PEN-protocol is the package of essential noncommunicable disease interventions as a minimum set of essential NCD interventions administered by WHO in a low resource settings and countries. The aim of the study was to identify opportunities to improve the implementation of the PEN in Kyrgyzstan with the use of the electronic stroke registries and questionnaires regarding the stroke risk factors and management.
With the clinical staff we conducted interviews, made educational workshops on the clinical settings rearrangements, created the stroke pathway for the 2 main hospitals, introduced NIHSS and mRS in Kyrgyzstan. With the patients we made educational campaigns for the stroke recognition, assessed the stroke awareness level in population. From stroke registries we included variables such as demographics, stroke risk factors, treatment options and compliance.
Our team implemented the RES-Q stroke registry which enrolled 10 stroke centers with 1021 patents in 2 years. The median age was 61 (48;71), 55% were males,leaving 71% for the ischemic stroke. Median NIHSS was 5 (4;11) with the most severe strokes at the high altitudes with mean NIHSS 11. In the Roadmap for stroke we created a stroke pathway where patients were admitted directly to the separate CT-centers avoiding hospital admission to the centers without neuroimaging. Stroke risk factors were high altitude OR 8 (2-11, 95% CI), smoking, animal fat consumption. The predictors for the worst outcome was the late admission and non-compliance to the preventive therapy. We educated 78 neurologists with the NIHSS and mRS use and via telemedicine trained them repeatedly. For the remote regions lacking internet we developed the paper-based version of RES-Q stroke registry.
The fact of joining the ESO-EAST project by Kyrgyzstan, made possible to implement the PEN-protocol settings introducing a user-friendly stroke registry RES-Q.We were able to reorganise the stroke service and make a preparations of several hospitals to the pilot implementation of the thrombolysis. The results of our work included at the Roadmap on stroke by WHO in Kyrgyzstan.