Page 40 - AN-3-2

Advanced Neurology Stroke care in sub-Sahara Africa

Table 3. Awareness, treatment, and control of hypertension in selected sub‑Saharan African countries and the United States
Country Study population Awareness (%) Treatment (%) At‑Goal control (%) References
Tanzania 1,698 <20 10 <1 Edwards et al. 84
Nigeria 78,949 29 12 2.8 Adeloye et al. 85
(Meta-analysis)
Ghana 1,334 34 18 4 Amoah 86
Zimbabwe 749 26 22 49 Matenja et al. 87
South Africa 13,802 32 28 20 Steyn et al. 88
United States 5,448 69 58 31 Hajj and Kotchen 89

jobs. This shift has resulted in lifestyle changes, such as guidelines recommend secondary stroke prevention
sedentary habits, poor diet, and increased use of tobacco strategies, which include the use of antihypertensive,
products, all contributing to the growing number of antithrombotics, antidiabetics, lipid-modifying, and
emerging modifiable risk factors in SSA. Cigarette smoking anticoagulation medications as foundational components.
99
is a known independent risk factor for stroke. In fact, one Data on the rate of utilization and sustainable use of
meta-analysis found that smokers have an increased risk these evidence-based stroke risk reduction therapies
of stroke compared to non-smokers, with a pooled odds among stroke survivors in SSA are scarce. A retrospective
ratio of 1.61 (95% CI: 1.34 – 1.93). Unfortunately, the observational study involving 418 stroke survivors
90
marketing of cigarettes and other tobacco products is enrolled in a neurology clinic in Ghana found a high
increasingly targeting developing countries, making them utilization and sustainment rate (12-month follow-up)
the primary target of transnational tobacco industries. for antihypertensive use (94.3% for initial prescription
According to World Bank 2020 data, the prevalence of and 97.5% for sustained use), lipid-lowering medications
91
current tobacco use among adults in SSA ranged from a (72.5% and 94.1%), antiplatelet medications (65.6% and
low of 3.5% in Ghana to a high of 27.8% in Madagascar. 94.8%), antidiabetic medications (14.6% and 85.7%), and
A health survey of 22 SSA countries, including male and anticoagulation medications (0.5% and 50%), which
100
female participants aged 15 – 49, conducted between is reassuring. However, this study was conducted in a
2011 and 2019, found that the prevalence of current specialty referral neurology clinic affiliated with a tertiary
tobacco use among male participants ranged from 6.1% medical center in a large metropolitan city, where 90% of
(95% CI: 5.2 – 6.9%) in Ghana to 38.3% (95% CI: 35.8 – the participants were registered with the Ghana National
40.8%) in Lesotho. Among children, the global Youth Health Insurance program, which covered the cost of the
92
Tobacco Survey showed that >10% of 13 – 15-year-olds drugs. While cautious interpretation and extrapolation to
use tobacco in many SSA, with this prevalence reaching as most of the SSA are warranted, it demonstrates the feasibility
high as 33% in South Africa. Formal tobacco prevention of implementing secondary stroke interventions even in a
93
programs are grossly inadequate and, in some cases, non- resource-limited environment. Indeed, poor compliance
existent in SSA. A systematic review of published studies with secondary stroke prevention medications is more
found only six articles on tobacco prevention programs, common than not in most SSA countries, with compliance
four conducted in South Africa and two in Nigeria. Four rates ranging from 17% to 45% for antihypertensive and
tobacco prevention programs were incorporated into the antithrombotic medications. 101,102 Reasons cited for poor
annual curriculum targeting 8 and 9 graders, while two medication compliance include lack of knowledge about
were temporary programs. 94 the need for continued use, cost of drugs, inconsistent
Diabetes is another well-recognized independent risk prescription patterns, availability of the drugs, and alcohol
factor for stroke, with a relative risk of stroke estimated to use.
95
be 1.5 – 3.0. It has been demonstrated that tight control
96
of blood glucose can substantially reduce the incidence of 5.3. Stroke rehabilitation
stroke. However, up to 61% of subjects in a cross-sectional Early mobilization and the initiation and maintenance of
97
study conducted in Mali were unaware of their diagnosis. 98 therapy after stroke are crucial for recovery and help reduce
post-stroke complications, morbidity, and mortality. In
5.2. Secondary stroke prevention 2017, the WHO launched the “Rehabilitation 2030”
103
The risk, severity, morbidity, and mortality of a second initiative, identifying 10 priority areas for action and
stroke following the first are high. Multiple international highlighting the profound unmet needs for rehabilitation

Volume 3 Issue 2 (2024) 10 doi: 10.36922/an.2804