Africa is currently experiencing a changing pattern of diseases and deaths. The continent has a double burden of infectious diseases and rapid increase of non-communicable diseases such as stroke and heart disease. These conditions are driven by factors such as aging populations, changes in eating habits, and rising rates of high blood pressure, physical inactivity, smoking, diabetes, elevated cholesterol, alcohol abuse, and obesity.
Stroke is a leading cause of disability, death and dementia worldwide. As a region, Africa has a part of the highest rates of stroke. About 23% of people in Africa have a stroke at some point in their lives. Fortunately, the vast majority of stroke risk factors are changeable – and thus most strokes can be avoided.
A stroke is a serious medical condition that affects the blood supply to the brain. It is caused by the blockage of an artery in the brain (ischemic stroke) or by the rupture of an artery in the brain (hemorrhage). If left untreated, it deprives the brain of vital oxygen and nutrients, leading to brain damage.
A stroke often leads to the sudden onset of weakness that includes the face, arm or leg, an inability to speak, walking problems or impaired vision. Strokes can cause death and irreversible disability. It can have huge economic losses and have serious consequences for the individual, family and society in terms of spiritual capital, productivity and socio-economic progress.
We recently had the African Stroke Organization, a pan-African coalition that brings together stroke researchers, clinicians and other health professionals.
Its role is to address the rising rate of stroke on the continent as well as the country high mortality rates and disability which can follow. An African organization is needed because there are combinations of risk factors that are unique to this continent, especially because of their combined impact on stroke. A very good example of this is hypertension which works along with diabetes and high levels of cholesterol in the blood. Research, education and policy responses should focus separately and in combination on these factors.
An Africa Network for an Africa Problem
Most African states have a fraction of the available resources for most developed countries, and are therefore unable to pursue established treatment guidelines of the latter. The situation in Africa requires innovative thinking to make optimal use of its available resources.
Migration from rural to urban areas has led to a epidemiological transition. There is also a significant increase in a diet rich in processed foods high in salt, saturated fats and sugar. These lifestyle changes have led to an increase in risk factors such as people who are overweight or obese. The WHO estimates that the number of children under five who are overweight on the continent has increased by 24% since 2000.
Elevated smoking and higher levels of physical inactivity contributed to the problem. Around 80% smokers around the world live in low- and middle-income countries. Walking and cycling are the most important means of transportation. But this is change quickly in these countries, where people are switching to motorized transport. And new research confirmed the effect of air pollution as a driver of cardiovascular disease.
This is particularly relevant for the incidence of stroke in African countries where air pollution is increasing due to indoor use of fossil fuels for cooking in rural areas and urban slums and particulate air pollution in growing urban areas.
Infections, especially HIV, malaria and tuberculosis – everything that occurs on the continent – can also lead to increased stroke.
Some infectious agents such as the HIV virus can damage the inner lining of small veins in the brain and affect blood clotting processes. They represent such blood vessels to form blood clots. The drugs used to treat HIV can also increase the risk of stroke.
Tackling the increasing burden of stroke on the continent is preferred, multiple and intersectoral strategies. It must be adapted to the epidemiological, cultural, socio-economic and lifestyle landscape in African countries.
What can be done
Fortunately, three factors can help prevent a stroke pandemic in African countries.
The first is that more than 90% of all strokes have risk factors. This means that the vast majority of strokes are preventable with adequate healthcare policies and interventions such as the detection, treatment and control of high blood pressure or high blood sugar. Also, if you do the recommended amount of exercise each week, you reduce the risk of having a stroke. Just 30 minutes of exercise five times a week can reduce your stroke risk by 25%. Exercise plays an important role in reducing several risk factors for stroke, including high blood pressure, high blood sugar, high cholesterol levels, depression and stress.
Secondly, there are improvements in stroke care that can reverse the effects of a stroke within hours of its onset. If this does not succeed, stroke and rehabilitation units are powerful tools to reduce mortality rates and disabilities.
Third, and recently, there has been a shift in the approach to stroke. It has been led by healthcare professionals who have a good attitude towards stroke, and who are able to make significant changes in their individual hospitals and on a national scale.
There is an urgent need for a framework that will bring together clinics, researchers, other health professionals and trainees, national and regional associations, and professional support organizations.
With the aim of reducing the rapidly increasing burden of stroke in Africa, the African Stroke Organization focuses on research, capacity building, development of stroke services and collaboration with all interested parties.
Dr Patty Francis, President of the Neurological Association of South Africa (NASA), contributed to this article.
Rufus Akinyemi, Deputy Director, Center for Genomic and Precision Medicine, University of Ibadan; Alan Bryer, Professor, University of Cape Town; Foad Abd-Allah, Professor of Neurology and Stroke Medicine, Cairo University; Kathleen Bateman, Consultant Neurologist, University of Cape Town; Lawrence Tucker, Head: Division of Neurology, University of Cape Town; Mayowa Owolabi, Professor of Neurology and Dean, Faculty of Clinical Sciences, University of Ibadan; Naeem Breyneurologist and lecturer, Stellenbosch University, en Pamela Naidoo, Honorary Professor, University of Cape Town