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Advanced Neurology Stroke care in sub-Sahara Africa

11 out of 17 countries in Africa, with a mere 5% 5.1. Primary stroke prevention and risk factor
of stroke cases receiving thrombolytics overall. management
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Despite the low rates of thrombolytic usage, Primary prevention of any disease is reliant on at-risk
case series and observations have demonstrated individuals possessing awareness and knowledge of the
the efficacy and safety of thrombolytic use on disease’s risk factors, and stroke is no exception. This
the continent, providing further support for its knowledge may empower individuals to seek timely
adoption. Notably, in one observational cohort, intervention and treatment. A meta-analysis of stroke
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approximately 40% of patients achieved functional care studies conducted in Africa between 2013 and 2017
independence at discharge. These promising revealed poor awareness of stroke signs and symptoms,
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results provide additional evidence bolstering the with only 18% of subjects in Uganda and 66% in Nigeria
established efficacy of thrombolytics in developed able to identify paralysis or weakness as major stroke
countries. However, several barriers limit the indicators. Similarly, a cross-sectional study targeting
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availability of thrombolytics, including delayed a rural community in Southeastern Nigeria, where 91%
patient presentation, with the time from stroke of participants had attained only elementary school
onset to hospital arrival reported at nearly 2 days in education, found that 99% were unable to name two or
most hospitals. Other barriers include the lack of more stroke signs or symptoms. Furthermore, awareness
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head imaging to exclude hemorrhage during after- and basic knowledge of stroke are equally deficient.
hours, human resource constraints, and the cost of A population-based survey conducted in Uganda between
thrombolytic agents. With regard to anticoagulants, 2012 and 2013 indicated that nearly 75% of respondents
warfarin is widely available and affordable, but were unaware of any warning signs of stroke and failed to
novel oral anticoagulants are available, although at recognize the brain as the affected organ. 79
a high cost. Other stroke-supportive medications,
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such as antiplatelet therapy and antihypertensive Hypertension emerges as the most consistent and
medications, are accessible to 60 – 80%. 69 powerful predictor of stroke, causally implicated in nearly
(ii) Surgical stroke treatments: Surgical treatments 70% of all stroke cases. 80,81 Treatment of hypertension has
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such as mechanical thrombectomy, decompressive been shown to reduce stroke risk by 35 – 40%. Population-
hemicraniectomy, and hematoma evacuation are based reduction in systolic blood pressure by as little as
only available at select HHCCs, with access to 1 – 3 mmHg can decrease the relative risk of stroke by
surgical treatment approaches for less than 25% of as much as 20 – 30%. Several studies, as summarized
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patients at best. A large survey involving multiple in Table 3, found a very low prevalence of hypertension
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African countries found that the capacity to perform control (defined as BP <140/90 mmHg) in SSA. However,
thrombectomy existed in only six out of 17 countries control of hypertension is limited by the lack of awareness
surveyed. 69 of the diagnosis. For example, in Tanzania, less than 20% of
patients with hypertension were aware of their condition.
5. Primary, secondary, and tertiary stroke Approximately 10% were receiving treatment, and of
prevention care in SSA those receiving treatment, less than 1% had achieved goal
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Globally, stroke imposes a substantial social and economic blood pressure control. A meta-analysis that included
burden, particularly accentuated in low- to middle- 53 studies (78,949 subjects) published between 1990 and
income countries such as SSA. Stroke tends to affect 2020 in Nigeria highlighted the poor state of hypertension
management in SSA. Only 29% of the subjects were aware
younger individuals in developing countries compared of their diagnosis, 12% were on treatment, and a dismal
to their counterparts in developed countries, with 2.8% achieved goal blood pressure control in 2020.
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the first index stroke occurring possibly 10 – 15 years
earlier in Africa. 74,75 Consequently, the years of potential Similar trends of low awareness, low treatment, and low
life lost due to stroke are considerable, significantly control rates of hypertension have been documented in
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impacting the socioeconomic landscape of SSA. A survey multiple studies conducted across SSA, such as Ghana,
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study conducted in Gambia, which enrolled 106 stroke Zimbabwe, and South Africa, compared to the United
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inpatients, revealed that 61% succumbed to death States. The low level of awareness, treatment, and control
following their first-ever stroke, and of the 25% who of hypertension underscores the importance of aggressive
survived after 4 years, merely 33% achieved complete intervention at the national, state, and community levels to
recovery. This observation underscores the importance reduce the stroke burden in SSA.
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and urgency of both stroke prevention and post-stroke Global industrialization has led to the urban migration
care in curbing this substantial burden. of young Africans in search of new and higher-paying
Volume 3 Issue 2 (2024) 9 doi: 10.36922/an.2804