Title : Pediatric stroke in Bangladesh: Epidemiology, clinical profiles, and policy implications for an underrecognized public health challenge
Abstract:
Pediatric stroke is an underrecognized yet significant cause of morbidity and mortality among children, particularly in low- and middle-income countries (LMICs) like Bangladesh, where it remains underdiagnosed, undertreated, and underreported due to limited awareness, inadequate neuroimaging facilities, and poor integration of pediatric neurology services. This paper explores the prevalence, etiology, clinical presentation, and treatment patterns of pediatric stroke in Bangladesh using data from tertiary hospitals and recent population-based studies. Drawing on a retrospective cohort study at Dhaka Medical College Hospital (DMCH) and records from the Institute of Paediatric Neurodisorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University (BSMMU), the paper highlights the incidence of arterial ischemic stroke (AIS) — more common in urban centers — and hemorrhagic strokes, which are more prevalent in peripheral districts. Common etiologies include congenital heart disease, sickle cell anemia, infections, and prothrombotic conditions. Delayed diagnosis — often beyond the therapeutic window — is linked to a shortage of trained personnel and limited MRI access. Outcomes are concerning: over 45% of survivors experience long-term neurological deficits such as hemiparesis, speech impairments, and epilepsy; mortality ranges from 10–15%, with neonatal strokes being more prevalent and severe. The article emphasizes the urgent need for national pediatric stroke protocols, public awareness initiatives, physician training, and expanded access to neurodiagnostic tools. Integration of rehabilitation services into primary care is essential to improve long-term outcomes. The paper recommends establishing a national stroke registry, enhancing pediatric neurologist training, and promoting research into genetic and environmental risk factors. This study adds to the growing but limited literature on pediatric stroke in South Asia.
