By Oluwasola Samuel, Freelance Writer. Medically reviewed by Dr. Seyi Roberts, Consultant Neurologist, Lagos, Nigeria and Editorial support from The DLHA Team
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Highlights
Stroke is a blood vessel related disorder of the brain (cerebrovascular disease) that occurs when a blood vessel to the brain is ruptured or blocked. This causes little or no oxygenated blood to be supplied to the brain, and results in the death of brain cells within minutes if not recognised and treated promptly.
A stroke is a serious medical emergency that should be treated immediately to avoid permanent brain damage.
Stroke often occurs acutely and depending on its severity results in chronic disability of public health impact in sub-Saharan Africa and globally.
A high percentage of stroke-related death and disability occur in low-and middle-income countries and African countries generally face considerable diagnostic and treatment challenges in tackling the condition.
In this blog post, you will learn about stroke in Africa; its burden, risk factors, symptoms and other relevant information that should help you to recognise and provide prompt assistance to anyone suffering from the condition.
In the past, knowledge about the burden of stroke in Africa and most especially sub-Saharan Africa was overshadowed by the several communicable diseases that are common in the region.
"Stroke can cause paralysis, and it's the largest cause of disability and death in the world," says Dr. Seyi Roberts, a Consultant Neurologist and Medical Director at Royal Cross Medical Centre, Lagos, Nigeria.
According to a recent report 1, research in the last 10 years or more now suggest that Africa could have up to 2-3 times greater rates of stroke occurrence and higher stroke commonness than in western Europe and the USA.
Put in crude figure terms, stroke is as common as in 15 of every 1,000 Nigerians (a seriously high figure) and the condition occurs in 3 of 1,000 Africans yearly with a crude death rate ranging from 24 - 85% (i.e., 1 in 4 and worse) at 30 days post-stroke and crude and disability rates of 80% and 87% respectively at 3 years post-stroke. 1
Although stroke can occur in anyone at any age, many Africans have a stroke within the fourth and sixth decades of life, 1 with higher occurence noted in people aged 65 years and above in hospital populations. This age profile is associated with a low sense of self-worth, depression and low productivity.
"I have seen several young and productive patients end up becoming liabilities following a stroke due to being disabled and unable to be productive as before," Dr. Seyi Roberts explains.
80% of stroke survivors in Africa have some form of disability that may become a liability. 2
While significant progress in stroke care continues to be made in high-income countries, the same cannot be said to be true in sub-Saharan Africa and other low to middle-income countries due to several factors.
Additional research is needed into the epidemiology, genetics, prevention, care, and treatment outcomes in order to provide African health stakeholders with better understanding of how to prevent and manage stroke. 2 This is important because stroke is a leading cause of death and disability in Africa, and the burden is expected to rise due to the ageing population and many other social determinant factors like poverty, low awareness of the disease, etc.
Stroke is a critical disease and different conditions (risk factors) increase your chances of having a stroke. These are classifiable into two categories, namely:
These are conditions or risk factors that occur naturally and cannot be changed by you. Included in this category are:
These are health conditions that can be altered or changed to reduce your risk of having a stroke. The modifiable risk factors include the following:
"Stroke is an emergency, and most people do not know when they have a stroke. It's important to know the symptoms of stroke to help save lives," says Dr. Roberts.
The common symptoms to quickly recognise in someone who is having a stroke are summarised in simple letters identified as B.E.F.A.S.T. These letters are made up from the initial letters of other words that describe the symptoms of stroke as indicated below.
B - BALANCE
E - EYES
F - FACE
A - ARMS
S - SPEECH
T - TIME
Other symptoms and conditions to note, include:
Details about the treatment of stroke in Africa is covered in another blog but the challenges to the treatment and prevention of stroke will be touched upon here and discussed in details elsewhere.
"In Africa, most people aren't aware they have a stroke. Sometimes, when they see signs of stroke in a person, they begin to administer herbal treatments and consult their spiritual heads for healing instead of visiting the nearest hospital for treatment. This makes it difficult to combat and treat strokes in Africa," Dr. Seyi Roberts explains.
According to various research and findings, some of the challenges of stroke treatment in Africa are more common than others, and they include the following:
Addressing these challenges is complex. But it's important to tackle them in order to reduce stroke burden and improve the outcomes of stroke survivors in sub-Saharan Africa.
When you survive a stroke, it becomes a chronic and debilitating disease that should be tackled adequately because of its impact on your quality of life.
The reasons why stroke is rampant in Africa are due to many factors among which are;
These factors greatly hinder the fight against stroke in Africa. If these factors aren't tackled comprehensively and strategically, they will advance the many serious public health issues that impact the growing and productive population in the future.
To tackle stroke in Africa, certain strategies should be adopted, and they include the following:
The best way to tackle stroke is to prevent it through raising awareness of its risk factors, and reducing the chances of these risk factors leading to a stroke.
Risk factors like diabetes and obesity can be addressed early through lifestyle changes and medication use before they lead to a stroke. Prevention of risk factors is far cheaper and better than treatment of a stroke because it can be economically draining to treat a stroke relative to preventing the risk factors.
Adequate treatment
When a person has a stroke, it's vital to make available prompt and effective care or treatment within the first 4 hours of having the stroke. This can help reverse the impact of the stroke, minimize the damage caused, and increase the chances of survival or reasonable recovery for the patient.
Rehabilitation
There is a need for well-equipped rehabilitation centres to help stroke patients gain use of the disabled part of the body affected by stroke and also help patients learn to live with their disabilities in the promotion of a better quality of life.
Policymakers and health authorities need to invest heavily in public health campaigns and awareness programmes to help raise awareness of stroke and its risk factors. This will help people to be more aware and ensure they know the right and immediate steps to take in case they or someone around them has a stroke.
Affordable treatment
Policymakers should allocate nation-wide resources that enable easy and affordable access to stroke treatment, prevention and rehabilitation resources to the general public. A plan should be put in place for financial support through social or universal health insurance or through direct subsidy of the cost of drugs and treatment of stroke patients at the point of care. Also, transportation and other accessibility support to primary healthcare centres in both urban and rural communities should be made available.
Support research on stroke
Better measures and improved outcomes for people with stroke will be attained through improved funding of research into epidemiology, prevention, treatment, and rehabilitation.
Train healthcare workers
Healthcare workers need to be well-trained and equipped to help address stroke incidence. Through proper training, they will ensure they are more aware of how to detect and manage stroke incidents. This training should be provided at all levels of the healthcare system, from primary healthcare centres to specialised stroke units across each country in Africa.
Implementing these strategies will reduce the burden of stroke in Africa considerably and also help improve the lives of survivors of stroke in Africa.
"The reason many stroke patients end up being disabled is because they aren't able to detect the signs of stroke, which is one of the factors that contributes to the high prevalence of stroke in Africa. The sooner treatment is started, the better the outcome," says Dr. Seyi Roberts.
He further explained that the best and easiest way to identify the symptoms and signs of a stroke is through familiarisation with the acronym (abbreviation), B.E.F.A.S.T, as already detailed above.
"Yes, most strokes are preventable if only stroke patients had a better lifestyle. They would have been able to avert it," says Dr. Seyi Roberts.
To prevent strokes, you have to take the following steps:
By following the steps mentioned above, you can significantly reduce your risk of this very serious disease.
"Sadly, there is no permanent cure for stroke at the moment, but there are effective treatments like the "thrombolysis" that must be administered between 1 and 4 hours after a stroke occurrence. The thrombolytic agent is administered through the veins or arteries to unblock blood vessels so blood can reach the brain and ensure stroke is reversed," Dr. Seyi explains.
Aside from thrombolysis, minimally invasive procedures are advised to stop a bleed in the brain or unblock a vessel responsible for a stroke. Additional surgical procedures may be needed to reduce the pressure on the brain. Some promising new treatments for long term stroke care are currently being researched, namely:
The risk of stroke increases with age; after every 10 years of your life, your risk doubles after age 55.3 Please note that strokes can occur at any age, but older adults in Africa are at greater risk.
Depending on the impact or severity of the stroke, it could last for a few minutes, several days, or years. The duration is also determined by the type of stroke.
Stress can trigger or lead to a stroke in people with certain underlaying conditions. Here is how; when you are stressed, your heart rate and blood pressure tend to increase, smetimes dramatically. Given the existence of certain underlying conditions like atheriosclerosis, these can lead to damage or narrowing of the blood vessels in your brain and might result in a stroke.
Stroke is an acute disorder with long-term chronic impact if a patient survives the immediate consequences. Its burden, care and prevention poses considerable public health challenges in sub-Saharan Africa with significant socio-economic impact on individuals, families and communities.
Most stroke cases in the world occur in low- and middle-income nations. The ageing population, increasing occurrence of noncommunicable diseases, low economic status, low awareness and health literacy generally, and poor healthcare infrastructure and delivery systems are some of the reasons for the high burden of stroke in Africa.
Despite these challenges, several programmes and strategies can be implemented by public health stakeholders in sub-Saharan Africa in order to reduce the burden of stroke in respective countries.
Public policy makers should invest more in stroke research, training of healthcare staff, subsidisation of the cost of drugs and treatment, and improving the healthcare infrastructure generally. In addition, continuous awareness raising and educational campaigns are needed. All these and more would help the fight against stroke in Africa.
Related: Stroke treatment in Africa
Published: October 5, 2023
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