Worldwide, stroke is a leading cause of death and of chronic disability, with an estimated 15 million people reported to suffer a stroke annually.
According to the World Health Organization (WHO) data published in 2017, stroke claimed the lives of 12,147 Ugandans.
Worldwide, stroke is a leading cause of death and of chronic disability. It is estimated that 15 million people suffer a stroke annually. Of these, five million die and another five million are left permanently disabled, placing a burden on families and communities.
General data on stroke in Uganda is, however, limited.
A cross-sectional population survey on stroke knowledge and attitudes in Greater Kampala conducted in 2017 in Mukono district indicates that stroke knowledge is generally poor. Stress and hypertension were noted to be the leading perceived risk causes of stroke in Uganda.
Neuro-physician Dr. Mark Kaddumukasa of Mulago Referral Hospital says prevalence of stroke risk factors may vary with gender and age due to individual risk factors. The life expectancy for women is longer and their stroke onset usually begins later than it does for men.
He says stroke is a serious medical condition that requires medical attention. Unfortunately, many people ignore the telltale stroke signs until the situation reaches a potentially devastating medical stage which leads to disability or death.
Two years ago, Andrew Kaweere suffered a sudden diabetic stroke while taking his early morning breakfast in Kampala.
Kaweere, who is 45 now, had for long ignored the warning stroke signs that usually affect diabetic people, including blurred vision and weakness in the legs and arms, which normally happens in brief intervals.
After some time, these symptoms graduated to a full-brown stroke that almost put him out of action with frail mobility.
Kaweere, a real estate dealer, recalls the fateful day. He woke up as usual and set out for work. While having breakfast at a busy city restaurant, his sight suddenly became blurry and he collapsed. He had been hit by an ischemic stroke, which Kaddumukasa says occurs when an artery in the brain becomes blocked and restricts the flow of blood, causing the brain cells (neurons) to stop working, hence a stroke.
“I was rushed to Nsambya Hospital in critical condition where I spent some time confined in coma,” recalls Kaweere.
The preliminary medical checks were done, confirming he had suffered a stroke prone to diabetic people. The medical report further revealed that his blood sugar levels and high blood pressure – key factors for the occurrence of a stroke – had hit dangerous levels. He was put on medication that normalized his blood sugar levels and controlled his blood pressure.
After he had stabilized and was discharged, Kaweere had to endure the long ordeal of treatment and the uncompromising realities of battling with stroke. He soldiered on.
After his recovery, he still felt part of his body side feeling numb as he still battled with persistent neuropathic pain, which is associated with impaired quality of life.
“My motor function was impaired as it wasn’t easy for me to walk and function normally,” he says. However, the most humiliating battle was in his mind. He wondered how he would survive with a stroke and the prospect of failing to provide for his family weighed heavily down on him.
“I was scared that I would be home-bound for the rest of my life and I also worried for not providing for my family,” recalls the father of five school-going children.
His desire and will to get better paid off. He was told about Stroke Rehabilitation Centre in Wampewo, Kasangati, where he was taken through physiotherapy treatment.
Today, after receiving rehabilitation exercise, Kaweere says that the nerve pain has greatly reduced and his motor is slowly improving.
“After receiving physiotherapy treatment, I was able to get back to work and started carrying on with my family duties, of course with the help of my wife.”
Ibrahim Bukenya, the principal physiotherapist at Stoke Rehabilitation Centre who handled Kaweere’s physiotherapy treatment, confirms that he had suffered an ischemic stroke.
Bukenya says there two types of stroke: the ischemic occurs when an artery supplying oxygen-rich blood to the brain becomes blocked and forms clots which creates blockages that leads to brain stroke. The hemorrhagic stroke, in the other hand, is caused by rupture blood vessels resulting from a weakened vessel that ruptures and bleeds into the surrounding brain, causing high blood pressure that leads to stroke.
Kaweere’s experience is not so different from the late Bruno Joseph Kibiira, a former senior civil servant at the education ministry. Eight years ago, he suffered a similar fate. He arrived at this workplace in Kampala, where he was scheduled for a meeting with his boss.
Kibiira opted to do the stairs. On his way up, he became numb and collapsed. A rescue team took him to Mulago Referral Hospital, before he was flown to India where he received treatment for stroke and heart-related problems.
The stroke marked his premature exit from civil service and for the rest of his life he was home-bound and often hospitalized until his death on February 12 this year due to stroke and other related complications.
Dr. Kaddumukasa says increased stroke knowledge and education is crucial. Ignoring short-lived stroke symptoms in the early stage and unhealthy lifestyles, according to him, is the main cause of the stroke burden in Uganda.
“If there was a structured self-management programme to support the high-risk group and help them to adhere to a healthy lifestyle, which includes proper diet and regular exercise, the risk of falling victim to stroke would be minimal.”
The tell-tale signs
Bukenya says some of the symptoms of stroke are often ignored because at times they go away, but if they are not attended to, may lead to death.
He notes loss of balance or coordination and trouble in walking as some of the signs.
“People experiencing difficult in speaking and comprehending things, with speech incoherent with stammers may be at risk,” says Bukenya.
“Disturbed vision such as experiencing blurred vision or double vision, whereby one object appears as two, paralysis or numbness of some of parts of the body, severe headache that may be accompanied by vomiting, dizziness or altered consciousness, are among other revealing signs.”
Bukenya says the longer the stroke goes untreated, the greater the potential for brain damage and disability.
He thus advises regular checkup for blood pressure, blood glucose, cholesterol levels, heart diseases, health diet lifestyle and regular exercise at least 20 minutes every day as one of the ways of managing stroke occurrences.
Kaddumukasa says the triggers for most of the stroke are medically known and can easily be managed at their onset. Unfortunately, most of them are ignored until when the situation is almost irreversible. He says people with high blood pressure are more prone to have suffer a stroke during their life time.
He further explains that there is an undeniable link between heart disease and stroke. “People with heart diseases and experiencing cardiac arrest are at high risk of suffering stroke.”
The heart disease risk factor can be controlled or treated with healthy dietary lifestyle and engaging in regular exercise.
Other factors that may cause stroke include blood clotting disease and dietary causes like too much sodium intake which leads to high blood pressure increasing the risk of stroke.
Kaddumukasa subscribes to the notion that “prevention is better than cure,” and therefore gives preventive measures on how to control stroke occurrence.
People with blood pressure problems should maintain a healthy lifestyle and strict physical exercise routine.
He advises those who had suffered stroke before to avoid getting another bout because the chances of survival are minimal, after all, “once beaten, twice shy.”
Bukenya recommends regular exercise, a healthy diet which includes eating more fruits and vegetables, avoiding alcohol and cigarette smoking for those who want to dramatically reduce their risk of having stroke, avoiding compromising stressful situation and regular blood pressure, glucose and cholesterol checks up, among others.
Life after physiotherapy treatment
Bukenya says there are benefits for patients to receive physiotherapy treatment which includes helping the stroke patients to rebuild their lives and manage to walk again by themselves.
If administered well, physiotherapy can help a patient resume working duties and provide for their family. It also helps to prevent disabilities and reduce pain, numbness and lack of sensations.
Kaddumukasa says the government has not been silent on the increasing stroke burden in Uganda, as it has put in place medical facilities in most of the government hospitals to counter the growing medical threat.