Ibrahim Gezawa

Overweight and Obesity among Adolescents in Kano, Nigeria

Background: Childhood and adolescent obesity is a global public health concern because of associated increased risk of cardiovascular diseases later in life. Although there are several studies on childhood obesity in Nigeria, few have assessed it in adolescents. Objectives: This study intends to assess the prevalence of overweight and obesity in adolescents in urban northern Nigeria. Method: A cross sectional school based survey was conducted to determine the prevalence of overweight and obesity. Stratified sampling was used to select 718 students. Their weight and height were measured and used to compute the Body Mass Index (BMI). Overweight and obesity were defined using the International Obesity Task Force (IOTF). Results: The prevalence of obesity and overweight were 0.84% and 1.98% respectively; with advancing age as a risk factor for both overweight and obesity. Multivariate logistic regression showed that the risk of overweight was almost two times higher with advancing age adjusted odds ratio of {1.79} with a p-value of { 0.03} and C.I. { 1.05 - 3.09}, adjusted for gender and school type. Conclusion: The data suggest the prevalence of overweight and obesity are low, and that advancing age is a risk factor for obesity.

Knowledge, attitude, and practice of diabetic retinopathy among Physicians in northwestern Nigeria

Background: Diabetic retinopathy (DR) is the leading cause of preventable blindness in the productive population that poses a considerable global public health burden. Objective: The objective of this study is to assess the knowledge, attitude, and practice of DR screening among physicians in Northwestern Nigeria. Materials and Methods: Survey responses were obtained from 105 physicians in 4 tertiary hospitals using a Likert scale questionnaire. The internal consistency of the questionnaire was calculated using Cronbachs alpha coefficient. Principal component analysis was used for data reduction and grouping with the varimax rotation method, and the factors were extracted based on an Eigenvalue >1. Results: Most of the respondents (78.8%) were aware of the most effective method of delaying the onset of DR and frequency of eye examination (94.1%). Lack of ophthalmoscopes (70.6%) and dilating eye drops (50.6%) form important barriers to performing a good eye examination. Conclusion: DR screening among physicians practicing in Northwestern Nigeria was suboptimal, which prompts the need for improved training of physicians managing persons with diabetes on eye examination in a bid to strengthen DR screening and reduce the burden of visual impairment in our environment.

Stroke in patients with diabetes mellitus: A study from Northwestern Nigeria

BACKGROUND Stroke is one of the major causes of morbidity and mortality worldwide and apart from being exceedingly harmful in diabetics, stroke is a disabling disorder. The study was undertaken to describe the clinical characteristics, outcome pattern and predictors of mortality in a cohort of diabetic patients presenting with stroke in two tertiary health facilities in North Western Nigeria. METHOD Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke in the emergency unit of the two tertiary hospitals in Kano were consecutively recruited for the study. Classification of stroke into hemorrhagic and infarctive subtypes was based on brain computerized tomography (CT), brain magnetic resonance imaging (MRI) and World Health Organization (WHO) criteria. Follow-up period was for thirty days. RESULT Out of the five hundred and thirty six stroke patients seen during the study period, 85 (15.9%) patients, comprising 48 (56.5%) males, had diabetes. Thirty eight (44.7%) of the identified diabetics were previously undiagnosed. Sixty four (75.3%) had infarctive stroke. One-month case fatality rate was 30.6%. Factors associated with death included male sex, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening GCS. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in the patients. CONCLUSION In DM patients studied, infarctive stroke was more common, case fatality was 30.6%. Male gender, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening Glasgow Coma Score (GCS) were associated with mortality. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in diabetic patients.

Prevalence and risk factors for diabetes mellitus in Nigeria: a systematic review and meta – analysis

Introduction : there has not been any recent nationwide health (diabetes) survey in Nigeria ever since the last one conducted in 1992 which reported a diabetes mellitus (DM) prevalence of 2.2%. We aimed to determine the prevalence and risk factors of DM in Nigeria using a systematic review and meta-analysis. Methods : we searched Medline, EMBASE, PubMed, Papers First, the Cochrane Library, Scopus, Bioline, African Journal Online, Institute of Science Information, and Google Scholar from year 1990 to 2016. Using MeSH headings, text words and word variations of diabetes mellitus, risk factors, prevalence and Nigeria was searched. The last search was performed on the 26th November 2016. We included only studies utilizing OGTT, random plasma glucose, fasting plasma glucose or HbA1c for diagnosis of DM. We included 23 studies (n = 14,650 persons). A random effect modeling was used to determine the pooled estimate of DM. We estimated overall pooled prevalence estimates of DM and sub group specific prevalence accounting for inter-study and intra-study variability/heterogeneity. Results : the overall pooled prevalence of DM was 5.77% (95% CI; 4.3-7.1). The pooled prevalence of DM according to the six geopolitical zones of Nigeria showed North-west 3.0% (95%CI; 1.7–4.3), North-East 5.9% (95%CI; 2.4–9.4), North-Central 3.8% (95%CI; 2.9–4.7), South-West 5.5% (95%CI; 4.0–7.1), South-East 4.6% (95%CI; 3.4–5.9), and South-South 9.8% (95%CI; 7.2–12.4). The pooled prevalence of DM among individuals with family history of DM was 4.6% (95%CI; 3.5 – 5.6); urban dwellers 6.0% (95%CI; 4.3–7.8); unhealthy dietary habits 8.0% (95%CI; 5.4 – 10.5); cigarette smokers 4.4% (95%CI; 1.3 – 10.2); older age 6.6% (95%CI; 4.5 – 8.7); the physically inactive 4.8% (95%CI; 3.2 – 6.4); and obese individuals 5.3% (95%CI; 3.8 – 6.9). Conclusion : there is an increase in the prevalence of DM in Nigeria affecting all regions of the country with the highest prevalence in the south-south geopolitical zone. Urban dwelling, physical inactivity, advancing age and unhealthy diet are important risk factors for DM among Nigerians. A national diabetes care and prevention policy is highly recommended.

Is glycated haemoglobin testing appropriate for screening and diagnosis of type 2 diabetes mellitus among Africans

Introduction : Glycated Haemoglobin (HbA1c) has been recommended for use as a diagnostic tool for diabetes mellitus (DM), but has not been adequately validated in the African population. We aimed to compare HbA1c and the OGTT in the diagnosis of type 2 DM, and to establish the optimal diagnostic cut-off value of HbA1c for diabetes Mellitus among Nigerians. Methods : a cross-sectional population-based screening of 1200 apparently healthy adults was performed using the WHO STEP wise method in Kano, Northwestern Nigeria using a multistage cluster random sampling technique. The fasting plasma glucose (FPG) was performed on subjects who observed the standard protocol (8 – 12 hour overnight fast) while casual plasma glucose (CPG) estimation was performed on the remaining subjects. HbA1c assay and oral glucose tolerance test (OGTT) were also performed on all subjects who had FPG between 6.1 – 6.9mmol/l or CPG between 7.8 – 11.0 mmol/l. The validity of the HbA1c was calculated while the receiver operator characteristics curve was used to establish the optimum diagnostic cut-off value for the HbA1c. Results : HbA1c 5.7- 6.4% identified 2.28% subjects as pre-diabetes. In subjects at high risk of diabetes, the OGTT identified newly diagnosed diabetes in 14 (1.37%) subjects, while the HbA1c 10 (0.98%) subjects. HbA1c cut-off value of ≥ 6.5% compared with FPG had a specificity, sensitivity, positive predictive value and negative predictive value of 63.63%, 98.92%, 70.00% and 98.57% while compared to OGTT, the HbA1c had a specificity, sensitivity, positive predictive value and negative predictive value of 57.14%, 96.49%, 80.00% and 90.16%. Conclusion : the use of glycated haemoglobin as a potential screening and diagnostic approach for T2DM in Nigerian adults at high risk of DM may be useful for its convenience after adjusting for confounders. An HbA1c cut-off value of 6.2% has an optimal sensitivity and specificity of 76.2% and 80.9% and can be used as a screening test.

Metabolic syndrome among HIV infected patients: A comparative cross sectional study in northwestern Nigeria

INTRODUCTION The increasing availability of antiretroviral drugs has made HIV-positive patients to live longer, and conditions that are associated with longevity such as metabolic syndrome and other cardiovascular related conditions have become relevant in them. This is less well studied among African populations. Therefore the study aimed at estimating and comparing the prevalence of and associated risk factors for the metabolic syndrome (MS) among African HIV infected patients. METHOD In this comparative cross-sectional study, we analyzed the data of 300 participants matched for age and gender who satisfied the inclusion criteria with half of the subjects on HAART, while the other half was HAART naïve. The MS was diagnosed using ATP-III criteria. RESULTS The mean age of the patients was 34.8±9.9years. The majority of the patients were females 64%. The prevalence of MS among HAART-exposed patients was found to be 19.3%, while it was 5.3% among HAART naïve patients (p=0.001). Raised triglyceride and elevated blood pressure were the criteria with the highest occurrence among HAART-exposed, 82.8% for each. Advanced age, longer duration of HIV diagnosis and HAART exposure, increased BMI, weight gain after HAART exposure, exposure to PIs and increased mean CD4 cell count were found to be significantly associated with MS (p<0.05). However, only age (OR 4.3, 95% CI 1.6-11.8, p=0.005) and BMI (OR 4.2, 95% CI 1.5-11.9, p=0.007) were found to be independently associated with the development of MS. CONCLUSION Exposure to HAART particularly protease inhibitor based regimen increases the risk of MS among HIV-infected patients.

Performance of waist circumference and proposed cutoff levels for defining overweight and obesity in Nigerians

Background: Waist circumference (WC) is a simple tool for measuring central obesity in routine clinic settings. Gender- and ethnic-specific optimal cutoff points for WC are encouraged for populations lacking such data. Objectives: To derive WC cutoff values, predictive of overweight and obesity in Nigerians and to evaluate the performance of currently recommended values. Subjects and Methods: Apparently, healthy urban dwellers from six cities spread across Nigeria were selected for this cross-sectional study. Biophysical profiles such as blood pressure and anthropometric indices were measured according to the World Health Organizations STEPs instrument protocol. Receiver operating characteristics curve analysis was used to determine the optimal cutoff levels using the decision rule of maximum (sensitivity + specificity). The level of significance was set at P < 0.05. Results: A total of 6089 subjects (3234 males and 2855 females) were recruited for the study. WC demonstrated a high area under the curve in both genders. Selected cutoff points ranged from 83 to 96 cm with high sensitivities and specificities. Conclusions: The currently recommended gender-specific WC cutoff values proved inappropriate in this study group, but WC remains a reliable tool for measuring obesity.

Prevalence of thinness among adolescents in Kano, Northwestern Nigeria

Background: Thinness in older children has been associated with delayed pubertal maturation, reduced muscular strength and work capacity. There is paucity of studies on thinness among adolescents in Nigeria. Objectives: The aim of this study was to determine the prevalence of thinness among adolescents in Kano, Northwestern Nigeria . Materials and Methods: In this descriptive cross-sectional survey, we used a multi-staged random sampling technique to select 718 students from six secondary schools in Kano metropolis. A pretested questionnaire was used to collect socio-demographic data. Physical measurements for weight and height were carried out using standard procedures. Results: The overall prevalence of thinness was 60.6%, with a higher prevalence among boys (63.0%) compared with girls (58.7%). Grades-I, II and III thinness were found in 26.0%, 15.5% and 19.1% of the studied subjects respectively. The prevalence of grade III thinness was higher among boys (19.4%) compared with girls (18.8%). The rate of thinness was observed to increase with age up to 16 years after which it starts to fall. Older age was also found to be independently associated with thinness among our subjects. Conclusion: The prevalence of thinness among adolescents in Kano is high, with a slightly higher rate in boys than girls. There is need for concerted effort by policy makers to come up with programmes aimed at reducing the burden of undernutrition among school children in our setting.

Prevalence of hypertension and its relationship with indices of obesity in Maiduguri, Northeastern Nigeria

Background: Hypertension is the greatest preventable cause of death one of the most important modifiable risk factors for cardiovascular diseases. There is paucity of studies on the relationship between obesity and hypertension in northern Nigeria. Objective: To determine the prevalence of hypertension and its relationship with indices of obesity in Maiduguri, northeastern Nigeria. Materials and Methods: We recruited 1700 consenting adults aged 15-70 years using a multistage random sampling technique. Data on socio-demographic characteristics were obtained using a pretested questionnaire. Physical measurements for anthropometric indices and blood pressure (BP) were carried out using standard procedures. Hypertension was defined as systolic BP ≥ 140mmHg and/or diastolic BP ≥ 90mmHg. Multiple logistic regressions were fitted and odds ratios with 95% confidence intervals were calculated to identify associated factors. Results: Of the 1700 subjects recruited, 1650 responde, d yielding a response rate of 97%. The overall prevalence of hypertension was 32.3%, with a higher prevalence among women than men (46.1% vs. 34.5%, P 40 years), BMI and WC were found to be independently associated with hypertension. There is need for further studies to determine the role of lifestyle modification in reducing the burden of hypertension in our environment.

Choreoathetosis as a manifestation of thyrotoxicosis in a Nigerian woman: A case report and review of the literature

We report the case of a 65-year-old Nigerian woman with thyrotoxicosis manifesting as choreoathetosis, which misdiagnosed as a seizure disorder. The movement abnormality was characterized by bilateral jerky, purposeless, intermittent, irregular, and sometimes writhing movements, predominantly in the distal joints. Thyroid function test showed elevated total serum triiodothyronine (T3) and thyroxine (T4), and reduced serum thyroid stimulating hormone (TSH). There was complete resolution of choreoathetoid movement after 1 week of propanolol use. The relationship between choreoathetosis and thyrotoxicosis is discussed.