A shortage of neurologists has slowed down the early detection of stroke in Kenya, putting the country’s non-communicable disease care systems, especially cardiovascular care, on the spot.
The latest World Health Expectancy ranking, a global health and life expectancy database, says stroke remains the leading cause of mortality in Kenya, with a death rate of 92 per 100,000 people.
Stroke deaths accounted for six percent of total deaths in Kenya in 2020, with 15,895 fatalities that ranked the country at position 81 out of 183 nations.
The World Health Organization estimates that, by 2030, deaths from NCDs are likely to increase by 17 percent globally and by 27 percent in Africa. In Kenya, NCDs were responsible for 39 percent of deaths in 2020, up from 27 percent in 2014.
“A growing number of premature deaths are due to NCDs, with half of all hospital admissions and deaths being NCD-related at present. Roughly a quarter of all deaths are caused by NCDs, with cancer and cardiovascular disease including heart attacks and strokes being the biggest killers,” said WHO.
Health experts have expressed concern over the shortage of professionals in stroke management, despite requiring highly specialised care.
Tasneem Yamani, a geriatric medical practitioner at Hamat Healthcare, attributes the high number of stroke deaths to the lack of neurologists and inadequate emergency medical services.
“Early detection of stroke is crucial to improving the patient's outcome, and time is always of the essence in treatment. Unfortunately, there are only around 18 neurologists in the country, and a neurovascular neurologist is the correct sub-speciality needed for stroke treatment. As a country, we have a significant need in this field and a significant gap that must be addressed by providing training opportunities,” said Dr Tasneem.
She explains that the "golden hour" is crucial to stroke cases, as it presents the best opportunity to restore blood flow to the affected areas and save at-risk tissues from dying. Unfortunately, ambulance response times have been a major obstacle to timely intervention.
“A significant number of stroke cases can be prevented, and patients who receive treatment during the first few hours after the onset of symptoms at a stroke unit, have a better chance of survival and functional recovery. Until a year ago, the average response time for an ambulance was approximately 160 minutes,” she says.
While the number of young people experiencing strokes is increasing, the condition remains more common among the elderly. This is largely due to the higher prevalence of risk factors such as hypertension and diabetes. Other contributing factors include diet, lack of physical activity, tobacco use, and excessive alcohol consumption.
The rising stroke burden is also caused by fewer dedicated stroke units, lack of awareness about risk factors, and poor knowledge of symptoms, highlighting the need for increased investment in care and research, both in hospitals and communities.
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts.
The symptoms usually begin suddenly but sometimes develop over hours or days, depending on the type of stroke. In both ischemic and hemorrhagic strokes, one or more areas of the brain can be damaged.
Depending on the area affected, a person may lose the ability to move one side of the body, the ability to speak, or several other functions.
The damage may be temporary or permanent. A person's long-term outcome depends on how much of the brain is damaged, how quickly treatment begins, and several other factors.
Despite the high burden of stroke in the country, its prevalence is poorly documented, resulting in neglect and delayed management. The high cost of treatment and care are the biggest contributors to the death rates.
A larger percentage of stroke services in Kenya are financed out-of-pocket, which has a significant financial and psychological impact on the patient, family, and healthcare system, leading to increased healthcare costs.
“The cost of stroke treatment and care can go up to Sh1 million in private hospitals and the aftercare ranges between Sh100,000 to Sh150,000 per month.”
The burden of stroke-related mortality and disability is rapidly increasing worldwide, especially in resource-limited countries like Kenya.
Implementing evidence-based interventions could help in reversing the epidemiological trajectories related to strokes, according to Dr Tasneem.
Moreover, rehabilitation can effectively reduce disability in stroke survivors, enhancing quality of life for patients and caregivers.
The World Stroke Organisation states that stroke-related deaths and disabilities can be prevented. It identifies risk factors such as high blood pressure, atrial fibrillation, smoking, physical inactivity, diabetes, high cholesterol, tobacco, and alcohol use.