ISC 2026 | Key disparities in stroke care in low- and middle-income countries
Ahmed Nasreldein, MD, PhD, Assiut University Hospitals, Asyut, Egypt, discusses the disparities in stroke care in low- and middle-income countries. Prof. Nasreldein notes that these countries face numerous challenges, including limited stroke units, difficulty in accessing reperfusion therapy, and weak rehabilitation services. This interview took place at the 2026 International Stroke Congress (ISC), held in New Orleans, LA.
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Transcript
Stroke is a medical emergency, but for millions of people around the world, it’s a matter of geography. 85% of stroke diseases occur in low- and middle-income countries. Moreover, there is a rising incidence of stroke, younger age at onset, and hence also increasing disability. This is not because stroke is different there, but because healthcare systems are. The major stroke inequities in low- and middle-income countries are delayed hospital arrival...
Stroke is a medical emergency, but for millions of people around the world, it’s a matter of geography. 85% of stroke diseases occur in low- and middle-income countries. Moreover, there is a rising incidence of stroke, younger age at onset, and hence also increasing disability. This is not because stroke is different there, but because healthcare systems are. The major stroke inequities in low- and middle-income countries are delayed hospital arrival. This is due to low public awareness. Many patients don’t know that the stroke is treatable, so they arrive in hospital late. Limited emergency medical services infrastructure, and non-trained healthcare workers in stroke recognition and helping to direct the patient to the nearest stroke-ready hospital. Even within the low-income countries, there is a rural and urban disparity. One study from Egypt showed that only 12% of rural acute ischemic stroke patients who were eligible for intravenous thrombolysis arrived at the hospital within the therapeutic time window in comparison to 47% of urban patients. And those rural patients who arrived at the hospital, most of them arrived after seven and a half hours of stroke onset, leaving limited time for stroke workup and decision making. Number two, there is a limited number of stroke units in low- and middle-income countries. Only 18% of low- and middle-income countries’ hospitals have dedicated stroke units. Most of them are clustered within urban cities or capital cities. There is also a difficulty in implementing stroke units in low- and middle-income countries due to financial troubles, limited infrastructure, and a lack of trained personnel. Number three, there is a difficulty in accessing reperfusion therapy like intravenous thrombolysis and mechanical thrombectomy. Number four, there is weak rehabilitation service, either non-implemented or a lack of workforce capacity.
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