29/07/2025
Stroke in a Developing Country: The Case of Fiji
Introduction
Stroke is a leading cause of morbidity and mortality worldwide, with an increasing burden in low- and middle-income countries (LMICs) such as Fiji. The nation faces a significant Non-Communicable Disease (NCD) crisis, with stroke forming a major component of this growing epidemic.
Epidemiology and Burden of Stroke in Fiji
Fiji has seen a rise in stroke cases, with recent estimates suggesting cerebrovascular diseases are among the top five causes of death. According to the Fiji Ministry of Health and Medical Services, strokes accounted for approximately 7.8% of all deaths in 2019 (1).
Types and Etiologies of Stroke
Strokes are broadly categorized into ischemic (about 85%) and hemorrhagic (about 15%) types. In Fiji, modifiable risk factors such as hypertension, diabetes mellitus, dyslipidemia, obesity, and to***co use significantly contribute to the high prevalence of stroke (2).
Primary Screening and Prevention Strategies
Primary prevention focuses on controlling NCDs through lifestyle interventions and pharmacological treatment. Routine screening for hypertension and diabetes at the primary care level has been emphasized in the Fijian national NCD strategic plan (3).
Early Diagnosis and Management in Fiji
Early diagnosis is often delayed due to limited imaging resources such as CT and MRI, which are primarily available in urban centers. The WHO STEPwise approach has been instrumental in identifying high-risk individuals (4).
Comparison with Developed Countries
In contrast, developed nations employ robust stroke units, thrombolytic protocols, and telemedicine for timely intervention. Australia, for instance, maintains a nationwide stroke registry and ensures thrombolysis within the golden hour in eligible patients (5).
Pharmaceutical and Surgical Management Options
Pharmacologic prevention includes antihypertensives, statins, and antiplatelet agents like aspirin or clopidogrel. Acute management may include thrombolysis with tPA, though access is limited in Fiji. Surgical options like carotid endarterectomy or decompressive craniectomy are rarely available but are standard in high-income countries (6).
Conclusion
Addressing stroke in Fiji requires a multifaceted approach, integrating NCD prevention, health education, and improved diagnostic and treatment infrastructure.
References
1. Ministry of Health and Medical Services, Fiji. Annual Report 2019. Suva: Government of Fiji; 2020.
2. World Health Organization. Noncommunicable Diseases Country Profiles 2020. Geneva: WHO; 2020.
3. Fiji NCD Strategic Plan 2021–2025. Ministry of Health and Medical Services. Suva: Government of Fiji.
4. WHO STEPS Survey Fiji 2011. World Health Organization. Suva: WHO Pacific Office; 2012.
5. Australian Stroke Alliance. National Stroke Audit 2022. Canberra: Stroke Foundation; 2023.
6. Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017;120(3):439–448.
