In 2013 Thabiso Senamela had a terrible headache. He walked from his home in Soshanguve, north of Pretoria, to buy painkillers at a local pharmacy. But before reaching his destination he  suddenly collapsed in the street. 

Passersby rushed him to a hospital. He had had a stroke. 

“I am told that I was in a coma for two weeks. I had also experienced internal bleeding in my head. Doctors say I was lucky that I was rushed to the hospital before or else I would have suffered more severe effects,” says Senamela.

He was only 18 years old and in his matric year at the time. He had to spend the whole of 2014 recovering at home and only returned to school in 2015 to complete his matric.

“The stroke really affected me in a negative way, even in my schoolwork. By the time I was discharged from the hospital I found that my classmates had already written their final year exams. I was gutted,” Senamela recalls.

Underlying causes

Strokes usually happen when the blood supply to a part of the brain is reduced or interrupted. According to the Heart & Stroke Foundation South Africa, every hour, ten people in South Africa suffer from a stroke. 

Hypertension is the main cause of cardiovascular diseases including strokes. Cardiovascular diseases are non-communicable diseases (NCDs) affecting the heart and brain. 

In South Africa more than one in three adults have hypertension. The condition is responsible for one in two strokes. A 2022 study estimates that 49% of hypertension cases go undiagnosed. 

In addition to strokes, untreated or poorly managed hypertension can lead to heart attacks and kidney failure. A recent report by Statistics South Africa (Stats SA)  shows that NCD-related deaths have been increasing since 1997. Cardiovascular diseases accounted for half of all NCD-related deaths over this period. By 2018, it made up more than 17% of all deaths recorded.  

Source: Stats SA

Some of the major risk factors associated with this condition are modifiable and include physical inactivity, poor diet, excessive alcohol use and smoking.

Historically strokes were known to mainly affect the elderly. But in recent years studies have found that cases of strokes are on the increase among young people, especially young adults from the age of 18 years.

Other risk factors associated with strokes can be genetic, or having comorbidities such as diabetes, high cholesterol or dyslipidemia. 

Personal and public health challenge

In South Africa strokes are the second highest cause of disability and death. Those who survive are usually left with life-long complications. 

Senamela developed epilepsy as a result of the stroke. He now suffers from occasional (four to five times a year) epilepsy episodes or fits. His hands are always shaky and he can no longer lift heavy objects and he must  take medication on a daily basis to manage the condition. 

“The stroke really affected the left side of my body. I can no longer walk properly like the way I used to before the stroke. I also used to be a soccer player but due to the stroke I can no longer play the sport I dearly love as I have difficulties running now,” says Senamela.

The stroke also had a negative impact on Senamela’s social life. Most of his friends and classmates distanced themselves from him while he was recovering from the stroke.

“To be honest I lost self-confidence while on my road to recovery. I used to doubt my abilities, but luckily because of the support I received from my family, I managed to work on regaining my self confidence but it was not easy,” he says.

Interventions 

Dr Annabale Cois is a senior researcher at Stellenbosch University whose primary focus is on the epidemiology of NCDs and associated risk factors. Cois says that cardiovascular diseases pose an immense burden on society at large.

“Treatment services for cardiovascular diseases, especially for acute events such as strokes and heart attacks are highly specialised and expensive to establish and run. There is growing evidence that, especially in low- and middle-income countries, cardiovascular diseases are important contributing factors to poverty,” says Cois.

Cois says that cardiovascular diseases are the result of a complex interplay of various factors, which include insufficient physical activity, excessive alcohol consumption and unhealthy diets.

“The effect of these factors is often an increase in blood pressure, raised levels of blood glucose and cholesterol, and obesity, which in turn are directly related to the development of severe cardiovascular disorders,” says Cois.

Dr Lynn Hendricks has conducted research about cardiovascular diseases including strokes, and says South Africa has a host of policies to address NCDs. 

These policies include the national strategic plan for the prevention and control of NCDs and restrictions on alcohol advertising. There are also population-based interventions such as conducting awareness about the importance of reducing salt and sugar intake. But these measures are not always implemented well for various reasons.

“We’ve previously done work with decision-makers looking at how these policies were planned. We found that, to address the risk factors for hypertension and diabetes in South Africa, policies and programmes must account for the needs of the public and address the historical and social-economic climate,” says Hendricks.

She says that the feasibility and sustainability of programmes can only be ensured when the resources are provided, and environments are enabling to promote behaviour change. For example, healthy meals could be provided for those who can’t afford it. And job creation will go a long way towards enabling people to take care of their immediate needs. 

Looking ahead

Thanks to the support of his family Senamela has been able to forge a life for himself. 

In October he graduated from the University of South Africa with a qualification in supply chain management and is currently doing a learnership.

Senamela says that more awareness is still needed in South Africa to educate people about the dangers of cardiovascular diseases and how people can prevent most of them.

“I did not know it could affect young and physically fit individuals. I used to think that only the old and fragile with compromised immune systems could suffer a stroke,” he says.

“Now every chance that I get, I always advise people about the importance of health screening and healthy eating as I believe that had I gone for a regular health screening maybe the stroke signs might have been picked up earlier.” –Health-e News.