Prevention and care of stroke in low- and middle-income countries; the need for a public health perspective.

Stroke is a leading public health problem, causing significant disability and premature mortality, particularly in low- and middle-income countries (LMIC). A public health strategy is required for the prevention and care of stroke in LMIC. Although specific estimates are difficult to calculate, increasing cost-effective interventions that reduce cardiovascular risk in the population can have a substantial impact on stroke burden. Public health interventions that address tobacco use, unhealthy diet (salt and transfat), and physical inactivity of the population need to be complemented with equitable stroke services. The main components of an equitable stroke service include: * assessment and management of cardiovascular risk in primary care, * assessment and follow-up of transient ischaemic attack (TIA) patients, * provision of secondary prevention through a primary health care approach, * education of the public, health care staff and patients with stroke, * equitable access to acute stroke care and stroke rehabilitation and * community and family engagement for support to care givers and stroke patients. Unless services for stroke care are complemented with prevention programmes to reduce stroke risk in the population, health care costs will continue to escalate due to increasing rates of stroke.