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Onwuchekwa Maps Out Stroke Prevention Strategies

In view of the rising cases of stroke in Nigeria and other parts of the world, a Neurologist, Professor Arthur Onwuchekwa of the Department of Medicine, Faculty of Clinical Sciences in the College of Health Sciences, has called for moderation, sustained advocacy and media campaigns as ways of sensitising the populace on effective strategies to prevent the killer disease.  
Delivering the 135th Inaugural Lecture entitled: “Stroke: A Preventive Disaster Waiting to Happen” at the Ebitimi Banigo Auditorium on Thursday, October 27, 2016, Professor Onwuchekwa observed that the saying: “prevention is cheaper and better than cure” was critically relevant in tackling the menace of rising stoke in Nigeria. He recommended “population-based strategies that would include community education, using printed materials, audio-visual programmes, lectures, television and billboard advertisements, and radio jingles, as major means of reaching out to the vulnerable segments of society.
“Stroke is defined by the World Health Organisation as rapidly developing clinical signs of focal (or global) disturbance of cerebral (brain) function lasting more than 24 hours or leading to death with no apparent cause other than vascular origin,” the Neurologist noted, pointing out that stroke results when blood flow to the brain was suddenly interrupted, leading to the death of cell.
“This manifests as inability to move or have sensation on one part of the body, problems of understanding or speaking, feeling like the world is spinning (dizziness) or loss of vision to one or both eyes. This is usually sudden in onset within seconds and minutes. If the symptoms last less than 24 hours (usually 1 hour) and resolves completely with no residual deficit, it is known as Transient Ischaemic Attack (TIA) or Mini Stroke,”he explained.

Disclosing that stroke symptoms usually start suddenly within seconds to minutes, Onwuchekwa, said: “The symptoms depend on the area of the brain affected and the function of that area; the more extensive area affected, the more functions are likely to be lost. The commonest way to recognise stroke is by the use of FAST, which stands for Facial deviation, Arm weakness, Slurred speech, Time is brain (emphasising the urgency in stroke intervention).
“Every minute in which a large vessel ischaemic stroke is untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses (junctions where these neurons join each other). Each hour in which treatment fails to occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging,” the Inaugural Lecturer disclosed, listing high blood pressure, diabetes mellitus, high blood cholesterol, excessive alcohol intake, obesity, active and passive cigarette smoking, drug abuse, sickle cell disease, lack of physical activity, among others, as major risk factors that predispose people to stroke. 
He stated that stroke can be classified into two major categories, namely: ischaemic, which is also known as cerebral infraction, caused by interruption of blood supply to the brain and haemorrhagic, which results from bleeding into the brain tissue due to the rupture of blood vessels, a condition called intra-cerebral haemorrhagic (ICH), stressing the importance of teamwork amongst health workers to ensure effective treatment.    
“Stroke is the new face of chronic, Non-Communicable Disease in sub-Saharan Africa, a forerunner of health transition in the developing countries, and a preventable disaster waiting to happen! Dealing with stroke will involve policy-makers in health, education, transport, finance, power, agriculture, information, youths and sports, acting in concert,” he stated.
“Stroke education should target prospective patients such as hypertensive patients, diabetics, old stroke patients, sicklers, the aged and the aging, including caregivers. The campaign should be carried to tertiary, secondary and primary schools, including churches and mosques. All health workers, including medical practitioners should spend quality time to educate their patients on preventive measures and ability to recognise stroke,” he submitted.
The Inaugural Lecturer noted that another important public education strategy was to advise patients and their relatives to take stroke victims to the hospital immediately it is noticed. “The right quality of food to prevent hypertension called DASH (Dietary Approaches to Stop Hypertension) diet should be encouraged. The main goal is to eat more vegetables and fruits while limiting intake of fats,” he recommended, adding that hypertensive patients have to be placed on drugs without delay for the rest of their lives. He also advocated regular exercise sessions of, at least, 30 minutes on a daily basis, maintenance of the right body weight in proportion to one’s body mass index, low consumption of salt as some of the measures aimed at preventing stroke.     
Professor Onwuchekwa called for improved healthcare delivery system that would lay strong emphasis on primary care, adding that health promotion leaflets and regular health talks should be given by community health nurses to stress the importance of lifestyle changes and good nutrition. He also stressed the need for rehabilitation facilities for physiotherapy, occupational and speech therapy to cater to the needs of those who eventually come down with stroke. 
Regretting the absence of special centres for stroke management, the Inaugural Lecturer recommended that there should be trained specialists in clinical neurology, adding: “All these are hindered by lack of funds and commitment by policy-makers on health matters. These are worsened by unhealthy rivalry amongst health workers resulting in incessant strikes.”   
Speaking at the end of the lecture, the Vice-Chancellor, Professor Ndowa Lale, commended the Inaugural Lecturer for his deep insight into the subject of stroke and how it could be prevented or managed. “Professor Onwuchekwa has dispelled some of the fears we harbour about certain food items we consume in this part of the world. We now know that consumption of palm oil is not detrimental to our health as was speculated by those who may wish to market alternative products. 
“The bad news is that stroke affects the poor, the middle class and the upper class, but quite unfortunately, the drugs available for its treatment are mainly available to the upper class that can afford the cost. I charge the Faculty of Pharmaceutical Science to focus on research that would lead to the production of drugs for patients in the lower and middle class brackets. We need to live responsibly by practising moderation in our consumption patterns in line with the recommendations of our Inaugural Lecturer,” the Vice-Chancellor told the audience that included three former Vice-Chancellors.   

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