Ac Onwuchekwa

Pattern of heart failure in a Nigerian teaching hospital

Background Congestive cardiac failure (CCF) has emerged as a major public health problem worldwide and imposes an escalating burden on the health care system. Objective To determine the causes and mortality rate of CCF in the University of Port Harcourt Teaching Hospital (UPTH), south Nigeria, over a five-year period from January 2001 to December 2005. Methods A retrospective study of CCF cases were identified from the admission and discharge register of the medical wards of UPTH and the case notes were retrieved from the medical records department and analyzed. Results There were 423 patients: 242 males and 181 females. Their ages ranged from 18 to 100 years with a mean of 54.4 ± 17.3. The commonest causes of CCF were hypertension (56.3%) and cardiomyopathy (12.3%). Chronic renal failure, rheumatic heart disease, and ischemic heart disease accounted for 7.8%, 4.3%, and 0.2% of CCF, respectively. Peripartum heart disease was rare despite being commonly reported in northern Nigerian females. Eighteen patients died from various complications with a mortality rate of 4.3%. Conclusion The burden of CCF in the Niger Delta is mainly attributed to hypertension. Efforts should be geared towards hypertension awareness, detection, treatment, and prevention in the region.

Stroke in young Nigerian adults

Stroke in adults under the age of 45 results in a greater loss of potential years of life than for other adults. This premature loss of life is associated with a high social and economic burden. Few data are available regarding stroke among young Nigerian adults in the Niger Delta Basin. This study sought to determine the incidence, risk factors, stroke subtypes and case fatality of stroke among young Nigerian adults. The medical records of all 18- to 45-year-old patients admitted with stroke in the medical wards of the University of Port Harcourt Teaching Hospital (UPTH) from January 2003 to December 2008 were retrospectively reviewed. Of the 611 patients admitted with stroke, 54 (8.8%) were aged 18-45 years. There were 26 males and 28 females. Hypertension was responsible for 42 (77.8%) stroke cases. Other important risk factors were excessive alcohol intake (27.8%), heart disease (13%), diabetes mellitus (11.1%), cigarette smoking (11.1%) and HIV infection (7.4%). The total case fatality was 29.6% with intracerebral hemorrhage (ICH) having higher case fatality of 69.2% than cerebral infarction (CI) with a case fatality of 16.7%. Among the young Nigerian adults who presented with stroke, 53.7% survived. The authors conclude from the above information that the incidence of stroke in young patients at UPTH is low. Hypertension is the most important risk factor of stroke; however, other less common but important risk factors in the young adults are cigarette smoking, diabetes mellitus and HIV. Efforts should be made to reduce the impact of stroke in this age group by focusing on these risk factors, which are either preventable or modifiable.

Urinary schistosomiasis in Maiduguri, north east Nigeria

From January to December 1983, 12,207 specimens of urine were examined for ova of Schistosoma haematobium and 753 (6.17%) were positive. From this group, 44 adult patients were investigated for urinary tract abnormalities. Haematuria was the commonest presenting symptom (81.8%) followed by lower abdominal pain (77.3%) and dysuria (68.2%). Urinalysis revealed proteinuria in 55.5%, leucocyturia in 90.9% and microhaematuria in 88.6% of patients. Twenty-four hour protein excretion ranged from 230 mg to 2.2 g (mean 960 mg). Serum creatinine was raised in one patient (2.2 mg dl-1), Urological abnormalities included calcification of the bladder in 36.4%, ureteric strictures and dilatations in 65.9%, hydronephrosis in 9.1%, squamous cell carcinoma of the bladder in 4.5%, vesicle calculus in 2.3%, and multiple granulomatas in the bladder in 2.3% of the patients. The results of the study suggest that a sizeable population of this area is at risk of developing urological complications and consequently chronic renal insufficiency.

Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region

The burden of stroke has been projected to increase in low-and middle-income countries due to the ongoing epidemiological transition. However, community-based stroke prevalence studies are sparse in sub-Saharan Africa particularly in Nigeria. This study aimed to provide a comparative estimate of the prevalence of stroke survivors in the rural Niger Delta region. A three-phased door-to-door survey was conducted using WHO modified instruments. In the first-phase, 2028 adults (≥18years) participants randomly selected from two rural communities were screened by trained health research assistants for probable stroke. In the second phase, suspected cases were screened with stroke-specific tool. Positive cases were made to undergo complete neurological evaluation by two study neurologist in phase-three. Stroke diagnosis was based on clinical evaluation using WHO criteria. Overall, 27 (8 first-ever and 19 recurrent cases) stroke survivors with crude prevalence of 13.31/1000 (95% CI, 8.32-18.31) and a non-significant difference in prevalence between the two study communities were found, (P=0.393I). In addition, age-adjusted prevalence of stroke survivors was 14.6/1000 person, about 7-folds higher than previous estimates outside the Niger Delta region. The prevalence increases significantly with advancing in age, P<0·001. Among others, hypertension (92.59%) was the commonest risk factor and comorbidity found. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure, remains a public health priority.

Prevalence and Risk Factors for Stroke in an Adult Population in a Rural Community in the Niger Delta, South-South Nigeria

Sub-Saharan Africa is experiencing an epidemiologic transition with stroke contributing to the disease burden. However, community-based stroke prevalence studies are sparse. This study aimed to determine the prevalence of stroke in a rural population in the Niger Delta region in south-south Nigeria and to describe known risk factors for stroke among them. A door-to-door stroke prevalence study was conducted in 2008 among randomly selected adults of 18 years or older in rural Kegbara-Dere community in Rivers State, south-south Nigeria. We administered a modified screening tool by the World Health Organization, a stroke-specific questionnaire, and conducted a physical/neurological examination (on persons screening positive) in 3 stages of assessments. The crude prevalence of stroke was 8.51/1000 (95% confidence interval [CI] = 3.9-16.1) representing 9 of 1057 participants. The age-adjusted prevalence was 12.3/1000 using the US Population 2000. Men had higher unadjusted prevalence than women (12.9/1000 versus 5.1/1000) but were not at more risk (unadjusted relative risk = .99; 95% CI = .98-1.00). Stroke prevalence increased with age (Mantel-Haenszel χ(2) P = .00). Hypertension (blood pressure ≥140/90 mm Hg) was present in all stroke cases and diabetes mellitus (fasting blood sugar >126 mg/dL) in 1 person, but none had hypercholesterolemia, obesity (body mass index >30 kg/m(2)), or a history of alcohol intake or smoking. Stroke prevalence was found to be high, commoner among men and the elderly population, and likely to be predisposed by hypertension, in rural south-south Nigeria. The need to conduct follow-up studies on the burden and outcomes of stroke among this study population is acknowledged.

Clinical profile of hypertension at a University Teaching Hospital in Nigeria

Background: Hypertension in Nigeria is a widespread problem of immense social and economic importance because of its high prevalence and the severity of its complications. Aim: To define the morbidity and mortality pattern of hypertension at the University of Port Harcourt Teaching Hospital (UPTH). Method: Records of all patients admitted to the medical wards of the UPTH over a 5-year period with essential hypertension or any of its complications were retrieved from the ward and medical records and reviewed. Result: A total of 780 hypertensive patients were reviewed, constituting 28.2% of all medical admissions. Only 424 (15.2%) had complete records and were analyzed. Record keeping was poor. There were 173 (41%) males and 251 (59%) females with a male to female ratio of 1:1.5. The ages ranged from 18 years to 100 years with a mean of 56.5 ± 16.2. Stroke was responsible for 169 (39.9%) hypertensive complications. Heart failure occurred in 97 (22%) cases while renal failure and encephalopathy accounted for 40 (9.4%) and 7 (1.7%) hypertensive complications respectively. There were 99 deaths out of which 51 (51.5%) were due to stroke, 14 (14.12%) were due to heart failure, and 12 (12.1%) were due to renal failure. Conclusion: The contribution of systemic hypertension to the morbidity and mortality of adults at UPTH is quite significant.

The Burden of Hypertension in an Oil- and Gas-Polluted Environment: A Comparative Cross-Sectional Study

BACKGROUND Evidence of positive association between traffic-related air pollution and elevated blood pressure has been published widely. However, the risk of hypertension and prolonged exposure to crude oil pollution and gas flares remains unexplored. METHODS We recruited 2,028 residents (aged 18-80) in a cross-sectional survey of both oil/gas polluted and nonpolluted communities in the Niger Delta region of Nigeria. Prevalence and risk of hypertension, anthropometric indices, lifestyle and sociodemographic factors, and cardiovascular comorbidities were examined and compared between the 2 groups. Hypertension was defined as blood pressure ≥140/90mm Hg or on antihypertensive medication. Both univariate and multivariate logistic regression models were used to examine factors associated with hypertension. Model fits statistics were used to assess the parsimonious model and predictive power. RESULTS More than one-third of participants were hypertensive (37.4%). Half of the participants were from oil-polluted areas (51%). Only 15% of participants reported family history of hypertension. In the adjusted model, participants living in oil-polluted areas were almost 5 times as likely to have developed hypertension (adjusted odds ratio (aOR) = 4.85, 95% confidence interval (CI): 1.84-12.82) compared to participants in unpolluted areas. Age modifies the association between pollution status and risk of hypertension. For every 10 years increase in the age of the participants, the odds of developing hypertension increased by 108% (aOR = 2.08, 95% CI: 1.77-2.43). CONCLUSION The results suggested that exposure to oil/gas pollution may be associated with an increased risk of hypertension. Our findings need to be further investigated in longitudinal studies.

Pattern of rheumatic heart disease in adults in Maiduguri--north east Nigeria.

The pattern of rheumatic heart disease in 84 adolescent and adult patients seen over a 9 year period (1982–1990) at the University of Maiduguri Teaching Hospital (UMTH) is presented. Over 70% were in the second and third decades of life. Pure mitral incompetence and mixed mitral valve disease were the commonest valvular lesions. This pattern appears similar to those in other developing countries. Congestive cardiac failure was the commonest complication. Declining economic fortunes of the developing countries, over crowding, malnutrition and inadequate medical facilities may further perpetuate the condition. Early recognition and the management of rheumatic carditis and early valvular lesions will reduce the morbidity and mortality.

The Role of Computed Tomography in the Diagnostic Work‐Up of Headache Patients in Nigeria

Objective.— To determine the yield of computed tomography (CT) scan of the brain in the evaluation of patients presenting with headache at the University of Port Harcourt Teaching Hospital (UPTH).

Pattern of admissions to the University of Port Harcourt Teaching Hospital intensive care unit – a 10-year analysis

Objective. To determine the admission pattern and outcome of patients in the Intensive Care Unit (ICU) of University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria. Method. A retrospective review of all patients admitted to the ICU at the UPTH from 1996 to 2005 was carried out. Data were obtained from the ICU admission and discharge registers and nurses’ handover records. Results. A total of 1 447 patients were admitted from 15 departments. There were 658 males and 789 females (male/female ratio 1:1.2). Ages ranged from 4 months to 90 years, the median age was 30 years and the mean age was 31.7±5.6 years. The highest proportion of admissions (48.7%) was from the Department of Obstetrics and Gynaecology, and the lowest from Ophthalmology and Anaesthesia (0.1%). Postoperative cases made up 62.1% of total admissions, with post-caesarean section (CS) contributing 65.7% of these. Non-availability of beds in the ward was the reason for the majority of the post-CS admissions. Up to 41.5% of the patients admitted to the ICU had no justifiable reason for admission. Average length of stay was 8.1±2.8 days, median 4.5 days. One patient was manually ventilated for 5 hours, none was mechanically ventilated, and none had invasive cardiac monitoring. Three children had peritoneal dialysis for acute renal failure. Unconscious patients were fed enterally through a nasogastric tube, while conscious patients ate orally. Analysis of outcomes showed that 597 patients (41.3%) were transferred to the wards, while 352 (24.3%) were discharged home. The outcome was not indicated in 128 cases (8.8%), 16 patients (1.1%) left the ICU against medical advice, 1 patient (0.1%) was referred to another tertiary institution and 1 (0.1%) absconded. Three hundred and fifty-two patients died, giving a mortality rate of 24.3%. Conclusion. The highest percentage of admissions to the ICU was from the Department of Obstetrics and Gynaecology. The majority of the patients did not require intensive care but were admitted because there was no bed in the wards.