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BACKGROUND BURDEN OF NON-COMMUNICABLE DISEASE – STROKE AND RISK FACTORS

BACKGROUND
BURDEN OF NON-COMMUNICABLE DISEASE – STROKE AND RISK FACTORS


Cardiovascular diseases (CVDs) are major health threats across the globe with stroke being the most debilitating (Ezejimofor et al., 2017). Globally, over 16 million new cases of stroke and 62 million stroke survivors were reported in 2005, with deaths from stroke accounting for 9.7% of all global deaths, and this is expected to increase to over 23 million new stroke cases and 7.8 million stroke deaths by 2030 if no drastic attention and response is administered. Data from sub-Saharan Africa have shown that stroke is the leading cause of medical admissions in older adults (Akinyemi et al., 2014) with an annual incidence rate of up to 316 per 100,000, a prevalence rate up to 1460 per 100,000 and 3-year fatality rate up to 84% (Owolabi, 2011). Stroke is the second largest contributor to disability adjusted life years (DALYs) lost in SSA and this is almost seven times those lost in high-income countries (HIC) (Feigin, 2005). More worrisome is the fact that its younger generation who are the major drivers of economies in their countries are also hit by stroke (Gorelick, Farooq, & Min, 2015; Jeet, Thakur, Prinja, & Singh, 2017). In Nigeria, the existence of increased stroke admission (Owolabi et al., 2015; Sarfo et al., 2015), severe depletion of human, infrastructural and financial resources for prevention, investigations, acute care and rehabilitation of stroke patients which further over-stretches the already unstable health sector (Owolabi, 2011) makes conduct of effective and appropriate surveillance required to understand the exact burden, incidence and stroke outcomes challenging. This impinges on the development of target-based interventions; where available, it is of low quality (Ovbiagele & Nguyen-Huynh, 2011; Owolabi et al., 2018).

APPROACHES TO STROKE PREVENTION
Several guidelines and reports by stroke organizations in collaboration with World Health Organization have been produced to guide implementation of target-driven interventions and initiatives on stroke prevention (Ovbiagele et al., 2013; WHO Regional Office for South-East Asia, 2016). These guidelines emphasizes the need for effective and sustainable interventions that address key areas including primary and secondary prevention, acute care, rehabilitative services and the need for greater commitment and involvement of policy makers at all government levels in the fight to tame stroke burden especially in LMICs. Although certain medical-modifiable risk factors can be treated using pharmacological interventions as it were, their identification among individuals/populations could be a pointer to identify and target underlying behavioral risk factors with multi-level interventions.

Multi-level interventions incorporating sustained (culturally-relevant, population-context specific) stroke education, high-risk screening, early referral, administration of pharmacological therapeutic interventions, counselling have been documented to be effective in reducing stroke risk factors and to a large extent, deaths among individuals (Olaiya et al., 2017; van de Vijver et al., 2016). Moreover, more cost effective in reach, is the adoption and implementation of, population-wide, community-based programs, innovative interventions including the use of mobile app incorporating health promoting, preventive and behavioural modification strategies (Feigin, 2017; Feigin et al., 2015; Yan et al., 2016). This strategy have greater capacity and advantage in reaching greater population and reducing occurrence of cardiovascular-associated risks (Olaiya et al., 2017; Sampson, Amuyunzu-Nyamongo, & Mensah, 2013).

STROKE PREVENTION ACTIVITIES AND ESTABLISHED COLLABORATIONS
Sub-Saharan Africa (SSA) is currently witnessing a radical, significant shift from communicable to non-communicable diseases fuelled by several factors including aging population, change in and adoption of westernized lifestyle/behaviors, epidemiologic transition among others (Adeloye, 2014; Akpalu et al., 2015). Regardless of type, topmost risk factors for stroke globally have been documented (Gorelick et al., 2015; O’Donnell et al., 2010; Ovbiagele & Nguyen-Huynh, 2011) and are influenced by socio-economic inequalities (Havranek et al., 2015; Palomo et al., 2014; Psaltopoulou et al., 2017; Quispe et al., 2016). These factors, if not regulated can metabolise to other co-morbidities including obesity, high cholesterol levels, increased blood pressure and glucose levels; either as single or combined co-morbidities translating to the occurrence of stroke.

The Stroke Investigative Research and Education Network (SIREN) project is the largest study ever on stroke in Africa. Domiciled in Ibadan, Nigeria, it is a multi-site, multi-disciplinary project designed to highlight the environmental and genetic risk factors to stroke in SSA. The SIREN project has for the first time, delineated twelve (12) topmost modifiable risk factors for stroke that are peculiar to Africans and ranked them in descending order as thus: hypertension, dyslipidemia, regular meat consumption, elevated waist-to-hip ratio, diabetes mellitus, income level >$100/month, stress, cardiac disease, added salt at table, tobacco use, while green leafy vegetable consumption and physical activity were protective (Owolabi et al., 2018). The risk factors identified in SIREN provide context-specific potential targets for public health control of stroke on the African continent and in Nigeria specifically. The Anambra State Government, as part of its activities to mark the World Stroke Day, will collaborate with and leverage on the findings of the SIREN Project to implement context-specific, population-wide awareness creation and interventions aimed at addressing the impact of the leading risk factors at the population level among Nigerians – especially Anambrarians. This would, by extension, reduce the incidence and prevalence of some other non-communicable diseases that share the same risk factors as stroke.

OVERARCHING GOAL OF THE WORLD STROKE DAY
Leveraging on the findings of the SIREN project, this symposium is to compliment the efforts of the Anambra State Ministry of Health in combating stroke and its risk factors among its youths, women and general population through stroke health awareness and promotion, free risk factor/medical screening and medical counselling.

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