Journal Article2025

Stroke Prevalence and Risk Factors in Rural Communities Within a Resource-Constrained South Asian Setting: Population-Based Study of 1.3 Million Individuals

Farhana Sarker, Rony Chowdhury Ripan, Moinul H Chowdhury, AKM Nazmul Islam, Mashiar Rahman, Shariful Islam, Shumit Saha, Khondaker A Mamun

JMIR Public Health and Surveillance

JMIR Publications Inc., Vol. 11, pp. e46122-e46122, ISBN: 2369-2960

DOI: 10.2196/46122Open AccessURL

Abstract

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 are limited, making it difficult to develop effective early prevention and intervention programs. Objective: This study aimed (1) to present the prevalence of stroke in a rural community in Bangladesh and (2) to identify and associate various stroke risk factors. Methods: Data collection was done by community health workers, as a part of the "Enriched Sastho" program of the Palli Karma Sahayak Foundation, Bangladesh. Community health workers received 2 weeks of training to ensure data quality. The presence of stroke was determined by a binary survey question, with a history of stroke=1 and absence=0. The prevalence of stroke per 1000 people was examined along with the 95% CI. In addition, the association of stroke risk predictors was calculated using multivariate logistic regression and presented in crude odds ratio (OR) and adjusted OR along with 95% CI. Results: The study analyzed data from 1,341,589 individuals, with an average (SD) age of 29.23 (19.05) years. The overall stroke prevalence was found to be 1.07 per 1000 people, with a higher prevalence in male participants and increasing with age. The highest stroke prevalence was observed in the Khulna division (OR 1.881, 95% CI 1.671-2.117), and the least in the Rangpur division (OR 0.677, 95% CI 0.576-0.795). Individuals aged 65-79 years were at a higher risk of having a stroke than other age groups (crude OR 9.883 and adjusted OR 9.728 [adjusted for sex]). In addition, male participants were at greater risk of having a stroke than female participants were (crude OR 1.565 and adjusted OR 1.469 [adjusted for age]). Conclusions: The study emphasizes the need for early prevention and intervention programs for stroke in rural Bangladesh and the importance of managing hypertension and diabetes to reduce stroke risk.

Keywords

  • stroke prevalence
  • stroke risk factors
  • rural communities
  • Bangladesh
  • community health workers
  • hypertension
  • Diabetes mellitus
  • sex differences
  • age differences
  • stroke prevention
  • resource-limited settings

CCDS Authors

Farhana Sarker, PhD
Farhana Sarker, PhD

Farhana Sarker, PhD

  • Director, WiSE Wing

  • Associate Professor

    Department of Computer Science and Engineering

    Independent University, Bangladesh (IUB)

Published at

ICDMW, IEEE Access

References

  1. 1.Colin D Mathers, Dejan Loncar. (2006). Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLoS Medicine, 3(11), e442[10.1371/journal.pmed.0030442]
  2. 2.Valery L Feigin, Carlene MM Lawes, Derrick A Bennett, Suzanne L Barker-Collo, Varsha Parag. (2009). Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. The Lancet Neurology, 8(4), 355–369[10.1016/s1474-4422(09)70025-0]
  3. 3.Mira Katan, Andreas Luft. (2018). Global Burden of Stroke. Seminars in Neurology, 38(02), 208–211[10.1055/s-0038-1649503]
  4. 4.Kathleen Strong, Colin Mathers, Ruth Bonita. (2007). Preventing stroke: saving lives around the world. The Lancet Neurology, 6(2), 182–187[10.1016/s1474-4422(07)70031-5]
  5. 5.Hatem A. Wafa, Charles D.A. Wolfe, Eva Emmett, Gregory A. Roth, Catherine O. Johnson, Yanzhong Wang. (2020). Burden of Stroke in Europe. Stroke, 51(8), 2418–2427[10.1161/strokeaha.120.029606]
  6. 6.Jeyaraj Durai Pandian, Paulin Sudhan. (2013). Stroke Epidemiology and Stroke Care Services in India. Journal of Stroke, 15(3), 128[10.5853/jos.2013.15.3.128]
  7. 7.Graeme J. Hankey, Konrad Jamrozik, Robyn J. Broadhurst, Susanne Forbes, Craig S. Anderson. (2002). Long-Term Disability After First-Ever Stroke and Related Prognostic Factors in the Perth Community Stroke Study, 1989–1990. Stroke, 33(4), 1034–1040[10.1161/01.str.0000012515.66889.24]
  8. 8.William Checkley, Hassen Ghannem, Vilma Irazola, Sylvester Kimaiyo, Naomi S. Levitt, J. Jaime Miranda, Louis Niessen, Dorairaj Prabhakaran, Cristina Rabadán-Diehl, Manuel Ramirez-Zea, Adolfo Rubinstein, Alben Sigamani, Richard Smith, Nikhil Tandon, Yangfeng Wu, Denis Xavier, Lijing L. Yan. (2014). Management of NCD in Low- and Middle-Income Countries. Global Heart, 9(4), 431[10.1016/j.gheart.2014.11.003]
  9. 9.S. M. Didar-Ul Islam, Mohammad Amir Hossain Bhuiyan, Tanjena Rume, Gausul Azam. (2017). Hydrogeochemical investigation of groundwater in shallow coastal aquifer of Khulna District, Bangladesh. Applied Water Science, 7(8), 4219–4236[10.1007/s13201-017-0533-5]
  10. 10.Mengyan Cao, Xiujian Zhao, Xiao Gong. (2023). Achieving High-Efficiency Large-Area Luminescent Solar Concentrators. JACS Au, 3(1), 25–35[10.1021/jacsau.2c00504]
  11. 11.Ziyao Huang. (2022). Association Between Blood Lead Level With High Blood Pressure in US (NHANES 1999–2018). Frontiers in Public Health, 10, 836357[10.3389/fpubh.2022.836357]
  12. 12.Akhtar Sherin, Zia Ul-Haq, Sheraz Fazid, Basharat Hussain Shah, Maria Ishaq Khattak, Fazal Nabi. (2020). Prevalence of stroke in Pakistan: Findings from Khyber Pakhtunkhwa integrated population health survey (KP-IPHS) 2016-17. Pakistan Journal of Medical Sciences, 36(7), 1435–1440[10.12669/pjms.36.7.2824]
  13. 13.Md Badrul Alam Mondal, A.T.M. Hasibul Hasan, Nusrat Khan, Quazi Deen Mohammad. (2022). Prevalence and risk factors of stroke in Bangladesh: A nationwide population-based survey. eNeurologicalSci, 28, 100414[10.1016/j.ensci.2022.100414]
  14. 14.A.K.M. Monwarul Islam, Abdullah A.S. Majumder. (2012). Hypertension in Bangladesh: a review. Indian Heart Journal, 64(3), 319–323[10.1016/s0019-4832(12)60096-0]
  15. 15.Md. Nazmul Islam, Mohammed Moniruzzaman, Md. Ibrahim Khalil, Rehana Basri, Mohammad Khursheed Alam, Keat Wei Loo, Siew Hua Gan. (2012). Burden of Stroke in Bangladesh. International Journal of Stroke, 8(3), 211–213[10.1111/j.1747-4949.2012.00885.x]
  16. 16.Thashi Chang, Seneth Gajasinghe, Carukshi Arambepola. (2015). Prevalence of Stroke and Its Risk Factors in Urban Sri Lanka. Stroke, 46(10), 2965–2968[10.1161/strokeaha.115.010203]
  17. 17.Mohammed Islam, Shamima Aktar. (2011). Measuring Physical Accessibility to Health Facilities – A Case Study on Khulna City. World health & population, 12(3), 33–41[10.12927/whp.2011.22195]
  18. 18.Thomas Engels, Quentin Baglione, Martine Audibert, Anne Viallefont, Fouzi Mourji, Mustapha El Alaoui Faris, for the GRAVCM Study Group. (2014). Socioeconomic Status and Stroke Prevalence in Morocco: Results from the Rabat-Casablanca Study. PLoS ONE, 9(2), e89271[10.1371/journal.pone.0089271]
  19. 19.AM Hossain, NU Ahmed, M Rahman, MR Islam, G Sadhya, K Fatema. (1970). Analysis of Sociodemographic and Clinical Factors Associated with Hospitalized Stroke Patients of Bangladesh. Faridpur Medical College Journal, 6(1), 19–23[10.3329/fmcj.v6i1.7405]
  20. 20.F. J. Mateen, M. Carone, N. Alam, P. K. Streatfield, R. E. Black. (2012). A population‐based case–control study of 1250 stroke deaths in rural Bangladesh. European Journal of Neurology, 19(7), 999–1006[10.1111/j.1468-1331.2012.03666.x]
  21. 21.Jahidur Rahman Khan, Nabil Awan, Rownak Jahan Archie, Nasrin Sultana, Olav Muurlink. (2020). The association between drinking water salinity and hypertension in coastal Bangladesh. Global Health Journal, 4(4), 153–158[10.1016/j.glohj.2020.11.001]
  22. 22.(2000). TABLE8TocolDerivativeContentinCerealGrainsTocolderivatives ( m g / 100g ) aGrainsa -T a -T -3 1 3 -T I 3 -T -3 y -T y -T -3 6 -T 6 -T -3 TotalRef . Barley0 . 2 -0 . 4 1 . 1 -1 . 3 0 . 0 4 -0 . 4 0 . 3 -0 . 7 0 . 0 3 -0 . 5 0 . 2 0 . 0 1 -0 . 040 . 1 6 < 5 . 030 . 4 1 . 3 0 . 3 0 . 7 0 . 050 . 2 0 . 1 -8 9 0 . 5 1 . 3 0 . 020 . 7 0 . 070 . 8 0 . 020 . 0750 . 3 1 . 6 < 0 . 1 0 . 6 0 . 1 0 . 6 < 0 . 1 -9 0Genotype0 . 7 2 -1 . 162 . 3 8 -4 . 300 . 0 5 -0 . 130 . 3 1 -1 . 210 . 0 4 -0 . 120 . 2 4 -0 . 960 . 0 4 -0 . 140 . 0 2 -0 . 204 . 2 2 -8 . 0091Location0 . 8 8 -1 . 113 . 0 5 -3 . 630 . 002 -0 . 190 . 6 7 -0 . 750 . 070 . 5 0 -0 . 560 . 0 4 -0 . 130 . 0 7 -0 . 115 . 6 7 -6 . 0891Malt1 . 003 . 070 . 140 . 460 . 040 . 390 . 040 . 065 . 292Spentgrain2 . 029 . 210 . 311 . 600 . 091 . 760 . 120 . 1815 . 392Corn0 . 6 -2 . 1 0 . 2 -0 . 5 -0 . 5 -1 . 1 3 -0 . 6 0 . 2 0 . 4 3 . 8 0 . 5tr890 . 1 -2 . 3 0 . 3 -0 . 7 1 . 1 -7 . 1 0 . 1 -1 . 9 2 . 6 -1 0 . 29Millet0 . 05tr1 . 3 0 . 489 -0 . 1 < 0 . 1 0 . 1 1 . 7 < 0 . 1 0 . 690Bulrushmillet0 . 1 3 -5 . 540 . 530 . 080 . 25Foxtailmillet0 . 190 . 040 . 042 . 780 . 065Fingermillet0 . 320 . 050 . 031 . 7 6 -5 Pearlmillet0 . 041 . 5 -0 . 355 -O ats0 . 3 -1 . 7 0 . 7 -1 . 1 0 . 1 -0 . 2 0 . 1 -0 . 3 0 . 3 -3 0 . 7 0 . 7 0 . 2 0 . 1 0 . 3 -8 9 1 . 3 -4 . 0 0 . 2 -6 . 3 0 . 3 -0 . 5 0 . 3 -1 . 1 0 . 7 -6 . 1 0 . 910 . 140 . 321 . 3 -3 . 011Genotype0 . 5 5 -0 . 960 . 9 1 -1 . 860 . 0 7 -0 . 130 . 0 5 -0 . 150 . 0 5 -0 . 130 . 0 0 -0 . 061 . 9 -3 . 091Location0 . 7 2 -0 . 961 . 1 7 -1 . 830 . 0 7 -0 . 110 . 0 5 -0 . 140 . 0 8 -0 . 110 . 0 1 -0 . 032 . 1 -3 . 191RiceBrownrice0 . 6 0 . 4 0 . 1 < 0 . 010 . 1 0 . 7 < 0 . 190Polishedrice < 0 . 1 0 . 1 < 0 . 1 < 0 . 1 < 0 . 1 0 . 3 < 0 . 190Milledrice0 . 0 5 -0 . 3 0 . 2 -0 . 5 0 . 1 -0 . 3 -< 0 . 0440 . 3tr0 . 3 0 . 5 0 . 04890 . 060 . 080 . 260 . 020 . 025 -R ye0 . 5 -1 . 8 0 . 7 -1 . 5 0 . 3 -0 . 7 0 . 8 -0 . 9 0 . 6 -3 0 . 8 1 . 3 0 . 4 0 . 9 0 . 689Flour0 . 6 0 . 4 0 . 3 0 . 6 -9 0Meal1 . 0 1 . 4 0 . 3 1 . 190Sorghum0 . 081 . 155Triticale0 . 911 . 030 . 301 . 515Winter0 . 7 -0 . 9593Spring1 . 3 5 -1 . 4593 -W heat1 . 0 0 . 2 0 . 4 1 . 9 -5 0 . 9 -1 . 8 0 . 3 -0 . 7 2 . 5 -3 . 6 4 . 9 -5 . 831 . 0 0 . 4 0 . 9 2 . 5 0 . 0889aTocopherolsincludea -T , 0 -T , y -T , and5 -T , andtocotrienolsincludea -T -3 , 0 -T -3 , y -T -3 , andS -T -3 . ( -) denotedatanotreported .. CRC Press eBooks, 449–494[10.1201/9781420027228-47]
  23. 23.Rachel Malone. (2021). The role of the physician associate: an overview. Irish Journal of Medical Science (1971 -), 191(3), 1277–1283[10.1007/s11845-021-02661-9]
  24. 24.Russell Kabir, Mohammad Kabir, Mohammad Sheikh Gias Uddin, Nahida Ferdous, Mohammad Rocky Khan Chowdhury. (2016). Elderly Population Growth in Bangladesh: Preparedness in Public and Private Sectors. IOSR Journal of Humanities and Social Science, 21(08), 58–73[10.9790/0837-2108025873]
  25. 25.M. Mostafa Zaman, Sohel Reza Choudhury, Jasimuddin Ahmed, Syed Md Akram Hussain, Sheikh Mohammad Mahbubus Sobhan, Tanvir Chowdhury Turin. (2015). Prevalence of Stroke in a Rural Population of Bangladesh. Global Heart, 10(4), 333[10.1016/j.gheart.2014.04.007]
  26. 26.MZ Hossain, SU Ahmed, MH Sarder, R Dasgupta, A Das, RN Sarker, KAK Azad, SM Arif, QD Mohammad. (1970). Analysis of Risk Factors Associated with Stroke in Young Adults: A Prospective Study. Journal of Dhaka Medical College, 18(2), 95–99[10.3329/jdmc.v18i2.6265]
  27. 27.U.K. Saha, M.B. Alam, A.K.M.F. Rahman, A.H.M.E. Hussain, S.R. Mashreky, G. Mandal, Q.D. Mohammad. (2018). Epidemiology of stroke: findings from a community-based survey in rural Bangladesh. Public Health, 160, 26–32[10.1016/j.puhe.2018.03.024]
  28. 28.MNA Miah, MA Azhar, A Rahman, D Halder, M Akteruzzaman, NC Kundu. (2012). Risk Factors of Stroke in Young and Old age Group - A Comparative Study. Journal of Medicine, 13(2), 138–142[10.3329/jom.v13i2.12741]
  29. 29.Md Titu Miah, AKM Aminul Hoque, Binoy Krishna Tarafder, Syed Mohammad Ali Romel, Md Kamrul Hassan. (1970). Stroke in Young Age - Study of 50 Cases. Journal of Medicine, 9(1), 10–15[10.3329/jom.v9i1.1419]
  30. 30.Md Jabed Iqbal, Md Mahmudur Rahman Siddiqui, Quazi Tarikul Islam, Ahmed Hossain, Ekramul Mustafa, Md Ruhul Amin Shipa, Md Yousuf Ur Rahman, Hashmi Sina. (1970). Association Between Acute Stroke and Metabolic Syndrome. Journal of Medicine, 11(2), 124–127[10.3329/jom.v11i2.5453]
  31. 31.Claude Cartigny. (1987). Ni Pershing, ni SS 20 ?. Recherches Internationales, 24(1), 7–41[10.3406/rint.1987.2831]
  32. 32.U.S. Geological Survey. (1972). Mars charts, uncontrolled photomosaics--MC-2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29. Antarctica A Keystone in a Changing World[10.3133/ofr72415]
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