GLOBAL STROKE LEADERS LAUNCH RADICAL STROKE AND DEMENTIA PREVENTION STRATEGY

The World Stroke Organization (WSO) has published a radical strategic framework that aims to transform prevention of stroke and dementia.

Published in latest edition of The Lancet Neurology, the WSO Declaration on Global Prevention of Stroke and Dementia, recognizes the commonality and reciprocity of stroke and dementia risk and calls for urgent action by governments and healthcare policy bodies to address the limitations of current prevention strategy. Over the past ten years the adult lifetime risk of stroke has increased from 1 in 6, to 1 in 4.

Without new evidence-based interventions, the WSO projects a current trajectory of disease that will lead to an annual death toll of 12 million stroke deaths and 5 million dementia deaths by 2050.

Highlighting the need for action in low- and medium-risk populations, who will ultimately represent 80% of the stroke and cardiovascular disease burden, the Declaration identifies four interdependent interventions that will significantly reduce the incidence and prevalence of stroke and dementia. The strategy also takes into account the specific challenges experienced by governments and communities in Low- and Middle- Income countries, putting in place a lower cost alternative to current prevention approaches.

Key principles of the Declaration

1 Adoption of population wide strategies that reduce exposure to stroke risk factors such as tobacco, alcohol and food policies, as well as action to address environmental risk factors, including air pollution, across the lifespan of the whole population.

2 Implement and promote the adoption of motivational mobile technologies, e.g. the WSO endorsed StrokeRiskometer to identify individual risks and support action on lifestyle risk factors among adults.

3 Access to low dose combination of generic blood pressure and lipid-lowering therapies in one polypill for middle age and older adults with at least two behavioural or clinical stroke risk factors.

4 Investment, training and deployment of community health workers to facilitate implementation.

WSO presents combined research evidence that shows a combination of these interventions would lower the incidence and of stroke by 50% and dementia incidence by 30% while contributing to decrease in incidence of other non-communicable diseases which share common risk factors.

Another proposed shift of approach is to change the way risk is communicated to patients, by health professionals. Current categorization into low-, medium- and high-stroke risk can give a false sense of security for those who are told they are low or medium risk and may not take into account all risk factors that are present. The global stroke body instead calls for a more holistic approach, that places stroke risk on a continuum and encourages early intervention and a life-course approach to risk reduction.

WSO President Prof Michael Brainin, who champions the organization’s prevention effort said ‘COVID-19 has spurred previously inconceivable levels of government intervention and individual behaviour change around the world, but we have been effectively living with a stroke pandemic and a failing prevention strategy for years.

The need for radical action is clear and our prevention principles provide low cost, evidence-based approaches that if implemented globally would not only save millions of lives but would deliver savings of hundreds of billions of dollars annually. This is money that will be desperately needed to strengthen global health systems and to fuel economic recovery in the wake of COVID-19.’

For more information please contact Anita Wiseman awiseman@kenes.com

1 The World Stroke Organization is the only global body solely focused on stroke. With around 90 organizational members from countries in every global region, we represent over 55,000 stroke specialists in clinical, support and community settings. The WSO vision is a ‘life free from stroke’. We work towards this vision through a strategic programme that addresses key factors in stroke mortality and morbidity at global, regional and national levels. Our strategy combines evidence-based advocacy, context-sensitive guidelines, tool kits, clinical education and training programmes and public campaigns that aim to raise awareness of the symptoms of stroke and stroke prevention.

2 WSO is an NGO in official consultative relations with the UN Economic and Social Council and a WHO implementation partner.

Lancet. (2020). news-and-blog/news/global-stroke-leaders-launch-radical-prevention-strategy. Retrieved June 2020, from World Stroke Organization : https://www.world-stroke.org

Sickle Cell and Stroke

What is sickle cell disease?

Sickle cell disease (SCD) is a family of inherited disorders, of which the most severe and common is sickle cell anaemia(HbSS).

SCD affects how red blood cells carry oxygen around the body, is a lifelong condition that affects both males and females, and is the most common genetic disorder globally. Sickle cell disease can cause fluctuating symptoms ranging from pain and infection to anaemia and fatigue.

People with SCD have abnormal haemoglobin. When this haemoglobin gives away oxygen it sticks together to form long rods in the red blood cell. These rods become rigid and can change the red cell from round and flexible to a shape like a sickle. It is because of this shape that sickled red blood cells cannot flow easily through small blood vessels . This means the small blood vessels can get blocked and stop oxygen from flowing.

Who does sickle cell disease affect?

Sickle cell disease is the most common genetic disease in the world. Commonly found in people whose families come from Africa, South or Central America , Caribbean islands, Mediterranean countries , Asia,  India, and Saudi Arabia

Recurrent Strokes in Sickle Cell Disease Children

Children who have suffered a stroke in the past have a high risk of having another stroke. SCD children have a 67 percent risk of recurrence with strokes recurring up to nine months apart.

The cause of such a high rate of recurrence is believed to be a rise in white blood cell count accompanied by a drop in hemoglobin (the protein in red blood cells that carries oxygen) after the first stroke.

“Silent” Strokes in Sickle Cell Disease Children

Recurrent overt strokes are not the only problem for SCD children. So-called “silent” strokes can also cause significant morbidity. Strokes are usually diagnosed by observing motor deficits, but silent strokes occur without obvious outward symptoms like movement difficulties. They can be detected only through brain imaging devices such as MRIs. It’s estimated that 17 percent of SCD children under the age of 14 have silent strokes and the rate increases to 23 percent by the age of 18, with the size and number of lesions increasing.

Silent strokes often occur in frontal areas of the brain, the area responsible for executive abilities (mostly having to do with academic achievement and memory). These strokes can impair intellectual ability, academic ability, attention, visual-spatial skills, language, and long-term memory. Early detection through screening and brain imaging is of the utmost importance, since imaging can help prevent recurrences.

Predictors of stroke in Sickle Cell Disease children

By far, the strongest predictor of stroke in children with SCD is a previous stroke. In predicting the risk of stroke in SCD children without a previous event, studies have revealed signs or symptoms that often occur before a stroke. These may include:

• A history of seizures.
• A previous transient ischemic attack (TIA) or “mini-stroke”.
• New or increased frequency of pain syndromes such as acute chest syndrome (ACS).
• Nervous system infections.
• Trauma.
• Increased blood pressure.
• Decreased hemoglobin level.
• An abnormal result on an image of cerebral arteries called a transcranial doppler (TCD) ultrasonograph.
• Increased white blood cell count.
• Increased cerebral blood flow pressure.
• A history of snoring and/or confirmation of sleep apnea (a condition in which breathing stops briefly during sleep).

NB. If your sickle cell child has any of these conditions, please discuss them and the possibility of stroke with your physician. For children with a high risk of stroke, or a history of stroke, blood transfusions can help prevent occurrence or recurrence.

Management of SCD

Management of sickle cell anemia is usually aimed at avoiding pain episodes, relieving symptoms and preventing complications. Treatments might include medications and blood transfusions. For some children and teenagers, a stem cell transplant might cure the disease.

Resource. (2020,June). Retrieved June Monday, 2020, from The internet Stroke Center & Sickle Cell Young Stroke Survivors: http://www.strokecenter.org/  https://www.scyss.org/

What are the chances of recovery after a stroke?

Recovery from stroke is a long process that can continue over several years. Most of the recovery occurs in the first 2-3 years, and especially the first 6 months. Rehabilitation needs to continue in hospital, rehabilitation services via organization support, home and residential care.

Approximately one-third of stroke patients recover their lost functions fully or almost fully, and get back to their pre-stroke activities within a year.

About 50% of stroke survivors under the age of 65 return to work.

However at one-year after a stroke, about two-thirds of stroke survivors will have some level of disability, ranging from light and moderate to very severe.

What are the possible medical complications after a stroke?

If a person does survive a stroke, as many people do, they may have permanent or temporary disability due to the damage to the brain caused by the stroke.

Possible effects after  a stroke are:

Approximately two thirds of stroke survivors have partial or complete loss of movement and strength in a hand and/or leg on one side of the body. Partial loss of movement and strength is called paresis, complete loss is called paralysis.

80-90% suffer from confusion, and problems with thinking and memory.

30% have communication problems such as an inability to speak or understand spoken language.

30% have difficulty swallowing, called dysphagia.

10% have vision problems such as complete or partial blindness, or double vision.

10% have impaired coordination, called ataxia.

30% have problems in right-left orientation.

Up to 70% suffer from mood disorders, including depression.

20% develop pain in the shoulder.

Less that 10% may develop seizures or epilepsy, especially after an intracerebral hemorrhage.

Without adequate prevention, 20% develop a chest infection within one month of stroke and 10-20% develop bedsores and/or skin infection.

Other possible complications are falls, joint deformities and contractures (where joints cannot fully bend or stretch), urinary tract infection, constipation, pulmonary embolism and heart attack (myocardial infarction).

WHAT PROBLEMS CAN OCCUR WITH THE STROKE SURVIVOR’S MIND AND BEHAVIOR?

Because of the damage to their brain, some stroke survivors struggle to remember or understand things. Others find it difficult to control their feelings and urges (needs), and behave in strange ways. But not all stroke survivors have these problems. An occupational therapist can check whether a person experiences any of these.

WHAT ARE THE SIGNS OF THESE PROBLEMS?

You may notice the following:

• Confusion: The person doesn’t recognize people, know where he/she is (place) or what the time or date is.
• Short-term memory problems: For example, the person cannot remember what was said an hour ago.
• Does nothing unless told: For example, the person will stay in bed unless being told to get up.
• Struggling with simple tasks: Tasks such as putting on a sweater becomes very difficult.
• Lack of control (for example temper, sexual desire or eating): The person may do things before thinking them through.
• Unsuitable behavior: For example, the person may laugh at someone getting hurt.
• Being demanding: For example, a stroke survivor may want your attention immediately or all of the time.
• Ignoring the weak side of the body: For example, when looking for something, the person would not even try looking on the weak side of the body.
• Doesn’t understand money or how to work with it.
• Depression/feeling extremely sad and ‘down’ all the time.
• Long excuses for strange behavior, because the person is not aware of these problems.

HOW CAN I DEAL WITH THESE PROBLEMS?

• Get professional help from an occupational therapist or a behavioral psychologist (ask your local clinic to refer you to the right person).
• Tell the stroke survivor the date, day and time Put a clock and a calendar in the room and show it to the person regularly.
• Follow the same daily routine, with meals, personal care (bathing, brushing teeth, combing hair) and resting at the same time and in the same way, every day.
• Start explaining any changes in the routine long before the time, for example when you need to go to the shop or the Repeat the explanation often.
• Do not allow certain behavior the one day and refuse it on other Decide what you see as acceptable behavior, and stick to it.
• Do not allow the person to control you with bad For example, don’t give in to what the person wants just because he/she keeps shouting.
• Have clear rules for unacceptable For example, say: ‘Do not shout. I will not answer you if you shout.’
• Do not laugh at strange and bad behavior, such as swearing, even if it is funny.
• Tell the person when his/her behavior is good and For example, say: ‘I enjoy helping you when you are thankful.’
• Let the person help make decision.
• Let the person do as much as possible for for him/herself, but stay close enough to make sure he/she is safe, for example in the bathroom and kitchen.
• It is normal for stroke survivors to cry more If the crying is not because of depression, distract the person by asking him/her to count to ten or to breathe deeply. Don’t show too much sympathy because it will make the crying worse.

E.S, S., & J.S, V. (2015). Stroke Care at Home. Western Cape South Africa: Center for Rehabilitation Studies Stellenbosch University.

When you are listening to a stroke survivor:
• Be patient.
• Watch the person’s lips.
• Remind the person to talk slowly and clearly.
• Remind the person to concentrate harder when using difficult words.
• Ask the person to repeat if you cannot understand. Don’t make as if you understand.
• Encourage the person to use the names of friends and family.
• Encourage the person to use common words such as ‘hello’ or ‘thank you’.
• If the person cannot speak, encourage him/her to use hand gestures and to point to objects.
In general:
• Make sure there is no noise in the background.
• Turn the TV or radio down.

E.S, S., & S.J, V. (2015). Stroke Care at Home. Western Cape South Africa: Center for Rehabilitation Studies Stellenbosch University.

WHAT IS COMMUNICATION?

Communication is how we share information with each other through talking, gesturing (showing with our hands), writing or other ways, and our ability to understand that information.

WHAT COMMUNICATION PROBLEMS DO STROKE SURVIVORS OFTEN HAVE?

Stroke survivors may experience the following communication problems:

• Deafness or being hard of this may be part of getting older and isn’t always because of the stroke. The nurse at the clinic or center can make sure that there is nothing blocking the outer ear (the part we can examine), such as wax.
• Struggling to understand.
• Cannot plan speech (put the right sounds together to form words).
• Cannot find or think of the right words.
• Cannot control the muscles that help us form words, such as the tongue and jaw muscles.
• Cannot read, write or understand pictures.
• Cannot speak loudly.

HOW CAN I HANDLE THESE COMMUNICATION PROBLEMS?

When you are talking to a stroke survivor:

• Turn your face towards the person.
• Look the person in the eye.
• Stay close to the person.
• Talk slowly and clearly, especially if the person is tired.
• Use your normal voice ,  Do not shout.
• Repeat what you have said if the person does not understand.
• Use short sentences.
• Wait between sentences.
• Use gestures while talking (show with your hands).
• Talk about ordinary, everyday topics.
• If the person cannot speak, ask questions that can be answered with a simple ‘yes’ or ‘no’.
• If you’re not sure whether the person understood, ask him/her to repeat important information.

Reference:Center for Rehabilitation Studies Stellenbosch University

Angels Initiative

People may experience the following problems after a stroke:

• Weakness or paralysis of one side of the body.
• Stiffness of arm, hand and/or leg.
• Struggling with balance, falling over easily when sitting and standing.
• Struggling to speak or understand language.
• Struggling to control their bladder and bowel (toilet needs) (but this usually gets better over time).
• Loss of feeling on the weak side of their bodies.
• Seeming to forget about/ignore the weak side of their bodies.
• Problems with vision (seeing).
• Seeming confused and struggling to remember.
• Mood and personality changes.
• Forgetting how to do everyday tasks.

HOW DO I TREAT SOMEONE WHO HAS HAS A STROKE?

• Let the person spend as little time as possible in Spending too much time in bed will cause more weakness. Rather let him/her take short rest breaks.
• Let the person get up at his/her usual time and get washed and dressed.
• Let the person have meals with the rest of the family as usual.
• Try to help the person to follow a structured daily programme.
• Encourage the person to do things for him/herself. Be patient and give him/her more time to complete and practise Doing as much as possible for him/ herself and practising daily activities is good exercise.
• Remember that the person is an adult; never treat stroke survivors as if they are children.

Reference: Center for Rehabilitation Studies Stellenbosch University

Angels initiative

WHAT IS A STROKE?

A stroke is caused when there are problems with the flow of blood to a part of the brain. These problems may be one of the following:

• Damage or disease may block or narrow a blood This stops the blood from flowing, and means that oxygen (air) and nutrients (food) cannot reach certain parts of the brain. Those parts of the brain are then damaged and can stop working.
• A blood vessel may The blood will then flood the brain and cause damage.

DO PEOPLE GET BETTER AFTER A STROKE?

Each stroke is different. It depends on the part of the brain that is damaged.

• Normally, people who survive a stroke get better slowly over a long time, but they almost never recover completely.
• Most people learn to walk again, but they walk slowly and can easily fall.
• Many people do not get back all the movement or control of their hand and arm.
• Some muscles stay paralysed or weak, and others become This makes it difficult for stroke survivors to move and control their bodies.
• Some people’s physical abilities (body movements and control) become almost normal again.
• Some people continue to have problems with their mental functions(such as thinking, making decisions and knowing to stay away from danger).

CAN MEDICINE MAKE A STROKE BETTER?

It is not possible to make dead brain cells come alive , however, new research  findings shows  some sign of hope. But if you treat the health problems that caused the stroke, you can help to prevent further strokes. Common health problems that cause strokes are diabetes (high blood sugar), high blood pressure, high cholesterol (too much fat in the blood) and heart problems.

A person who suffered a stroke should see a doctor to be treated for these diseases and to check that there are no other problems.

References : Center for Rehabilitation Studies Stellenbosch University

Angels Initiative

News release

Stroke Association Supportnetwork Ghana (SASNET-GHANA)  has rolled out  an online Program called Ask Dr. Charway-felli , as part of it’s Post Discharge Stroke Support (PDSS) Program. Dr Augustina Charway -Felli a renown neurologist  and  a lead person for the online program with other experts  will provide  answers  to  all questions asked.

If you know any survivor,carer, or families who have someone impacted by stroke, please encourage them to submit their questions through this form(free of charge): https://care.sasnetghana.org/ask-charway/

Whilst persons living/affected with stroke  stay safe in this era of COVID19 and beyond, it’s equally important to receive the needed  advice and support.

Upon receiving the form, SASNET Ghana’s  global stroke support community and professionals will respond to all questions and provide the best advice.

Please also keep in mind, that this online form is not a substitute to official medical advice a survivor is supposed to receive from his own doctors and therapists.

Report on Novel Corona Virus (COVID19 and Non Communicable Disease (NCDs) Public Education in the Eastern Region by Stroke Association Supportnetwork-Ghana (SASNET-GHANA)

The Ghana NCD Alliance and Stroke Association Supportnetwork-Ghana (SASNET-GHANA) in collaboration with the Eastern regional Health Directorate, Ghana Health Service and Information Service Department embarked on COVID19 and Non Communicable Diseases (NCDs) education within some selected districts in the Eastern region to help contain the spread of the disease and reduce the deaths relating to COVID19 with a total death record of 34 with over 80% being patients with existing conditions ,such as diabetes, hypertension, respiratory illness among others.

The exercise began on 14th May 2020 and will end on 31st May 2020 in the eastern hoping to replicate it in parts of the region and in the Volta region. COVID19 and NCDs public education was officially launched on MyFm 94.5, Eastern FM 105.5 and on all the social media platforms which was preceded with a press statement by persons living with Non Communicable Disease such as Strokes, Hypertension, Diabetes, Cancer, Alzheimer’s, persons wilt autoimmune disease, etc and care partners .The press statement was captured and used as a news item by radio stations in the region and on Ghana News Agency website( https://www.gna.org.gh/1.18271831 ) The campaign team visited Communities such as Yilo Krobo, New Juaben North and South, Akuapem , Akyem Tafo and Suhum and Kraboa coaltar all in the Eastern region .Persons Living with NCDs and care partners led the education on COVID19 and NCDs with one amplified voice and a call all Ghanaians especially Persons with NCDs to stay safe and healthy in this COVID19 era. The team sought views from persons living with Non-Communicable Diseases (NCDs) and carers on their needs, challenges, before and during the COVID19 pandemic and present those feedback as a report to keep government informed and guide in the implementation strategies to strengthen Ghana’s response to COVID19 and NCDs especially in the eastern region. The New Juaben South Municipal Chief Executive, Hon. Isaac Apaw Gyasi supported the COVID19 and NCDs public education with facemasks for the vulnerable especially the aged and persons living with Non Communicable Disease.
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Ghana NCD Alliance and Stroke Association Supportnetwork-Ghana (SASNET-GHANA) acknowledges the fact that, His Excellency President Nana Addo Dankwa Akufo-Addo, in his regular update on COVID19 , thus the nation address on COVID19 , which he made mention of diabetes, hypertension, and liver diseases among other NCDs been the major underlying factors to the COVID19 mortality in the country. As an organization with interest in NCDs and Persons living with NCDs, there was the need to act swiftly to reduce any further deaths from COVID 19 especially patients with underlying conditions who are more susceptible to the infection, corona virus. It was very necessary for the Ghana NCD Alliance and Stroke Association Supportnetwork-Ghana (SASNET-GHANA) to embark on this public education on COVID 19 and NCDs. Currently the region has recorded a total of 117 COVID19 cases. Ghana NCDA and SASNET-GHANA COVID19 and NCDs community’s education will go a long way to help those living with NCDs and carers (care partners) and residence in the region to be extra careful and ensure that ,they comply with all safety protocols, directives and measures to avoid being infected with the novel corona virus (COVID19) in the region.

Observations

Stroke Association Supportnetwork-Ghana (SASNETGHANA) and the Ghana NCDA made the following observations during COVID19 and NCDs education in part of the eastern region.

• Education on COVID19 is very poor among residence living within the various communities in the region.
• Protocols aimed at preventing further spread of the COVID19 are not properly observed and complied with , 4 out 10 persons are seen to comply with the safety protocol,ie, wearing of facemask, observing social distancing and hand washing with soap and under running water
• Groups of persons who are seen to flout with the directives within the communities ,includes, drivers, (Trotro drivers ), Pragia riders, Okada riders, etc – facemask are not worn , social distancing protocol are not properly observed by residence
• Market men and women— are usually seen flouting the directives, ie, about 75% do not wear face mask and social distancing , personal hygiene (Hand washing) directives are not complied with.
  Almost all the markets we visited including, Nkurakan market, Agartha market, Suhum, market, Adawso market,Asuboi market, Asesewa market,etc, with the exception of Asenema market and those at Jackson park in Koforidua where social distancing directives are complied with however most traders don’t wear facemask , Veronica buckets are also not available to used for hand washing. All the above named markets are crowded including some lorry stations in the region

• A section of Persons with Non communicable diseases( mental and Alzheimer’s patients) and other forms of disability
  are affected with some form of fear especially going to hospital or clinic for check ups and have their drugs refill in this covid19 era ,this is believed to be the fear of being infected with corona virus as a result of poor education on COVID19 within the communities and misinformation.
  • Majority of drinking spots and bets centers are in operating in the region without complying with the directives / ban on social gathering.

  Recommendations to Government

• Education on COVID19 at the communities, districts and regional level must be intensify especially within the local communities/ villages ie on ground education in order to reach all persons.
  • Government should set up Safety Compliance Task Force (SCTF) at the districts level to ensure that all persons comply with all safety protocols to prevent community spread of the virus (COVID19) especially at the market places and stations.
• Veronica buckets should be provided at all markets places and stations in the districts as well as provision of facemask to vulnerable group especially women, children and the aged.
• Government should implement strategy such as the Telemedicine – Online consultation especially for persons living with Non Communicable Diseases to enable them to have access to medical services from the comfort of their home while observing social distancing protocol.
• Stroke Association Supportnetwork-Ghana (SASNET Ghana) has created an online support program for persons with stroke called the Post Discharge Stroke Support (PDSS) to compliment government’s effort in providing support to persons living with Stroke in this COVID19 era and beyond. Government should recommend the PDSS to all health facilities managing stroke patients to sign up to the program. The PDSS services could be access at the comfort of their homes and is free of charge for all Ghanaians with Strokes.
• Government should promote the use of the emergency line (055-8439868, 050-9497700 and 112) at the community level to enable citizens report any suspected signs of symptoms relating to COVID19
• Government should enforce the ban on advertisement of alcohol and advertisement of tobacco on social media and the operations of drinking spots in this era of COVID19

Mr. Ad Adams Ebenezer, the Executive Director of Stroke Association Supportnetwork-Ghana, Secretary of the African Stroke Organization, Steering Committee and the Vice Chairman of the Ghana NCD Alliance, call on all Ghanaians to be discipline, observe personal hygiene and comply with all safety protocols, while government should also consider recommendations from various institutions and organizations which are all aim to combat and defeat COVID 19 in the country.

for more information
0555886912
ad.adams@sasnetghana.org