Stroke: Not just a disease for the old

Beatrice Onyango was overjoyed when she gave birth to her son. Leroy was her first child and she could not hide the joy of becoming a mother.

But, just as he was turning one, her happiness was cut short by a life-threatening illness. “Around November 2007, I noticed my son’s mood had changed. It was unusual, but I thought he was just being moody,” recalls the resident of Umoja One estate in Nairobi.

She, however, noticed something was amiss when she tried making him stand as she used to when bathing him. Leroy could only stand on one foot. “All hell broke loose when I decided to immerse the baby in water. He began stretching and crying uncontrollably,” she says.

There was one more sign everything was not okay. As the baby cried, his mouth moved leftwards and this time he could not stand at all. Panicky, she called her husband, explained what had happened and headed straight to a hospital in Buruburu. But, just before she was attended to, her husband called and told her to go to his sister’s place in Kariobangi to see a herbalist because he believed herbal medicine would do the magic. On arrival, her sister-in-law would hear none of it and was against visiting a herbalist upon seeing the baby.

The day was wearing out and Leroy was now grappling with pain and breathing heavily. Together with her husband, they took him to Mbagathi hospital where, after a series of tests, doctors could not tell what the problem was. “I was devastated, but telling me they did not know what the problem was broke my heart,” she recalls.

BLOOD CLOT

At Kenyatta National Hospital (KNH) where they had been referred for further tests and check-up, there was even less hope as doctors here too could not establish the cause of the problem. They, however, recommended the boy’s admission for close monitoring.

On one Sunday morning in December, a doctor, who got interested in the boy’s case, advised the mother to take him for a CT scan that revealed a blood clot in his head. He was diagnosed with a haemorrhagic stroke. “The news came as a relief! As much as it wasn’t good, I was better off knowing what my child was suffering from,” she says.

According to Prof Erastus Amayo, a neurophysician and a professor of medicine at University of Nairobi, contrary to common belief, stroke does not only affect older people, but also children. He adds that it is one of the top 10 causes of death in children worldwide.

“A stroke occurs when the blood supply to part of one’s brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. This can cause brain cells to cease functioning of the body parts they control. People can lose their speech, muscle strength, vision, memory, feeling or coordination. Some patients recover completely; others are seriously disabled or, in a worst case scenario, die,” he explains.

BRAIN DAMAGE

There are two types of stroke - ischemic, which may be caused by a blocked artery and haemorrhagic stroke, which comes as a result of bursting of a blood vessel. Prof Amayo says a stroke is a medical emergency, therefore, prompt treatment is crucial to minimise brain damage and potential complications.

“Leroy began treatment immediately, but the journey was not smooth,” explains Beatrice, adding, “In the ward, due to the large number of patients at KNH, Leroy had to share a bed with another child. He contracted pulmonary tuberculosis and chicken pox in the process, illnesses that prolonged his recovery.”

Six months later, when discharged, she was instructed to go for physiotherapy to enable his son move and occupational therapy to help him gain functionality of his hands. By that time, Leroy was three and could neither walk nor talk.

She says St Ann’s Primary School for special kids in Buruburu came in handy to help with physiotherapy while Gertrude’s Children Hospital in Buruburu was equally helpful with speech therapy.

In Kenya, as is the situation in sub-Saharan Africa, the burden of childhood stroke is a concern, but experts say reports from these countries are scarce and the pace with which we are reducing mortality rate is wanting.

OVERWHELMING COST

An analysis by National Center for Biotechnology Information, performed at KNH from files of patients aged between one month and 18 years with a diagnosis of stroke, showed the estimated prevalence of 16 per 100,000, higher than the 1.3–13 per 100,000 reported in other populations. This suggests that paediatric stroke is not uncommon in the Kenyan population.

The report, Paediatric stroke in an African country, further noted that 32 cases of paediatric stroke out of 712 were retrieved in an inpatient population of about 200,000 over the study period. Twenty of these (62.5 per cent) were male while 12 (37.5 per cent) were female.
Wilson Moti, a physiotherapist, urges stroke patients, irrespective of their age, to go for therapy. “Therapy is very essential and patients must avoid falling back on therapy the moment they start feeling better. Yes, the cost may be overwhelming, but therapy allows patients to regain both their physical abilities and functionality to become independent like everyone else,” he says.

The strain on finances is one Beatrice understands all too well. “One session of physiotherapy, which lasts for an hour, cost Sh1,500 and he needed three weekly,” she says.

Also, she was out of work most of the time, honouring dates with doctors and therapists.

Furthermore, when she decided to take his son to school, yet another problem she grappled with had was unwillingness by managers to admit pupils with physical disabilities such those who could neither walk nor talk.

But, perhaps one of the most positive things that came out of the boy’s experience at school was that he started uttering a few words and with time he could express himself. “He had a surgery on his left foot in April 2015 that got him walking with the support of crutches a month later. Faith in God is what kept me going,” she says.

Fast forward to 2020 and Leroy is now in Class Seven at the age of 13 and independently goes to school in perfect health.

According to Prof Amayo, some of the causes of stroke in children include inflammation of the blood vessels, heart issues such as congenital heart disease, clotting disorders and inherited conditions like sickle cell and migraines.

The signs and symptoms to watch out for include trouble speaking and understanding, paralysis of the face, arm or leg, trouble seeing with one or both eyes, headaches and difficulty in walking.

Mr Evans Nyambega, the chairperson of Stroke Association of Kenya, insists that recovery begins with acceptance and that is why he urges stroke survivors, irrespective of their age, to join support groups where they can meet with people who understand their pain and encourage one another.