Two South Africans suffer a stroke every 10 minutes

Two South Africans suffer a stroke every 10 minutes of every day, and minutes can make a crucial difference between life and death, or quality of life after a stroke.

About one-third of the approximately 240 people who suffer a stroke in South Africa daily do not survive,i while a third[ii] of survivors will live with chronic disability – but a stroke is treatable if symptoms are recognised quickly and treatment is accessed in time.

One in four adults over the age of 25 will experience a stroke in their lifetime, and it is the second leading cause of death worldwide.

“Time is brain,” said Neurological Society of South Africa (NASA) president Dr Patty Francis on World Stroke Day, 29 October.

“When stroke occurs, every second counts. The longer the brain is deprived of blood and oxygen, the more severe the damage and the higher the likelihood of death or disability. Quick action to restore the blood supply to the brain is therefore vital to arrest the damage and prevent further loss of function,” she said.

It has been estimated that for every minute of diminished blood flow to the brain, two million neurons are lost.

Life changes irrevocably for many stroke survivors, who lose mobility, memory and speech abilities, along with their independence and quality of life.

“They will not be able to return to work and many who have until now taken care of families, will themselves need fulltime care for the remainder of their lives.

“However, timely treatment saves lives and can vastly improve patient outcomes, leaving independence, quality of life and precious memories intact,” Dr Francis said.

On World Stroke Day, with the #Precioustime campaign, NASA and the World Stroke Organisation (WSO) aim to raise awareness of the signs of stroke and the importance of taking swift action, as well as ensuring better care and support for survivors.

Stroke symptoms appear suddenly and often simultaneously, and the most common are sudden weakness or numbness in the face, or the arm or leg on one side of the body, along with loss of speech, or difficulty speaking or understanding speech.

Unlike heart attacks, strokes are generally painless, which puts patients at risk of ignoring the symptoms until it is too late, Dr Francis said.

The acronym BEFAST acts as a reminder of both the signs and the need for swift action, standing for Balance (loss of), Eyesight (loss, blurred or fuzzy), Face (drooping to one side), Arm (weakness in one arm), Speech (slurring, difficulty speaking/understanding, not making sense) and Time to call for help.

“These are the signs used with high accuracy by paramedics to screen for stroke, and by simply remembering this acronym and an emergency number, anyone can save a loved one’s life,” Dr Francis said.

She explained that the majority (approximately 85%) of strokes occur when the blood supply to the brain is disrupted, depriving the brain of blood and oxygen, which causes rapid loss of brain cells (neurons); and consequent loss of functioning seen in stroke survivors.

Strokes can be also caused by haemorrhage (15%) when a burst vessel causes blood to leak into the brain, most commonly caused by high blood pressure.

“Clot-dissolving drugs can restore the blood supply; but to be effective they must be administered in less than 4.5 hours after stroke onset. The sooner a stroke patient therefore reaches a stroke-ready hospital where they can access urgent treatment, the better their chances of surviving the event and leading a disability-free life,” she said.

Although stroke can occur at any age, and up to 15% of strokes occur in people under 50,[v] the risk is higher among people over the age of 65 and those with a family history of stroke.i

People living with HIV are also at higher risk of stroke, at a younger age. A recent study of stroke patients in the Western Cape found that those with HIV were younger on average than HIV-negative stroke patients, with an average age of 46 compared to 55 years. Stroke patients with HIV also had fewer of the traditional risk factors for stroke and were more likely to develop infections in hospital.[vi]

High, uncontrolled blood pressure and atrial fibrillation (abnormal heart rhythm) are the highest risk factors for having a stroke. Global efforts to reduce risk highlight blood pressure treatment, and screening and treatment for irregular heart rhythm.

Up to 80% of strokes can be prevented[vii] by medical treatment of hypertension, diabetes, arrhythmia, and elevated cholesterol and triglycerides. Additionally, prioritising a healthy lifestyle by following a healthy diet, exercising regularly, smoking cessation and alcohol reduction is strongly recommended.

“Even small improvements in each of these can make a difference, and it is never too soon to start a stroke-prevention strategy. By quitting smoking, drinking less alcohol, moving more, choosing healthy foods and keeping blood pressure under control, almost everyone can protect themselves from a potentially devastating event,” Dr Francis said.

The Neurology Association of South Africa (NASA) in collaboration with the South African Stroke Society (SASS) partners annually with The Angels Initiative and World Stroke Organisation (WSO) for World Stroke Day.

The Angels Initiative and the FAST Heroes project are two key global projects in the WSO’s drive to raise awareness of the signs of stroke, and aim for faster and better treatment, which have also been implemented in South Africa.

The Angels Initiative aims to establish more stroke-treating hospitals around the world and provides training for medical professionals to raise the standard of stroke treatment worldwide. Founded in 2016, it is now the biggest stroke community in the world, with over 7 500 registered hospitals that treat 3.8 million stroke patients annually.

Steve Biko Academic Hospital in Gauteng last year (2021) became the first hospital in South Africa to win a WSO Diamond Award, given to hospitals that provide the highest level of stroke care.

FAST Heroes leverages children’s enthusiasm for learning and sharing to transfer knowledge about stroke to their parents and grandparents. Children enrolled in FAST Heroes at their school learn about the most common symptoms of stroke and the importance of calling an ambulance immediately if these symptoms appear.

FAST Heroes has so far been launched in almost 9,000 classrooms around the world, and in 26 countries including South Africa. In March 2022, the campaign collected a Guinness World Record for creating the world’s largest online photo album of people wearing superhero costume masks.

At the first-ever FAST Heroes awards ceremony and teacher summit held on 22 June 2022, primary school learner Ivanechia Jooste from South Africa received an award for engaging with the programme in a way that inspired others and offered an example to their peers.