Preventing Stroke In Sub-Saharan Africa

Until recently, precisely in the 21st century, the common thinking was that stroke was the function of bewitchment. So everyone suffering from stroke is a victim of a mystical influence or evil powers. While it is difficult to dismiss those beliefs as mere figment of imagination, superstition and old wives’ fables, because of the reality of evil and mean people who cast spells and bring hardship on unsuspecting people, Medical Science has revealed that stroke could also be medically deficient living especially in the Sub-Saharan Africa where  life expectancy is conservatively as low as 47 years. When people refused to lead lives in keeping with medical and health rules, neurologists say that stroke is  inevitable according to Director, Trinity Health Group, Dr. Patrick,  some people distinguish a stroke from  a heart attack. Some people refer to a Stroke as a “brain attack”. A stroke is also known as silent killer.. He said all stroke occur when a blockade prevents blood flow to portions of the brain, starving it of oxygen. “A stroke also occurs if there is a haemorrhage in the artery in the brain and blood flows where it should not, damaging brain cells and the affected brain cells die rapidly”.
However, the Heart and Stroke Foundation defines stroke as a sudden loss of brain function which is caused by the interruption of flow of blood to the brain or the rupture of blood vessels in the brain.”The interruption of blood flow or the rupture of blood vessels causes brain cells in the affected area to die”, it says. The Foundation, however, maintains that the effects of a stroke depend on where the brain is injured, as well as the extent of the damage. It says that a stroke can affect body function including one’s ability to move, see, remember, speak, reason, read and write. The foundation insists that stroke is a medical emergency that requires prompt and adequate response to enable the victim to survive and recover. Sharing similar sentiments, the National Stroke Association says, stroke is a “brain attack” which can happen to anyone at any time.
“It occurs when blood flow to an area of the brain is cut off”.”When this happens, brain cells are deprived of oxygen and they begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost. “The association says the effect of stroke on a person largely depends on where the stroke occurs in the brain and the extent of the damage in the brain. “For example, someone who had a minor stroke may only have minor problems such as temporary weakness of an arm or leg. “While persons who have larger strokes may experience permanent paralysis on one side of their body or lose their ability to speak. “However, some people recover completely from stroke but more than two thirds of survivors will have some kind of disability”, the association says.
On its part, the Nigeria Stroke Reference Group says that stroke is a leading cause of long-term disability and death in Nigeria, stressing that more than 160,000 Nigerians die from stroke every year. An executive member of the group, Dr Biodun Ogungbo, was quoted as  saying that mortality of stroke is higher than that of malaria and HIV combined, adding, however, that stroke is not truly recognised as a killer. He argues that often, many of the deaths and disability caused by stroke are erroneously ascribed to malaria and witchcraft. He, therefore, underscores the need to sensitise Nigerians to the effects and management of stroke in order to reduce the number of deaths and disabilities arising from it.
“Common stroke symptoms include sudden weakness of the face, arm, or leg; sudden confusion; trouble in speaking or understanding speech; and sudden trouble in walking or seeing. “Others include loss of balance; and sudden, severe headache”, he added.
He insists that the ability to recognise the symptoms and seek prompt medical attention is critical to surviving a stroke and minimising long-term disability. He also stresses the need to develop an emergency telephone line for stroke emergencies in Nigeria and a coordinated ambulance service as well.” There is also the need for the establishment of more treatment centres to address the increasing number of stroke patients in the country”, he said.
However, the Founder of Stroke Care International, Mrs Gloria Ekeng, says that “the lack of education, not in terms of academic learning but in terms of awareness about stroke, has contributed to the growing incidence of stroke in the country. “People do not realise that stroke is a medical emergency which could also be prevented”, she says. Ekeng says that the early warning signs of stroke include persistent headaches, which fail to go away even after the use of analgesics, and weakness or heaviness in certain parts of the body.
She says that people, whose blood pressure is terribly high, face a serious risk of having a haemorrhagic stroke (a kind of stroke that occurs when a weakened blood vessel ruptures). She, however, insists that no one is immune to stroke, saying that it can affect anyone with ages between 19 and 90 years. Ekeng said simple lifestyle changes are the best way to prevent stroke, particularly for people with a family history of high blood pressure and its complications. “You have to check your blood pressure and make sure it is not up to 120 over 70 for any reason. “People with a family history of diabetes are also at the risk of having a stroke; they should, therefore, endeavour to keep their condition under control. “People have to actively be healthy by choosing healthier cooking oils, maintaining a low salt diet and exercising regularly.
“They should also keep their stress levels low. I know this can be difficult in Nigeria where there are a lot of stress activators like gridlocks and lack of funds to take care of pressing, daily needs”, she says.
For his part, a neurologist Dr. Patrick of the Trinity Health Medical Group ..says  there are two types of stroke namely: Ischemic Stroke-when there is a blockade, lack of blood flow in the blood vessels to the brain and the Haemorrhage Stroke- when an artery carrying blood in the brain leaks or ruptures. He identified common causes  as High Blood Pressure. “It is medically important to each person to know their blood pressure and to check with a primary care provider if it is high. Normal blood pressure is 120/80mm. High Blood Pressure affects the arteries, heart, kidney, eyes and brain. Other factors and causes of stroke according to the neurologist are, “Smoking/vaping, overweight, high cholesterol, diabetes, lack of exercise, poor diet, high alcohol consumption”.
He posits that unchangeable risk factors are: Racial/Ethnic groups, Age/Sex and Family History. “About 55 percent of black adults have High Blood Pressure, the older the person the greater the risk of stroke” adding that men who before 65 years old have a higher risk while women who are above 65 years of age have a higher risk. All the same, a Neurologist at University College Hospital (UCH), describes stroke as a medical and occasionally, a surgical emergency that requires treatment as quickly as possible. In a paper, he presented, Dr Ogunniyi, a neurologist says, “stroke occurs without warning and their symptoms often appear suddenly.”Stroke accounts for 40 to 60 percent of neurological admissions and it poses a major burden to Nigeria, in terms of number of cases, preventable disability and economic costs; this will continue as the population ages”, he says. Ogunniyi says that stroke is the second leading cause of preventable disability in low and middle-income countries like Nigeria.
“The disability burden is increasing in Nigeria.”We have so many cases and this calls for a better health care system to enable us to manage the situation effectively, as the cost of managing stroke runs into millions of naira”, he says. In the same vein, the Director of National Clinical Centre for Stroke in UK, underscores the need for Nigeria to adopt a coordinated policy and the right approach to controlling the rising incidence of stroke-related deaths. He also said that the rising cases of vascular disease in Nigeria required the urgent attention of the authorities. Rudd, nonetheless, said that stroke is treatable and manageable if the necessary steps are taken on time. “In Nigeria, there is this wrong perception that non-communicable diseases have yet to reach an epidemic level. “This is wrong because available statistics indicate that stroke prevalence is 1.14 per 1000 persons, while the mortality rate of stroke has gone up to 40 per cent in Nigeria,” he adds.
According to Rudd, the risk factors for stroke include HIV, sickle cell anaemia and cigarette smoking, among others.” HIV increases the risk of stroke by 40 percent; 11 percent of sickle cell patients have stroke before the age of 20, while 24 percent of sickle cell patients suffer stroke before reaching the age of 45 years”, he said. He, therefore, urged Nigerians to avoid lifestyles, such as extreme passion and too much sleep which could also trigger stroke. Rudd particularly advised persons who are at risk to avoid smoking and develop the habit of constantly checking their  blood pressure. However, the debilitating effects of stroke, perhaps, propelled the World Stroke Organisation to set aside October 29 every year as “World Stroke Day” The Day aims to highlight the serious nature and high rates of stroke; raise awareness of how to prevent ot treat the condition; while providing better care and support for survivors.
Nevertheless, medical experts call on individuals, irrespective of their gender to adopt healthier lifestyles that could lessen the risks of contracting stroke, while undergoing regular health checks.

Igbiki Benibo