Non-communicable diseases have not always received ample global attention and investment, for example, stroke, which remains undetected, undiagnosed, neglected, and uncared for, experts say.

Dr Nima Wangchuk, Program Coordinator for The Defeat-NCD Partnership United Nations Institute for Training and Research (UNITAR), RBC, says stroke or cerebrovascular disease constitutes the second leading cause of mortality worldwide.

Low and middle-income countries bear most of the stroke burden worldwide. Dr Wangchuk says the sad part of it is that the prevention, control, and management of stroke have been further perpetuated by the current Covid-19 pandemic.

 "Today, the number of people suffering from stroke is staggeringly high,” he says.

Meanwhile, World Stroke Association predicts that 14.5 million people will have a stroke and 5.5 million people will die as a result of a stroke in 2021.

Rwanda reported 2,915 deaths from stroke in 2019, accounting for five per cent of total deaths in the country, and it remains the third leading cause of death in Rwanda.

Understanding stroke and its impact

Dr Alain Sayinzoga, a neuro-disability specialist, says it’s ideal to understand that stroke is an acute medical condition characterised by sudden weakness or numbness of the face, arm, or leg, most often on one side of the body.

This, he says, results from an inadequate supply of oxygen and nutrients to the brain due to disruption of blood supply to the brain.

He says stroke has phases, including acute and subacute. At the acute phase, it is always considered an emergency case where medics try to remove the blood by surgery, or thrombolysis—a treatment to dissolve dangerous clots in blood vessels and improve blood flow.

Dr Wangchuk says it is the brain equivalent of a heart attack. There are mainly two types of stroke, namely ischemic and haemorrhagic.

"The impact of stroke on the lives of the patient and society is devastating. Many stroke survivors become physically disabled, psychologically challenged, and emotionally depressed,” Dr Wangchuk points out.

He says such patients are not able to talk or communicate properly; almost all of them lose their job and source of income, and in some cases, lose their circle of friends and social networks.

"They become dependent on their family and social handouts. Since the long-term care and rehabilitation of stroke patients are expensive, the family is often driven into extreme poverty thus affecting the wellbeing of the family and society at large.

"One can understand it better only if one has a stroke patient in the family,” Dr Wangchuk adds.

Challenges

Experts note that one of the primary challenges to better stroke management and care is the lack of awareness about stroke and its risk factors among people.

Dr Wangchuk says the other gaps include poor prehospital care, delay in seeking medical attention, inadequate stroke treatment centres, lack of thrombolysis facilities, and underdeveloped rehabilitation centres for stroke patients. 

In some countries, he says, there are even no doctors/clinicians trained to manage stroke patients, while in others there is an inadequate or handful of doctors/neurologists that can handle stroke patients.

Similarly, some countries do not even have the basic guidelines for the management of stroke, thus complicating the already fragile situation of stroke management in the country. 

"Undoubtedly, an integrated and comprehensive approach to address the growing burden of stroke is the need of the hour. The first and foremost key strategy would be to educate the masses with correct information about stroke,” Dr Wangchuk says.

Dr Sayinzoga says when it comes to diagnosis, there is need for early identifying and recognising symptoms, as well as improved health-seeking behaviours, which can help save many lives.

Meanwhile, studies have shown that stroke patients receiving treatment within the first one and half hours of the onset of the symptoms have better clinical outcomes.

While having a specialised centre for stroke management and thrombolysis centre is paramount, Dr Wangchuk says the use of artificial intelligence (AI) and digital health solutions can help in the quick transmission of patient information for faster management, thus resulting in better survival. 

"Up-scaled efforts to prevent stroke are urgently needed in our country, and the opportunity to act is now,” he urges.