Stroke Know the signs
 
     
 

STROKE: subarachnoid haemorrhage in Nigeria

 
 
 
 
KNOW THE SIGNS, PREVENT DEATH AND DISABILITY
  
     
 

Subarachnoid Haemorrhage in Nigeria

  
 

Subarachnoid Haemorrhage is reported as rare in many communities in the developing world. Whether this is because it is underdiagnosed, diagnosed as stroke or simply unreported is difficult to ascertain.

A recent Medline literature review of publications on stroke in Nigeria was conducted on the 20th July 2002. Only 26 papers on stroke related subjects were found to have been reported in the English literature since 1966. Four of the papers reported on SAH and aneurysms.

 
     
     
 

Incidence:

 
 
This was not evaluated in any of the papers.
  
 

 

 

 

  
  Age of occurence:  
  It appears that SAH was more common in young males. Adeloye reported that spontaneous SAH was found mostly in males below 45 years of age. Nwosu detailed that 11.9% of 67 young patients (16-45 year olds) presenting with stroke in Enugu, had SAH. It seems that from the age of 50 years the incidence of SAH fell progressively. Given the life expectancy of 51 years in Nigeria, it is possible that the fall is due to reduced numbers of people older that 65 years of age. The percentage of older people in Nigeria has been recently quoted as 2.82% in comparison to 15-20% in some Western communities.  
     
  Diagnosis and Management:  
  Information available from the Lagos University Teaching Hospital, Lagos, indicate that patients with SAH are treated as Ischemic stroke patients and managed by the neurologists. Surgery is rarely undertaken. Patients are treated conservatively, routinely with bed-rest and nursing care. There are many reasons for this. More importantly is the lack of appropriate diagnostic facility such as cerebral angiography or computed tomography angiography or Magnetic Resonance Angiography. Even where this is available, there is a dearth of microsurgical facilities and neurosurgeons. It has been recorded that there is one neurosurgeon in Lagos to treat a population close to 10 million. Similar ratio exists for neurologists and neurosurgeons in many other parts of the country. This can be compared to the figure of 1 neurologist to 180,000 patients in the UK.  
     
 

The future:

  
  The future is difficult to imagine. What can be done to improve the care of patients with SAH in Nigeria? Information about stroke in general and SAH in particular must be disseminated widely. People participation should be encouraged in developing local services. We must aim to give information about the need for private investments in medical and surgical management of stroke. The cost of setting up the services is minimal when compared to the loss of lives, disability and economic losses to each individual, family, and the country as a whole.  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
   
     
  Created by B I Ogungbo in September 2002. Modified May 2009. ©