A stroke is a neurological disorder that causes localized or widespread neurological impairments of vascular origin that persist longer than 24 hours. In some situations, a stroke might result in death. According to studies, it is a prevalent disorder that affects millions of individuals worldwide each year, and it may place emotional and economic pressures on patients, families, health care providers, and governments.
Types of Strokes
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Strokes are the second leading cause of mortality and the third leading cause of disability-adjusted life-years (DALYs) lost globally. Unlike in high-income countries (HICs), where stroke death rates have decreased, the burden of stroke in developing nations has increased in recent years and is likely to increase further.
Eighty-six percent of all stroke fatalities worldwide occur in low- and middle-income nations (LMICs). Furthermore, LMICs account for over 87% of stroke-related DALYs lost, about seven times the DALYs lost in developed countries. In 80% of instances, stroke occurs by an infarction (ischemic stroke). The other 20% happens as a hemorrhage.
Strokes manifest clinically as a localized neurological dysfunction of abrupt onset with headache, weakness of a region of the body, and loss of speech as frequent symptoms. Hemorrhagic stroke develops differently depending on the location and extent of the bleeding.
Headache, vomiting, global neurological deficiency, and reduced state of awareness are common symptoms, and a coma may develop quickly. A hemorrhagic stroke happens with uncontrolled hypertension.
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Cardiac illnesses, particularly rheumatic valvular heart disease, which can lead to atrial fibrillation and embolic strokes, are also the main risk factors for stroke. Several other risk factors are present in developing countries, contributing to the high prevalence of stroke in these regions.
The chance of surviving a stroke is low in underdeveloped nations
Stroke care begins in acute settings and proceeds to chronic management. However, both are lacking in developing countries, reducing the chances of survival. Acute stroke care comprises; ambulance service, emergency department care, neurointensive care, and stroke unit management. The stroke care ward and physiotherapy unit are where the subacute phase management takes place. The chronic phase occurs in the community and the outpatient clinic.
However, shortcomings in modern diagnostic and treatment equipment accessible in underdeveloped nations such as Nigeria have made this difficult. Rehabilitation is essential in the management of post-stroke impairments. Physical therapy, occupational therapy, speech and language therapy, and other therapies help a stroke patient recover. However, a lack of professionals in these various fields is a cause for concern.
Because psychological difficulties such as melancholy, anxiety, frustration, and rage are frequent poststroke disabilities, many stroke victims require psychological or psychiatric assistance. In underdeveloped nations, certain variables impede excellent prognosis and recovery prospects following a stroke.
The most prevalent aspects of acute stroke care are the period between the start of the stroke and the patient’s availability to brain imaging such as CT/MRI. Studies in impoverished nations, particularly Nigeria, demonstrate that stroke victims arrive late at the hospital. Within three hours of the beginning of a stroke, very few patients had access to brain imaging. Stroke care in underdeveloped nations is limited by a lack of access to imaging for accurate diagnosis. Access to well-equipped stroke units is another critical component of stroke care. Such facilities are scarce, limiting the availability of holistic therapies.
Rehabilitation services are an essential component of stroke treatment. In Africa, only a limited percentage of patients undergo inpatient physiotherapy rehabilitation.
Only South Africa has a high proportion of patients receiving inpatient treatment. There are low attendance rates in outpatient therapy due to a lack of funds, living distance from the hospital, migration to other locations, or a general disregard for rehabilitation services. While patients in Nigeria are well delighted with physiotherapy services, the exorbitant expense of these therapies causes a lack of consistency.
In impoverished nations, only a few hospitals provide specialist rehabilitation centers with a multidisciplinary team of health experts. Many obstacles hinder access to continuity of treatment in long-term stroke rehabilitation. The most prevalent is a lack of health care in rural regions, as well as a lack of government assistance.
Emergency measures such as thrombolysis for ischemic stroke reduce the odds of survival and recovery. The high cost or scarcity of brain imaging techniques impedes the use of antithrombotic therapy in developing countries. According to research, no patient in Nigeria obtained brain imaging within three hours after a stroke started. This lack is a significant impediment to meeting the recommended standard of thrombolysis for ischemic stroke within 4 hours of start. Although medical and physiotherapy services are widely available in developing countries, there are recognized impediments. These impediments as high costs, inadequate facilities, a lack of continuity of treatment, geographic inaccessibility, and a shortage of health staff, lead to a low chance of surviving or recovering from a stroke.
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Conclusion
Stroke has a terrible effect on its sufferers, both physically and mentally. Surviving and recovering from a stroke is less likely in Africa than in underdeveloped countries. With a high incidence in African nations, there is a need to address the problems impeding effective treatment. Nigeria, Morocco, and other developing nations account for more than 80% of worldwide stroke mortality. The significant disparity in treatment results between LMICs and their developed counterparts has resulted in more disability-adjusted life-years in Africa. African nations must invest in stroke treatment to reduce this disparity. Direct stroke health strategies must be developed and implemented. Professionals participating in stroke management must be well-trained and well-equipped. Measures to limit brain drain by providing adequate working conditions can help improve the quality of survival of stroke patients. Accessible and adequate infrastructure, technology, and drugs for optimal stroke care can help improve recovery. Furthermore, implementing insurance programs to lower the high cost of medical care and collaboration with foreign organizations can significantly enhance stroke care in African nations.
References
Stroke care in Africa: A systematic review of the literature – PubMed (nih.gov)
