27th July, 2015
Oluremilekun Osobu-Asubiojo
World Health Organisation, WHO, experts along side other leading stroke experts have estimated that 6.2 million die of stroke each year. An estimated 17.3 million people died from cardiovascular diseases in 2008, representing 30 per cent of all global deaths with 7.3 million due to coronary heart disease and 6.2 million to stroke.
According to experts, in Nigeria, one stroke case occurs every 40 seconds and every four minutes, someone dies of stroke. Stroke is a second leading cause of death of cardiovascular deaths worldwide.
WHO, report shows that children, including the new born are victims of stroke. This is contrary to the general belief that it is a disease for the aging and old people.
In an effort to address the burden of stroke in Nigeria and Africa, a summit was held to sensitise and tackle the high prevalence of the disease in Nigeria.
Titled “Cardiovascular Summit 8.0” and themed “Stroke” the summit was organized by Pfizer Nigeria at the Oriental Hotel in Lagos, Nigeria.
At the summit, the Marketing Director for West and EAST Africa, Mr. Winston Ailemoh stated that “Pfizer will continue to invest in Nigeria to support initiatives that can help save lives. The Cardiovascular Summit in its 8th Edition is one of such long term investment. We are committed to also continually support the practice of medical specialists like Cardiologists, Neurologists and Neurologists”.
The healthcare practitioners and international experts outlined the global and local best practice in the management of cardiovascular disease and stroke.
Professor David Waters, Professor of medicine and Chief of Cardiology at the University of California, San Francisco, highlighted that the global and regional burden of stroke between 1990–2010. In low and middle–income countries, he estimated that of 69 per cent of incident strokes, 52 per cent prevalent strokes, 71 percent of stroke deaths while 78 per cent is daily loss.
Prof. Waters affirmed that stroke is common worldwide, often devastating but noted that is preventable at the early stage. He identified hypertension, diabetes, and high blood cholesterol as the risks factors of stroke.
“Traffic usually in Nigeria is also one of the contributory factors of high incidence of stroke, which can be associated to increase in blood pressure as hypertension has been identified as the number one risk factor for stroke,” he said .
Similarly, Professor Adesola Ogunniyi, Consultant Physician and Neurologist at University College Hospital, UCH, Ibadan described stroke as a medical and occasionally a surgical emergency that requires treatment as quickly as possible.
“Stroke occurs sudden and their symptoms often appear suddenly. It is due to the problems of blood supply to the brain either the blood supply is blocked or the blood vessels within the brain ruptures whereby the brain does not get enough oxygen or nutrients which causes the brain cell to die irrespective of the duration of the clinical symptoms.
“Stroke accounts for 40-60 per cent of neurologically admission which poses a major burden to Nigeria in terms of number of cases, preventable disability, economic cost and this will continue as the population ages,” he submitted.
Ogunniyi mentioned that stroke is second leading cause of preventable disability in low- middle income countries like Nigeria. “The disability burden is increasing in Nigeria, we have so many cases and this calls for a better healthcare system to enable us manage the situation at hand because managing of stroke consume direct cost which runs into millions.
According to Dr. Adeyemi Johnson, the Medical Director and Chief Executives Officer of the First Cardiology Consultants, the most important factor is early detection and early treatment of stroke, as time window for treatment of patients with acute stroke is narrow.
“Application of acute emergency management of stroke, assessment of neurological vital functions treatment of stroke which requires parallel processes operating at different levels of patient management if applied go a long way to prevent the onset of stroke early,” he said.
He also pointed that the use of Emergency Medical Systems, EMS can delay the increase on the early onset of stroke . “If doctors outside the hospital are consulted first patients stand a better chance to be diagonised but many people believe it is associated with spiritual attacks.
“At the early stage they reject the attack, they go to church and do all sort of things. Then report after two or three days when nothing can be done. All of these delays increase the episode between stroke onset which is acutely a life threatening condition,” he said.
He added that rapid recognition of, and reaction to stroke signs and symptoms is key to cutting the number of stroke death, noting that, Immediate emergency room triage, clinical, laboratory and imaging evaluation, accurate diagnosis, and administration of appropriate treatments at the receiving hospital will go a long way to reduce the incidence of stroked in Nigeria.
He urged the government and private sector to promote educational programmes to increase awareness on stroke at the population level and among professionals; paramedics, emergency physicians to reduce stroke disability burden at all levels of treatment including religious centres which is always the first point of call for treatment.
He also mentioned the construction of stroke unit with a dedicated and geographically defined part of a hospital that takes care of stroke patients with specialized staff with coordinated multidisciplinary expert approach to treatment and care that comprises core disciplines: medical, nursing, physiotherapy, occupational therapy, speech and language therapy, social work accommodating all types of patients, irrespective of gender, age, stroke subtype and severity will reduces mortality absolute risk reduction of three per cent, reduces dependency 5 percent and reduces need for institutional care two per cent.
He listed types of stroke to be; ischemic, hemorrhagic and transient ischemic attack.
He stressed that often times early detection of stroke could be the manifestation of Transient Ischemic Attack (TIA), a type of stroke that manifest in a short time with temporarily disruption of flow of blood to the brain without delay calls for serious emergency work up to be done less than 24-48 in our environment. As fast evaluation and treatment of transient ischemic attack can reduce the risk of stroke by 80 per cent if treated appropriately.
“TIA should be regarded as a medical emergency just like any other kind of stroke. They serve as warning signs for future stroke. Approximately 10-20 per cent of patients will experience a stroke after a TIA within the first 90 days, and in approximately 50 per cent of these patients, the stroke occurs in the first 24-48 hours.”
Accumulating evidence suggests that immediate evaluation and intervention after a TIA or minor ischemic stroke reduces the risk of recurrent stroke.
Other factors associated with increased stroke risk: advanced age, overweight, lack of exercise, menopause, smoking, westernized food, heavy consumption of alcohol diabetes mellitus, symptoms more than 10 minutes; weakness, and impaired speech.
While stroke in young people below 50 years of age can be as a result clotting disorders, migraine, the use of birth control pills, illicit drug use such as cocaine, and autoimmune disorders (lupus) among others.
“Stroke is a potential salvageable condition; if we are aggressive about it we might be able to reduce the patient mortality,” Johnson explained.