It can strike a child in the middle of a school day, a young parent at the height of their working life or an older person who has spent decades believing they understand the risks. Across Kenya, doctors are increasingly confronting a disease that is breaking the old stereotype of who gets a stroke.
Globally, more than 12 million people experience a first stroke every year, according to the World Stroke Organisation. More than 60 per cent occur in people below 70, while 16 per cent affect those below 50.
Behind the numbers are lives abruptly interrupted — breadwinners unable to work, children forced to relearn basic movements and families confronting months or years of rehabilitation.
“Stroke is basically limited blood supply in an area of the brain,” explains Dr Kuria Waweru, a vascular and endovascular neurosurgeon and chair of the Kenya Stroke Society.
Whether caused by a blocked blood vessel or bleeding in the brain, the result can be devastating. And because brain cells begin dying when deprived of oxygen, doctors emphasise a simple rule: Time is brain.
Dr Waweru says the damage can happen quickly, making stroke a medical emergency where every minute can affect the outcome.
There are two main types of stroke—an ischaemic stroke, which occurs when a blood vessel supplying the brain becomes blocked, usually by a blood clot or fatty deposits; and haemorrhagic stroke which occurs when a blood vessel ruptures and bleeds into the brain. There is also transient ischaemic attack (TIA), sometimes referred to as a mini-stroke, which occurs when blood supply to part of the brain is temporarily disrupted, producing stroke-like symptoms that later resolve. TIA should not be ignored because it develop into full stroke.
The growing burden is becoming more urgent as hypertension, diabetes, obesity and sedentary lifestyles continue to rise across Kenya. According to Waweru, hypertension remains the single most contributor to stroke. “Kenya’s adult hypertension prevalence is more than 28 per cent, yet less 10 per cent people with high blood pressure have it properly controlled,” he says. “A lot of patients come with stroke and they didn’t even know they had high blood pressure.”
Diabetes, unhealthy cholesterol levels, tobacco use, obesity, heavy alcohol consumption and physical inactivity also increase the risk. An irregular heartbeat known as atrial fibrillation is another major contributor, although it often goes undiagnosed.
The growing burden among younger people is particularly worrying. Stroke is increasingly being diagnosed among people below 50. A study by Lancet Neurology noted a 20.4 per cent increase in stroke rates among people below 55 between 2000 and 2019.
Kennedy Kang’ang’i, a physiotherapist at Karen Hospital, says stroke commonly manifests through weakness affecting one side of the body. One side of the face may droop, while the arm and leg on the same side may lose strength. A person may also struggle to hold food or liquid in the mouth, begin drooling, experience dizziness or difficulty standing.
The warning signs are commonly remembered through FAST: Face drooping, Arm weakness, Speech difficulty and Time to seek emergency help. Kenya’s stroke awareness campaign also uses the Kiswahili acronym UPESI to reinforce the same message. The important thing is not to wait for symptoms to disappear or assume someone simply slept badly. Stroke requires urgent attention.
Once a patient reaches hospital, doctors first need to establish the type of stroke, often via an urgent brain scan to determine whether the problem is a blockage or bleeding. A patient with ischaemic stroke may receive clot-dissolving medicine or undergo a procedure to remove the clot. In a haemorrhagic stroke, doctors work to prevent the bleeding from worsening.
The difference between arriving early and arriving late can be enormous. Waweru says Kenya has the science and treatment needed to manage stroke, yet access remains a major challenge. He estimates that fewer than one in every 200 eligible stroke patients currently receive the life-changing treatments.
Treatment is only the beginning for many survivors. Stroke can leave someone struggling to walk, speak, swallow, remember, concentrate or perform everyday tasks. Rehabilitation brings together professionals such as physiotherapists, occupational and speech therapists to help survivors regain independence.
Kang’ang’i says: “Physiotherapy is active exercise to awaken the muscles that have been affected by the stroke.”
Rehabilitation should begin once a patient is medically stable, to restore function and independence.
The emotional side of recovery can be just as difficult. “Recovery of stroke first and foremost is very emotional,” Kang’ang’i says.
Someone who was previously independent may suddenly need help with dressing, eating, walking or working.
Prevention starts long before a stroke happens. “It looks remarkably ordinary,” says Dr Waweru. “It means knowing your actual blood pressure number rather than guessing at it. It means treating hypertension and diabetes consistently, moderating salt, sugar and alcohol, staying physically active and quitting tobacco.”
Kang’ang’i has another way of putting it. “We take our cars to the garage every few months,” he says. “How often do you take your body to the garage (hospital for check ups)?” Routine check-ups can reveal silent conditions such as high blood pressure and diabetes before they cause serious complications.
The message from both experts is straightforward. Stroke can happen at any age, yet many of its major risk factors can be controlled. Knowing the warning signs can save precious time. Reaching the right hospital quickly can change the outcome, while rehabilitation can help survivors rebuild their independence.
For stroke, every second matters.
