Health
Neurologists raise the alarm as stroke hits one Nigerian every minute
As the global community commemorates World Brain Day tomorrow, July 22, leading neurologists in Nigeria have said that at least one Nigerian develops a stroke every minute, noting that the country remains under-resourced in specialists, infrastructure and diagnostics to prevent, diagnose and treat neurological disorders.
The brain and stroke specialists exclusively told PUNCH Healthwise that stroke was the leading cause of brain disease in Nigeria, with dementia, epilepsy, headaches, neonatal encephalopathy, traumatic brain injuries and other brain conditions accounting for a significant disease burden.
They noted that about 80 per cent of strokes and 45 per cent of dementias were preventable through lifestyle changes and the control of underlying conditions such as hypertension, diabetes and high cholesterol, stating that Nigeria bore a peculiar triple burden of rising non-communicable diseases such as stroke, post-infection complications particularly from meningitis, and malnutrition-related conditions.
They advised Nigerians to eat more fruits and green leafy vegetables, exercise regularly, avoid smoking and alcohol, and undergo routine screening for chronic diseases.
The neurologists called for urgent government action to expand the neurological workforce, extend universal health coverage to neurological conditions, strengthen prevention through public awareness campaigns and early screening, and ensure equitable access to diagnostic services, treatment and rehabilitation across the country.
World Brain Day is celebrated annually on July 22 and spearheaded by the World Federation of Neurology.
The theme for this year is “Brain Health for All.”
Commenting on the matter, a professor of Neurology and Precision Medicine at the University of Ibadan and one of Nigeria’s foremost stroke and brain health specialists, Mayowa Owolabi, said that at least one Nigerian is developing a stroke every minute as the country is still far behind in implementing pragmatic solutions for responsive surveillance, effective prevention, appropriate acute care and holistic rehabilitation.
Owolabi, who chairs the Lancet Commission on Stroke and currently leads the Lancet Commission on Neurehabilitation, said stroke is the leading cause of brain disease in Nigeria, stressing, “every minute at least one Nigerian is developing a stroke, which is really quite alarming.”
The don further stated that dementia, neonatal encephalopathy commonly known as cerebral palsy, epilepsy, headaches, sleep disorders, spinal cord conditions, traumatic brain injuries, and nerve damage caused by diabetes and heavy alcohol use were conditions that affect the brain and neurologic health.
He stated that despite up to 60 to 80 per cent of strokes being preventable through lifestyle changes and control of underlying conditions and risk factors, Nigeria remained behind in surveillance, workforce capacity, acute care infrastructure, and rehabilitation services needed to confront the crisis, with “roughly 400 neurologists and neurosurgeons” serving a population of over 250 million Nigerians.
He added that other healthcare workers, including psychotherapists, occupational therapists, physiotherapists and speech therapists, are also grossly inadequate.
Owolabi said, “Worldwide, about 3.4 billion people are suffering from neurological disorders, and that’s about 43 per cent of the world population, so it’s a major, major issue. The common conditions include stroke, dementia, neonatal encephalopathy, headaches, and seizure disorders/epilepsy. And what is noteworthy is that with proper measures for primordial, primary, and secondary prevention, close to 60 to 80 per cent can be prevented. Almost 80 per cent of strokes can be prevented, and almost up to 45 per cent of dementia can be prevented.”
He said the global economic cost of brain diseases was enormous, noting that dementia alone cost the global economy about $1.3trn annually, while stroke cost approximately $1trn.
Owolabi, who described the brain as the most important part of the human body, said the consequences of allowing these conditions to go unchecked extended far beyond individual health.
He said, “When the brain is gone, we say the person is now in a vegetative state. Even if they can eat and drink and the heart is beating, it’s actually gone, because it can no longer interact with the environment or with people or communicate. So that’s the best part of us, really, physically, is our brain. And that is why brain health is really important.”
On what was driving the stroke epidemic in Nigeria, Owolabi said the brain was an extraordinarily oxygen-hungry and glucose-hungry organ, and that anything damaging the blood vessels supplying it would eventually cause brain disease.
The Academy Secretary, Academy of Medical Sciences, Nigeria, added that uncontrolled hypertension, diabetes, high cholesterol, alcohol consumption, obesity, smoking, poor diet, and sedentary lifestyles all damage the blood vessels that supply the brain with oxygen and glucose.
He said, “The brain consumes oxygen, actually more than almost any other organ in the body. It is two per cent of the body weight but consumes 20 per cent of the oxygen. Anything that affects blood vessels would affect the brain at some point in time, things like hypertension, things like diabetes mellitus, things like high blood cholesterol. All these can damage the brain. Alcohol, cigarette smoking, because all these things affect the vessels.”
The leading neurologist noted that diets high in trans fats and ultra-processed foods were harmful to the brain and its blood supply, urging a return to traditional African diets, especially diets rich in green leafy vegetables, which are “nutritious, medicinal and preventive.”
Owolabi said the consequences of these unhealthy habits were now seen among young people, further stressing that “lifestyle is extremely important to protect the brain and protect the vessels.”
On Nigeria’s capacity to respond to stroke, the stroke specialist said the country was severely under-resourced at every level of the chain, from the number of specialists available to the infrastructure needed to administer emergency treatment.
He said, “With our population size of more than 250 million people, we don’t have enough neurologists, we don’t have enough speech therapists, psychotherapists, physiotherapists, so on and so forth. So that’s really a huge gap.”
The don said delays in accessing care were occurring at multiple points, from patients or bystanders or family members failing to recognise stroke symptoms, to peripheral health facilities lacking the expertise to investigate and refer appropriately, to the financial barriers that drove patients towards faith and traditional healers before presenting at hospitals in a critical state.
Owolabi said, “There are delays at different levels. The first one is even the patient or bystander. If the patient doesn’t recognise that he has a clinical problem, nothing is going to happen. Getting to where the patient goes first, sometimes it’s a peripheral facility, sometimes there are no specialists there. They also need to be adequately educated to be able to recognise, with a high index of suspicion, what may be going wrong in that patient, and then be able to refer to a facility where urgent and appropriate care can be delivered.”
The neurologist further said the out-of-pocket cost of neurological care was pushing patients away from hospitals.
He said, “Universal health coverage needs to be extended or strengthened to cover neurological conditions, so that people don’t have to pay out of pocket most of the time, because that sometimes prevents them from getting to where they can get help, and so they patronise the non-orthodox care ecosystem, faith healers, traditional healers, and all of that without getting help. And by the time they are coming, it sometimes is very late.”
He stressed that stroke was a time-critical emergency, and that reaching a hospital within hours of symptom onset was the difference between recovery and permanent disability.
The precision medicine specialist said, “If a stroke happens, then you need to go to a facility where, if need be, within hours, you can get what is called a clot buster, or thrombolytic therapy or thromobectomy.”
Owolabi called on Nigerians to screen regularly for hypertension, diabetes, and high cholesterol, and to treat and control any conditions found, saying that doing so could eliminate the vast majority of strokes before they happen.
He said, “You treat hypertension, you control it, you control diabetes, you control dyslipidaemia, 70 to 80 per cent of strokes can be prevented.”
Also, a Professor of Internal Medicine and Neurology at the University of Nigeria, Nsukka, Ikenna Onwuekwe, said neurological disorders, which affect the brain and other parts of the nervous system, are a leading cause of disability and death globally, affecting over three billion people.
He stated that Nigeria has a high burden of brain illnesses, noting that the country faces a peculiar triple burden comprising the rising incidence of non-communicable diseases such as stroke, post-infectious complications, especially from meningitis, and an increase in malnutrition-related conditions.
The don further noted that stroke, migraine and other headache disorders, dementias, of which Alzheimer’s disease is the leading type worldwide, and meningitis are major contributors to global disability-adjusted life years.
The neurologist said that despite low-income countries bearing a high burden of neurological conditions, they have fewer neurologists to manage them.
“Stroke is the primary driver. It causes great morbidity and mortality, occurring even among young people. People tend to think that stroke is a disease of older individuals, but these days, we are seeing the rate to be quite high among young people. That’s what we call stroke in the young, when it occurs in people less than 40 years. The largest driver for this is untreated hypertension,” the don said.
Onwuekwe, who is the Continuing Education Manager for Nigeria for the World Federation of Neurology, listed other prevalent brain conditions in Nigeria as epilepsy, headache disorders such as migraine, and degenerative conditions such as dementia. He identified rapid population growth, stress, excessive alcohol intake, and smoking as factors contributing to the increasing burden of brain disorders.
The neurologist also cited poor prenatal care, rising infectious diseases, and environmental toxins, particularly air and water pollution, as contributors to the burden of neurological diseases. He added that pollution from oil spillages, smoke, and dirty air further worsens the situation.
He decried the limited access to specialised neurological care, highlighting the wide geographical disparities in the availability of neurologists, neurosurgeons, and diagnostic facilities across the country.
He further lamented the inadequate number of neurologists, neurosurgeons, and diagnostic facilities in the country, urging governments at all levels and the private sector to do more to improve neurological care.
Despite the challenges, Onwuekwe said neurologists and neurosurgeons in the country were doing their best with the limited resources available.
He also emphasised the need for greater specialisation in neurological sciences.
Speaking on this year’s World Brain Day, he stressed the need for smarter prevention strategies and equitable access to neurological care.
“By studies, we know that over 42 per cent of the world lives with a neurological condition. This year, we are looking at five core pillars to reduce the burden of brain disorders. The first pillar is awareness. There is a need to highlight that brain health is important for all people of the world, Nigeria inclusive. Whenever we want to talk about all aspects of physical and mental health, brain health is crucial.
“The second pillar is prevention. By this, we need to focus on the modifiable risk factors for brain diseases. There are things that we can change through early intervention, healthy diets, regular physical activity, and proper stress management. The socio-economic situation in Nigeria is such that there is a higher level of stress, and people are not doing so many things very well.
“The third pillar is advocacy. There is a need to continue to push for global efforts and policy changes by the government to support optimum brain health. The fourth pillar is education. There is a need to share crucial information about brain health so that we can empower individuals in the country and worldwide.
“The last pillar is access, and here we are demanding equitable access to diagnostic services, proper treatment, and the availability of rehabilitation for those who need it, everywhere and at all times,” Onwuekwe said.
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