Nigeria joined the rest of the world last week, precisely October 28 to mark the World Stroke Day. The Nigeria Stroke Assembly has been campaigning vigorously to sensitive Nigerians on the debilitating disease which has held many down and reduced quite a number to a sorry state. The organisation has also been offering palliative care for those struck with stroke. In this interview with WINIFRED OGBEBO, a consultant neuro-surgeon, Dr. Biodun Ogungbo sheds light on the disease and how to prevent it.
What is stroke?
Stroke is the acute and dramatic onset of focal or global neurological deficit, which is most often caused by interruption of the blood supply to the brain or indeed bleeding into brain tissue.
Among Nigerians, is stroke on the increase or is it decreasing because of increased awareness?
The incidence of stroke is increasing worldwide. Stroke is now the second leading cause of death in most industrialized countries, among adults aged 65 years or more. It does seem that stroke is affecting younger people in Nigeria. A study and anecdotal evidence suggest that stroke principally affects middle aged women, with increasing cases of stroke in the young Nigerians. Most of the patients we see are between 40 and 60 years old.
In your estimation what’s the number of Nigerians with stroke?
We do not know the actual number of Nigerians suffering a stroke each year. But, we can estimate. The population of Nigeria exceeds 168,833,379 people. If we assume an average stroke incidence of 116 per 100,000 of the population in Nigeria, then 195,846 people suffer a stroke in Nigeria yearly. Using figures from Sagamu, Nigeria, it can be estimated that roughly 34 per cent (n = 59, 160) will die within a month and 60 per cent (n=118, 320) within six months.
What are the danger signs before someone gets a stroke?
Transient ischemic attack (TIA) is the name for a mild stroke. This is a harbinger of death and a warning sign of impending major stroke. People who have a mild stroke are at increased risk of having a major stroke within the year. They are the best people to see and treat in hospitals because doctors can then make great efforts to identify why they have had a mini stroke and do all they can to prevent a bigger stroke.
It is important to recognize and diagnose a patient with TIA. Confusion, blurring of vision, speech impairment, difficulty walking and weakness of an arm or a leg are possible pointers to impending major stroke.
How can a person avoid getting stroke?
Identifying patients with hypertension, diabetes, obesity, smokers, sickle cell patients and those with a strong family history of stroke is very important. These people are at risk of stroke and so must change their lifestyles or go on medications to prevent stroke.
Hypertension is the single most important cause of stroke and the one, which is eminently reducible by treatment. It has been estimated that between 52-70 per cent of stroke patients have hypertension. Up to 60 per cent of patients have undiagnosed high blood pressure (BP) prior to presentation. Reduction of high blood pressure substantially reduces the stroke risk.
It is the duty of every clinician or nurse to at least check the BP of all adults they are reviewing for any health problem.
How can stroke be treated first hand before a patient is taken to the hospital?
Prevention is important. Next to that is early presentation to hospital. ‘Brain attack’ is a term that has been coined to emphasize the need for URGENT action. Studies have shown that delays in presentation are caused mostly by lack of awareness of stroke. Stroke victims MUST be taken to hospital immediately. Do not waste time at home.
Is it true that stroke can be caused by enemies or evil spirits as some people believe?
The idea that somebody hates you and therefore wished stroke on you is one of the major impediments to early presentation for treatment of stroke victims. We must keep emphasizing that stroke occurs in the brain due to lack of blood going to the brain. It is not due to witches or witchcraft and cannot be ‘sent’ by one person to another. It occurs in people with risk factors for stroke who have not looked after themselves.
How can this kind of belief be dispelled?
Public awareness programmes are important. Information about stroke should be made widely available to the public. The local press, celebrities and television personalities should be educated on the risks of stroke and the importance of wide public awareness. Stroke issues should be introduced in schools, churches, mosques, plays on television, in the theatre and brought to national attention.
What’s the achievement of Stroke Action, Nigeria so far?
Stroke Action, Nigeria carried out the first STROKE ASSEMBLY in Nigeria last year and generated massive public awareness about stroke. People know now that stroke is no longer an untreatable condition.
Stroke Action, Nigeria has started the active recruitment of stroke ambassadors to cover every nook and corner of Nigeria. These ambassadors are empowered to spread the news about stroke and educate the wider public. We also evaluate strategies to enlist the support of politicians and the general public in stroke awareness.
The public must in return help Stroke Action, Nigeria by supporting and sponsoring Stroke Action Nigeria’s ‘STROKE OUTREACH PROGRAMMES’. Investing ’seed finance’ for capacity building to establish a pilot Stroke Action’s ‘Life After Stroke’ centre and supporting the sustainability of the service, and subsequent efforts to reduce the incidence of stroke.
Culled from LEADERSHIP