In a 2022 report by Rwanda Biomedical Centre (RBC), it was revealed that stroke-related deaths in Rwanda escalated from the seventh position in 2009 to the third in 2019, becoming a significant cause of mortality, representing 5.1 per of total deaths. The report highlights that the median delay in seeking medical attention in Rwanda is 72 hours for ischemic stroke patients and 24 hours for those with haemorrhagic stroke. Despite Rwanda’s efforts to combat non-communicable diseases (NCDs), the fatality rate from strokes continues to rise. Stroke remains the third leading cause of death in Rwanda, underscoring the pressing need to alleviate its impact on the population. In light of this, Rwanda anticipates implementing the ‘Act FAST’ campaign—a public health initiative aimed at raising awareness about the signs of stroke and the importance of acting quickly—in 13 districts to control 12,685 cases of hypertension— a major risk factor for stroke—per year. Rwanda Biomedical Centre recommends policy formulation and endorsement, revising NCD guidelines and protocol that include the management of stroke, improving data capturing to avail stroke, prioritising. It also calls for allocating a budget for stroke prevention related activities and engaging stakeholders to enhance mobilisation to prevent stroke, and considering stroke day among annual diseases events. Stroke and young people A stroke is an acute loss of neurological function due to an interruption of blood supply to the brain. As per the World Health Organization (WHO), stroke is the leading cause of disability worldwide and the second leading cause of death. Stroke in young individuals is becoming a growing concern in developing and developed nations partly attributed to a rise in the prevalence of traditional risk factors including hypertension, obesity, diabetes, smoking and heart disease. In comparison to strokes in the elderly, strokes in young individuals are more varied because of the numerous potential risk factors and causes, as reported by the Journal of Neurology, Neurosurgery, and Psychiatry. ALSO READ: Uncovering stroke: The not-so-silent killer The World Health Organization states that annually, 15 million people worldwide suffer a stroke. Of these, five million die, and another five million are left permanently disabled. High blood pressure and tobacco use are the most significant modifiable risks. For every 10 people who die of stroke, four could have been saved if their blood pressure had been regulated. ALSO READ: Stroke: What you should know Dr Joseph Rukelibuga, Legal Representative of Stroke Action Rwanda, an NGO founded by stroke survivors in Rwanda to fight cerebrovascular accidents (stroke) through prevention, treatment, and long-term care and support, explained that the cases of stroke among young adults are due to an upsurge of risk factors among this group of population because of lifestyle change. ALSO READ: Understand the warning signs of mini-stroke, take action now He noted that eating unhealthy food such as high-fat, high-salt, high-sugar, or processed foods can directly contribute to an escalation of plaque in the arteries. As this plaque blocks and tightens blood flow throughout the body, the result is an intensely higher risk for heart disease, heart attack, and stroke. “Poor stress management can cause the heart to work harder, increase blood pressure, and upsurge sugar and fat levels in the blood. This can increase the risk of clots forming and travelling to the heart or brain, causing a heart attack or stroke.” Dr Gerald Urimubenshi, a stroke rehabilitation expert and senior lecturer at the University of Rwanda, said that an unhealthy diet, and consumption of food with too much salt and oil are linked to stroke among young people. He added that low physical activity, or inactivity, for example not walking, sitting for long while watching TV, or engaging in activities that don’t require physical activity can contribute to an increase of cholesterol in the body. If cholesterol level is too high, it may boost the risk of stroke. In fact, high cholesterol is not healthy, because it can lead to the development of fatty deposits in blood vessels. Eventually, these deposits grow, hindering enough blood to flow through one’s arteries. The deposits can break suddenly and form a clot that causes stroke. He noted that drinking too much alcohol can increase one’s risk of stroke. Research shows that globally, excessive alcohol consumption is linked to over one million strokes each year. Stroke isn’t a condition for old people, thus the need for a change of mind-set. Stroke is common in all continents especially low medium countries. It is, therefore, advised to prevent it by eating healthy food such as vegetables, fruits, and white meat and decreasing consumption of red meat, Urimubenshi stressed. He urges controlled drinking, not going beyond two glasses for a 4 per cent alcohol content. “Physical activity is very important, eating without exercising hinders an individual from acquiring great components. Not exercising, or getting physical activity is a confirmed risk factor of premature death.” Some studies show that inactivity and being sedentary cause more deaths around the world than cigarette smoking or diabetes. For secondary prevention, Urimubenshi advises seeking immediate help once one notices the stroke signs. The acronym FAST can help one remember the most common signs of a stroke and what to do if you think you or someone else is having a stroke: F (face drooping) A (arm weakness) S (speech trouble) T (time to call for emergency) The burden of stroke Urimubenshi explained that after getting a stroke, the brain is affected yet it is the command center of the body. Typically, the area of the brain affected may be the one responsible for controlling limbs, speech, planning, and thinking. Many different parts are affected, for example, the muscles lose the ability to support the body, thus, leaving one in a state where they can’t walk, move, or do activities such as cooking, washing, running errands, and so forth. Urimubenshi said minor stroke symptoms disappear quickly, but a stroke that persists beyond 24 hours can’t heal completely, however, doctors reduce the impact of the stroke—someone who was unable to talk can start talking. A person can return to work and do some activities on their own. “Stroke affects people physically and psychologically since they start being a burden to their families as they can’t do anything for themselves, it is the vulnerability that triggers depression. It affects the body’s emotions and behaviour.” Urimubenshi added that some patients are not cooperative, thus, making it hard for caregivers. Caring for stroke patients may lead to caregiver strain. Caregiver burden is the level of multifaceted strain perceived by the caregiver from caring for a family member and loved one over time. Provider adherence to screening and treatment protocols can help to control hypertension and its complications in Rwanda. Improving public awareness of the causes and symptoms of stroke can prevent over 130 stroke deaths per year, the RBC report states.
