The burden of stroke is startling; according to the World Health Organisation (WHO) 15 million people worldwide suffer a stroke annually.
The World Stroke Organisation (WSO) states that over 12 million people worldwide will have their first stroke this year and 6,5 million will die as a result of a stroke. More than 110 million people in the world have experienced a stroke in their lifetime.
The incidence of stroke increases significantly with age, but more than 60% of strokes happen to people under the age of 70 and 16% happen to those under the age of 50. Stroke falls within the cluster of non-communicable diseases (NCDs).
NCDs cause more than 60% of the world’s deaths, 80% of which occur in low and middle income countries. South Africa, being an upper middle-income country, is also affected. It is anticipated that by 2030 NCDs will overtake all other causes of death in Africa. Every hour 10 people suffer from a stroke in South Africa.
To highlight the burden of disease World Stroke Week is commemorated from 28 October to 3 November and is marked around the world. WSW is one of the key annual flagship health campaigns of the Heart and Stroke Foundation SA (HSFSA).
World Stroke Day is observed on Sunday 29 October. Every year a different aspect of stroke prevention and medical care is highlighted, although broadly the primary aim is to raise awareness on the symptoms of strokes, reduce the incidence of strokes and prevent strokes.
This year’s focus is to create awareness and disseminate knowledge on the risk factors for stroke, and on the critical importance of the population at large to be aware of what to look out for when someone is having a stroke.
Most often, an individual having a stroke is not aware that they are. Consequently, the campaign theme for 2023 is: “Together we are #Greater than Stroke.’’ The theme was developed by the World Stroke Organisation (WSO).
As a WSO member, the HSFSA is aligned with the former’s mission and vision. The campaign messaging also emphasises post-stroke care and rehabilitation, as well as the importance of belonging to a supportive network of friends, colleagues, communities and family.
What is a stroke?
Stroke is a cerebrovascular event that includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders.
A stroke, sometimes called a “brain attack”, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. If the brain does not receive enough oxygen or nutrients, brain cells start to die, which may be permanent in nature. A stroke can cause lasting brain damage, long-term disability or death.
Given the severe nature of the consequences of a stroke, it’s imperative that we adopt a “prevention is better than a cure” approach, as the damage as a result of a stroke may not be reversed. However, with timeous treatment at an emergency medical facility a stroke patient can recover fully or suffer only minimal effects.
Together, committed South Africans can make a difference and reduce the prevalence and incidence of strokes and other cerebrovascular diseases by addressing key behaviours that put us at risk.
Professor Pamela Naidoo, CEO of the HSFSA, highlights the fact that stroke is a medical emergency. “Every day, up to 360 South Africans are affected by stroke,” she said. “About a third of those who suffer a stroke will die, and a quarter will be left with a life-changing disability.
“The economic burden of stroke must not be minimised as very often it stops an individual from playing a vital role in our country’s workforce.”
Know the signs
Although a stroke is a complex medical incident, there are ways to significantly reduce its impact. Recognising the signs of a stroke early, treating it as a medical emergency and having access to the best professional care, can substantially improve outcomes.
The warning signs of a stroke are sudden, and knowing how to recognise the signs of a stroke is an important first step in getting the affected person treatment. An important acronym for stroke symptoms to remember is “FAST”:
Face: Is one side of the face droopy? Can the person smile or show their teeth?
Arms: Is one side weak? Can the person raise both arms for 10 seconds without one arm leaning lower than the other?
Speech: Is the person able to speak? Are the words slurred? Can they repeat a simple sentence?
Time: If even one of these signs is present, act quickly and call emergency services. “Minutes can save lives”
Prevention is key
Stroke prevention is an important pillar during World Stroke Week and at the HSFSA wants to highlight the different controllable and uncontrollable risk factors for stroke.
Uncontrollable risk factors include: age (strokes are more likely among older persons); sex (there is a higher risk for menopausal and postmenopausal women); and family history (inherited high cholesterol, blood pressure, abnormal heart rhythm or clotting disorders can increase the risk of strokes).
Recent trends are important to consider. The prevalence of stroke in the young is increasing due to several factors. Stroke is often disabling, hence this trend poses a threat to socio-economic stability, particularly in developing countries.
In young patients with an absence of conventional vascular risk factors and negative preliminary stroke work-up, clinicians need to take into consideration less common causes of stroke in this population. There is an imperative opportunity for future investigations as there is currently a lack of evidence-based management guidelines for these rare etiologies based on research completed to date.
Controllable risk factors are behaviours you control that may impact your risk for stroke. Unhealthy behaviours increase your risk of stroke. Up to 70% of strokes can be prevented by adopting health-seeking behaviours. These include eating a healthy diet, exercising regularly, not smoking, managing stress effectively, managing chronic illnesses like hypertension, diabetes and high cholesterol as well as maintaining a healthy weight. Adopting healthy behaviours not only reduces your risk of having the first stroke, but can also greatly reduce the risk of another stroke in stroke survivors.
Proactive promotion
As part of its mission, the HSFSA works towards halting the rise of premature deaths through cardiovascular disease (CVD) and cerebrovascular disease in SA and promoting the adoption of positive health behaviours.
Through its health promotion activities, the foundation reaches out to vulnerable communities to educate them about the condition. These include conducting health-risk assessments of blood pressure, blood cholesterol, blood glucose, body mass index and waist circumference. Should any of these be out of the normal range, the person under assessment is given a referred to their closest clinic.
Further to this, information tables with information brochures as well as health talks are conducted to educate the public on the risk factors of stroke, how to manage them and how to identify them.
The HSFSA also has its Heart Mark endorsement programme, which assists consumers to identify foods good for their heart and brain, addressing the influence diet may have as a risk factor for stroke. The programme works with food manufacturers to improve food formulation.
It is managed in accordance with the food regulatory framework and operates with the approval of the national Department of Health. It’s not a diet but a guaranteed way to buy food lower in salt, sugar and saturated fats, and higher in fibre.
An innovative and exciting campaign in which the HSFSA is involved in is the FAST Heroes campaign, which leverages children’s enthusiasm for learning and sharing, encouraging the spread of knowledge to the rest of their family, particularly to their grandparents. It is an award-winning educational initiative, aimed at raising awareness of stroke symptoms and the need for speedy action.
The foundation advocates to minimise South Africans’ risk of developing heart disease and stroke at all levels, and are therefore involved in many policy initiatives. These policies include the Sugar Sweetened Beverage Tax, Tobacco Sin Tax and the salt legislation. It is proud to have been at the centre of these initiatives and continues to play an important role along with other NGOs, health care practitioner and associated stakeholders.
Through campaigns like World Stroke Week, the HSFSA hopes to promote cardiovascular health and cerebrovascular health through advocacy, influencing policy, providing information, tools, and support which will empower people to adopt healthier behaviours and seek appropriate care early in the manifestation of the disease.
