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Stroke in Nigeria: the state of affairs

Stroke is a very common neurological disorder and is currently the most frequent reason for neurological admissions in hospitals in Africa. The current definition of stroke requires the use of neuroimaging for documenting lesions while the previous time limit of disability lasting more than 24 hours before making a diagnosis has been excluded. Thus, transient ischaemic attacks are not expected to have demonstrable neuropathological lesions in the brain.1

Stroke is the second leading cause of cardiovascular deaths worldwide after ischaemic heart disease; and 80% of all strokes occur in low and middle income countries who can least afford to deal with the consequences. Worldwide, 5.7 million people die each year and the annual deaths are projected to increase to 7.8 million by 2030.2

One peculiarity of stroke in Africa is the higher frequency of haemorrhagic stroke (34%) as compared with 10-15% in the other regions of the world.3 The reasons for this are not clear but, may have to do with the calibre of the cerebral blood vessels with less proneness to rupture. Another reason could be genetic and related to cholesterol transport. This should be an interesting subject of research.

The hitherto reported lower prevalence of stroke in Nigeria, and adduced to rapid mortality of acute stroke cases, no longer seems tenable because more recent studies have come up with rates that are comparable, if not higher, than figures from western countries. Caution must be exercised because direct comparison of results from studies using different methodologies is fraught with errors. The rising prevalence and incidence of stroke is in line with the rising burden of non-communicable diseases worldwide which have been ascribed to the adoption of western life styles and dietary changes. With rising prevalence of hypertension, obesity, diabetes and ageing of the population, it is inevitable that stroke prevalence will increase.

Our attention should focus on the prevention of cases through increased awareness of the risk factors and their effective management.

The INTERSTROKE study, which involved some centres in Nigeria, has provided a comprehensive list of risk factors for this purpose.3 In addition, public enlightenment on the presenting features will go a long way in ensuring early detection of cases and their being brought to medical attention. Useful medications for acute management like recombinant thromboplastin activator (tPA) are not readily available in Nigeria and patients must be brought for emergency care within four and a half hours of onset. This could be a challenge in remote settings where neuroimaging may not be available.

Cost of care is another concern. Despite these constraints, a lot can still be done for stroke cases within the available care facilities in Nigeria. The ultimate step is to advocate the establishment of more stroke units in our tertiary care centres to provide specialized care for those needing such as management in these units is associated with better outcome.

REFERENCES
1. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st Century. Stroke 2013; Vol 44. May 7 (online).
2. World Health Organization. Global Burden of Disease (GBD) 2002estimates. World Health Report 2004. Geneva, Switzerland: WHO.
3. O’Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016 Aug 20; 388(10046):761-775. doi: 10.1016/S0140-6736(16)30506-2.


Adesola OGUNNIYI
BSc, MBBCh, FMCP, FWACP, FRCPE
Professor of Medicine (Neurology), College of Medicine, University of Ibadan
Chief Consultant Neurologist, University College Hospital Ibadan, Nigeria
Phone: +234 803 809 4173
Email: aogunniyi@comui.edu.nig <mailto:aogunniyi@comui.edu.nig>; aogunniyi53@yahoo.com