05). Conclusion: In this prevalence study, conducted after a gap of 20 years in rural India, the prevalence of stroke was high and was more than twice the prevalence reported from the previous study. The prevalence was double among men compared to women. Stroke is emerging as a public health priority in rural India.

BackgroundStroke has emerged as a leading cause of death in rural India. However, well-tested healthcare interventions to reduce stroke mortality in rural under-resourced settings are lacking. The aim of this study is to evaluate the effect of a community-based preventive intervention on stroke mortality in rural Gadchiroli, India.MethodsThe study is a two-arm, parallel group, cluster randomised controlled trial in which 32 villages will be randomised to the intervention and the enhanced usual care (EUC) arm. In the intervention arm, individuals ≥50 years of age will be screened for hypertension, diabetes and stroke by trained Community Health Workers (CHWs). Screened individuals who are positive will be referred to a mobile outreach clinic which will visit the intervention villages periodically. A physician in the clinic will confirm the diagnosis, provide guideline-based treatment and follow up patients. The CHWs will make home visits once a month to ensure medication compliance and counsel patients to reduce salt consumption and quit tobacco and alcohol. In the EUC arm, households will be provided information on the ill effects of tobacco use and steps to quit it. Individuals from both the arms will have access to the government’s national programme for the prevention and control of non-communicable diseases, where treatment for hypertension, diabetes and preventive treatment after stroke is available at the nearest primary health centres (PHCs). The intervention will be implemented for 3.5 years. The primary outcome will be a reduction in stroke mortality in the last 2.5 years of the intervention.DiscussionThis trial will provide important information regarding the feasibility and effect of a community-based preventive intervention package on stroke mortality in a rural under-resourced setting and can inform India’s non-communicable diseases prevention and control programme. If successful, such an intervention can be scaled up in the rural regions of India and other countries.Trial registrationClinical Trials Registry of India: CTRI/2015/12/006424. Registered on 8 December 2015.

Background

Background Stroke has emerged as a leading cause of death in rural India. However, well tested healthcare interventions to reduce stroke mortality in rural under-resourced settings are lacking. The aim of this study is to evaluate the effect of a community-based preventive intervention on stroke mortality in rural Gadchiroli, India. Methods The study is a two-arm, parallel group, cluster randomised controlled trial where 32 villages each will be randomised to the intervention and the enhanced usual care (EUC) arm. In the intervention arm, individuals ≥ 50 years of age will be screened for hypertension, diabetes and stroke by trained Community Health Workers (CHWs). Screen positive individuals will be referred to a mobile outreach clinic which will visit intervention villages. A physician in the clinic will confirm the diagnosis, provide guideline-based treatment and follow up patients at periodic intervals. The CHWs will make home visits once a month to ensure medication compliance and counsel patients to reduce salt consumption and quit tobacco and alcohol. In the EUC arm, households will be provided information on the ill effects of tobacco and steps to quit it. Individuals from both the arms will have access to government’s national programme for prevention and control of non-communicable diseases where treatment for hypertension, diabetes and preventive treatment after stroke is available, nearest at the primary health centres (PHCs). The intervention will be implemented for 3.5 years. The primary outcome will be reduction in stroke mortality in the last 2.5 years of the intervention. Discussion This trial will provide important information regarding the feasibility and effect of a community-based preventive intervention package on stroke mortality in a rural under-resourced setting and can inform India’s non-communicable diseases prevention and control programme. If successful, such an intervention can be scaled up in rural regions of India and other countries.

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