May is adopted universally by health practitioners as a Stroke Awareness Month where medics hold activities geared towards reaching people with information about the condition outside hospitals.
Globally it is estimated that stroke is the second leading cause of death and the third leading reason for disability. No accurate data is available locally, but judging by experts’ views at the Kenya Cardiac Society, it could be rising.
By definition, a stroke is a sudden or insidious loss of neurological function occasioned by impaired oxygen supply to the brain. Two variants are acknowledged — ischemic and hemorrhagic.
Depending on the type, the presentation can be slow as is common in the former type, or sudden as seen in the latter. Both, however, end up with devastating sequelae.
The effects can be loss of neurological function, physical disability, psychological as well as emotional. Given the irreversibility, it also has economical angles with employment loss, lifestyle adjustment, insurance or family. The World Health Organisation (WHO) intimates a doubled stroke incidence in low and middle-income countries in the last 50 years as well as a 15 year earlier onset.
The WHO estimates “70percent of strokes and 87percent of stroke-related deaths and disability occur in low- and middle-income countries”.
In a 2015, Ministry of Health report dubbed ‘Kenya STEPwise Survey for Non Communicable Diseases Risk factors’, hypertension was noted as a leading contributor of stroke and noncommunicable disease (NCD) mortalities.
As a risk, 56 percent of respondents did not know their BP readings despite it being a quick, easily accessible test. This indicates more knowledge and screening is needed.
Other factors predisposing one to stroke include diabetes, obesity, unhealthy diets as well as tobacco or harmful alcohol use. It reports a 13 percent tobacco-use prevalence, 19.35 percent harmful alcohol use, unhealthy diets and physical inactivity signified by a 27 percent obesity rate.
Prevention remains the best approach.
Compared to the West, the percentage of patients who receive intervention upon a stroke are few, most are late and we also have poorer outcomes.
Despite improved treatment advances over time locally on both medical and interventional fronts, gaps are noted in this parameter. The disparity is due to gaps in diagnostic capacity, trained-stroke-management staff, timely referrals and availability of intensive care.
Given our low insurance penetration rates, cost of management itself is high, meaning out-of-pocket payers are often locked out of care.
In a survey by the Health Information Network, the drugs were unavailable in nine out of 10 Level Four public hospitals, and when available the cost was upwards of Sh80,000 for some. Inclusive of admission costs, management of a stroke is over Sh500,000.
Given these sums, emphasis should be on prevention of occurrence. Medical insurers should be on the forefront of this.
If you are reading this, take some time to learn about stroke and have your pressures measured.