Three claims about burden of stroke in Nigeria
Source: Prof Abayomi Ogun, president of the Nigerian Stroke Organisation
One correct, one unproven, one misleading
The president of the Nigerian Stroke Organisation said stroke was the most common medical emergency in most hospitals in Nigeria and accounted for up to eight out of 10 neurological hospital admissions, with at least 100,000 cases every year.
There isn't enough evidence to back up the claims that stroke is the most common medical emergency, or that it accounts for that many hospital admissions.
While Nigeria like many other countries is unprepared to treating stroke, accurate data would help improve the public debate.
Researched by Motunrayo Joel
A photo taken in October 2015 shows the emergency entrance of the University of Calabar Teaching Hospital. Stroke is a common medical emergency in Nigeria. Photo: PIUS UTOMI EKPEI / AFP
On World Stroke Day in 2019, Nigerian media reported on the toll of the life-threatening condition, which is caused by the sudden interruption of blood supply to the brain.
We checked three of his claims reported in the Daily Trust, a national newspaper.
In Nigeria, stroke is the most common medical emergency in most hospitals.
Ogun told Africa Check he had been accurately quoted, and shared six academic and medical research papers to support his claim.
A paper on medical mortality in the accident and emergency unit of the University of Port Harcourt Teaching Hospital. This found that of 5,304 patients seen from January to December 2005, all older than 16, there were 349 deaths. Sixty (25.8%) of them were from "all forms of stroke". It did not say how many were diagnosed with stroke.
An analysis of 4,005 autopsy reports at the Lagos University Teaching Hospital from 1982 to 2001. Half (52%) of the 252 deaths linked to high blood pressure were due to stroke.
A study of 200 unconscious adult patients at the University College Hospital in Ibadan from August 2004 to March 2005. A third of them were diagnosed with acute stroke, which was the most common cause of the patients' coma.
A follow-up study, in 2011, of 66 of the adults diagnosed as having had a stroke in the previous research at the University College Hospital in Ibadan.
A 2016 study to see if hospital admission after hours or over weekends resulted in higher death rates. Out of 339 patients, 55.7% (187) had suffered a stroke. But the 339 patients accounted for 34.5% of all admissions in the study period.
A study of 2,922 patients admitted into the accident and emergency department of the Federal Medical Centre in Ekiti state from January 2010 to December 2012. Heart failure was the leading cause of admission with 329 patients, followed by stroke with 283 patients.
We asked several experts if this evidence supported the claim.
Comprehensive survey needed
Dr Abiodun Bello, a consultant neurologist at the University of Ilorin Teaching Hospital, reviewed the papers shared with us. More evidence was needed, he said.
"One would need to look for articles on medical admissions as a whole out of which the percentage that form stroke patients can be determined."
Bello said stroke was a common medical emergency, but if primary, secondary and tertiary health centres were all considered, it was unlikely to be the most common.
Consultant neurosurgeon Prof Timothy Odebode agreed that a comprehensive survey would be required.
"In my field, I believe the most common medical emergency is head injury. For a neurologist, it is stroke. Each medical field has its most common medical emergency," Odebode said.
"Medical emergency is a broad topic. If the claim was that stroke is the most common neurological emergency then I would say it is true," she said.
"For adult internal medicine, which is a subspecialty in medical emergency, the claim you are fact-checking is true. However, there are other subspecialties in medical emergency."
Prof Tanimola Akande, a consultant public health physician, told Africa Check that other emergencies were more common. These included cardiac failure, severe hypertension, gastroenteritis and bronchial asthma.
Most common neurological emergency
But Akande added that the claim could be true for specific age groups and hospital settings.
Emmanuel Sanya, a consultant physician and neurologist, told Africa Check that many studies showed stroke was the leading cause of medical admission in adults and elderly patients in Nigeria.
"It is equally the most common neurological diagnosis warranting admissions," Sanya said.
Dr Muhammed Adeboye, a consultant paediatrician, said stroke was the most common medical emergency "among adults". But "in children, I would say febrile convulsion" or seizure was most common.
Based on this, we rate this claim as unproven.
Stroke accounts for up to eight out of 10 neurological hospital admissions.
The Nigerian Stroke Society's Ogun directed us to a study on admissions for neurological diseases in Kano, which he said was Nigeria's most populous state.
Out of 6,282 admissions at the Aminu Kano Teaching Hospital from January 2005 to September 2008, some 980 were for neurological diseases. The study found stroke accounted for 77.6% of these.
Dr Uduak Umana, secretary of the Neuroscience Society of Nigeria, said the figure would likely change from one healthcare facility to another.
"I wouldn't state for a fact that stroke accounts for up to eight out of 10 neurological admissions. It varies."
Yakub Nyandaiti, a professor of neurology at the college of medical sciences, University of Maiduguri, said it would be inaccurate to draw a general conclusion that stroke accounts for eight out of 10 neurological admissions based on findings from one hospital.
"Findings or the data from the hospital (mentioned in the claim) is not a general picture of what is going on in all hospitals in Nigeria. Also, a claim must have a time frame. That is, the claim should read in the last five to 10 years, or something," he said.
As admissions at one hospital are not representative of 'most hospitals' in Nigeria, we rate this claim as misleading.
At least 100,000 stroke cases occur every year [in Nigeria].
Other organisations have given different figures. In October 2019, the chief executive officer of Stroke Action Nigeria, Rita Melifonwu, was widely reported as saying that "in Nigeria, stroke continues to affect 200,000 people annually". We have asked her for the source of this statistic.
A 2017 article in the Lancet journal also made an estimate of 200,000 new cases, adding that Nigeria did not yet have a national stroke registry.
Ogun told Africa Check that his number was likely "underestimated", which was why he said "at least". He gave as evidence a 2007 study in the Surulere Local Government Area of Lagos state. This focused on 189 first-ever cases of stroke, which were then adjusted for age to allow for comparisons, to find an incidence rate of 54.08 cases per 100,000 people a year.
This study was "the most up to date reference we have on the incidence of stroke in Nigeria", he said.
Ogun said that with "Nigeria's 2019 population being estimated at over 200 million, the number of incidents (new) stroke cases will be at least 108,000 per year".
But Nigeria's population is disputed, with a census last conducted in 2006.
Dr Abiodun Bello, a consultant neurologist at the University of Ilorin Teaching Hospital, told Africa Check the evidence was "sufficient since it is an estimate derived from incidence reported".
Bello asked us to check further with the World Health Organization or the global burden of diseases study led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US.
WHO communications officer Paul Garwood told Africa Check the organisation did not have specific data on the number of new cases of stroke in Nigeria in a year. It only had data on how many deaths were due to cerebrovascular disease, he said. But this didn't cover Nigeria.
But Dr Valery Fiegin, who heads the neurology section at the global burden of diseases study, told Africa Check that their latest 2019 estimates showed that there were "over 149,000" new strokes in Nigeria. This could have been as high as 167,000 or as low as 133,000.
We therefore rate Ogun's claim of 'at least 100,000' as correct.