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India launches stroke registry to combat “epidemic”

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f223 (Published 11 January 2013) Cite this as: BMJ 2013;346:f223

Re: India launches stroke registry to combat “epidemic”

“Stroke Registry in India”: Neglected issues.

Recently launched National Stroke Registry Programme (1,2), in India is a value addition to stroke understanding for prevention and management. The registries provide accurate estimates of incidence and time trends through conglomerating epidemiological information of certain diseases. History of the registries in India can be traced long back since 1963 with the establishment of Bombay Cancer Registry. However, the stroke registry programme is an add-on to the series of existing disease registry systems. In this article we reveal few uncovered issues of registry programmes that will be vital in making policy decisions.

Several registries are running vertically in different parts of the country. Instead of starting a new registry system, collaboration, integration, incorporation and strengthening of the existing registries seems to be a sound alternative. From the past experience of public health programmes in India, it has been corroborated that integration of vertical programmes has been an effective and more sustainable choice. In 1973, basic health workers, family planning health assistants and auxiliary nurse mid-wives were replaced by multi-purpose health workers to serve primary health requirements of the country. Government of India launched NRHM in 2005 to bring all national vertical programmes under one umbrella. Integrated Disease Surveillance Project, a pioneer programme for surveillance of several diseases in India is also valuable example. Over time these integrated programmes have proven their value.

Understanding of stroke epidemiology has advanced in terms of cure. It is high time for the policy makers to divert their focus towards preventive component. Registry system of disease again adapted a methodology which is skewed towards the curative aspect of the disease. Enhanced and in-depth comprehension of behaviour and other preventive aspects need to be prioritized. In this scenario, slight reluctance to focus preventive face would cost a huge burden on future generations.
India, being a developing country, has multiple challenges that are already competing for the available resources. The amount of resources spent for establishing an independent stroke registry must be cautiously evaluated against competing priorities like maternal and child health, vital events registration, mental health etc. rather than jumping into such an exhaustive exercise without a significant gain (3).

Complete disease registry primarily requires the complete coverage of vital events. India is one of the countries having inadequate vital registration data. The level of registration across the country is around two third (4). In absence of sound vital registration, we conduct ad-hoc demographic surveys to generate data for planning and developing disease control strategies. But it proves costly and only yield macro level information. We argue for strengthening the vital events registry along with moving towards such rigorous exercises.

In the end, we argue that creating such programmes has to be well thought off and balanced against the basic requirements and needs of the country. This calls for perusal of other aspects before planning such resource intensive exercise in favour of broad population health attainments.

References

1- National Centre for Disease Informatics and Research (Indian Council of Medical Research). National Stroke Registry Programme. www.http://strokeregistryindia.org/. (accessed Feb 10, 2013)
2- Bhaumik S. India launches stroke registry to combat “epidemic”. BMJ 2013;346:f223. http://www.bmj.com/content/346/bmj.f223. (accessed Feb 10, 2013)
3- Biswas T. India unveils plans to improve stroke research and care. The Lancet 2013;381(9862):190. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60073-2/fulltext. (accessed Feb 9, 2013)
4- Level of registration of births and deaths, 2008. http://www.censusindia.gov.in/2011-Documents/Reg_formula/Level_Registrat.... (accessed Jan 9, 2013)

Competing interests: No competing interests

24 February 2013
Rahul Srivastava
Public health specialist
Mohan Bairwa, Chandrakant S. Pandav
All India Institute of Medical Sciences, New Delhi
Room No. 14, Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029
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