Stroke in Uganda

Strokes occur when blood supply does not get to an area of the brain. There are 2 types of stroke. One where a blood vessel gets blocked (ischemic stroke) and areas of the brain served by the blood vessel are starved of life giving blood. The second and more dramatic type of stroke happens when a blood vessel bursts. Bursting has 2 consequences: Firstly blood does not go to the area of the brain the blood vessel supplies, and second the pressure of the blood that comes from the rupture damages brain cells.

Strokes have many complications for survivors depending on the severity and the area of the brain affected. Besides alterations in movement and sensation, there may be changes in mood and cognition. 

The high prevalence of HIV/AIDS and sickle cell disease are major contributors to the incidence of strokes in Uganda. Besides other factors like high blood pressure and diabetes. It should be noted that high cholesterol levels have been inconsistently associated with (ischemic) stroke (see Wikipedia)

Rehabilitation at the Stroke Rehabilitation Centre in Kampala

The 2010 Global Burden of Disease Profile for Uganda shows that in 1990 stroke was ranked at number 19, responsible for 0.9% of deaths in the top 25 causes of death in Uganda; by 2010 this had risen to number 14, responsible for 1.4% of all deaths. The 2014 World Health Organisation country profile for Uganda shows that strokes are responsible for 3.9% of all deaths in Uganda, ranking stroke at number 5 in the top 10 causes of death.

An Estimate of the Incidence and Prevalence of Stroke in Africa: A Systematic Review and Meta-Analysis suggests there are 317.3 stroke survivors per 100,000 people living in Africa in 2009. Which means that in 2009 there were an estimated 1,042,000 stroke survivors in Uganda.

Stroke has serious consequences if it is not recognized early, yet there is little knowledge about strokes in Uganda. The conclusion of the 2014 paper Knowledge and Perception of Stroke: A Population-Based Survey in Uganda provides the following insights about stroke knowledge:

This first report of a large Ugandan general population sample found that individuals had extremely limited knowledge of stroke and did not feel that stroke as a disorder had any personal relevance to them. Primary health care workers were not identified as a key resource in stroke care. These results indicate a need to increase public stroke awareness in Uganda. Local and regional healthcare workers are resources that are not optimally used and represent an opportunity to improve stroke prevention and stroke community response.

Limited knowledge and lack of recognition of the importance of stroke symptoms leads to further complications. In the 2015 paper Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30 day follow-up the high mortality rate of patients admitted to hospital is discussed:

the high case fatality has been blamed on limited health care access, delayed presentation to hospital, and a shortage of adequately trained professionals to provide acute care and rehabilitation of stroke patients (Owolabi et al.2007) as well as lack of stroke units. Similar factors may be responsible for the poor functional outcome among the survivors seen in this study. The early recovery in activities of daily living among stroke survivors in developed countries is generally more favorable (Wade and Hewer 1987) than our findings. This study dealt with patients admitted to a national referral hospital. Hospital data on stroke are usually biased towards the more serious or complicated cases (Bamford et al. 1986). It is possible that only the most severe stroke cases end up presenting to hospital, and that this cohort is not likely to be entirely representative of all strokes in the community, given that a large number of stroke patients per year is expected in a hospital with over 1500 beds serving Kampala’s 1.6 million people, as well as an additional estimated 1.5 million from neighbouring districts and beyond. Also, only participants with onset of stroke symptoms within 7 days were recruited. While our study does not permit a causal inference regarding the relatively high mortality outcomes, it is likely that care access issues in line with limited health budgets in most of sub-Saharan Africa play a substantial role.

The problems encountered in combating strokes in Uganda are hightlighted in the 2012 paper A Descriptive Epidemiological Study on Stroke in Kampala, Uganda: A Hospital-Based Study:

In the future, the global burden of cardiovascular disease and stroke will continue to rise, as life expectancy continues to increase. In developing nations such as Uganda, barriers to cardiovascular disease recognition and treatment include low educational levels and poverty. These factors can lead to difficulty with risk factor modification, and have likely contributed to the overall increase in stroke incidence by 20% in low and middle income countries compared to high income countries from 2000.

There is hope for stroke patients in Uganda. This is the story of Ibrahim Bukenya who graduated from the Mulago School of physiotherapy. He wanted to help stroke survivors. In 2010 with the help of Grow International, Ibrahim established the Stroke Rehabilitation Centre in Wampewo. This article, Grow Movement advises Ugandan Stroke Rehabilitation Centre describes his work:

From singlehandedly running a home physiotherapy service from a rented room in Kampala, Ibrahim is now the founder and principal physiotherapist of The Stroke Rehabilitation Centre, a non-governmental organisation which treats about 15 patients, recovering from strokes or spinal problems, each month, as well as offering employment to local people.
His work is crucial in treating the severe psychological and physical conditions found in people after a stroke. Stroke survivors commonly experience depression, anxiety, loss of mobility and impaired speech. If left untreated, these conditions may last a lifetime. Before they can resume their daily lives, a long period of rehabilitation is often required. At the Stroke Rehabilitation Centre, to aid patients in their recovery process, each is individually assessed to ensure that they recieve the ideal treatment for their specific situation. The centre also offers support and advice to the family and friends of patients.

There is little doubt that the sooner a  person can begin rehabilitation and therapy after a stroke the better the outcome. The Stroke Rehabilitation Centre provides a useful service rehabilitating stroke survivors, see also their Facebook page.