OPINION: Alarming data on stroke

Thursday November 7 2019

Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

In the last week of October, doctors from Muhimbili National Hospital in a press conference relayed that in a day they see 3 to 4 patients suffering from stroke. I just could not believe this.

As a medical student in the early eighties we saw one or two stroke patients in a month (from two patients to 120 patients a month!!). This is an increase of 6000 per cent, so what is being done to prevent this?

Are we supposed to wait for a preventive policy document from the Directorate of Preventive services of the Ministry of Health?

Readers, I submit that this is alarming, shocking, disturbing, frightening and distressing data and someone somewhere should be held accountable for this uncheck situation. Millions of shillings are spent to treat such patients and there is absolutely no preventive strategy in place, WHY? Isn’t it well known that an ounce of prevention is worth a pound of cure?

Prevention has always been affordable and easy. The cure, however, is largely expensive and usually very painful and unusually obtrusive, not stress-free in any way.

A healthy population is not only happy and contented population with a good quality of life, but efficient as well in their respective fields.


Therefore, it is not only the individuals and family but the state as well, which suffers expenditure in managing the illness.

Thus preventing disease and promoting health pays high dividends to society at large. May I ask what % of total healthcare expenditure goes towards preventive healthcare?

This data is indeed disturbing and I do not see any serious response from the powers that be.

I get the feeling that to the concerned ministry this seems normal and for them it is business as usual, maybe we need some celebrity and a few politicians to get stroke to then perhaps there will be some action.

By now there should have been on the ground a functional implementation program to prevent strokes and other NCDs.

Today my aim is not to write an essay on NCDs and its preventive strategies, I am sure there are experts who should be doing this. My aim is to give a wake up call to the ministry that is in deep somber sleep.

Taxpayers are paying dearly for NCDs but this is not overtly felt or is visible, it is indirect, somehow concealed from the public eye because it’s a technical/professional domain hence even Presidents office is overlooking this. It is high time that we need to see preventive activities for NCDs.

I will elaborate on some of the biggest challenges in preventing NCDs: first NCDs are posing an increasing challenge for health systems, which have to date largely focused on tackling infectious diseases and maternal, neonatal, and child deaths. To effectively address these changing needs, we need detailed epidemiological data on NCDs. This includes a strong component of research.

The second challenge is behavioral change, to change the mind set that these diseases can be controlled and prevented by modern medicine and life style changes and there is no need to visit witchcraft specialist or sorcery.

Next is to bring about a culture of healthy eating and systemic physical activity. I think this challenge in behavior change is even bigger than the one we encountered in HIV control. Next is to control smoking and alcohol intake, which are a big risk factors. Again this is part of the behavior change agenda.

Another mind-set change is undergoing annual medical check ups especially for age fifty and above.

The next challenge is to put more emphasis on population-wide prevention and inclusion of the non-health sector stakeholders to help cascade national efforts to the grassroots level.

A concerted effort from the highest political level is needed to address overarching NCD drivers while maintaining health system improvement strategies.

The factors that increase the likelihood of both ischemic and hemorrhagic stroke include: smoking, high blood pressure, obesity, cholesterol levels, diabetes, excessive alcohol intake and stress.

Other non-lifestyle modifiable related factors that may have an effect on stroke include your age, family history, ethnicity and your medical history.

NCDs (include motor traffic accidents) should not be tackled separately as a vertical program, nor should they displace communicable diseases as priorities.

Instead, given resource constraints, and some shared determinants, characteristics, and interventions, there is scope for an integrated approach focusing on functions (prevention, treatment, and care) rather than on disease categories.

Selective, evidence-based actions to reduce NCDs will address the changing disease burden and achieve a more sustainable improvement in health outcomes, more efficient use of resources, and better equity across patients and populations.

When will Tanzanians see an effective NCDs control program implemented?

Zulfiqarali Premji is a retired MUHAS professor. His career spans over 40 years in academia, research and public health.