The Federal Government has initiated moves to prevent Nigerians from developing stroke and other preventable conditions by enrolling them for screenings at a fee. But, can the project fly? OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU report.
THe minister chose his words carefully. May be because they carry a lot of weight. Minister of Health Prof. Onyebuchi Chukwu says the country is expected to lose an estimated $8 billion to non-communicable diseases. Chukwu said the economic loss to the country would emanate from expenditures by Nigerians on stroke, heart disease and diabetes-related illnesses estimated by the World Health Organisation (WHO) to be within the range of $400 million.
He spoke in Abuja at the World Stroke Day celebration organised by the Nigeria Stroke Assembly. He gave the mortality rate of stroke as between 40 and 50 per cent within the first three months of diagnosis.
He had more shocking facts: “A facility-based study showed that 39 per cent of those who survived stroke after three months died within 12 months and the remaining 12 per cent developed severe disability.”
To curb this scary state of things, the Federal Government has proposed the National Stroke Prevention Programme. He explained that the programme is aimed at encouraging Nigerians to routinely carry out medical check-ups as well as change their lifestyles.
The need for urgent attention to stroke may become more meaningful when experts’ positions are considered. As much as 200,000 Nigerians are killed or disabled by stroke each year, experts estimate.
“We think almost 200,000 Nigerians are suffering a stroke each year,” said Dr Biodun Ogungbo, neurosurgeon with the group, Stroke Assembly. Half of those people are dying each year. The rest of them are becoming disabled.
“The key thing is that stroke is killing Nigerians. Every single Nigerian knows somebody, either within their own family or in the street or chose to them in their neighbourhood who has suffered from a stroke.”
A recent review by three doctors of stroke cases in a military hospital concluded that stroke still contributed significantly to increasing death and injury among patients admitted in hospitals.
The researchers identify the risk factors–including hypertension, diabetics, other cardiovascular events–that can be modified should be “aggressively addressed to reduce the burden of stroke in our society.”
What is stroke?
A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen. This can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralysed.
According to Consultant physician/ Endocrinologist, Dr Olufemi Fasanmade, stroke is the part of the leading cause of death in Nigeria and a leading cause of adult disability, yet up to 80 per cent of strokes are preventable.
He said because stroke is a brain attack, it is a medical emergency, and every second counts and the first place to go is the hospital.
Fasanmade said: “Time is of essence. There are simple tricks to the prevention of stroke. And the initiative by the government to set the ball rolling in the anti-stroke battle is commendable.”
The President approved a Nigerian National Stroke Prevention Programme. The programme is to be managed by the Ministry of Health in collaboration with Federal Teaching Hospitals and other hospitals in Nigeria; as well as Nigerians in Diaspora to execute the programme through MOU. The sum of N10,000, is required to qualify for some of the basic medical screenings can be conducted any clinic of the hospitals. The cost of the test, which is about N50, 000, has been reduced by the government through a subsidised arrangement to now cost N10, 000; particularly for indigent Nigerians.
According to Fasanmade: “The policy of N10, 000 per individual to undergo screenings depends on the kinds of routine testing government has in mind. There are procedures for such things. We expect people to participate. The routine screening and other diagnostic belt is elastic, ranging from one naira to a million naira. With N10, 000, some basic medical screenings can be conducted any clinic. Some screenings can be conducted by even a nurse while some need experts like pathologist and other laboratory workers. Affordability depends on the person’s pocket. It could be as expensive as Magnetic Resonance Imaging (MRI) or as cheap as measuring for a Blood Pressure (Bp),” he said.
The reasons why am advancing that people should enroll in the policy include the preponderance of the situation in our clime.
Dr Fasanmade said: “In Nigeria, stroke is responsible for 33 per cent of medical causes of coma; 3.2 per cent of hospital admissions; 7.3 per cent of causes of death in medical (non surgical, non gynaecological adult) wards; it is the commonest cause of disability; second commonest cause of dementia; third commonest cause of death and one of the three top causes of prolonged hospital stay.
“But all these can be halted if the several factors responsible for stroke are prevented or adequately managed so the blockage of a brain blood vessel or bleeding of a brain blood vessel.”
And the factors that cause stroke? They include hypertension; diabetes mellitus; irregular heart-beats; Sickle cell disease; advancing age; smoking and alcohol.
A neurologist at LUTH, Dr Frank Ojini, corroborated what Dr Fasanmade said that more patients were coming to the hospital for diabetes and hypertension, among other NCDs. He called for a change in diets and lifestyle changes.
He said: “Most NCDs are due to westernization lifestyle. Our people are now becoming more western in their lifestyle because they eat more fast food than proper solid natural food. Most fast food tends to contain much salt and sugar. This is because they are over processed and canned.”
On way out, Ojini advised that people should exercise regularly by at least engaging in 30 minutes daily brisk walk, change their diet and try to live a stress-free life.
At the Lagos University Teaching Hospital (LUTH), more patients are attended to for diabetes and hypertension than the other communicable diseases, which were responsible for major hospitals’ attendants and admissions.
“Records showed that patients visit diabetic and hypertension clinics more than before. It may be because people are more aware of the dangers of diabetes and hypertension and want to access treatment,” she added.
Types and prevention tips
Fasanmade said there are two
main types of stroke- ischemic
stroke and hemorrhagic stroke.
He said: “Ischemic stroke accounts for about three-quartres of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.
“A hemorrhagic stroke occurs when a blood vessel on the brain’s surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).
“Both types of stroke result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain. The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking, and incontinence and bladder problems.”
He gave further preventive tips: “Good diet; engage in physical activity; be careful of drugs eg aspirin, statins, that thin blood; monitor your blood pressure (Bp). It is essential to diagnose stroke early and get patient to hospital as soon as possible as some can be reversed or disability limited by active management. Also call for help e.g call 767 or ambulance. And Quit unhealthy habits; take BP medications regularly if on treatment; take diabetes mellitus (DM) drugs regularly if on them. Stroke is a brain attack and management has to be coordinated by multidisciplinary professionals. It is best prevented and those who already have should be extra careful.”
Ojini said the rising incidence may be due to adoption of westernisation which has impaired lifestyle, especially the consumption of fast food.
“People are now taking more calories than they need. They take soft drinks, fizzy and carbonated sweetened drinks in place of water, which is quite harmful,” she said.
Explaining the dangers inherent in such drinks, she said: “A bottle of soft drink has between 140 and 200 calories while water has zero per cent. Now if a person takes three bottles of soft drink, such would have taken 600 calories. This means the same person would have increased his calories intake by more than 30 per cent. However, the quality of his exercise is still the same. This is why people are pre-disposed to obesity and diabetes.”
Medics advise people to eat natural food, befriend fruits and water.
They warn against juices, which are not devoid of sugar.
“It doesn’t matter what names they are called, they all contain extra calories. The juices with the inscription: ‘No added sugar’, still contains sugar. The producers may just be talking about specific types- fructose, lactose, sucrose, and glucose and other forms of simple or complex sugar. But they all contain sugar. They all also contain calories,” they added.
Fasanmade said power drinks are dangerous because they contain stimulants like caffeine, sugar and other extra calories.
“So, it means the person who drinks them is at risk of developing various health problems, apart from being overweight or obese. Most stimulants can induce stress. This means they can cause negative effects on the heart and other respiratory organs,” he said.