Njideka Okubadejo

Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria

BackgroundTo study the frequency and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension attending a tertiary hypertension clinic.MethodsTwo hundred and twenty-five consecutive hypertensive patients attending the hypertension clinic of the Lagos University Teaching Hospital over a 3-month period were interviewed. Socio-demographic data, duration of hypertension, clinic attendance, current blood pressure, and compliance to conventional medications was documented. CAM utilization was explored using both structured and open-ended questions.ResultsThere were 90 (40%) male and 135 (60%) female patients with mean age ± SD overall was 55.1 ± 12.4 years. 88 (39.1%) of the respondents used CAM. Herbal products were the most commonly used CAM type. Amongst the CAM users, the most common herbal product used was garlic (69.3%). Others were native herbs (25%), ginger (23.9%), bitter leaf (Vernonia amygdalina) (9.1%), and aloe vera (4.5%). 2.5% used spiritual therapy. There was no difference in the clinical characteristics, socio-economic status, and blood pressure control of CAM users and non-users. Patients who utilized CAM had higher BMI compared with those who did not, but the difference was not statistically significant (mean BMI ± SD of 29.1 ± 5.6 vs 27.1 ± 5.9 kg/m2; P = 0.05).ConclusionA significant proportion of hypertensive patients attending our tertiary facility and receiving conventional treatment also use CAM therapies. Clinicians need to be aware of this practice, understand the rationale for this health-seeking behaviour, proactively enquire about their use, and counsel patients regarding the potential of some of the therapies for adverse reactions and drug interactions.

Prevalence of Stroke in an Urban, Mixed-Income Community in Lagos, Nigeria

Background: The burden of cerebrovascular disease in developing countries is projected to be on the rise. However, data on the current epidemiology of stroke in Africa are sparse. Methods: Using a 3-staged method, we conducted a door-to-door study of stroke in an urban, mixed-income community in Lagos, Nigeria. We used a modification of the WHO protocol in the first stage, a stroke-specific questionnaire in the second stage and neurological examination of all persons screening positive for stroke in the third stage. We also examined an equal number of stroke-negative persons. Results: Overall, the crude prevalence rate of stroke in urban Nigeria was 1.14/1,000 (males: 1.51; females: 0.69). The age-adjusted prevalence rates per 1,000 (adjusted to the USA population 2000) in mid-decade strata showed a trend of increasing prevalence with advancing age as follows: 35–44 years = 0.009, 45–54 years = 0.33, 55–64 years = 0.71, 65–74 years = 0.98, 75–84 years = 2.04 and >85 years = 0.74. Conclusions: Stroke prevalence rates in urban Nigeria are lower than those in most developed countries. The lower rates may be related to lower incidence and higher stroke mortality in developing countries.

Prevalence and clinical characteristics of headache in medical students of the University of Lagos, Nigeria

We investigated the 1-year prevalence, clinical features and mode of treatment of headache in medical students of the University of Lagos, Nigeria, using a self-administered headache questionnaire. Headache prevalence was 46.0% and was significantly higher in women than in men (62.8% vs. 34.1%). Prevalence of tension-type headache was higher than that of migraine (18.1% vs. 6.4%). Although tension-type headache had a similar prevalence in both sexes (male 17.3%, female 19.2%), migraine was three times more common in women (10.9% vs. 3.2%). A family history of headache was present in 22.0%. Only 4.6% sought medical assistance, whereas 68.2% took non-prescription drugs, mainly simple analgesics. Specific drugs for migraine and tension-type headache were rarely used. In conclusion, 1-year headache prevalence is high among medical students at this university. The low consultation rate and the rarity of usage of specific anti-headache drugs probably reflect inadequacies in the management of primary headaches in this population.

Analysis of Nigerians with Apparently Sporadic Parkinson Disease for Mutations in LRRK2, PRKN and ATXN3

Several genetic variations have been associated with Parkinson disease in different populations over the past few years. Although a considerable number of worldwide populations have been screened for these variants, results from Sub-Saharan populations are very scarce in the literature. In the present report we have screened a cohort of Parkinson disease patients (n = 57) and healthy controls (n = 51) from Nigeria for mutations in the genes PRKN, LRRK2 and ATXN3. No pathogenic mutations were found in any of the genes. Hence, common pathogenic mutations in these genes, observed in several different populations, are not a frequent cause of Parkinson disease in Nigeria.

Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians

BackgroundHyperhomocysteinemia is a potentially modifiable risk factor for stroke, and may have a negative impact on the course of ischaemic stroke. The role of hyperhomocysteinemia as it relates to stroke in Africans is still uncertain. The objective of this study was to determine the prevalence and short-term impact of hyperhomocysteinemia in Nigerians with acute ischaemic stroke. We hypothesized that Hcy levels are significantly higher than in normal controls, worsen stroke severity, and increase short-term case fatality rates following acute ischaemic stroke.MethodsThe study employed both a case-control and prospective follow-up design to study hospitalized adults with first – ever acute ischaemic stroke presenting within 48 hours of onset. Clinical histories, neurological evaluation (including National Institutes of Health Stroke Scale (NIHSS) scores on admission) were documented. Total plasma Hcy was determined on fasting samples drawn from controls and stroke cases (within 24 hours of hospitalization). Outcome at 4 weeks was assessed in stroke patients using the Glasgow Outcome Scale (GOS).ResultsWe evaluated 155 persons (69 acute ischaemic stroke and 86 healthy controls). The mean age ± SD of the cases was 58.8 ± 9.8 years, comparable to that of controls which was 58.3 ± 9.9 years (T = 0.32; P = 0.75). The mean duration of stroke (SD) prior to hospitalization was 43.5 ± 38.8 hours, and mean admission NIHSS score was 10.1 ± 7.7. Total fasting Hcy in stroke patients was 10.2 ± 4.6 umol/L and did not differ significantly from controls (10.1 ± 3.6 umol/L; P = 0.88). Hyperhomocysteinemia, defined by plasma Hcy levels > 90th percentile of controls (>14.2 umol/L in women and >14.6 umol/L in men), was present in 7 (10.1%) stroke cases and 11 (12.8%) controls (odds ratio 0.86, 95% confidence interval 0.31 – 2.39; P > 0.05). In multiple regression analysis admission NIHSS score (but not plasma Hcy) was a significant determinant of 4 week outcome measured by GOS score (P < 0.0001).ConclusionThis exploratory study found that homocysteine levels are not significantly elevated in Nigerians with acute ischaemic stroke, and admission Hcy level is not a determinant of short-term (4 week) stroke outcome.

The prevalence and genetics of Parkinson's disease in sub-Saharan Africans

Parkinsons disease (PD) is under-studied in Black Sub-Saharan African (SSA) populations. To date, there have been only six prevalence and no incidence studies. The crude prevalence of PD in SSA varies from 7 to 20 per 100,000, which is appreciably lower than in Caucasian populations. There are a limited number of published studies (nine) on the genetic factors associated with PD in SSA populations. Mutations have been reported in the parkin gene, and are restricted to only three patients (two Black South Africans and one Zambian). No mutations have been identified in the LRRK2, SNCA, PINK, or DJ-1 genes. Given the unique ancestry of SSA populations, their inclusion in genetic studies may provide a substantial contribution to the identification of novel genetic factors and genetic-environmental interactions underlying this disorder. More initiatives are needed to drive further research on PD in these populations and to facilitate collaborative projects across Africa.

Influence of Age and Neurotoxic HAART Use on Frequency of HIV Sensory Neuropathy

Background. Sensory neuropathy (SN) is one of the most common AIDS-associated neurologic disorders especially in the era of highly active antiretroviral therapy (HAART). The aim of this study was to determine the prevalence of SN among highly-active-antiretroviral-therapy- (HAART-) experienced and HAART-naïve HIV-positive individuals and to investigate the relationship to demographic, clinical, and laboratory factors. Methods. 323 patients with HIV infection (142 on HAART and 181 HAART naïve) were enrolled in a cross-sectional neuropathy screening program. Data was collected using structured questionnaires which contained the brief peripheral neuropathy screening tool of AIDS Clinical Trial Group protocol. Neuropathy was defined by the presence of at least 1 clinical sign in a distal, symmetrical pattern. Patients were classified as symptomatic if they described aching, stabbing, or burning pain, paresthesia, or numbness in a similar distribution. Demographic, clinical, and laboratory details were documented as risk factors. Result. The prevalence of sensory neuropathy was 39.0% (126/323), (of which 29/126 (23%)) were symptomatic. Amongst those on HAART, 60/142 (42.3%) had SN compared to 66/181 (36.5%) HAART-naïve individuals (P = 0.29). On multivariate analyses, the independent associations with SN were increasing age (P = 0.03) and current exposure to stavudine (P = 0.00). Gender (P = 0.99) height (P = 0.07) use of HAART (P = 0.50), duration of HAART treatment (P = 0.10), and lower CD4 count (P = 0.12) were not associated with an increased SN risk. Conclusion. HIV SN remains common despite improved immunologic function associated with HAART and decreased neurotoxic HAART use. In this cross-sectional analysis, age and stavudine-based therapies were the independent risk factors.

High-risk of obstructive sleep apnea and excessive daytime sleepiness among commercial intra-city drivers in Lagos metropolis

Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra-city commercial drivers. Setting and Design: A descriptive cross-sectional study in three major motor parks in Lagos metropolis. Materials and Methods: Demographic, anthropometric and historical data was obtained. The risk of OSA and EDS was assessed using the STOP BANG questionnaire and the Epworth Sleepiness Scale, respectively. Statistical Analysis: The relationship between the OSA risk, EDS risk and past road traffic accident (RTA) was explored using the Pearsons chi square. Independent determinants of OSA risk, EDS risk and past RTA, respectively, were assessed by multiple logistic regression models. Result: Five hundred male commercial drivers (mean age (years) ±SD = 42.36 ± 11.17 and mean BMI (kg/m2) ±SD = 25.68 ± 3.79) were recruited. OSA risk was high in 244 (48.8%) drivers and 72 (14.4%) had EDS. There was a positive relationship between OSA risk and the risk of EDS (Pearsons X2 = 28.2, P < 0.001). Sixty-one (12.2%) drivers had a past history of RTA but there was no significant relationship between a past RTA and either OSA risk (X2 = 2.05, P = 0.15) or EDS risk (X2 = 2.7, P = 0.1), respectively. Abdominal adiposity, regular alcohol use and EDS were independent determinants of OSA risk while the use of cannabis and OSA risk were independent determinants of EDS. No independent risk factor for past RTA was identified. Conclusion: A significant proportion of commercial drivers in Lagos metropolis are at high risk of OSA and EDS.

Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, south-west Nigeria.

Introduction Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients. Methods One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD4 count was measured in all patients. Results The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ2 = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ2 = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction. Conclusion Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.

Primary Headache Disorders at a Tertiary Health Facility in Lagos, Nigeria: Prevalence and Consultation Patterns

Background. Primary headaches are underdiagnosed and undertreated, with a significant impact on social activities and work. Aim. To determine the last-year prevalence and health care utilization pattern of primary headaches at a tertiary centre. Methods. A cross-sectional study was carried out amongst staff of the Lagos State University Teaching Hospital in Lagos, Nigeria. 402 staff members were selected by simple random sampling and administered a detailed structured headache assessment questionnaire. Migraine and tension-type headache were diagnosed according to the criteria of the International Headache Society (2004). Results. The participants comprised 168 males and 234 females. The mean age was 36.9 ± 7.9 years. The overall headache prevalence was 39.3% with female predominance (P < 0.0001). Tension-type headache was the most prevalent at 72.8% and migraine at 18.9%. Unclassifiable headache constituted 8.2%. Migraine headache showed female preponderance (P = 0.000). 80.4% of participants did not seek medical consultation compared with 19.6% who did (P = 0.000). Of the latter, 83.9% consulted the general practitioner (GP), whilst 16.1% consulted the neurologist. Conclusions. Primary headache prevalence is high in our population. It is not recognised as that requiring care by most of the staff of this tertiary health facility; thus education is required to increase health care utilization.