Kolawole Wahab

Modifiable cardiovascular risk factors among apparently healthy adult Nigerian population - a cross sectional study

BackgroundCardiovascular disease (CVD) remains a major cause of morbidity and a leading contributor to mortality worldwide. Over the next 2 decades, it is projected that there will be a rise in CVD mortality rates in the developing countries, linked to demographic changes and progressive urbanization. Nigeria has witnessed tremendous socio-economic changes and rural-urban migration which have led to the emergence of non-communicable diseases. We set out to determine the prevalence of modifiable CVD risk factors among apparently healthy adult Nigerians. This is a descriptive cross-sectional study carried out at Katsina, northwestern Nigeria from March to May 2006. Subjects for the study were recruited consecutively from local residents, hospital staff and relations of in-patients of the Federal Medical Centre, Katsina using convenience sampling. Socio-demographic information, anthropometric measurements and blood pressure were obtained from the subjects in a standardized manner. Venous samples were collected for necessary investigations and analyzed at the hospital central laboratory.FindingsThree hundred subjects (129 males and 171 females) with a mean age of 37.6 ± 10.6 (range 18-75) years were studied. Prevalence of the modifiable cardiovascular risk factors screened for were as follows: generalized obesity 21.3% (males 10.9%, females 29.2%, p < 0.05), truncal obesity 43.7% (males 12.4%, females 67.3%, p < 0.05), hypertension 25.7% (males 27.9, females 24%, p > 0.05), type 2 diabetes mellitus 5.3% (males 5.4%, females 5.3%, p > 0.05), hypercholesterolaemia 28.3% (males 23.3%, females 32.2%, p < 0.05), elevated LDL-cholesterol 25.7% (males 28%, females 24%, p > 0.05), low HDL-cholesterol 59.3% (males 51.9%, females 65%, p < 0.05), hypertriglyceridaemia 15% (males 16.3%, females 14%, p > 0.05) and metabolic syndrome 22% (males 10.9%, females 30.4%, p < 0.05).ConclusionsWe found high prevalence of CVD risk factors among apparently healthy adult Nigerians. In order to reduce this high prevalence and prevent subsequent cardiovascular events, encouragement of a healthy lifestyle is suggested.

Prevalence and determinants of obesity - a cross-sectional study of an adult Northern Nigerian population

Background Obesity is assuming an epidemic dimension globally. It is important to appreciate factors associated with the disease so that a holistic approach can be taken in tackling the rising burden. The objective of this study was to determine the prevalence of overweight and obesity and the factors independently associated with obesity in an urban Nigerian population. Methods A cross-sectional study of 300 healthy adult subjects was conducted in the urban city of Katsina, northern Nigeria. Relevant sociodemographic and clinical information were obtained. Screening for obesity was done using the Body Mass Index while relevant laboratory investigations were conducted. Univariate and multivariate logistic regression analyses were performed to determine the predictors of obesity. Results Overweight and obesity was found in 53.3% and 21.0% respectively with a significantly higher prevalence in females compared to males (overweight: 62.0% vs 41.9%, p < 0.001; obesity: 29.8% vs 9.3%, p < 0.001). In univariate analysis, the odds of obesity were higher in women and in the presence of hypertension, hypercholesterolaemia and hyperuricaemia. However, in multivariate analysis, factors independently associated with obesity were female sex (OR 6.119, 95% CI 2.705-13.842, p < 0.001), hypercholesterolaemia (OR 2.138, 95% CI 1.109-4.119, p = 0.023) and hyperuricaemia (OR 2.906, 95% CI 1.444-5.847, p = 0.003). Conclusion There is a high prevalence of obesity in northern Nigeria and women are significantly more affected. The high prevalence is independently associated with female sex, hypercholesterolaemia and hyperuricaemia. Public health education is urgently needed in order to reduce this burden and prevent other non-communicable cardiovascular disorders.

The burden of stroke in Nigeria

Stroke is a leading cause of morbidity and mortality worldwide, and it is likely to worsen in developing countries over the next two decades based on the projections by the World Health Organization (WHO). With the current scourge of HIV/AIDS and the battle against other communicable diseases like multi-drug resistant malaria and tuberculosis; Nigeria, the most populous black nation in the world, stands to risk the further straining of its resources as a result of the increasing prevalence of stroke and other cardiovascular diseases due to epidemiological transition. The current prevalence of stroke in Nigeria is 1.14 per 1000 while the 30-day case fatality rate is as high as 40%. Management of the disease is largely conservative while there is little or no funding for high-quality research. Primary prevention is the key to reducing the burden of the disease in a country with such poor resources.

A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria

BACKGROUND Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. OBJECTIVES To review the clinical patterns, risk-factors, and outcome of stroke in a tertiary hospital in rural Nigeria and examine the rural-urban variation of stroke hospitalization in Nigeria. MATERIALS AND METHODS We carried out a retrospective study of patients who had a clinical diagnosis of stroke at the Federal Medical Centre, Ido-Ekiti, South-western Nigeria between November 2006 and October 2009. RESULTS A total of 101 patients who had stroke were admitted during this review period, accounting for 4.5% of medical admission and 1.3% of total hospital admission. Women accounted 52.5% of cases, with a male to female ratio of 1 : 1.1. Their mean age was 68 ± 12 years. Stroke occurrences increased with age, as almost half (49.5%) of the cases were aged ≥70 years and majority (84.2%) of them were in low socioeconomic class. The mean hospital stay for stroke treatment was 12 ± 9 days, Glasgow coma score on admission was 11 ± 4. Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; and indeterminate, 1.0%. Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking (22.8%) were the common identifiable risk factors for stroke. Of all the patients, 69% had ≥2 risk factors for stroke. Thirty-day case fatality was 23.8%; it increases with age and was higher among men than women (29.2 vs 18.9%) and in patients with diagnosis of hemorrhagic stroke (34.3 vs 18.5%). The numbers of identifiable risk factors of stroke has no effect on the 30-day case fatality. When compared with stroke in urban areas of Nigeria, we found no differences in frequency of hospitalization (1.3 vs 0.9 - 4%) and the major risk factor (hypertension). Hemorrhagic stroke was more common in urban than in the rural community (45.2 - 51 vs 34.7%) and the 30-day case fatality was lower in the rural community (23.8 vs 37.6 - 41.2%). CONCLUSION Stroke is also a common neurological condition in rural Nigeria, in view of the fact that almost 70% of the patients had ≥2 risk factors of stroke. We recommend that, sustainable, community-friendly intervention programmes are incorporated into the health care system for the early prevention, recognition, and modification of the risk factors in persons prone to the disease.

Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: A cross-sectional study

BackgroundAlthough stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.MethodsA hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.ResultsThere were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.ConclusionAwareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.

Migraine: prevalence and associated disability among Nigerian undergraduates.

BACKGROUND Studies on migraine in Nigeria are scanty while the disability associated with the disease has not been determined. We aimed at determining the lifetime prevalence of migraine and its associated disability among the students of a Nigerian university. METHOD Using a multi-stage sampling method, undergraduates of Ambrose Alli University, Nigeria were screened with the International Headache Society (IHS) criteria. Those who satisfied the criteria for migraine were then assessed with the Migraine Disability Assessment questionnaire to ascertain the level of disability resulting from migraine in the three months preceding the study. Information was also obtained on the use of preventive and abortive medications. RESULTS Out of the 1513 respondents screened, 145 satisfied the IHS criteria for the diagnosis of migraine giving an overall lifetime prevalence of 9.6% (females 10.3%, males 8.9%, p > 0.05). Migraine associated disability was little or none in 53.1% (males 55.2%, females 51.3%, p > 0.05), mild in 10.3% (males 11.9%, females 9.0%, p > 0.05), moderate in 20.7% (males 20.9%, females 20.5%, p > 0.05) and severe in 15.9% (males 11.9%, females 19.2%, p > 0.05). In spite of the fact that 53 (36.6%) of the migraineurs had moderate-severe disability, only 19/53 (35.8%) reported being on preventive treatment while none had ever used a triptan. CONCLUSION Prevalence of migraine among our respondents falls within the range reported from similar studies among university students outside Africa. In spite of the high disability associated with the disease, use of effective preventive and abortive therapies is very poor.

Pain as a Symptom in Patients Living With HIV/AIDS Seen at the Outpatient Clinic of a Nigerian Tertiary Hospital.

Although the negative impact of pain on the quality of life of patients living with HIV has been documented in many Western studies, there is a paucity of data on pain in HIV-infected patients in Nigeria in spite of a large disease burden. We studied the frequency of pain as a symptom and determined the body regions often affected among our cohort of patients attending the antiretroviral (ARV) clinic. An interviewer-administered questionnaire was used to obtain information on presence of pain in the 2 weeks before the interview. Those with pain were further screened with the modified Brief Pain Inventory. There were 79 respondents-40.5% males, mean age 37.1 ± 8.6 years. Pain was present in 22 (27.8%) of the respondents. The major regions affected by pain were lower limbs (40.9%), head and neck (31.8%), and abdomen (31.8%). Only 40% of those with moderate to severe pain intensity reported being on any form of analgesia.Although the negative impact of pain on the quality of life of patients living with HIV has been documented in many Western studies, there is a paucity of data on pain in HIV-infected patients in Nigeria in spite of a large disease burden. We studied the frequency of pain as a symptom and determined the body regions often affected among our cohort of patients attending the antiretroviral (ARV) clinic. An interviewer-administered questionnaire was used to obtain information on presence of pain in the 2 weeks before the interview. Those with pain were further screened with the modified Brief Pain Inventory. There were 79 respondents—40.5% males, mean age 37.1 + 8.6 years. Pain was present in 22 (27.8%) of the respondents. The major regions affected by pain were lower limbs (40.9%), head and neck (31.8%), and abdomen (31.8%). Only 40% of those with moderate to severe pain intensity reported being on any form of analgesia.

Knowledge of Stroke Risk Factors among Nigerians at High Risk

BACKGROUND Although the first step toward effective primary prevention of stroke is awareness of its risk factors, there is limited information on knowledge of these risk factors among Nigerians at increased risk. We assessed the knowledge of risk factors for stroke among Nigerians at high risk. METHOD Using an interviewer-administered questionnaire in a cross-sectional design, high-risk patients (defined as those with a diagnosis of hypertension and/or diabetes) attending the specialist medical outpatient clinics of the University of Ilorin Teaching Hospital were requested to mention all the stroke risk factors they knew. The outcome measure was ability to mention at least 1 well-documented modifiable or potentially modifiable risk factor. Binary logistic regression analysis was used to determine predictors of the outcome measure. RESULTS The mean age of the respondents was 56.4 ± 12.6 years. Only 39.8% were able to mention at least 1 well-documented modifiable or potentially modifiable risk factor; hypertension was the most recognized (34.7%). Other risk factors mentioned by the respondents were: diabetes (7.3%), alcohol intake (4.5%), smoking (3.8%), overweight and obesity (1.9%), and heart disease (.6%). Factors found to be significantly associated with ability to correctly mention at least 1 stroke risk factor were younger age (<55 years), more than 12 years of formal education, family history of stroke, urban residence, and previous health education on stroke. CONCLUSIONS Despite being at high risk, knowledge of stroke risk factors is poor among our respondents. Intensive health education is needed to improve on this poor knowledge.

Frequency and determinants of the metabolic syndrome in apparently healthy adult Nigerians

Non-communicable disease conditions such as the metabolic syndrome further strain the already insufficient health resources in Africa, where communicable diseases such as malaria and HIV/AIDS are still causing significant morbidity and mortality. We studied the frequency and determinants of the syndrome in apparently healthy Nigerian volunteers in order to provide a basis for the establishment of a prevention programme.

Interleukin–6 (IL-6) rs1800796 and cyclin dependent kinase inhibitor (CDKN2A/CDKN2B) rs2383207 are associated with ischemic stroke in indigenous West African Men

BACKGROUND Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub - Saharan African populations. Interleukin-6 polymorphisms have been previously associated with ischemic stroke in some non-African populations. AIM Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6, CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. METHODS Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 23 SNPs in rigorously phenotyped cases (N=429) of ischemic stroke (Men=198; Women=231) and stroke- free (N=483) controls (Men=236; Women=247). RESULTS Interleukin-6 (IL6) rs1800796 (C minor allele; frequency: West Africans=8.6%) was significantly associated with ischemic stroke in men (OR=2.006, 95% CI=[1.065, 3.777], p=0.031) with hypertension in the model but not in women. In addition, rs2383207 in CDKN2A/CDKN2B (minor allele A with frequency: West Africans=1.7%) was also associated with ischemic stroke in men (OR=2.550, 95% CI=[1.027, 6.331], p=0.044) with primary covariates in the model, but not in women. Polymorphisms in other genes did not show significant association with ischemic stroke. CONCLUSION Polymorphisms rs1800796 in IL6 gene and rs2383207 in CDKN2A/CDKN2B gene have significant associations with ischemic stroke in indigenous West African men. CDKN2A/CDKN2B SNP rs2383207 is independently associated with ischemic stroke in indigenous West African men. Further research should focus on the contributions of inflammatory genes and other genetic polymorphisms, as well as the influence of sex on the neurobiology of stroke in people of African ancestry.