Cultural Beliefs and Psychosocial Stress Are Unseen Potential Predisposing Factors for Stroke in Sub-Saharan Africa: Reality for Post-Stroke Rehabilitation

Abstract

This work considered post-stroke rehabilitation in sub-Saharan Africa, referencing psychosocial stress and wrongful cultural beliefs. Stroke, a neurological disease preventable by lifestyle changes, is increasing at, particularly in sub-Saharan Africa (SSA). First-ever stroke cases stand the risk of a second, which could be fatal; hence the need for review of post-stroke rehabilitation strategies. In our work on survivors, we noted that most established risk factors do not necessarily apply in SSA. Of the 10 risk factors studied, hypertension was the commonest reported. In our study of 149 survivors in Nigeria, 73.1% suffered from hypertension; only 53.7% were aware of their hypertensive status before stroke incidence. When asked about risk factors, 19.4% mentioned hypertension, 0.7% diabetes mellitus but 13.1% psychological stress, and 13.4% spiritual attack/diabolical; 39.6% had no idea what caused stroke. The findings show the role hypertension, psychological stress and cultural ignorance play in fueling stroke in SSA. Further, 97.3% of survivors were married, 65.1% had 5 to 8 children, engaged in sedentary occupations, trading, farming, civil service, occupations also prone to economic woes in Nigeria. Commonest age of survivors was 60 to 75 years; a period of very stressful life in Nigeria. All these culminate to sustained psychosocial pressures, hypertension and stroke. There is urgent need to reduce psychosocial pressures, correct wrongful cultural beliefs, especially among survivors in sub-Saharan Africa. The strength of this work lies in the observation of lack of awareness and community screening as the most pronounced common variable among the survivors. The place of herbal medicine in post-stroke rehabilitation should be recognised. Of the 117 survivors who visited Bebe Herbal Centre for management, 99.1% were satisfied; 67.5% of them had satisfactory recovery in less than 1 month. Introduction of physiotherapy in Herbal centres would speed up recovery.