Abstract

 Stroke is the leading cause of death and disability worldwide. Stroke is also known as a cardiovascular accident defined as a brain attack when the blood vessel supplying the brain with oxygen and nutrients are interrupted or completely cut off.

Approximately 13.7million new cases of stroke occur annually, and about 5.5million people die of the disease. What motivated the researcher to carry out this work is the prevalence rate she experienced at the solidarity hospital Molyko Buea. Thus identifying the risk factors can help inhabitants of the Ndongo 1 community establish prevention strategies. This study was conducted to assess the knowledge of inhabitants aged 40years and above on the risk factor and prevention of stroke in the Ndongo 1 community.

This was a community based cross-sectional study conducted in 2022 amongst randomly selected inhabitants aged 40years and above. Data on socio-demographic characteristics, knowledge on the risk factor of stroke and prevention on stoke were acquired using a well-structured questionnaire

Out of 100participant 70% were females while 30% were men. 82% were aware of stroke while 18% have never heard of stroke. Only 20% could correctly define stroke. Majority of the participant knew stroke had a cause and rightly sorted out the underlying cause but had little knowledge about the risk factor. Again they had little knowledge on the prevention and some went as far as to say it cannot be prevented.

There exist a significant gap in population awareness about stroke, risk factor and prevention in the Ndongo 1 community and this is similar to previous report. Cost effective community health education intervention taking into account socioeconomic status may be beneficial in this setting.

 CHAPTER ONE

GENERAL INTRODUCTION

1.0 Introduction

Introduction runs from background to statement of problem, objective, significant of study, scope of study. Stroke is defined as the abrupt onset of a focal neurological deficit lasting more than 24hours. It is also called cerebrovascular accident (CVA) or apoplexy.

1.1 Background 

Stroke occurrence has been reported as early as 2700 years ago in ancient Mesopotamia and Persia. The first more detailed account of stroke, referred to as apoplexy meaning struck down with violence, were written by Hippocrates (460 to 370 BC), describing a sudden collapse, a loss of consciousness and paralysis (Barnhart R, et al., 2012). Physicians knew very little about the cause of stroke and the only established therapy was to feed and care for the patients until the attack ran its course.

As technology advanced, Physicians and scholars began to evaluate pathophysiological changes. Thomas Willis (1621-1675) recorded the clinical history of two patients in whom he suggested that the anatomical configuration of the arteries at the base of the brain could prevent apoplexy (Thompson JE et al., 2011).

Willis was the first to recognize that lesion in the region of the internal capsule will produce hemiplegia (kopit J.A et al., 2001). In his apoplexia, Johann Jacob Weper (1620-1695) suggested that people who died of apoplexy had bleeding in their brain, Weper also identified the main arteries supplying the brain, the vertebral and carotid arteries, and he suggested that apoplexy might be caused by a vessel. Thus stroke became known as cerebrovascular disease (national Institute of neurological disorder and stroke NINDS).

Stroke is defined as abrupt onset of a focal neurological deficit lasting more than 24 hours. It is also called cerebrovascular accident (CVA) or apoplexy (Easton JD et al., 2001).  An acute stroke refers to the first 24 hour period of a stroke. Focal neurological deficit lasting less than 24 hours (usually 520 minutes). Stroke is classified on the basis of its etiology as either ischemic (87%) or hemorrhagic (13%) (Donnan et al., 2008).

Ischemic stroke is produced by occlusion of a cerebral artery [thrombotic or Hemorrhagic stroke is caused mainly by spontaneous rupture of blood vessels or aneurysms or secondary to trauma (Warlow C, et al., 2011). Stroke has different risk factors which can be grouped into modifiable and non-modifiable risk factors.

Major risk factors for stroke includes; age, history of cerebrovascular event, smoking, alcohol consumption, physical inactivity, hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, obesity, diet, nutrition, and genetic risk factor (Bamford J et al.,2016). A stroke assessment scale used in conjunction with a CT may help resolve Uncertainties resulting from an inconclusive scan. Computerized tomography (CT) is the most immediately useful imaging method in identifying/differentiating cerebral hemorrhage from infarction (bigbee, J et al., 2012). However, perhaps the most exciting new advance in the field of stroke research is the recent approval of a drug treatment that can reverse the cause of stroke if given during the first few hours after the onset of symptoms.  (National Institute of Neurological Disorders and Stroke (NINDS). (NINDS, 1999).

Stroke is the leading cause of disability, dementia and death worldwide. Approximately 70% deaths from stroke and 87% of stroke related disability occur in low-income and middle Income country (Hamdy et al., 2013).

Stroke is a public health burden because approximately 13.7 million new cases of stroke occur annually and about 5.5 million people die of the disease every year. Of which 53% are men while 43% are women.

Stroke accounts for every nine deaths in the United States and on average, someone dies of stroke every 3minutes 42seconds (Abd-Allah et al., 2014). Stroke occurs approximately 152,000 times a year in the United Kingdom and every 3minutes 27seconds a stroke do occur and every 2second someone in the world will have stroke for the first time (Scottish intercollegiate guideline 2012).

A total of 57million deaths occurred in the world in 2008. WHO projections show that non-communicable disease death shall increase the rate of stroke by 15% globally between 2010-to-2020, to 44 million deaths. In sub Africa, stroke mortality remains a problem because 30% of health workers in the hospital could not identify the brain as an organ affected by stroke. 90% correctly identified hypertension as a risk factor. 14% considered as an evil spirit or witchcraft as cause of stroke and 13% preferred to go for spiritual healing (Davis et al., 2016) WHO project that by the year 2025 there will be an increase in regions of Africa, south Eastern Asia and Eastern Mediterranean by 20%.

In African regions, WHO estimated non communicable diseases will be 3.9 million deaths of stroke by 2020. South Eastern Asia will be 10.4 million deaths and western Pacific 12.3 million deaths (Anderson 2016) Current projections estimated that the number of deaths stood at 6.5 million in 2015 and will raise to 7.5million by 2030 (Elaine et al., 2018). In Cameroon, basic epidemiological data are not routinely available. Stroke patients are at higher risk of death in the first weeks after an event, and between 20 to 50% die within the first month depending on type, age, severity and effectiveness or treatment of complications (European journal of neurology).

WHO published in 2017 stroke in Cameroon reached 14 056 or 6.36% of total deaths. The age adjusted rate is 136 18 per 100,000 of population and it ranks Cameroon the number 28th in the world (Hinkle JL et al., 2007). Here is a paucity of data regarding the burden of CVD admissions in Cameroon in this era of epidemiological transition which limits the formulation of data driven national policies. Also there are no morbidity and mortality registries for CVD in Cameroon.

1.2 Problem Statement

Stroke remains the second leading cause of death at the global level and in the European region. Out of the 56million deaths occurred worldwide. 10.8% are due to stroke (World Health Organization. 2008).

Stroke accounts for about 1 of every 19 deaths in the United States. (American Heart Association 2013) on average someone dies of stroke every 3minutes 42seconds in 2016. Virtually, no country in the world has a reduction in stroke burden in terms of absolute numbers of incidence and fatal stroke (strong K et al., 2007).

The increasing global stroke burden strongly suggests that the current primary stoke prevention strategies are not sufficiently effective. Although global incidence and mortality declined from 1990-2013, the stroke burden, in terms of absolute number of people affected by stroke, continues to increase (Rowthwell PM et al., 2014).

From the researcher’s observation at Solidarity hospital Molyko Buea, 95% of the patient’s age 40years and above who came visiting, were diagnosed of transient ischemic attack (TIA), which is a warning sign of future stroke.

This has been a great burden to the researcher seeing parents, elderly once suffering from a disease that awareness of the risk factor and avoiding it can to a greater extent prevent the disease from occurring. To satisfy my curiosity the researcher decided to assess inhabitants knowledge aged 40years and above on the risk factors and prevention of stroke in the Ndongo 1 community Molyko Buea.

1.3 Objectives Of The Study

1.3.1 General Objective

Assessing inhabitants knowledge aged 40years and above on the risk factor and prevention of stroke in the Ndongo 1 community Molyko Buea.

1.3.2 Specific Objective

1. To assess inhabitants knowledge aged 40years and above on stroke in Ndongo 1 community
2. To assess inhabitants knowledge aged 40years and above on the risk factor of stroke in the Ndongo 1 community
3. To ascertain inhabitants knowledge aged 40years and above on the prevention of stroke in the Ndongo 1 community

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