Open Access Research article

The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study

Ayeesha Kamran Kamal1*, Ahmed Itrat1, Muhammed Murtaza2, Maria Khan1, Asif Rasheed3, Amin Ali2, Amna Akber4, Zainab Akber4, Naved Iqbal4, Sana Shoukat2, Farzin Majeed1 and Danish Saleheen5

Author Affiliations

1 Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

2 Medical College, Aga Khan University Hospital, Karachi, Pakistan

3 Department of Biological and Biomedical Sciences, Aga Khan University Hospital, Karachi, Pakistan

4 Dow University of Health Sciences, Karachi, Pakistan

5 Department of Public Health and Primary Care, University of Cambridge, UK

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BMC Neurology 2009, 9:58  doi:10.1186/1471-2377-9-58

Published: 1 December 2009



The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan.


Individuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pre-tested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by neurological examination of suspected cases. Anthropometric measurements and random blood glucose levels were recorded. Multivariable logistic regression was used to determine the association of vascular risk factors with prevalence of stroke.


Five hundred and forty five individuals (49.4% females) participated in the study with a response rate of 90.8%. One hundred and four individuals (19.1%) were observed to have a prior stroke while TIA was found in 53 individuals (9.7%). Overall, 119 individuals (21.8% with 66.4% females) had stroke and/or TIA. Female gender, old age, raised random blood glucose level and use of chewable tobacco were significantly associated with the prevalence of cerebrovascular disease.


This is the first study demonstrating an alarmingly high life-time prevalence of cerebrovascular disease in Pakistan. Individual and public health interventions in Pakistan to increase awareness about stroke, its prevention and therapy are warranted.