Fast track — ArticlesStandard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke)
Section snippets
Background
In 2005, estimates suggested that 58 million people died, and chronic diseases accounted for 35 million deaths (60%).1 Cardiovascular diseases, predominantly heart disease and stroke, are the cause of death in 17·5 million individuals. Stroke, after heart disease, is the second leading single cause of death, with 5·8 million fatal cases per year, 40% of which are in people younger than 70 years. About 15 million new acute stroke events arise every year, and about 55 million people have had a
Methods
STEPS Stroke is described in detail elsewhere.6 In brief, a standard manual, questionnaire, and data-entry strategy were developed for gathering hospital-based and population-based data for stroke, according to local needs and resources. Stroke patients were included in consecutive order, and the STEPS Stroke study site coordinator ensured complete registration of all eligible individuals.
Results
A total of 5557 stroke patients were registered. Table 1 lists participating surveillance sites together with brief details about number of people registered and over what period, the proportion of men, and mean age. For statistical analyses, 81 patients with missing values for age, and ten who were younger than 15 years, were excluded. Table 2 shows descriptive data from the combined surveillance sites. The highest number of stroke events was recorded in patients aged 65–74 years (figure).
Discussion
Findings of this feasibility study show that STEPS Stroke has fulfilled three basic requirements for an international surveillance study. First, it has generated new standardised data for stroke from low-income and middle-income countries. Second, sites in different geographical regions could adhere to a standard protocol for stroke data collection despite large differences in infrastructure and capacity for undertaking epidemiological studies of stroke; missing data were kept to a minimum.
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