Dr. Biodun Ogungbo
Stroke
is a significant economic, medical and social problem all over the
world. Politicians are a significant economic and social force in
Nigeria. It should be possible to utilise these similarities in
stimulating the development of management strategies for stroke,
customised to the unique health structure in Nigeria.
The current situation
Currently, there are limited resources,
manpower shortage, lack of an organised stroke unit, poor neuro-imaging
facilities, lack of ambulance services, poor education of patients and
general practitioners, as well as impracticable use of life-saving
thrombolytics.
The way forward
We need to harness the power of the
political cadre and encourage their interest in stroke care. One thought
was that providing data on the increasing incidence, high number of
families affected, high morbidity and significant mortality of stroke in
Nigeria would pique their interest. However, despite numerous
publications in medical and lay media, we are no further forward.
Stroke and politicians
Perhaps a more interesting statistic may
be to analyse the incidence of stroke among politicians? The key
questions would be to find out how many politicians have suffered a
stroke directly related to the high stress levels and the impact of
politics on their lives. Where was the stroke care carried out? What is
the outcome of care? What was the cost and continuing recurrent
expenditure following the stroke? Are the survivors empowered to improve
stroke care delivery in their communities? (Please send your answers
privately to my email box).
Even if politicians are not suffering
from stroke, they would know — or be aware of someone close — who has
had a stroke. Stroke has touched the life of every single Nigerian.
The stroke burden
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 million 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, Ogun State, 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.
Who can afford a stroke?
No one, no matter how rich, can afford
to have a stroke. In Nigeria, the impact on the local economy and the
financial burden of stroke has not been estimated. The size of the
problem appears to be underestimated by the government, as no actual
publications or statements exist acknowledging the impact of stroke on
the health of the nation.
A more up-to-date and current
information on the magnitude of the stroke problem in Nigeria is needed.
The majority of the stroke costs are borne by individual families.
There is the need to evaluate the percentage of patients dependent on
carers and the yearly expenditure on hospital stay, home rehabilitation,
as well as information on the loss of income for the patient and
carers.
This is one problem that medical tourism
to India, South Africa or the United Kingdom cannot solve. Once you
have had a stroke, you are at risk of further strokes and early death.
Where do we go from here?
Stroke is a preventable and treatable
condition, but the management of stroke patients in Nigeria is
sub-optimal. Specialised stroke units are not available. Neuro-imaging
centres are very few and access limited by cost and distance. We need to
do something about these.
However, the main focus in Nigeria must
be on preventive strategies and ways to harness local resources in the
acute treatment of stroke patients. Health education of the community,
with emphasis on control of the predisposing factors, especially
hypertension, would reduce the burden of stroke in the country.
Risk factor management should begin in
childhood, with emphasis on exercise, nutrition, weight and blood sugar
control, avoidance of tobacco and excessive alcohol.
Politicians should support Stroke Action
Doctors, nurses, drug companies, the
public and officials from the Federal Ministry of Health, with other
specialists, will deliberate on and create advocacy on stroke. We need
the help of the political cadre in Nigeria. Start and support stroke
advocacy and activities in your local areas.
Stroke Action, Nigeria held the first
Nigeria Stroke Assembly last year and generated massive public awareness
about stroke. People now know that stroke is not an untreatable
condition. The next edition comes up tomorrow (see below for details).
The politicians (You!) 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 Life After Stroke Centre
• Supporting the sustainability of the service, and subsequent efforts to reduce the incidence of stroke.
We need your help physically, morally
and financially to reduce the incidence of stroke in Nigeria, by
creating much awareness about this dreadful disease. Call or email me
for more information on how you can help locally.
You can also pop into Transcorp Hilton
Hotel on October 29, 2013 (World Stroke Day). We have the Nigeria Stroke
Assembly starting at 10am till 4pm. You will learn all you can and have
your questions answered.
For donations, please make payments to:
Account Name: Stroke Action LTD/GTE
Diamond Bank: Acct No. 0029726120 (giving your office/name as a reference).
In answer to our prayers, President Goodluck Jonathan flagged off the campaign about stroke and heart attacks a few weeks ago.
Stroke Action, Nigeria has therefore
taken on the mantle of spearheading the awareness campaign, in
collaboration with the office of the Honourable Minister of Health,
Prof. Onyebuchi Chukwu.
NB: A BIG THANK YOU to our
esteemed and highly generous PUNCH readers who raised the N2m for the
lady with head tumour, published last Monday.
We are highly honoured and indebted to you all.
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