1. To evaluate the feasibility of identifying stroke patients in villages using Accredited Social Health Activists (ASHAs) 2. To study the establishment of acute stroke care pathway in the rural areas

Stroke incidence studies from rural regions are scarce from low- and middle-income countries. Task shifting using community health workers in stroke surveillance and establishing stroke care pathway has not been studied.

Population based rural stroke registry was carried out from January 2017 till December 2017. Two blocks (164 villages) in Ludhiana district was selected (population of 158,298, adults over 18 years). WHO STEPS approach was used for data collection and first ever stroke cases were included. The ASHAs and other health workers were trained to identify stroke patients in the community (n=328). They reported stroke patients (old and new) to the research staff through the toll-free number and the neurologist confirmed the cases. Stroke characteristics, first response to symptom, use of ambulance and treatment were documented. Outcome was collected at 6 months using modified Rankin Scale (mRS).

174 stroke cases were identified, 93 (53%) were men. 141 (82.5%) patients were reported by ASHAs. The age standardised rate was 133/100,000. Ninety patients (51.7%) reached health-care facilities ≤4.5 hours and 36 (40%) of them approached unqualified practitioners. Others went to city hospitals by own conveyance and none received thrombolysis. CT or MRI or both was done in 72 (41.3%) patients and 56 (77.8%) had ischemic stroke. ASHAs were able to identify stroke patients with a sensitivity 80.7% and positive predictive value 99.3%. At 6 months, 101 (58.7%) had good outcome.  

ASHAs identified stroke patients in the villages in the acute and chronic phase. Despite high number of patients reaching health-care facility in window period the health system is not geared to deliver appropriate acute stroke care.