JMIR Publications

Background:

Stroke is a leading cause of death and long-term disability worldwide, with an estimated 6.2 million deaths each year. In Bangladesh, data on stroke prevalence and risk factors in rural areas is limited.

Objective:

This study aimed to present the prevalence of stroke in a rural community in Bangladesh and to identify and associate various stroke risk factors.

Methods:

Data collection was done by surveys and conducted by the community health workers (CHWs), as a part of the “Enriched Sastho” program of Palli Karma Sahayak Foundation, Bangladesh. CHWs received two weeks of training before conducting the surveys to ensure data quality. The presence of stroke was determined by a binary survey question, with a history of stroke indicated by a "1" and absence indicated by a "0". We examined the prevalence of stroke per 1000 people with a 95% confidence interval (CI). Furthermore, we also analyzed the prevalence in terms of age, sex, and regions of Bangladesh. We analyzed the association of stroke risk predictors using multivariate logistic regression (i.e., presence of hypertension, diabetes, other cardiovascular diseases, cancer, and COPD) and presented in crude odds ratio [Crude-OR] and adjusted odds ratio [Adjusted-OR] along with 95% CI.

Results:

We analyzed data from 1,341,589 individuals, with an average age of 29.23±19.05 years. The overall stroke prevalence was found to be 1.07 per 1,000 people. The “Khulna” division (Southwest of Bangladesh) had the highest stroke prevalence rate (1.77 per 1000 people) among all other seven divisions, which is a major finding in the context of Bangladesh. Our risk factor analysis showed that 65–79-year-olds were at a higher risk of having a stroke than other age groups [Crude-OR: 9.883, Adjusted-OR: 9.728 (adjusted for Sex)]. In addition, males were at greater risk of having a stroke than females (Crude-OR: 1.565, Adjusted-OR: 91.469 [adjusted for Age]). In terms of region-based analysis, the highest stroke prevalence was observed in the Khulna division [OR: 1.881 (1.671 – 2.117)] and the least in the Rangpur division [OR: 0.677 (0.576 - 0.795)]. In terms of disease analyses, individuals with cardiovascular disease had the highest OR [109.888 (92.069 – 131.156)], with hypertension at the second highest OR [80·642 (72·169 –90·108)].

Conclusions:

To the best of our knowledge, our study was the first study that was conducted on the largest population of Bangladesh covering 7 divisions. Therefore, this study showed a comprehensive picture of stroke prevalence in rural Bangladesh, with a major finding that the southeast region of Bangladesh (Khulna), had a higher prevalence than other divisions. As the water of the Khulna division has a high salinity hazard along with a lack of primary healthcare facilities, our findings could help the policymaker to take necessary steps to mitigate these challenges.