‘There are more stroke deaths than HIV, malaria combined’

How many Nigerians suffer from stroke yearly? We do not have exact figures for the number of Nigerians who suffer or die from stroke. The conservative estimates range from 150, 000 to 200, 000. But, of course, many strokes are not reported and many strokes are labelled as other diagnoses such as malaria, witchcraft and […]

How many Nigerians suffer from stroke yearly?
We do not have exact figures for the number of Nigerians who suffer or die from stroke. The conservative estimates range from 150, 000 to 200, 000. But, of course, many strokes are not reported and many strokes are labelled as other diagnoses such as malaria, witchcraft and an act of the devil.
There seems to be more stroke deaths than malaria and HIV put together. But stroke is not given the credit it deserves as a major killer in Nigeria. We do not have a registry for recording deaths. We have very poor uptake of autopsies to find out the exact cause of death.
In Nigeria, we allow personal, financial and religious factors to cloud what should be enforced as a government health policy. We need to know what is really killing people in Nigeria.On stroke specifically, we are now hoping to be able to register all strokes in Nigeria. The Federal Government recently inaugurated the Nigeria Stroke Reference Group to deal with this exact problem. So perhaps in the future, we will have a good grasp of the morbidity and mortality related to stroke in Nigeria.

What causes stroke?
A stroke is a brain injury that occurs because the brain’s blood supply is interrupted. It is similar to blockage of pipe carrying water into a house. The brain’s blood supply can be disrupted for many reasons such as blockage of the arteries (pipes carrying blood to the brain) or sometimes the arteries can burst open due to high blood pressure. In both situations the brain is starved of food and oxygen and so it suffers.
If the blood supply and the food are restored to the brain within three to four hours, sometimes the brain recovers fully and the person gets better. However, if the blood is not restored, the brain suffers and may die. This leads to the disability noticed such a paralysis or blindness or difficulty speaking. In some situations, the stroke can be so bad that it leads to death immediately or sometime later.

Do we have effective stroke care in Nigeria?
We do not have any credible centres for the management of stroke in Nigeria. Managing stroke demands effective transport system, efficient ambulance services, a stroke centre ready and equipped and a team of stroke specialists who know exactly what to do, do it quickly and manage the stroke victim without recourse to asking for money.
Since many and almost all of our healthcare expenses are out of pocket, it means the stroke victim must have at least N200, 000 in hand at the time of the stroke to get anything close to good care. You and I know that this kind of money is difficult for many people to come by, let alone be carrying around, just in case they have a stroke.
Ideas to develop an emergency telephone number in Nigeria and a coordinated ambulance service were all scuppered by greed and corruption. Yet, these are ideas to benefit this generation and generations yet unborn. We are not  serious people in Nigeria. Stomach infrastructure and poverty mentality is effectively ruining our future.
To treat stroke effectively, the stroke victim must be able to call an emergency response number and be transported to a dedicated stroke centre within minutes, for clot bursting drugs to be administered.
At the stroke centre, a brain scan is mandatory and must be performed immediately to see what type of stroke the person has suffered. Then, if suitable and within the recognised time window of about three to four hours, clot bursting drugs must be given to reopen the pipes that are blocked in the brain. In some situations, this leads to immediate recovery from the stroke.
The clot bursting drugs such as Alteplase, Streptokinase and Urokinase are not readily available. Where they are available, they are too expensive for the common man to buy. For the rich who have money to fly out of the country, Europe, America and India are too far to go for a drug that must be administered within three hours. In effect, developing a local solution to cater for everyone favours both the rich and the poor.

How can we reduce the incidence of stroke in Nigeria?
We must first acknowledge the importance of stroke as a major killer in Nigeria. Everyone knows someone who has suffered stroke in Nigeria. Stroke has devastated many families and has visited almost every street in the country.
Secondly, we must carry the advocacy as regards the risk factors of stroke to the grassroots. Everyone must know the root causes of stroke such as high blood pressure and diabetes. High blood pressure or hypertension is the biggest underlying cause of stroke in Nigeria.
Many people do not know they have high blood pressure because they have not checked. We need to change this. Others who have been diagnosed stop taking medications for various reasons. Some because their pastor said they were cured at the last retreat!
Following on from this is that doctors and nurses must treat high blood pressure effectively. At the moment, many people dabble in blood pressure control using drugs, they do not understand and with no consistent or sensible format. Our physicians need to do more research on which drugs are actually truly good for Nigerians. Further, every patient is different and the drug therapy must be individualised for each person.
The Nigeria Stroke Reference Group (NSRG) is a great step in the fight against stroke. The group is charged with improving stroke care in Nigeria. We hope to do this via massive collaboration across the nation working with all groups including churches and mosques. Training and education of healthcare practitioners is also a vital part of the remit of the NSRG.

Is there a cure for stroke?
Stroke is best prevented. There are situations where the treatment is effective in restoring the function of the brain but stroke care is life-long. So we cannot talk about cure. Anyone who has had a stroke is at increased risk of having more strokes so ‘continuous treatment’ is required.
You have to be preventing stroke everyday for the rest of your life! So, activities such as exercise, weight reduction, no smoking, watching the blood pressure and blood sugar levels must be done for the rest of your life. There is no cure for stroke, so do not let bogus people fool you.

Are there any latest treatment or research on the disease?
There is no latest or earth shattering research on stroke at the moment. Many nations are concentrating on the advocacy and effective treatment in stroke centres. We know that treatment in a stroke centre reduces the disability and death significantly.
Therefore establishing such centres in Nigeria is the way forward. There are some efforts being made in Benin and Abeokuta and they need to be supported more seriously by government. The government needs to realise that stroke kills more people daily than even the dreaded Boko Haram.

Do you have any advice for relatives?
Most Nigerians have up to 10 doctors: The mechanic, the meat seller, the chemist, the co-worker etc all pretend to be doctors offering poor and ignorant advice in many situations. The best advice is to only listen to a learned healthcare practitioner and use your common sense. If it sounds stupid, it probably is! Going to a herbalist in this day and age with the knowledge God has given to mankind is stupid.
With stroke early recognition and immediate presentation to a responsible hospital is critical to survival. Some of the symptoms of stroke are as follows: sudden weakness of one side of the face , sudden weakness of an arm or a leg, slurring of speech or difficulty speaking, sudden severe, headache like never before, sudden loss of consciousness.
The victim must be rushed to a hospital immediately for investigation and treatment. Please do not take them to a church or mosque or the local chemist. Think stroke and rush to the nearest health facility. We have to promote the acronym called ‘FAST’. F is for Face weakness, A is for Arm weakness, S is for Speech problems while T means telephone the emergency hotline and go straight to a hospital. Since we do not have an emergency number, please telephone a family member or friend and have them take you to a hospital.
Also, Thursday, October 29th is World Stroke Day.  Stroke Action, Nigeria in collaboration with the Federal Ministry of Health will be marking the day at Transcorp Hilton Hotel, Abuja.