Stroke — A worrying health burden in Ghana

StrokeA 40-year old man was rushed to a medical facility one early morning. He was found in the bathroom sprawled on the floor. According to the younger brother, he was a commercial long distance driver who covered the distance from Accra to a border town every morning.

He said the brother was actually washing down for the morning trip when he heard a loud noise from his bathroom. When he rushed there he found the brother sprawled on the floor barely conscious. According to him he did not know his brother had any history of epilepsy (seizure).

His blood pressure at the time of reporting was 190/120. Further examination and investigations gave a diagnosis of haemorrhagic stroke (intracerebral haemorrhage).

Stroke is a “brain attack” cutting off vital supplies of blood and oxygen to the brain. A stroke happens when the blood supply to part of the brain is cut off. Over 80% of strokes happen because of a blockage in an artery. These are called ischemic strokes. An ischemic stroke can either be caused by:

A cerebral thrombosis – when a blood clot forms in a main artery leading to the brain or a cerebral embolism – when a blood clot, or sometimes a piece of fatty debris from another part of the body is carried in the bloodstream to the brain.

A hemorrhagic stroke occurs when a blood vessel in the brain breaks leaking blood into or around the brain. Hemorrhagic strokes account for about 15% of all strokes, yet are responsible for more than 30% of all stroke deaths.

Intracerebral haemorrhage (ICH) is the most common type of hemorrhagic stroke. It occurs when a blood vessel inside the brain ruptures, and leaks blood into surrounding brain tissue.

While an ICH causes blood to leak into the brain itself, a subarachnoid hemorrhage (SAH) occurs when blood spills into the space surrounding the brain.

It is sad to relate that the young man never recovered and died. He was the sole breadwinner for the family. We were left asking ourselves a few questions. Did he know he had high blood pressure? Did he ever receive medications for high blood pressure?

Did he go for any medical screening (check-up) at least once a year?

What would have happened if the stroke had occurred in the course of the journey from Accra to the border town?

We were left explaining to the relations the risk factors for haemorrhagic stroke.

To them the brother’s sudden ill health and death was shocking and highly suspicious. High blood pressure is the most common cause of ICH, responsible for about 60% of all cases. High blood pressure is also implicated in ischemic stroke.

High blood pressure is the most important controllable stroke risk factor. In the case of the long distance driver, periodic checks would have identified the high blood pressure months ago. He would have been placed on medications, and given education on the management of high blood pressure.

We got some information from the affected person’s relatives which suggested that the deceased parents were both hypertensive. Indeed subsequent checks on the surviving brother showed him to have high blood pressure.

The demise of their sibling became a rallying point for general public education to them all. With stroke there are risk factors beyond your control.

These include age, gender (until women reach menopause they have a lower risk of stroke than men), race (African or South Asian descent tend to have a higher rates of high blood pressure and diabetes and, therefore, are at greater risk of stroke than the general population), family history, prior stroke or TIA (transient ischemic attack).

There are risk factors you can do something about. These include high blood pressure (hypertension), high blood cholesterol, smoking, diabetes, heart disease – atrial fibrillation, being overweight, physical inactivity, poor diet, excessive alcohol consumption and stress.

It needs to be added that certain infections (endocarditis, meningitis, HIV/AIDS, etc). Stroke is one of the top five causes of deaths in Ghana and is also a frequent cause of admission to hospitals.

Stroke is associated with severe disability which poses many challenges to patients and their families; healthcare staff, and the entire nation.

Increasing rate of high blood pressure, diabetes and obesity are major determinants of stroke in Ghana (Agyeman et al, (2012), Stroke burden in Ghana: A Review of Research). Systemic hypertension (High blood pressure) is a major modifiable risk factor identified in stroke patients.

This is followed by physical inactivity, obesity, hypercholesterolemia and type 2 diabetes mellitus (Sarfo et al (2014), The profile of risk factors and in-patient outcomes of stroke in Kumasi, Ghana).

The burden of stroke does not only lie in the high mortality but the high morbidity also results in up to 50% of survivors being chronically disabled (Lopez et al 2001). Thus, stroke is a disease of immense public health importance with economic and social consequences.

The burden of stroke seems to be shifting to the developing world and currently two-thirds of stroke mortality cases occur in Sub-Saharan Africa (Bravata et al 2005) where poverty, malnutrition and communicable diseases such as HIV/AIDS also exert their greatest toll.

Stroke is the most preventable neurological disease, and this is mainly because, many of its risk factors such as hypertension, high cholesterol, diabetes and smoking can be prevented either through healthier lifestyle choices or by medication (Sacco et al 1997).

I am beginning to think that if we could link our public education on stroke prevention as a critical aspect of health screening (check ups) many more persons would perhaps begin to take health issues more seriously.

For instance a study concluded within Accra, on community awareness about stroke showed low awareness even though stroke is perceived as a serious and preventable disease (Donkor et al,(2014), Community awareness of stroke in Accra, Ghana).

By Edward O. Amporful

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