Nepal Stroke Research Workshop: Report

05 Dec 2025

December 5, 2025 in Hotel Shanker, Kathmandu

Executive Summary
The Nepal Stroke Research Workshop convened about 64 multidisciplinary experts to advance stroke research in Nepal. Morning sessions mapped global and low- and middle-income country (LMIC) strategies from the World Stroke Organization (WSO), Nepal Stroke Project (NSP), Gurkha Welfare Trust (GWT), Nepal Health Research Council (NHRC) and PHASE Nepal. Afternoon breakout groups produced four actionable research proposals, with one receiving 25,000 NPR seed funding – demonstrating strong momentum for collaborative, LMIC‑tailored stroke research.
This workshop was jointly supported by the Nepal Stroke Project (NSP) and the University of Edinburgh, UK, as part of their ongoing collaboration to strengthen stroke research and care in Nepal.

Workshop Objectives
● Network Nepali and international stroke experts (clinicians, researchers, non-governmental organizations (NGOs))
● Map ongoing initiatives and LMIC‑specific evidence gaps (surveillance, prehospital, acute and rehabilitation care)
● Generate fundable research proposals leveraging local resources for policy impact

Morning Session
First and foremost, heartfelt thanks to Prof. Gillian Mead, the main organizer of the event, who unfortunately could not attend, because of an acute illness and to Dr. Abhishek Man Shrestha, who graciously served as the Master of Ceremonies (EMCEE) for the entire session.
Dr. Raju Paudel delivered the welcome speech, highlighting the importance of advancing stroke research in Nepal and emphasizing the need for collaborative efforts. He underscored how working together across all areas of stroke care both pre- and post-stroke can significantly strengthen stroke research and ultimately improve patient outcomes.
Aims: Network colleagues, map ongoing work, generate new research ideas across awareness, prevention, acute/long-term care.

Morning Presentations
WSO Strategies to Reduce Global Stroke Burden (Prof. Jeyaraj Pandian, President of the World Stroke Organization), presented a global burden map and worldwide incidence data. He outlined the four pillars of stroke care (prevention, acute care, rehabilitation and policy) and WSO strategies, and highlighted non‑specialist physician models that reduce complications and length of hospital stay. He introduced the Enigma stroke app for training, the NSP/Hub model (including the Puja Stroke Project in India), the THRIVE project, and the WSO stroke center certification programme (over 130 centers in 19 countries), as well as the World Health Organization (WHO) model trainings (e.g. Manila, Iraq, Nepal, Tunisia) and the upcoming WSO assembly in Geneva with a United Nations General Assembly (UNGA) side‑event.
Nepal Stroke Association Progress (Dr. Christine Tunkl/ Dr. Lekhjung Thapa): Presentation on the progress of the Nepal Stroke Association (NSA) and NSP. They described a five‑year evolution from virtually no structured stroke care before 2016 to the emergence of NSP out of heart patient advocacy, followed by GIZ (Gesellschaft für Internationale Zusammenarbeit), Ministry of Health and Population and WSO “Rescue” funding (2020–2021). They reported on nationwide trainings and awareness activities since 2022, a project management workshops and HISS 2025 (a two‑day conference with around 500 participants and 45 sessions). A major achievement was the publication of a government‑endorsed national stroke treatment protocol this year.

Experiencing Stroke: Survivor's Perspective: Several stroke survivors were introduced and their cases and post-stroke-experiences shortly presented, leading up to an in-person interview with a stroke survivor from the Kathmandu region and her family, who started being her caregiver after the stroke. They described how the symptoms started and their way to the hospital. Furthermore, the challenges after discharge were discussed, including follow-ups, rehabilitation and life with disabilities, highlighting not just the struggles for the patient, but also their caregivers.

Palliative Care (Dr. Amrita): Sunita video
(https://www.youtube.com/watch?v=znnGKWgqUh0&t=2s) of pallative patient Sunita and her caregiver (her husband)
Introduced post-stroke family-inclusive model; SPICT-LIS screening tool for LMICs (general indicators: declining performance >50% bedbound/repeated admissions; stroke-specific: progressive deterioration, swallowing/speech issues, aspiration pneumonia); emphasized early palliative-enhanced care humanizing patients/families/communities including spiritual leaders.

Gurkha Welfare Trust: Long-term Stroke Survivor Needs (Dr. Gerda Pohl): UK charity (est. 1969) supports 5,800+ ex-Gurkhas/widows with pensions, medical clinics/residential homes/camps, home-based rehab, carer training, home adaptations; identified rural-urban gaps, acute care underutilization, research opportunities (awareness, rehab feasibility, access/follow-up, psychological needs).
Need for Stroke Research in LMICs (Dr. Raju): Called for Nepal-specific data on surveillance/prevention, prehospital care, acute care, rehabilitation, complications; cited national stroke protocol as research-to-policy success example.

Learning from Global NCD Initiatives (Dr. Biraj Karmacharya): Highlighted Dhulikhel Heart Study (2013) as successful Nepal NCD data collection model informing local research priorities.
Stroke Research: From Idea to Impact (Drs. Christine Tunkl/Khechar Paudel): Explained process indicators (resource utilization) vs. outcome indicators (patient improvement) for standardization/comparability using accessible questionnaires.

PHASE Nepal Research Expertise (Dr. Jiban Karki): NGO (est. 2006) delivers health/education/livelihood services in 6 remote Himalayan districts; research wing (since 2017) focuses NCDs/spinal injury/public health with policy impact (Every Newborn Action Plan); limited stroke activities via staff trainings (Dr. Gerda Pohl).
Lunch break

Afternoon Breakout Sessions: Funded Innovation
Format: Four randomly assigned groups had 45 minutes to develope research proposals on assigned topics (awareness, acute care, lifestyle, caregiver burden). Winner receives 25,000 NPR funding (first half post-proposal, second after execution). The criteria were relevant/feasible, innovative, ... Exceptional discussions showed strong enthusiasm for joint projects.
Detailed Group Presentations:
Group 1: Public Awareness (Gerda Pohl) – "Identifying an Effective Strategy to Raise Awareness of Stroke Symptoms in Nepal" (Radio vs. posters for Nepali BE-FAST; awareness vs. behavior outcomes
Group 2: Acute Care – "Stroke Unit vs. Non-Stroke Unit care in Nepal (SUCCEED Nepal)" (prospective multicentre observational; mortality/mRS)
Group 3: Lifestyle Modification – "Does lifestyle modification reduce recurrent stroke risk?" (Manipal Hospital cohort; adherence/follow-up challenges)
Group 4: Caregiver Burden (WINNER) – "Burdens experienced by primary caregivers of stroke survivors" (qualitative interviews/FGDs ≥6 months experience) – 25,000 NPR awarded

Overall Group Work Assessment: Very high-quality discussions addressing relevant aspects; palpable desire for collaborative research projects.
Afternoon Presentations on Potential Trials in Nepal

Following the breakout sessions, three additional presentations explored promising clinical trials for Nepal: ACT GLOBAL (Dr. Nishita Singh) on acute stroke interventions, I-CATCHER (Dr. Xia Wang) focusing on innovative stroke management, and Community BP Management for Stroke Prevention (Dr. Bishnu Marasaini), highlighting blood pressure control strategies to reduce stroke incidence in LMIC settings.

Research Workshop Outcomes and Summary
Extremely positive day with exceptional networking across disciplines, comprehensive mapping of Nepal's stroke research landscape, and tangible outputs through four innovative proposals – capped by Group 4's funded caregiver burden study. The results of 4
the study are to be presented at the next Stroke Research Workshop in 2026. Strong enthusiasm for joint projects emerged, positioning Nepal for LMIC-leading stroke research; next steps include proposal implementation, another stroke research workshop for 2026, and sustained collaboration among WSO/NSP/GWT/PHASE/NHRC partners.

Acknowledgements
Special thanks to Dr. Rachana Nakarmi, without whose management of major organizational aspects this event would not have been possible. Sincere gratitude also to Dr. Lekhjung Thapa, Dr. Raju Paudel, Dr. Christine Tunkl , Ms. Harriet Koch and Ms. Nooma Sharma for their constant positive input and strong support throughout.
Thanks to the Hotel Shanker for their excellent service.

And finally a big thank you to all participants, whose engagement through thoughtful questions and high-value contributions made this workshop as productive and inspiring as it turned out to be!

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