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Okekunle AP, Asowata OJ, Fakunle AG, Akpa OM, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Tiwari HK, Akinyemi J, Jenkins C, Arulogun O, Ibinaiye P, Appiah L, Agunloye AM, Adeoye AM, Yaria J, Calys-Tagoe B, Uvere EO, Ogbole G, Agyekum F, Sanni TA, Amusa GA, Ogunronbi M, Olowookere S, Balogun O, Ogunmodede JA, Olalusi OV, Samuel D, Mande A, Rabiu M, Adebayo P, Sunday A, Imoh LC, Oguntade AS, Ajose A, Singh A, Adeegbe OT, Mensah Y, Fawale MB, Abdul S, Ikubor J, Tolulope A, Yahaya IS, Akisanya C, Odo CJ, Efidi R, Chukwuonye II, Shidali V, Adebowale A, Ohagwu KA, Adeleye OO, Iheonye H, Akintunde A, Olabinri E, Akpalu J, Adesina J, Onyeonoro U, Onasanya A, Arnett DK, Lackland D, Akinyemi R, Ovbiagele B, Owolabi M. Secondhand smoke exposure is independently associated with stroke among non-smoking adults in West Africa. J Neurol Sci 2022; 443:120489. [PMID: 36399928 PMCID: PMC9712270 DOI: 10.1016/j.jns.2022.120489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/15/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability and mortality worldwide, but little is known about the contribution of secondhand smoke exposure (SHSE) to stroke epidemiology among indigenous Africans. OBJECTIVE To evaluate the association of SHSE with stroke among indigenous Africans. METHODS We analyzed the relationship of SHSE with stroke among 2990 case-control pairs of adults who had never smoked (identified in the SIREN study) using conditional logistic regression at a two-sided P < 0.05. RESULTS Multivariable-adjusted odds ratio and 95% confidence interval; 1.25 (1.04, 1.50; P = 0.02) revealed SHSE was positively associated with stroke independent of stroke subtypes. CONCLUSION Culturally relevant primary prevention strategies targeted at SHSE might be promising in preventing stroke among Africans.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Medicine, University of Ibadan, Nigeria; Department of Food and Nutrition, Seoul National University, Republic of Korea.
| | | | - Adekunle G Fakunle
- Department of Medicine, University of Ibadan, Nigeria; Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria; Institute of Cardiovascular Diseases, University of Ibadan, Nigeria
| | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria
| | | | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Nigeria
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Abiodun M Adeoye
- Department of Medicine, University of Ibadan, Nigeria; Institute of Cardiovascular Diseases, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, University of Ibadan, Nigeria
| | - Joseph Yaria
- Department of Medicine, University of Ibadan, Nigeria
| | | | | | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | - Francis Agyekum
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | - Olayemi Balogun
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Diala Samuel
- Department of Medicine, University of Ibadan, Nigeria
| | - Aliyu Mande
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Musbahu Rabiu
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Adeniyi Sunday
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | | | - Ayodipupo S Oguntade
- Department of Medicine, University of Ibadan, Nigeria; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Big Data Institute, Oxford Population Health, University of Oxford, UK
| | - Abiodun Ajose
- Department of Medicine, University of Ibadan, Nigeria
| | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Yaw Mensah
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Joyce Ikubor
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Isah S Yahaya
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Chidi J Odo
- Department of Radiology, University of Ibadan, Nigeria
| | - Richard Efidi
- Department of Radiology, University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | - Henry Iheonye
- Department of Medicine, Federal Medical Centre, Lokoja, Nigeria
| | - Adeseye Akintunde
- Ladoke Akintola University of Technology/Teaching Hospital, Ogbomosho, Nigeria
| | | | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | - Daniel Lackland
- Department of Neurology, Medical University of South Carolina, USA
| | - Rufus Akinyemi
- Federal Medical Centre, Abeokuta, Nigeria; Center for Genomic and Precision Medicine, University of Ibadan, Nigeria; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San Francisco, USA
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, University of Ibadan, Nigeria.
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Mthoko NFN, Pazvakawambwa L, Leonhardt M, Lien L. Risk factors for cardiovascular disease among people with mental illness in Namibia. Ghana Med J 2022; 56:285-294. [PMID: 37575634 PMCID: PMC10416288 DOI: 10.4314/gmj.v56i4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Objectives To determine the prevalence of risk factors for cardiovascular disease (CVD) among people with mental illness attending the Mental Health Care Centre, Windhoek, Namibia. Design Observational, cross-sectional study. Setting Mental health Care Centre, Windhoek Central Hospital. Namibia. Participants Adult patients with a mental illness attending the Mental Health Care Centre, Windhoek. Data collection Within a systematic random sampling method, 385 adult patients with mental illness were recruited between May and December 2017. Statistical analysis Validated assessment tools were used. Descriptive summary statistics and Chi-squared tests of association were conducted. Results One-third (31.7%) of participants used alcohol, 21% used nicotine, 21.3% had hypertension, 55% were over-weight or obese, 59.2% of females and 11.5% of males had abdominal obesity. About twenty per cent (19.9%) of participants did meet the World Health Organisation recommended level of activity, while more than two-thirds of participants did not participate in moderate or vigorous physical activities. The patient's psychiatric condition was significantly associated with alcohol use (Chi-square=20.450, p=0.002) and physical activity (Chi-square=20.989, p=0.002). The psychiatric condition was not associated with the waist circumference and gender of the participant. Conclusions The increased prevalence of CVD risk factors in people with mental illness calls for mental health practitioners to screen, monitor and manage these risk factors regularly. Systematically screening and monitoring for cardiovascular risk factors is likely to contribute to National targets and significantly impact cardiovascular morbidity and mortality in people with mental illness. Funding This work was financed by internal resources of the Mental Health Care Centre, Windhoek Central Hospital.
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Affiliation(s)
| | - Lilian Pazvakawambwa
- Department of Statistics and Population Studies, University of Namibia, P. O. Box 40933, Ausspannplatz, Windhoek, Namibia
| | - Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post box 104, 2381 Brumunddal, Norway
- Faculty of Health Studies, VID – Specialized University, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post box 104, 2381 Brumunddal, Norway
- Department of Health and Social Science, Innlandet University of Applied Science, Elverum, Norway
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Promise of Physiological Profiling to Prevent Stroke in People of African Ancestry: Prototyping Ghana. Curr Neurol Neurosci Rep 2022; 22:735-743. [PMID: 36181575 DOI: 10.1007/s11910-022-01239-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Worldwide, compared to other racial/ethnic groups, individuals of African ancestry have an excessively higher burden of hypertension-related morbidities, especially stroke. Identifying modifiable biological targets that contribute to these disparities could improve global stroke outcomes. In this scoping review, we discuss how pathological perturbations in the renin-angiotensin-aldosterone pathways could be harnessed via physiological profiling for the purposes of improving blood pressure control for stroke prevention among people of African ancestry. RECENT FINDINGS Transcontinental comparative data from the USA and Ghana show that the prevalence of treatment-resistant hypertension among stroke survivors is 42.7% among indigenous Africans, 16.1% among African Americans, and 6.9% among non-Hispanic Whites, p < 0.0001. A multicenter clinical trial of patients without stroke in 3 African countries (Nigeria, Kenya, and South Africa) demonstrated that physiological profiling using plasma renin activity and aldosterone to individualize selection of antihypertensive medications compared with usual care resulted in better blood pressure control with fewer medications over 12 months. Among Ghanaian ischemic stroke survivors treated without renin-aldosterone profiling data, an analysis revealed that those with low renin phenotypes did not achieve any meaningful reduction in blood pressure over 12 months on 3-4 antihypertensive medications despite excellent adherence. For a polygenic condition such as hypertension, individualized therapy based on plasma renin-aldosterone-guided selection of therapy for uncontrolled BP following precision medicine principles may be a viable strategy for primary and secondary stroke prevention with the potential to reduce disparities in the poor outcomes of stroke disproportionately shared by individuals of African ancestry. A dedicated clinical trial to test this hypothesis is warranted.
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Sarfo FS, Ovbiagele B, Akinyemi J, Akpa O, Akpalu A, Wahab K, Ogbole G, Obiako R, Komolafe M, Owolabi L, Osaigbovo G, Jenkins C, Fakunle A, Adeoye A, Lackland D, Arnett D, Tiwari HK, Olunuga T, Uvere E, Fawale B, Ogah O, Agunloye A, Faniyan M, Diala S, Yinka O, Laryea R, Osimhiarherhuo A, Akinsanya C, Abdulwasiu A, Akpalu J, Arulogun O, Appiah L, Dambatta H, Olayemi B, Onasanya A, Isah S, Akinyemi R, Owolabi M. Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans. J Stroke Cerebrovasc Dis 2022; 31:106805. [PMID: 36194925 PMCID: PMC9840812 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There are limited data from Africa on the burden and associations between pre-diabetes (pre-DM), diabetes mellitus (DM) and stroke occurrence in a region experiencing a profound rise in stroke burden. PURPOSE To characterize the associations between stroke and dysglycemic status among West Africans. METHODS The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with clinical and radiological evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular factors were performed. Pre-diabetes was defined as HBA1c of 5.7%-6.4% or Fasting blood glucose (FBG) 5.6-7.0 mmol/L and DM as HBA1c >6.5% or FBG>7.0 mmol/L. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. RESULTS Among 2,935 stroke cases the mean age was 60.0 ± 14.2 years with 55.2% being males. By glycemic status, 931 (31.7%) were euglycemic, 633 (21.6%) had Pre-diabetes and 1371 (46.7%) had DM. Of the age- and sex-matched stroke-free controls 69.2% were euglycemic, 13.3% had pre-DM and 17.5% had DM. Pre-DM [aOR (95% CI): 3.68(2.61-5.21)] and DM [4.29 (3.19-5.74)] were independently associated with stroke. The aOR of Pre-DM for ischemic stroke 3.06 (2.01-4.64)] was lower than 4.82 (3.37-6.89) for DM. However, the aOR of Pre-DM for hemorrhagic stroke 6.81 (95% CI: 3.29 - 14.08)] was higher than 3.36 (1.94-5.86) for DM. Furthermore, the aOR of pre-DM for ischemic stroke subtypes were 9.64 (1.30-71.57) for cardio-embolic stroke, 3.64 (1.80-7.34) for small-vessel occlusive disease and 4.63 (0.80-26.65) for large-vessel disease. CONCLUSION Pre-DM is strongly and independently associated with stroke in Africans. Improving glycemic control through screening, healthy lifestyle and pharmacotherapy at a population level may be strategic in reducing the rising burden of stroke in Africa.
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Affiliation(s)
| | | | | | - Onoja Akpa
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Godwin Ogbole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | | | | | - Abiodun Adeoye
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Ezinne Uvere
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bimbo Fawale
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Okechukwu Ogah
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Samuel Diala
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladele Yinka
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | | | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | - Mayowa Owolabi
- College of Medicine, University of Ibadan, Ibadan, Nigeria.
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Ayehu GW, Yitbarek GY, Zewdie EA, Amsalu BT, Abie Y, Atlaw D, Agegnehu A, Admasu FT, Azanaw MM, Amare AT, Emiru ZA. Risk profile, clinical presentation, and determinants of stroke subtypes among patients with stroke admitted to public referral hospitals, Northwest Ethiopia in 2021: A cross-sectional study. Front Neurol 2022; 13:988677. [DOI: 10.3389/fneur.2022.988677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia.MethodsFor this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p < 0.05.ResultsOf the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01–1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97–23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21–6.48), hypertension (AOR=0.51, 95% CI:0.31–0.85), and past stroke (AOR = 3.54, 95% CI:0.93–13.49) were found to be independent determinants of the stroke subtype.ConclusionAge, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype.
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Riedmann J, Solonavalona AF, Rakotozafy AR, Ralamboson S, Endres M, Siegerink B, Siebert E, Knauss S, Emmrich JV. Proportion of stroke types in Madagascar: A tertiary-level hospital-based case series. PLoS One 2022; 17:e0276199. [PMID: 36240194 PMCID: PMC9565373 DOI: 10.1371/journal.pone.0276199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Like other countries in sub-Saharan Africa, Madagascar has a high burden of stroke. The Malagasy population is unique in sharing both African and Asian ancestry. The proportion of ischemic and hemorrhagic stroke types is unknown for this population. AIM Our aim was to establish the proportion of stroke types and known risk factors for the Malagasy population. METHODS We conducted a single-center, tertiary-level hospital-based case series. We included all patients with a CT-imaging confirmed stroke who presented at the emergency ward of the study hospital between January 1, 2017, and November 20, 2018. RESULTS Of 223 patients with CT-confirmed stroke, 57.4% (128/223, 95% CI: 51-64%) had an ischemic stroke and 42.6% (95/223, 95% CI: 36-49%) had an intracranial hemorrhage. The majority (89.5%; 85/95, 95% CI: 83-96%) of intracranial hemorrhages were intracerebral; 4.2% (4/95, 95% CI: 0-8%) had a subdural hematoma, 5.3% (5/95, 95% CI: 1-10%) had a subarachnoid hemorrhage, there was one isolated intraventricular hemorrhage (1.1%; 1/95, 95% CI: -1-3%). The prevalence of hypertension among stroke patients was high (86.6%; 187/216, 95% CI: 82-91%). CONCLUSIONS Our study is the first to report the proportion of stroke types and known risk factors in Madagascar. We find that the proportion of hemorrhagic strokes was unexpectedly higher than that reported from other countries in sub-Saharan Africa. Our findings highlight the need for a country-specific approach to stroke prevention, treatment, and rehabilitation and provide guidance on public health resource allocation in Madagascar.
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Affiliation(s)
- Julia Riedmann
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Solofo Ralamboson
- Soavinandriana Military Hospital (CENHOSOA), Antananarivo, Madagascar
| | - Matthias Endres
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Göttingen, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Knauss
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Julius Valentin Emmrich
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- * E-mail:
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Wu Y, Chen X, Hu S, Zheng H, Chen Y, Liu J, Xu Y, Chen X, Zhu L, Yan W. The impact of potentially modifiable risk factors for stroke in a middle-income area of China: A case-control study. Front Public Health 2022; 10:815579. [PMID: 36062135 PMCID: PMC9437343 DOI: 10.3389/fpubh.2022.815579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/02/2022] [Indexed: 01/21/2023] Open
Abstract
Aims To reveal the impact of eleven risk factors on stroke and provide estimates of the prevention potential. Methods We completed a multicenter case-control study in Jiangxi, China, a middle-income area. Neuroimaging examination was performed in all cases. Controls were stroke-free adults recruited from the community in the case concentration area. Conditional logistic regression and unconditional logistic regression were used for subgroup analysis of stroke type, and other groups (sex, age and urban-rural area), respectively. Odds ratios (ORs) and their population attributable risks (PARs) were calculated, with 95% confidence intervals. Results A total of 43,615 participants (11,735 cases and 31,880 controls) were recruited from February to September 2018, of whom we enrolled 11,729 case-control pairs. Physical inactivity [PAR 69.5% (66.9-71.9%)] and hypertension [53.4% (49.8-56.8%)] were two major risk factors for stroke, followed by high salt intake [23.9% (20.5-27.3%)], dyslipidemia [20.5% (17.1-24.0%)], meat-based diet [17.5% (14.9-20.4%)], diabetes [7.7% (5.9-9.7%)], cardiac causes [5.3% (4.0-6.7%)], alcohol intake [4.7% (0.2-10.0%)], and high homocysteine [4.3% (1.4-7.4%)]. Nine of these factors were associated with ischemic stroke, and five were associated with intracerebral hemorrhage. Collectively, eleven risk factors accounted for 59.9% of the PAR for all stroke (ischemic stroke: 61.0%; intracerebral hemorrhage: 46.5%), and were consistent across sex (men: 65.5%; women: 62.3%), age (≤55: 65.2%; >55: 63.5%), and urban-rural areas (city: 62.2%; county: 65.7%). Conclusion The 11 risk factors associated with stroke identified will provide an important reference for evidence-based planning for stroke prevention in middle-income areas. There is an urgent need to improve awareness, management and control of behavioral and metabolic risk factors, particularly to promote physical activity and reduce blood pressure.
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Affiliation(s)
- Yuhang Wu
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China,Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaoyun Chen
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China,Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Songbo Hu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Huilie Zheng
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Yiying Chen
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China
| | - Jie Liu
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China
| | - Yan Xu
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China
| | - Xiaona Chen
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China
| | - Liping Zhu
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China
| | - Wei Yan
- Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China,*Correspondence: Wei Yan
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Determinants of metabolic syndrome and its prognostic implications among stroke patients in Africa: Findings from the Stroke Investigative Research and Educational Network (SIREN) study. J Neurol Sci 2022; 441:120360. [PMID: 35985161 DOI: 10.1016/j.jns.2022.120360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The prognostic implications of metabolic syndrome (METS) among African stroke patients are poorly understood. This study aimed to investigate the determinants of METS and its prognostic implications among Africans with newly diagnosed stroke in the SIREN study. METHODS We included stroke cases (adults aged >18 years with CT/MRI confirmed stroke). The validated tools comprehensively evaluated vascular, lifestyle, and psychosocial factors. We used logistic regression to estimate adjusted odds ratios (OR) with 95% CIs for the association between METS and risk factors. We also computed the prediction power of the domain of covariates in a sequential manner using the area under the receiver operating curve (ROC) curve. RESULTS Among 3998 stroke subjects enrolled in the study, 76.8% had METS by at least one of the clinical definitions. Factors associated with METS were age > 50 years (OR- 1.46, CI-1.19-1.80), male gender (OR 4.06, CI- 3.28-5.03), income >100USD (OR1.42, CI-1.17-1.71), stress (OR1.46, CI-1.14-1.87), family history of diabetes mellitus (OR1.38, CI-1.06-1.78), and cardiac disease (OR1.42, CI-1.18-1.65). Stroke severity was higher among those with METS (SLS = 5.8 ± 4.3) compared with those without METS (6.2 ± 4.5) at p = 0.037. METS was associated with higher odds (aOR 1.31, CI-1.08-1.58) of one-month fatality after adjusting for stroke severity, age > 50 years, and average monthly income >100USD. CONCLUSION METS is very common among African stroke patients and is associated with stroke severity and worse one-month fatality. Lifestyle interventions may prevent METS and attenuate its impact on stroke occurrence and outcomes.
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Ischemic stroke demographics, clinical features and scales and their correlations: an exploratory study from Jordan. Future Sci OA 2022; 8:FSO809. [PMID: 36248068 PMCID: PMC9540235 DOI: 10.2144/fsoa-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Aims: The authors aimed to assess the ischemic stroke risk factors and scales. Materials & methods: A retrospective cohort study was conducted on patients with acute ischemic stroke (from January 2017 to December 2018). The scores of the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge and of the modified Rankin Scale (mRS) and Barthel Index (BI) scale post-month of the stroke were collected. Results: Out of 376 patients, 359 were included, with a mean (standard deviation) age of 67.8 (12.2) years and male predominance (56.2%). Hyperlipidemia and hypertension were the most prevalent comorbidities (91.1% and 80.5%, respectively). The NIHSS, BI and mRS scores were worse among women, with no significant effects for comorbidities. The NIHSS scores at admission and discharge were significantly correlated with the post-month BI and mRS scores. Conclusion: The study findings suggest a complex interplay of gender, strict control and prevention of the modifiable stroke risk factors, as well as the association of neurological deficits' intensity with the functional outcomes. This study aimed to explore the demographics, the clinical risk factors and the scores of the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) scale at different points of time among the survivors of acute ischemic stroke at a tertiary hospital in Jordan. Also, the study aimed to investigate the differences in the scales' scores by the patients' characteristics and the correlations between these scales. Out of 376 screened patients, 359 were included. Their mean (standard deviation) age was 67.8 (12.2) years, and 56.2% were men. Compared with male participants, women scored significantly worse on the NIHSS at admission (7.61 [5.51] vs 9.47 [6.64]; p = 0.048), NIHSS at discharge (5.57 [4.72] vs 7.40 [5.88]; p = 0.028) and BI scale 1 month post-event (78.68 [28.33] vs 66.03 [35.86]; p = 0.011). The mean (standard deviation) mRS score post-month of stroke was lower in men (2.4 [1.7]) than in women (2.9 [1.9]), with a lack of statistical significance (p = 0.097). Thus, despite the male predominance in the cohort, women tended to have a more severe stroke, worse neurological impairment and poorer functional outcomes. Hyperlipidemia had the highest prevalence, sensitivity, positive predictive value and negative predictive value rates, followed by hypertension. No statistically significant differences existed in the comorbidities' NIHSS, BI scale and mRS scores. Strong and significant correlations were observed between the scores of NIHSS at admission and discharge and the BI scale and mRS scores at 1 month post-event. Thus, the authors concluded that neurological deficit severity has a potential role in predicting functioning outcomes and vice versa.
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Jørgensen JMA, Christensen DL, Nielsen KK, Sadiq HS, Khan MY, Jusabani AM, Walker R. Incidence and characteristics of stroke in Zanzibar–a hospital-based prospective study in a low-income island population. Front Neurol 2022; 13:931915. [PMID: 35968303 PMCID: PMC9366665 DOI: 10.3389/fneur.2022.931915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke in adults is a critical clinical condition and a leading cause of death and disability globally. Epidemiological data on stroke in sub-Saharan Africa are limited. This study describes incidence rates, stroke types and antecedent factors among patients hospitalized with stroke in Zanzibar.MethodsThis was a prospective, observational study of stroke patients at hospitals in Unguja, Zanzibar. Socioeconomic and demographic data were recorded alongside relevant past medical history, medicine use and risk factors. The modified National Institute of Health Stroke Scale (mNIHSS) was used to assess admission stroke severity and, when possible, stroke was confirmed by neuroimaging.ResultsA total of 869 stroke admissions were observed from 1st October 2019 through 30th September 2020. Age-standardized to the World Health Organization global population, the yearly incidence was 286.8 per 100,000 adult population (95%CI: 272.4–301.9). Among these patients, 720 (82.9%) gave consent to participate in the study. Median age of participants was 62 years (53–70), 377 (52.2%) were women, and 463 (64.3%) had a first-ever stroke. Known stroke risk factors included hypertension in 503 (72.3%) patients, of whom 279 (55.5%) reported regularly using antihypertensive medication, of whom 161 (57.7%) had used this medication within the last week before stroke onset. A total of 460 (63.9%) participants had neuroimaging performed; among these there was evidence of intracerebral hemorrhage (ICH) in 140 (30.4%). Median stroke severity score using mNIHSS was 19 (10–27).ConclusionZanzibar has high incidence of hospitalization for stroke, indicating a very high population incidence of stroke. The proportion of strokes due to ICH is substantially higher than in high-income countries. Most stroke patients had been in contact with health care providers prior to stroke onset and been diagnosed with hypertension. However, few were using antihypertensive medication at the time of stroke onset.www.ClinicalTrial.gov registration NCT04095806.
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Affiliation(s)
- Jutta M. Adelin Jørgensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Mnazi Mmoja Referral Hospital, Zanzibar, Tanzania
- *Correspondence: Jutta M. Adelin Jørgensen
| | | | | | | | - Muhammad Yusuf Khan
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ahmed M. Jusabani
- Radiology Department, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Richard Walker
- Department of Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Matuja SS, Ahmed RA, Munseri P, Khanbhai K, Tessua K, Lyimo F, Rodriguez GJ, Gupta V, Maud A, Chaudhury MR, Manji M, Sheriff F. Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion. Front Neurol 2022; 13:882928. [PMID: 35911912 PMCID: PMC9330741 DOI: 10.3389/fneur.2022.882928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Large vessel ischemic strokes account for more than one-third of all strokes associated with substantial morbidity and mortality without early intervention. The incidence of large vessel occlusion (LVO) is not known in sub-Saharan Africa (SSA). Definitive vessel imaging is not routinely available in resource-limited settings. Aims We aimed to investigate the burden and outcomes of presumed LVO among patients with ischemic stroke admitted to a large tertiary academic hospital in Tanzania. Methods This cohort study recruited all consenting first-ever ischemic stroke participants admitted at a tertiary hospital in Tanzania. Demographic data were recorded, and participants were followed up to 1 year using the modified Rankin Scale (mRS). A diagnosis of presumed LVO was made by a diagnostic neuroradiologist and interventional neurologist based on contiguous ischemic changes in a pattern consistent with proximal LVO on a non-contrast computed tomography head. We examined factors associated with presumed LVO using logistic regression analysis. Inter-observer Kappa was calculated. Results We enrolled 158 first-ever ischemic strokes over 8 months with a mean age of 59.7 years. Presumed LVO accounted for 39.2% [95% confidence interval (CI) 31.6–47.3%] and an overall meantime from the onset of stroke symptoms to hospital arrival was 1.74 days. Participants with presumed LVO were more likely to involve the middle cerebral artery (MCA) territory (70.9%), p < 0.0001. Independent factors on multivariate analysis associated with presumed LVO were hypertension [adjusted odds ratio (aOR) 5.74 (95% CI: 1.74–18.9)] and increased waist-hip ratio [aOR 7.20 (95% CI: 1.83–28.2)]. One-year mortality in presumed LVO was 80% when compared with 73.1% in participants without presumed LVO. The Cohen's Kappa inter-observer reliability between the diagnostic neuroradiologist and interventional neurologist was 0.847. Conclusion There is a high burden of presumed LVO associated with high rates of 1-year morbidity and mortality at a tertiary academic hospital in Tanzania. Efforts are needed to confirm these findings with definitive vessel imaging, promoting cost-effective preventive strategies to reduce the burden of non-communicable diseases (NCDs), and a call for adopting endovascular therapies to reduce morbidity and mortality.
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Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- *Correspondence: Sarah Shali Matuja
| | - Rashid Ali Ahmed
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Kezia Tessua
- Department of Internal Medicine, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Frederick Lyimo
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Gustavo J. Rodriguez
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Vikas Gupta
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Mohammad Rauf Chaudhury
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Mohamed Manji
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Faheem Sheriff
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
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Idowu AO, Sanusi AA, Balogun SA, Anele CO, Adebowale AA, Abidoye AK, Akinola GJ, Fawale MB, Komolafe MA. Outcome of Delayed Administration of Alteplase in a Resource-Poor Area: A Case Report. Cureus 2022; 14:e25996. [PMID: 35855247 PMCID: PMC9286309 DOI: 10.7759/cureus.25996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
An acute ischemic stroke, though carrying the risk of debilitating complications, is a preventable and treatable disease. Thrombolysis and endovascular thrombectomy are important components of its management. However, various challenges in resource-poor countries like Nigeria and other developing nations pose a great limitation in the timely intervention of ischemic stroke treatment. The challenges include late presentation, poor awareness of stroke symptoms even among health care workers, poor ambulance service/transportation network, intra-hospital delay, particularly in neuroimaging, and the unavailability of tissue plasminogen activator (alteplase/tenecteplase). We report a 32-year-old African man with an antecedent history of suspected migraine headaches with aura and a family history of hypertension and stroke, admitted 7½ hours after onset of stroke symptoms, scoring 13 on the National Institutes of Health Stroke Scale (NIHSS) with Medical Research Council (MRC) muscle power grades 1 and 3 on the right upper and lower extremities, respectively. Urgent non-contrast brain CT revealed only a hyperdense sign in the left middle cerebral artery (MCA). Intravenous tissue plasminogen activator (tPA) was administered at a lower dose of 0.6 mg/kg, 15½ hours after symptom onset, and a CT angiogram done 24 hours post-thrombolysis showed partial recanalization of the M1 segment of the MCA and intermediate collateral supply (Alberta stroke program early CT {ASPECT} score: 6). By the third day of admission, he had made a significant clinical improvement and was discharged home able to walk unsupported on the fourth day.
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Sarfo FS, Commeh ME, Tandoh IO, Agbogbatey M, Ankrah O, Akpalu A, Ovbiagele B. Nationwide rates of outpatient clinic attendance by stroke survivors in Ghana: Analysis by region and facility. J Neurol Sci 2022; 437:120250. [DOI: 10.1016/j.jns.2022.120250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/12/2022] [Accepted: 04/02/2022] [Indexed: 01/30/2023]
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Liu CX, Yin RX, Cao XL, Shi ZH, Huang F, Wei BL, Deng GX, Zheng PF, Guan YZ. EHBP1, TUBB, and WWOX SNPs, Gene-Gene and Gene-Environment Interactions on Coronary Artery Disease and Ischemic Stroke. Front Genet 2022; 13:843661. [PMID: 35559044 PMCID: PMC9086287 DOI: 10.3389/fgene.2022.843661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/17/2022] [Indexed: 12/04/2022] Open
Abstract
The associations among the EH domain-binding protein 1 (EHBP1), tubulin beta class I (TUBB), and WW domain-containing oxidoreductase (WWOX) single nucleotide polymorphisms (SNPs) and coronary artery disease (CAD) and ischemic stroke (IS) are not yet understood. This study aimed to detect the associations of these SNPs, gene-gene and gene-environment interactions and CAD and IS in the Guangxi Han population. A total of 1853 unrelated subjects were recruited into normal control (n = 638), CAD (n = 622), and IS (n = 593) groups. Related genotypes were determined by high-throughput sequencing. The genotypic and minor allelic frequencies of rs2278075 were different between the CAD and control groups, and those of rs2710642, rs3130685, and rs2278075 were also different between the IS and control groups. The rs2278075T allele, rs3130685-rs2222896-rs2278075, rs3130685-rs2222896-diabetes, rs3130685-rs2222896-drinking, and haplotype rs2710642A-rs10496099C-diabetes interactions were associated with increased risk, while G-T-G-C-G-A and G-T-T-T-G-T-drinking were associated with reduced risk of CAD. The rs2278075T and rs2710642G alleles, rs2710642G-rs10496099C haplotype, rs3130685-rs2278075-rs2222896, and rs2710642-rs2278075-hypertension interactions aggravated the association with IS, whereas the rs3130685T allele, rs2710642A-rs10496099C haplotype and the interactions of H1 (s2710642A-rs10496099C)-H2 (rs2710642G-rs10496099C)-drinking and I1 (A-C-G-C-A-A)-I3 (A-C-G-T-A-A)-I4 (A-C-G-T-G-A)-I5 (G-T-G-C-G-A) diminished the association with IS. Carrying WWOX rs2278075T was strongly associated with CAD or IS, while EHBP1 rs2710642 and TUBB rs3130685 might alter the association of IS by modifying the serum lipid profile. This study demonstrates that the EHBP1, TUBB, and WWOX SNPs, gene-gene and gene-environment interactions are associated with the risk of CAD and IS in the Guangxi Han population.
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Affiliation(s)
- Chun-Xiao Liu
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Xiao-Li Cao
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Zong-Hu Shi
- Department of Prevention and Health Care, The Fourth Affiliated Hospital, Guangxi Medical University, Liuzhou, China
| | - Feng Huang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Bi-Liu Wei
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Guo-Xiong Deng
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Peng-Fei Zheng
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Yao-Zong Guan
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Prevalence of central obesity in Nigeria: a systematic review and meta-analysis. Public Health 2022; 206:87-93. [DOI: 10.1016/j.puhe.2022.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 01/02/2023]
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Okekunle A, Asowata O, Akinpeloye O, Olahan R, Ayodele A, Olaleye B, Akanni O, Akpa O. Community-based Investigation of the Risk Factors for Cardiovascular Diseases in Ibadan and suburbs (COMBAT-CVDs): Design and Methods. AFRICAN JOURNAL OF BIOMEDICAL RESEARCH : AJBR 2022; 25:265-271. [PMID: 35812130 PMCID: PMC9265233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Africa is gradually becoming the epicentre for the burden of cardiovascular diseases (CVDs) worldwide, and community-based data alluding to the pattern and dynamics of escalating epidemiological thresholds of CVDs among indigenous Africans are limited. This manuscript focuses on the design and methods of Community-based Investigation of the Risk Factors for Cardiovascular Diseases in Ibadan and suburbs (COMBAT-CVDs), an ongoing community-based door-to-door study assessing the profile, burden and dynamics of CVDs risk factors among residents of Ibadan and suburbs. COMBAT-CVDs is a cohort of community-dwelling indigenous Africans, males and females, ≥18years from ten communities in Ibadan, Nigeria. The recruitment of participants for the first wave (W0) started in 2020, covering; questionnaire administration and physical examination. The World Health Organization's STEPS Instrument for Chronic Disease Risk Factor Surveillance was used for data collection. Data were collected on sociodemographic, socioeconomic and lifestyle-related characteristics, history of CVDs, stress, depression and sleep quality. Also, anthropometric and blood pressure measures were conducted by trained personnel using standard operating procedures and instruments. Data collection for the second wave is underway, and the collection of blood and other biological samples for genetic epidemiology is planned, subject to availability of funds. For the W0 recruitment, a total of 3638 community-dwelling adults (males - 54.6% and females - 45.4%) participated with a ≥99.7% response rate. The COMBAT-CVDs will likely provide novel data, insightful characterization of CVDs risk factors and evidence for context-specific and culturally relevant interventions for the community-based prevention and management of CVDs among Africans in this setting.
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Affiliation(s)
- A.P. Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- The Postgraduate College, University of Ibadan, Ibadan, 200284, Nigeria
| | - O.J. Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O.J. Akinpeloye
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - R. Olahan
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A.E. Ayodele
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - B.J. Olaleye
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O.O. Akanni
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Public Health, Lead City University, Ibadan, Nigeria
| | - O.M. Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- The Postgraduate College, University of Ibadan, Ibadan, 200284, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, 200284 Ibadan, Nigeria
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Sarfo FS, Ovbiagele B. Utilizing Implementation Science to Bridge Cerebrovascular Health Disparities: a Local to Global Perspective. Curr Neurol Neurosci Rep 2022; 22:293-303. [PMID: 35381952 PMCID: PMC9081275 DOI: 10.1007/s11910-022-01193-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Stroke is a prime example of a medical disorder whose incidence, prevalence, and outcomes are strongly characterized by health disparities across the globe. This scoping literature review seeks to depict how implementation science could be utilized to advance health equity in the prevention, acute treatment, and post-acute management of stroke in the underserved regions of high-income countries as well as in all low-income countries. RECENT FINDINGS A major reason for the persisting and widening cerebrovascular disease disparities is that evidence-based stroke prevention and treatment interventions have been differentially translated (if at all) to various populations and settings. The field of implementation science is endowed with frameworks, theories, methodological approaches, and outcome measures, including equity indices, which could be harnessed to facilitate the translation of evidence-based interventions into clinical practice for underserved and vulnerable communities. Encouragingly, there are several novel frameworks, which eminently merge implementation science constructs with health equity determinants, thereby opening up key opportunities to bridge burgeoning worldwide gaps in cerebrovascular health equity.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Private Mail Bag, Kumasi, Ghana.
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Sarfo FS, Olasoji E, Banfill GP, Ovbiagele B, Simpkins AN. Apparent Treatment-Resistant Hypertension Among Stroke Survivors: A Transcontinental Study Assessing Impact of Race and Geography. Am J Hypertens 2022; 35:715-722. [PMID: 35366323 PMCID: PMC9340623 DOI: 10.1093/ajh/hpac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/09/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Race and geographic differences in the prevalence and predictors of hypertension in stroke survivors have been reported, but apparent treatment-resistant hypertension (aTRH) among stroke survivors by race (African ancestry vs. non-Hispanic Caucasians) and by geography (continental Africa vs. the United States) are under studied. METHODS This is a cross-sectional study using ethically approved stroke registries from the University of Florida and the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Univariate and multivariate regression was used to evaluate for differences in prevalence of aTRH and associations with clinical covariates. RESULTS Harmonized data were available for 3,365 stroke survivors of which 943 (28.0%) were indigenous Africans, 558 (16.6%) African Americans, and 1,864 (55.4%) non-Hispanic Caucasians with median ages (interquartile range) of 59 (49-68), 61 (55-72), and 70 (62-78) years, P < 0.0001. The overall frequency of aTRH was 18.5% (95% confidence interval [CI]: 17.2%-19.8%) with 42.7% (95% CI: 39.6%-46.0%) among indigenous Africans, 16.1% (95% CI: 13.2%-19.5%) among African Americans, and 6.9% (95% CI: 5.8%-8.2%) among non-Hispanic Caucasians, P < 0.0001. Five factors associated with aTRH: age, adjusted odds ratio (95% CI) of 0.99 (0.98-0.99), female sex 0.70 (0.56-0.87), cigarette smoking 1.98 (1.36-2.90), intracerebral hemorrhage 1.98 (1.57-2.48), and Black race namely indigenous Africans 4.42 (3.41-5.73) and African Americans 2.44 (1.81-3.29). CONCLUSIONS Future studies are needed to investigate the contribution of socioeconomic disparities in the prevalence aTRH in those with African Ancestry to explore the long-term impact, and evaluate effective therapeutic interventions in this subpopulation.
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Affiliation(s)
| | - Esther Olasoji
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Grant P Banfill
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Alexis N Simpkins
- Department of Neurology, University of Florida, Gainesville, Florida, USA
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Walker R. Osuntokun Award Lecture 2021: Challenges of Measuring the Burden of Stroke in Africa. J Stroke Cerebrovasc Dis 2022; 31:106386. [PMID: 35317913 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Over recent years non-communicable diseases have dramatically increased in low- and middle-income countries, including those of sub-Saharan Africa. With continuing high levels of infectious disease, these countries now face the double burden of disease. Stroke has emerged as a major cause of hospital admission, disability, and mortality for which the major modifiable risk factor is hypertension, which is often not diagnosed and, even if diagnosed, not treated and, even if treated, not controlled. METHODS In this award lecture paper I outline my personal experience of measuring the burden of, and risk factors for, stroke in sub-Saharan Africa, along with the challenges faced. I will specifically describe the measurement of mortality and case fatality, prevalence and incidence as well as commenting on aetiology and risk factors and reflect on future initiatives and directions. RESULTS Over the past 5 decades there has been a dramatic increase in numbers of stroke patients admitted to hospital throughout sub-Saharan Africa, with high in hospital mortality rates, also reflected in high case fatality rates in those cohorts followed up following discharge from hospital. Community-based surveys assessing mortality from stroke using verbal autopsy have demonstrated very high age-adjusted rates. Age adjusted prevalence rates assessed by door-to-door surveys have generally shown lower prevalence than high income countries. The Tanzanian stroke incidence study, which incorporated verbal autopsy for those patients dying before reaching hospital, demonstrated some of the highest age-adjusted stroke incidence rates in the world. There were high rates of stroke in younger ages and high rates of intracranial haemorrhage though not as high as previously shown in hospital-based studies. Hypertension is the main modifiable risk factor but other risk factors such as HIV are important while, certainly in rural populations, raised cholesterol remains rare as does carotid artery stenosis and history of transient ischemic attack. Other vascular disease such as ischemic heart disease and peripheral vascular disease is also less common. CONCLUSIONS There is already a large burden relating to stroke in sub-Saharan Africa and this will only escalate further as the population ages. Hypertension is the biggest risk factor for mortality worldwide and in sub-Saharan Africa prevalence rates are very high with the majority of people suffering with stroke not being diagnosed with their hypertension prior to their stroke. The most important challenge is to improve primary prevention for which improving diagnosis and control rates for hypertension is the number one priority. For those who do have stroke there is a need to increase the number of suitably staffed stroke units as these have been shown to have a very large impact on improving both mortality and morbidity in high income countries. There are still many unanswered questions and a need for more research throughout sub-Saharan Africa on risk factors, and treatment, for stroke.
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Affiliation(s)
- Richard Walker
- Northumbria Healthcare NHS Foundation Trust, UK; Population Health Sciences Institute, Newcastle University, UK.
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Gebreyohanns M, Akinyemi RO, Owolabi MO, Sarfo FS, Tagge R, Ovbiagele B. The African Stroke Organization Conference 2021: Building Capacity, Careers, Collaborations, and Contributions. J Stroke Cerebrovasc Dis 2022; 31:106385. [PMID: 35317914 PMCID: PMC9397143 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The inaugural African Stroke Organization Conference (ASOC) aimed to create a forum to discuss the latest stroke science, highlight opportunities to address the high burden of stroke in Africa, develop a viable pipeline of emerging African stroke researchers, honor leading scientists and policy makers, and provide networking avenues to bolster future collaboration. Using a virtual platform, ASOC was held from Nov 3-4, 2021, and was attended by 236 participants. ASOC 2021 sessions included: (1) Osuntokun Award Lecture delivered by Prof. Richard Walker of Newcastle University; (2) Distinguished Policy Maker Lecture delivered by Dr. Raj Tajudeen of the African Centers for Disease Control and Prevention; (3) Invited presentations by prominent global stroke academicians on acute stroke, vascular malformations, vascular brain injury, Covid-19, nursing/allied care, rehabilitation/recovery, health services, imaging, pediatric stroke, precision medicine, and unusual causes of stroke; (4) six oral scientific abstract presentations; and (5) fifteen moderated oral poster presentations. Other sessions were (i) Vascular Brain Trust where early career African scholars presented manuscripts and grant proposals under development for feedback from seasoned researchers (ii) Moving on Up during which presentations were given to early career scholars about pathways for success in funding and advancement. A capstone event was the Frontiers of Research in Africa session which showcased the work and capabilities of 20 scientists and sites in Africa. All the ASOC sessions were lively and post-conference feedback from attendees showed high levels of satisfaction for the conference platforms and content. The ASOC marks a new dawn in the era of an escalating stroke burden in Africa, and it is anticipated to serve as a catalyst for exponentially building the capacity, careers, collaborations, and contributions of Africans to ameliorating stroke within and beyond the continent.
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Affiliation(s)
| | | | | | | | - Raelle Tagge
- Northern California Institute for Research and Education, USA
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Sarfo FS, Ovbiagele B. Key determinants of long-term post-stroke mortality in Ghana. J Neurol Sci 2022; 434:120123. [PMID: 34974202 PMCID: PMC8979649 DOI: 10.1016/j.jns.2021.120123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Stroke affects a predominantly young to middle-aged population in Africa and is associated with poor outcomes. There are limited data on patient-level determinants of long-term stroke survival on the continent. PURPOSE To assess factors associated with long-term, all-cause mortality among stroke survivors in a Ghanaian medical system. METHODS We analyzed the dataset of clinical trial involving hypertensive stroke survivors (n = 60) who enrolled in a 9-month study primarily assessing the effect of an m-health intervention on blood pressure control. This was a single tertiary center study conducted in a Ghanaian medical center. Participants or relatives were contacted by a phone call to assess vital status 4.5 years after stroke onset. Demographic, psycho-social and vascular risk factors data were collected during the study. Cox proportional hazards regression modeling was used to assess the factors associated with death. RESULTS Among the study participants, long term information was obtainable on 58 of 60 (97%). After a median follow-up of 52 months [IQR: 48 to 53 months], 16 participants had died, resulting in a mortality rate of 27.6% (95% CI of 16.6% - 40.9%). Upon adjustment for confounders, the two factors independently associated with long-term mortality were resistant hypertension (Hazard Ratio 3.99; 95% CI: 1.29-12.37] and depression (Hazard Ratio 1.18; 95% CI: 1.05-1.31; per unit rise on the Hamilton Depression Scale). CONCLUSION In this convenience sample of recent stroke patients in Ghana, over a quarter had died within 5 years of index stroke onset. Resistant hypertension and depression may be modifiable therapeutic targets to improve outcomes in these patients.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Haematological Indices and Antioxidant Enzyme Activity in Ghanaian Stroke Patients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1203120. [PMID: 35281592 PMCID: PMC8913147 DOI: 10.1155/2022/1203120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Abstract
Background Stroke is a cardiovascular disorder causing mortality globally and long-lasting harm worldwide. The disease occurs when the blood flow to the brain is either interrupted or blocked. This disruption leads to the increase in reactive oxygen species (ROS), especially superoxide free radicals, resulting in oxidative stress. The superoxide radicals are removed by superoxide dismutase (SOD), a key antioxidant enzyme. In this work, we investigated haematological indices and superoxide dismutase enzyme activity in Ghanaian patients with stroke and healthy control participants. Materials and Methods Thirty stroke patients attending a stroke clinic and thirty apparently healthy control participants were recruited into the study. Blood samples were collected to determine haematological indices and SOD enzyme activity in red blood cells. Results The stroke patients had significantly high blood parameters such as white blood cell (p < 0.001), neutrophil (p < 0.001), lymphocyte (p = 0.003), and eosinophil (p < 0.001) comparing with study participants without stroke, who were the control group in the study. Other blood parameters such as red blood cell, (p < 0.001), haemoglobin (p < 0.001), and haematocrit (p < 0.001) levels and mean cell haemoglobin concentration (p = 0.030), platelet (p = 0.010), and plateletcrit (p = 0.027) were high in stroke patients comparing with study control participants and statistically significant. Blood lymphocyte levels observed in stroke patients correlated negatively and significantly with SOD activity levels. SOD activity levels were significantly lower in stroke patients compared with the control group (p < 0.001). Low values of the antioxidant enzyme SOD activity levels, lymphocytes, and high values of plateletcrit were significant predictors of stroke. Conclusion Haematological parameters such as WBC, lymphocyte, platelet levels, and red cell indices were significantly different in the stroke patients being studied. There was negative correlation between lymphocyte significantly with SOD activity and high oxidative stress in stroke patients compared with the control group. Lymphocytes and plateletcrit levels were also good predictors of the occurrence of stroke.
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Ayeni EA, Gong Y, Yuan H, Hu Y, Bai X, Liao X. Medicinal Plants for Anti-neurodegenerative diseases in West Africa. JOURNAL OF ETHNOPHARMACOLOGY 2022; 285:114468. [PMID: 34390796 DOI: 10.1016/j.jep.2021.114468] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Neurodegenerative diseases are neuronal diseases that affect the brain components by degenerating the structure and function of the central or peripheral nervous system progressively. It is a leading cause of death and affects huge amount of people worldwide. Plant-based medicines have been utilised in the therapies for many illnesses that have defied western treatments, including neurodegenerative diseases. AIM OF THIS REVIEW This review presents an overview of the major neurodegenerative diseases and reported prominent medicinal plants used in managing those diseases in West Africa. METHODS Scientific articles regarding medicinal plants and their usefulness in managing neurodegenerative diseases in West Africa were pooled from different scientific databases. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to filter articles based on their relevance. Pharmacological activity, plant parts used, experimental models, and some isolated chemical compounds of those plants were summarised. RESULTS In the West Africa region, Fabaceae (19%) and Solanaceae (13%) have the highest representation of plant families used to treat neurological diseases, while Apocynaceae, Asteraceae, Euphorbiaceae have also been utilised. Flavonoids, alkaloids, phenolic compounds, terpenoids, coumarins present in those plants and their derivatives are reported to possess neuro-protective effects. Biochemical enzymes correlating to antioxidants, anti-inflammatory effects are the potential targets against neurodegenerative diseases. CONCLUSION Medicinal plants for anti-neurodegenerative diseases in West Africa have been documented with their neuropharmacological activities. Plant families such as Fabaceae, Solanaceae, Apocynaceae, Asteraceae, and Euphorbiaceae could be a major natural source for discovery of anti-neurodegenerative drugs, thus the metabolites from them should be given priority for neurological research. This review will provide clues for further investigations on the screening and development of anti-neurodegenerative natural products from West African medicinal plants.
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Affiliation(s)
- Emmanuel Ayodeji Ayeni
- Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, 610041, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yuzhou Gong
- Shanghai Natural History Museum, Branch of Shanghai Science & Technology Museum, Shanghai, 200041, China; School of Life Science, East China Normal University, Shanghai, 200062, China
| | - Hao Yuan
- Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, 610041, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yikao Hu
- Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, 610041, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xiaolin Bai
- Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, 610041, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xun Liao
- Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, 610041, China.
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Omisore A, Ogbole G, Agunloye A, Akinyemi J, Akpalu A, Sarfo F, Akpa O, Gebregziabher M, Arulogun O, Komolafe M, Wahab K, Jenkins C, Osaigbovo G, Obiako R, Owolabi L, Fakunle A, Ikubor J, Salaam A, Famurewa O, Adebayo O, Asaleye C, Akisanya C, Olabinri E, Egberongbe A, Fawale M, Olowookere S, Imoh L, Adeleye O, Efidi R, Tiwari H, Mensah Y, Calys-Tagoe B, Akintunde A, Ogunjimi L, Olugbo O, Aridegbe M, Abdullahi M, Sumonu T, Sanni T, Ogah O, Adeoye A, Uvere E, Ibinaiye P, Akinyemi R, Ovbiagele B, Owolabi M. Carotid and Vertebral Atherosclerosis in West African Stroke Patients: Findings from the Stroke Investigative Research and Education Network. Niger Med J 2022; 63:98-111. [PMID: 38803706 PMCID: PMC11128155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Background We evaluated the characteristics of carotid and vertebral atherosclerosis in indigenous West Africans with stroke. Methodology Of the 3778stroke patients recruited between 01/2014 and 08/2017, 1070 (28.3%) received carotid and vertebral artery evaluation with B-mode Ultrasound. Carotid and vertebral intima-media thickness (IMT) using multiple site technique were measured bilaterally and plaque frequency was determined. Descriptive and comparative analyses between stroke types and vessels were carried out. Results There were 809 (75.6%) patients with ischemic stroke. The prevalence of intima-media thickening in the study population was 84.0% (898/1070) [95% CI: 81.7-86.1], being higher in the ischemic stroke (688/809, 85.0%) [95% CI: 82.4-87.3] than in the hemorrhagic stroke group (211/261, 80.8%) [95% CI: 75.6-85.2]. Overall prevalence of plaques which was 26.1% [95% CI: 23.5-28.8], was found also to be higher in ischemic than hemorrhagic stroke (29.8%[95% CI: 26.7-33.0] vs. 14.6% [95% CI: 10.8-19.4], p < 0.05). The mean IMT (carotids: 2.01+1.33 mm; vertebrals: 0.96+0.54mm, p<0.001) and prevalence of plaques (carotids: 8.8%; vertebrals: 1.7%,p<0.001) were higher in carotid than vertebral arteries. Age, hypertension, level of formal education, history of smoking, average monthly income, and family histories of hypertension and stroke were associated with intima-media thickening in the carotids (all p< 0.05) in the ischemic stroke patients while family history of hypertension, diabetes mellitus, and level of formal education were independently associated with intima-media thickening in the carotids (all p< 0.05) in the hemorrhagic stroke patients. No CVRF showed an independent association with the presence of plaque in the carotid and vertebral arteries both stroke types. Conclusions One off our stroke patients in our cohort had atherosclerotic plaques, with ischemic patients being twice as likely to have this burden compared to hemorrhagic patients, and carotid atherosclerosis being five times as frequent as vertebral atherosclerosis.
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Affiliation(s)
- Adeleye Omisore
- Obafemi Awolowo University (OAU) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, Nigeria
| | - Godwin Ogbole
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Atinuke Agunloye
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Joshua Akinyemi
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Fred Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Onoja Akpa
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | | | - Oyedunni Arulogun
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Morenikeji Komolafe
- Obafemi Awolowo University (OAU) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, Nigeria
| | - Kolawole Wahab
- University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria
| | | | | | - Reginald Obiako
- Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria
| | - Luqman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Adekunle Fakunle
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Joyce Ikubor
- Delta State University Teaching Hospital (DELSUTH), Oghara, Nigeria
| | - Abdul Salaam
- Jos University Teaching Hospital (JUTH), Jos, Nigeria
| | - Olusola Famurewa
- Obafemi Awolowo University (OAU) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, Nigeria
| | - Oladimeji Adebayo
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Christianah Asaleye
- Obafemi Awolowo University (OAU) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, Nigeria
| | | | | | | | - Michael Fawale
- Obafemi Awolowo University (OAU) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, Nigeria
| | - Samuel Olowookere
- Obafemi Awolowo University (OAU) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, Nigeria
| | - Lucius Imoh
- Jos University Teaching Hospital (JUTH), Jos, Nigeria
| | | | - Richard Efidi
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | | | - Yaw Mensah
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Luqman Ogunjimi
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Obiabo Olugbo
- Delta State University Teaching Hospital (DELSUTH), Oghara, Nigeria
| | | | | | | | | | - Okechukwu Ogah
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Abiodun Adeoye
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
| | - Ezinne Uvere
- Blossom Specialist Medical Center, Ibadan, Nigeria
| | - Philip Ibinaiye
- Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria
| | - Rufus Akinyemi
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
- Federal Medical Centre, Abeokuta, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San-Francisco, USA
| | - Mayowa Owolabi
- College of Medicine, University of Ibadan, Ibadan, Nigeria and University College Hospital Ibadan, Nigeria
- Blossom Specialist Medical Center, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria, University College Hospital Ibadan
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Abstract
There are stark inequities in stroke incidence, prevalence, acute care, rehabilitation, risk factor control, and outcomes. To address these inequities, it is critical to engage communities in identifying priorities and designing, implementing, and disseminating interventions. This issue of Stroke features health equity themed lectures delivered during the International Stroke Conference and Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving meetings in 2021 as well as articles covering issues of disparities and diversity in stroke. Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, received the 2021 William Feinberg Award Lecture for his lifetime achievements in seeking global and local solutions to cerebrovascular health inequities. The second annual Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving symposium, which took place the day before the International Stroke Conference in February 2021, focused on community-engaged research for reducing inequities in stroke. Phil Gorelick, MD was awarded the Edgar J. Kenton III Award for his lifetime achievements in using community engagement strategies to recruit and retain Black participants in observational studies and clinical trials. Walter Koroshetz, MD, Director of the National Institute of Neurological Disorders and Stroke delivered the keynote lecture on stroke inequities and Richard Benson, MD, PhD, Director of the Office of Global Health and Health Disparities at National Institute of Neurological Disorders and Stroke, gave a lecture focused on National Institute of Neurological Disorders and Stroke efforts to address inequities. Nichols et al highlighted approaches of community-based participatory research to address stroke inequities. Verma et al showcased digital health innovations to reduce inequities in stroke. Das et al showed that the proportion of underrepresented in medicine vascular neurology fellows has lowered over the past decade and authors provided a road map for enhancing the diversity in vascular neurology. Clearly, to overcome inequities, multipronged strategies are required, from broadening representation among vascular neurology faculty to partnering with communities to conduct research with meaningful impact.
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Affiliation(s)
- Amytis Towfighi
- University of Southern California, Los Angeles (A.T.).,Los Angeles County-Department of Health Services, CA (A.T.)
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Hypertension and Diabetes in Akatsi South District, Ghana: Modeling and Forecasting. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9690964. [PMID: 35187174 PMCID: PMC8850043 DOI: 10.1155/2022/9690964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
Background The rising incidence of hypertension and diabetes calls for a global response. Hypertension and diabetes will rise in Ghana as the population ages, urbanization increases, and people lead unhealthy lives. Our goal was to create a time series algorithm that effectively predicts future increases to help preventative medicine and health care intervention strategies by preparing health care practitioners to control health problems. Methods Data on hypertension and diabetes from January 2016 to December 2020 were obtained from three health facilities. To detect patterns and predict data from a particular time series, three forecasting algorithms (SARIMAX (seasonal autoregressive integrated moving average with exogenous components), ARIMA (autoregressive integrated moving average), and LSTM (long short-term memory networks)) were implemented. We assessed the model's ability to perform by calculating the root mean square error (RMSE), mean absolute error (MAE), mean square error (MSE), and mean absolute percentage error (MAPE). Results The RMSE, MSE, MAE, and MAPE for ARIMA (5, 2, 4), SARIMAX (1, 1, 1) × (1, 1, 1, 7), and LSTM was 28, 769.02, 22, and 7%, 67, 4473, 56, and 14%, and 36, 1307, 27, and 8.6%, respectively. We chose ARIMA (5, 2, 4) as a more suitable model due to its lower error metrics when compared to the others. Conclusion All models had promising predictability and predicted a rise in the number of cases in the future, and this was essential for administrative and management planning. For appropriate and efficient strategic planning and control, the prognosis was useful enough than would have been possible without it.
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The contribution of potentially modifiable risk factors to acute ischemic stroke burden - Comparing young and older adults. Prev Med 2022; 155:106933. [PMID: 34954243 DOI: 10.1016/j.ypmed.2021.106933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022]
Abstract
Stroke is a leading cause of death and disability. In order to estimate the contribution of five modifiable risk factors to acute ischemic stroke (AIS) incidence in Israel, we conducted a case-control study based on first AIS cases aged 21-90 reported to the Israeli National Stroke Registry during 2014-2015, and controls from a national health survey conducted between 2013 and 2015. We calculated the population attributable risk (PAR) of each risk factor and the combined PAR for all risk factors (hypertension, diabetes, current smoking, obesity and hyperlipidemia), in all study population and by subgroups of young adults (age < 55) and older adults (age ≥ 55). The final analysis included 571, 577 and 500 matched pairs for all study population, young adults and older adults, respectively. Among young adults, current smoking and hypertension were the two most contributing risk factors for AIS, accounting for 33.6% (95% CI 27.3-39.9) and 28.9% (95% CI 22.1-35.7) of AIS cases, respectively. Among older adults, hypertension was the single most contributing risk factor for AIS and diabetes was the second most contributing risk factor for AIS, accounting for 64.9% (95% CI 57.3-72.5) and 25.7% (95% CI 17.5-33.9) of AIS cases, respectively. The combined PAR was significantly lower among young adults (PAR = 67.9%), compared with older adults (PAR = 80.7%). The combined PAR for all study population was 80.1% (95% CI 74.0-86.2), indicating that five common and modifiable risk factors explain ~80% of AIS incidence in Israel. Primary prevention strategies targeting these risk factors have the potential to drastically reduce stroke related morbidity and mortality.
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Ovbiagele B. The 2021 William Feinberg Award Lecture Seeking Glocal Solutions to Cerebrovascular Health Inequities. Stroke 2022; 53:643-653. [DOI: 10.1161/strokeaha.121.034563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Global and local (“glocal”) disparities in stroke incidence, prevalence, care, and mortality are persistent, pervasive, and progressive. In particular, the disproportionate burden of stroke in people of African ancestry compared to most other racial/ethnic groups around the world has been long standing, is expected to worsen, and so far, has defied solution, largely because conventional risk factors likely account for less than half of the Black versus White disparity in stroke outcomes. While hypotheses such as a differential impact or inadequate evaluation of traditional risk factors by race have been suggested as potentially key factors contributing to lingering racial/ethnic stroke disparities, relatively understudied novel risk factors such as psychosocial stress, environmental pollution, and inflammation; and influences of the social determinants of health are gaining the most attention (and momentum). Moreover, it is increasingly recognized that while there is a lot still to understand, there needs to be a major shift from incessantly studying the problem, to developing interventions to resolve it. Resolution will likely require targeting multilevel factors, considering contemporaneous cross-national and cross-continental data collection, creating scalable care delivery models, jointly addressing care quality and community drivers of stroke occurrence, incorporating policy makers in planning/dissemination of successful interventions, and investing in robust transdisciplinary research training programs that address the interrelated issues of health equity and workforce diversity, and regional capacity building. To this end, our international multidisciplinary team has been involved in conducting several epidemiological studies and clinical trials in the area of stroke disparities, as well as executing career enhancing research training programs in the United States and Africa. This award lecture paper shares some of the lessons we have learnt from previous studies, presents objectives/design of ongoing initiatives, and discusses plans for the future.
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Affiliation(s)
- Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco
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Cisse FA, Ligot N, Conde K, Barry DS, Toure LM, Konate M, Soumah MF, Diawara K, Traore M, Naeije G. Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry. Sci Rep 2022; 12:1125. [PMID: 35064178 PMCID: PMC8782910 DOI: 10.1038/s41598-022-05057-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Low- to middle-income countries (LMICs) now bear most of the stroke burden. In LMICs, stroke epidemiology and health care systems are different from HICs. Therefore, a high-income country (HIC)-based predictive model may not correspond to the LMIC stroke context. Identify the impact of modifiable variables in acute stroke management in Conakry, Guinea as potential predictors of favorable stroke outcome. Data were extracted from the Conakry stroke registry that includes 1018 patients. A logistic regression model was built to predict favorable stroke outcomes, defined as mRS 0–2. Age, admission NIHSS score, mean arterial blood pressure and capillary glycemia were chosen as covariates. Delay to brain CT imaging under 24 h from symptom onset, fever, presence of sores and abnormal lung auscultation were included as factors. NIHSS score on admission, age and ischemic stroke were included in the null model as nuisance parameters to determine the contribution of modifiable variables to predict stroke favorable outcome. Lower admission NIHSS, brain CT imaging within 24 h of symptoms onset and lower mean arterial blood pressure emerged as a significant positive predictors of favorable stroke outcome with respective odd ratios (OR) of 1.35 [1.28–1.43], 2.1 [1.16–3.8] and 1.01 [1.01–1.04]. The presence of fever or sores impacted negatively stroke favorable outcomes with OR of 0.3 [0.1–0.85] and 0.25 [0.14–0.45]. The area under receiver operating characteristic curves (AUC) of the model was 0.86. This model explained 44.5% of the variability of the favorable stroke outcome with 10.2% of the variability explained by the modifiable variables when admission NIHSS, and ischemic stroke were included in the null model as nuisance parameter. In the Conakry stroke registry, using a logistic regression to predict stroke favorable outcome, five variables that led to an AUC of 0.86: admission NIHSS, early brain CT imaging, fever, sores and mean blood pressure. This paves the way for future public health interventions to test whether modulating amendable variables leads to increased favorable stroke outcomes in LMICs.
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Affiliation(s)
- Fode Abass Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Noémie Ligot
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kaba Conde
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Djigué Souleymane Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Lamine Mohamed Toure
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mamadi Konate
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Fode Soumah
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Karinka Diawara
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Traore
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Gilles Naeije
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium. .,Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), 808 Lennik Street, 1070, Brussels, Belgium.
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Anwer S, Waris A, Gilani SO, Iqbal J, Shaikh N, Pujari AN, Niazi IK. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare (Basel) 2022; 10:healthcare10020190. [PMID: 35206805 PMCID: PMC8872602 DOI: 10.3390/healthcare10020190] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.
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Affiliation(s)
- Saba Anwer
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Asim Waris
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Syed Omer Gilani
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Javaid Iqbal
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Nusratnaaz Shaikh
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
| | - Amit N. Pujari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK;
- School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Imran Khan Niazi
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
- Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark
- Correspondence:
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81
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Ojagbemi A, Akinyemi J, Wahab K, Owolabi L, Arulogun O, Akpalu J, Akpalu A, Ogbole G, Akinsanya C, Wasiu A, Tito-Ilori M, Adekunle F, Lyrea R, Akpa O, Akinyemi R, Sarfo F, Owolabi M, Ovbiagele B. Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression. J Geriatr Psychiatry Neurol 2022; 35:121-127. [PMID: 33073691 PMCID: PMC8241399 DOI: 10.1177/0891988720968274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in Africa. METHODS We evaluated information collected as part of the Stroke Investigative Research and Education Network (SIREN) study, a multicentre, case-control study conducted at 15 sites in Ghana and Nigeria. Prestroke depression status was ascertained in stroke survivors using a validated self-report tool, while PSD was assessed using a stroke specific screening tool for depression ("HRQOLISP-E"). Independent associations were investigated using complementary log-log regression and binary logit models. RESULTS Among 1,977 participants, prestroke depression was found in 141 (7.1%). In multivariate analyses, prestroke depression was significantly associated with tachycardia (OR = 2.22, 95% CI = 1.37-3.56) and low consumption of green leafy vegetables (OR = 1.91, 95% CI = 1.12-3.24). Forty-one (29.1%) of the prestroke depression sub-sample developed PSD. However, prestroke depression was not significantly associated with PSD. CONCLUSION The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with depression who have multiple, additional, risks of stroke.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Adeniyi Wasiu
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | - Ruth Lyrea
- University of Ghana Medical School, Accra, Ghana
| | - Onoja Akpa
- College of Medicine, University of Ibadan, Nigeria
| | | | - Fred Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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82
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Level of knowledge, prevention practice, and predictors towards stroke among diabetic and hypertensive patients having a follow up at University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia. A cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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83
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Owolabi MO, Thrift AG, Mahal A, Ishida M, Martins S, Johnson WD, Pandian J, Abd-Allah F, Yaria J, Phan HT, Roth G, Gall SL, Beare R, Phan TG, Mikulik R, Akinyemi RO, Norrving B, Brainin M, Feigin VL. Primary stroke prevention worldwide: translating evidence into action. Lancet Public Health 2022; 7:e74-e85. [PMID: 34756176 PMCID: PMC8727355 DOI: 10.1016/s2468-2667(21)00230-9] [Citation(s) in RCA: 171] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 02/05/2023]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sheila Martins
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Neurology, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil; Brazilian Stroke Network, São Paulo, Brazil
| | - Walter D Johnson
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jeyaraj Pandian
- School of Public Health, Christian Medical College, Ludhiana, Punjab, India
| | - Foad Abd-Allah
- Department of Neurology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Joseph Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Hoang T Phan
- Department of Neurology, Monash University, Melbourne, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Greg Roth
- Institute for Health Metrics Evaluation, University of Washington, Seattle, WA, USA
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Richard Beare
- Monash Health, and Peninsula Clinical School, Monash University, Melbourne, VIC, Australia; Developmental Imaging Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Thanh G Phan
- Department of Neurology, Monash University, Melbourne, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robert Mikulik
- International Clinical Research Center, Neurology Department, St Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bo Norrving
- Department of Clinical Sciences, and Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Michael Brainin
- Department of Neuroscience and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | - Valery L Feigin
- Institute for Health Metrics Evaluation, University of Washington, Seattle, WA, USA; National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Scientific and Educational Department, Research Centre of Neurology, Moscow, Russia.
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84
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Sarfo FS, Ovbiagele B, Akpa O, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Ogbole G, Calys-Tagoe B, Fakunle A, Sanni T, Mulugeta G, Abdul S, Akintunde AA, Olowookere S, Uvere EO, Ibinaiye P, Akinyemi J, Uwanuruochi K, Olayemi B, Odunlami OA, Abunimye E, Arulogun O, Isah SY, Abubakar SA, Oladimeji A, Adebayo P, Shidali V, Chukwuonye II, Akpalu J, Tito-Ilori MM, Asowata OJ, Sanya EO, Amusa G, Onyeonoro U, Ogunmodede JA, Sule AG, Akisanya C, Mensah Y, Oyinloye OI, Appiah L, Agunloye AM, Osaigbovo GO, Olabinri E, Kolo PM, Okeke O, Adeoye AM, Ajose O, Jenkins C, Lackland DT, Egberongbe AA, Adeniji O, Ohifemen Adeleye O, Tiwari HK, Arnett D, Laryea RY, Olunuga T, Akinwande KS, Imoh L, Ogah OS, Melikam ES, Adebolaji A, Oguike W, Ogunronbi M, Adeniyi W, Olugbo OY, Bello AH, Ohagwu KA, Ogunjimi L, Agyekum F, Iheonye H, Adesina J, Diala S, Dambatta HA, Ikubor J, Singh A, Adamu S, Obese V, Adusei N, Owusu D, Ampofo M, Tagge R, Efidi R, Fawale B, Yaria J, Akinyemi R, Owolabi M. Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans. Stroke 2022; 53:134-144. [PMID: 34587795 PMCID: PMC8712357 DOI: 10.1161/strokeaha.120.032072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. METHODS The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. RESULTS There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001). CONCLUSIONS Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.
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Affiliation(s)
- Fred S. Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | | | | | - Taofeek Sanni
- Federal Teaching Hospital, Ido-Ekiti Ado-Ekiti, Nigeria
| | | | | | | | - Samuel Olowookere
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Balogun Olayemi
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Esther Abunimye
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Suleiman Y. Isah
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | | | | | | | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Osahon J. Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Emmanuel O. Sanya
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | - James A. Ogunmodede
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | | | | | - Atinuke M. Agunloye
- College of Medicine, University of Ibadan, Nigeria,University College Hospital, Ibadan, Nigeria
| | | | | | - Philip M. Kolo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Obiora Okeke
- Federal Medical Centre Umuahia, Abia state, Nigeria
| | - Abiodun M. Adeoye
- College of Medicine, University of Ibadan, Nigeria,University College Hospital, Ibadan, Nigeria
| | - Olabamiji Ajose
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | | | | | | | | | - Donna Arnett
- College of Public Health, University of Kentucky, USA
| | - Ruth Y. Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Lucius Imoh
- Jos University Teaching Hospital Jos, Nigeria
| | | | | | | | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Obiabo Y. Olugbo
- Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria
| | - Abiodun H. Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Olabisi Onabanjo University. Abeokuta, Nigeria
| | | | | | | | - Samuel Diala
- Department of Medicine, University of Ibadan, Nigeria
| | | | - Joyce Ikubor
- College of Public Health, University of Kentucky, USA
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Vida Obese
- Komfo Anokye Teaching Hospital Kumasi, Ghana
| | | | - Dorcas Owusu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Raelle Tagge
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | | | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Rufus Akinyemi
- Federal Medical Centre, Abeokuta, Nigeria.,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
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85
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Nyawornota VK, Tay DA, Adu E, Ocansey RT. A scoping review of 2018–2020 research on NCDs and physical activity in Ghana: Groundwork for a monitoring system and action plan. FASEB Bioadv 2021. [DOI: 10.1096/fba.2020-00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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86
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Ajayi A, Ajayi O. Pathophysiologically based antihypertensive pharmacotherapeutics rationality, efficacy and safety in Sub Saharan African Nations – A review. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2021; 11:200111. [PMID: 34825245 PMCID: PMC8605193 DOI: 10.1016/j.ijcrp.2021.200111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022]
Abstract
Background Hypertension (HT) prevalence, Uncontrolled Blood Pressure (UBP), morbidity and mortality are highest in Sub-Saharan Africa (SSA). Correlating pathophysiology of HT to pharmaco-therapy with antihypertensive drugs (AHD) may bring amelioration. Aims:To review peculiarities of HT in SSA, UBP causes, diagnostic modalities, AHD use, rationality and efficacy. Methods and results 14 published therapeutic audits in 4 SSA nations on Google Scholar or PUBMED, (total n = 6496 patients) were evaluated. Calcium Channel blockers (CCB) amlodipine, and thiazide diuretics (TD), hydrochlorothiazide (HCTZ) were the commonest AHD. Thiazide Like Diuretics (TLD) were underutilized. The % of patients on AHD were: 1 drug 5.4–55%; 2 drugs 37–82%; >/ = 3 drugs 6–50.3%. 2-drug combinations were: ACEI/ARB + TD (42%); CCB + TD (36.8%); ACEI + CCB (15.8%) of studies. Triple/quadruple therapy included Methyldopa (MTD) with ACEI + CCB or TD. The (%) attaining BP < 140/< 90 mmHg, ranged from 29 to 53.6%, median, 44%. The co-morbidities, range and median were: Diabetes Mellitus (DM): 9.8–64%, 19.2%; Chronic Kidney Disease (CKD): 5.7–7.5%, 6.9%, and Coronary artery Disease (CAD): 0.9–2.6%, 2.3%. ACEI + CCB ± TD were the preferred AHD for comorbidities. Conclusions Therapeutic inertia; Non-compliance; co-morbidities; refractory HT; ignorance; substandard AHD; contribute to UBP. Studies relating 24 hour ABPM to complications and mortality in SSA hypertensives; and impact of different AHD classes on ABPM, are needed. Study of ACEI + alpha-1 blockers + TLD on 24 hour ABPM and personalized care, are required.
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87
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Kossi O, Agbetou M, Noukpo SI, Triccas LT, Dossou-Yovo DE, Amanzonwe ER, Adoukonou T. Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1559. [PMID: 34693069 PMCID: PMC8517725 DOI: 10.4102/sajp.v77i1.1559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life. Objective To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou. Method This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests. Results A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments. Conclusion Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments. Clinical implications [AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.
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Affiliation(s)
- Oyéné Kossi
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin.,REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Mendinatou Agbetou
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Sènadé I Noukpo
- Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin
| | - Lisa T Triccas
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Daniel-Eude Dossou-Yovo
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin
| | - Elogni R Amanzonwe
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Thierry Adoukonou
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
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Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, Abbasifard M, Abbasi-Kangevari M, Abd-Allah F, Abedi V, Abualhasan A, Abu-Rmeileh NME, Abushouk AI, Adebayo OM, Agarwal G, Agasthi P, Ahinkorah BO, Ahmad S, Ahmadi S, Ahmed Salih Y, Aji B, Akbarpour S, Akinyemi RO, Al Hamad H, Alahdab F, Alif SM, Alipour V, Aljunid SM, Almustanyir S, Al-Raddadi RM, Al-Shahi Salman R, Alvis-Guzman N, Ancuceanu R, Anderlini D, Anderson JA, Ansar A, Antonazzo IC, Arabloo J, Ärnlöv J, Artanti KD, Aryan Z, Asgari S, Ashraf T, Athar M, Atreya A, Ausloos M, Baig AA, Baltatu OC, Banach M, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barone MTU, Basu S, Bazmandegan G, Beghi E, Beheshti M, Béjot Y, Bell AW, Bennett DA, Bensenor IM, Bezabhe WM, Bezabih YM, Bhagavathula AS, Bhardwaj P, Bhattacharyya K, Bijani A, Bikbov B, Birhanu MM, Boloor A, Bonny A, Brauer M, Brenner H, Bryazka D, Butt ZA, Caetano dos Santos FL, Campos-Nonato IR, Cantu-Brito C, Carrero JJ, Castañeda-Orjuela CA, Catapano AL, Chakraborty PA, Charan J, Choudhari SG, Chowdhury EK, Chu DT, Chung SC, Colozza D, Costa VM, Costanzo S, Criqui MH, Dadras O, Dagnew B, Dai X, Dalal K, Damasceno AAM, D'Amico E, Dandona L, Dandona R, Darega Gela J, Davletov K, De la Cruz-Góngora V, Desai R, Dhamnetiya D, Dharmaratne SD, Dhimal ML, Dhimal M, Diaz D, Dichgans M, Dokova K, Doshi R, Douiri A, Duncan BB, Eftekharzadeh S, Ekholuenetale M, El Nahas N, Elgendy IY, Elhadi M, El-Jaafary SI, Endres M, Endries AY, Erku DA, Faraon EJA, Farooque U, Farzadfar F, Feroze AH, Filip I, Fischer F, Flood D, Gad MM, Gaidhane S, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Ghozy S, Gialluisi A, Giampaoli S, Gilani SA, Gill PS, Gnedovskaya EV, Golechha M, Goulart AC, Guo Y, Gupta R, Gupta VB, Gupta VK, Gyanwali P, Hafezi-Nejad N, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hashi A, Hassan TS, Hassen HY, Havmoeller RJ, Hay SI, Hayat K, Hegazy MI, Herteliu C, Holla R, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iacoviello L, Iavicoli I, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Iqbal U, Irvani SSN, Islam SMS, Ismail NE, Iso H, Isola G, Iwagami M, Jacob L, Jain V, Jang SI, Jayapal SK, Jayaram S, Jayawardena R, Jeemon P, Jha RP, Johnson WD, Jonas JB, Joseph N, Jozwiak JJ, Jürisson M, Kalani R, Kalhor R, Kalkonde Y, Kamath A, Kamiab Z, Kanchan T, Kandel H, Karch A, Katoto PDMC, Kayode GA, Keshavarz P, Khader YS, Khan EA, Khan IA, Khan M, Khan MAB, Khatib MN, Khubchandani J, Kim GR, Kim MS, Kim YJ, Kisa A, Kisa S, Kivimäki M, Kolte D, Koolivand A, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Krishnamurthi RV, Kumar GA, Kusuma D, La Vecchia C, Lacey B, Lak HM, Lallukka T, Lasrado S, Lavados PM, Leonardi M, Li B, Li S, Lin H, Lin RT, Liu X, Lo WD, Lorkowski S, Lucchetti G, Lutzky Saute R, Magdy Abd El Razek H, Magnani FG, Mahajan PB, Majeed A, Makki A, Malekzadeh R, Malik AA, Manafi N, Mansournia MA, Mantovani LG, Martini S, Mazzaglia G, Mehndiratta MM, Menezes RG, Meretoja A, Mersha AG, Miao Jonasson J, Miazgowski B, Miazgowski T, Michalek IM, Mirrakhimov EM, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Mokhayeri Y, Molokhia M, Moni MA, Montasir AA, Moradzadeh R, Morawska L, Morze J, Muruet W, Musa KI, Nagarajan AJ, Naghavi M, Narasimha Swamy S, Nascimento BR, Negoi RI, Neupane Kandel S, Nguyen TH, Norrving B, Noubiap JJ, Nwatah VE, Oancea B, Odukoya OO, Olagunju AT, Orru H, Owolabi MO, Padubidri JR, Pana A, Parekh T, Park EC, Pashazadeh Kan F, Pathak M, Peres MFP, Perianayagam A, Pham TM, Piradov MA, Podder V, Polinder S, Postma MJ, Pourshams A, Radfar A, Rafiei A, Raggi A, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahmani AM, Rajai N, Ranasinghe P, Rao CR, Rao SJ, Rathi P, Rawaf DL, Rawaf S, Reitsma MB, Renjith V, Renzaho AMN, Rezapour A, Rodriguez JAB, Roever L, Romoli M, Rynkiewicz A, Sacco S, Sadeghi M, Saeedi Moghaddam S, Sahebkar A, Saif-Ur-Rahman KM, Salah R, Samaei M, Samy AM, Santos IS, Santric-Milicevic MM, Sarrafzadegan N, Sathian B, Sattin D, Schiavolin S, Schlaich MP, Schmidt MI, Schutte AE, Sepanlou SG, Seylani A, Sha F, Shahabi S, Shaikh MA, Shannawaz M, Shawon MSR, Sheikh A, Sheikhbahaei S, Shibuya K, Siabani S, Silva DAS, Singh JA, Singh JK, Skryabin VY, Skryabina AA, Sobaih BH, Stortecky S, Stranges S, Tadesse EG, Tarigan IU, Temsah MH, Teuschl Y, Thrift AG, Tonelli M, Tovani-Palone MR, Tran BX, Tripathi M, Tsegaye GW, Ullah A, Unim B, Unnikrishnan B, Vakilian A, Valadan Tahbaz S, Vasankari TJ, Venketasubramanian N, Vervoort D, Vo B, Volovici V, Vosoughi K, Vu GT, Vu LG, Wafa HA, Waheed Y, Wang Y, Wijeratne T, Winkler AS, Wolfe CDA, Woodward M, Wu JH, Wulf Hanson S, Xu X, Yadav L, Yadollahpour A, Yahyazadeh Jabbari SH, Yamagishi K, Yatsuya H, Yonemoto N, Yu C, Yunusa I, Zaman MS, Zaman SB, Zamanian M, Zand R, Zandifar A, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhong C, Zuniga YMH, Murray CJL. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20:795-820. [PMID: 34487721 PMCID: PMC8443449 DOI: 10.1016/s1474-4422(21)00252-0] [Citation(s) in RCA: 1651] [Impact Index Per Article: 550.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. METHODS We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. FINDINGS In 2019, there were 12·2 million (95% UI 11·0-13·6) incident cases of stroke, 101 million (93·2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6·55 million (6·00-7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8-12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1-6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0-73·0), prevalent strokes increased by 85·0% (83·0-88·0), deaths from stroke increased by 43·0% (31·0-55·0), and DALYs due to stroke increased by 32·0% (22·0-42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0-18·0), mortality decreased by 36·0% (31·0-42·0), prevalence decreased by 6·0% (5·0-7·0), and DALYs decreased by 36·0% (31·0-42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0-24·0) and incidence rates increased by 15·0% (12·0-18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5-3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5-3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57-8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97-3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01-1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7-90·8] DALYs or 55·5% [48·2-62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3-48·6] DALYs or 24·3% [15·7-33·2]), high fasting plasma glucose (28·9 million [19·8-41·5] DALYs or 20·2% [13·8-29·1]), ambient particulate matter pollution (28·7 million [23·4-33·4] DALYs or 20·1% [16·6-23·0]), and smoking (25·3 million [22·6-28·2] DALYs or 17·6% [16·4-19·0]). INTERPRETATION The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. FUNDING Bill & Melinda Gates Foundation.
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Sarfo FS, Akpa O, Ovbiagele B, Akpalu A, Wahab K, Komolafe M, Obiako R, Owolabi L, Osaigbovo GO, Jenkins C, Ogbole G, Fakunle A, Tiwari HK, Arulogun O, Arnett DK, Asowata O, Ogah O, Akinyemi RO, Owolabi MO. Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa. J Neurol Sci 2021; 428:117573. [PMID: 34260999 PMCID: PMC9980381 DOI: 10.1016/j.jns.2021.117573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 01/30/2023]
Abstract
Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50-65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82-71.58) and 4.13 (2.64-6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82-96.80) and aOR of 28.93 (15.10-55.44) was highest among the middle-age group. Diabetes with PAR of 32.29%(27.52-37.05) and aOR of 3.49 (2.56-4.75); meat consumption with PAR of 42.34%(32.33-52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02-21.60) and aOR of 2.23 (1.60-3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusion There is a differential influence of age on the associations of major risk factors with stroke in this West African cohort. Targeting modifiable factors predominant within an age group may be more effective as a stroke prevention strategy.
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Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Onoja Akpa
- College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
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90
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Youkee D, Deen G, Barrett E, Fox-Rushby J, Johnson I, Langhorne P, Leather A, Marshall IJ, O'Hara J, Rudd A, Sama A, Scott C, Thompson M, Wafa H, Wall J, Wang Y, Watkins C, Wolfe C, Lisk DR, Sackley CM. A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes. Front Neurol 2021; 12:712060. [PMID: 34557147 PMCID: PMC8453059 DOI: 10.3389/fneur.2021.712060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone. Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals. Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9-25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12-26) vs. 13 (IQR 7-22) (p < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) (p < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% (p = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6-73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0-7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65-6.75), pneumonia (OR 3.75, 1.82-7.76), subarachnoid haemorrhage (OR 43.1, 6.70-277.4) and undetermined stroke types (OR 6.35, 2.17-18.60) were associated with higher risk of in-hospital death. Discussion: We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.
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Affiliation(s)
- Daniel Youkee
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,*Correspondence: Daniel Youkee
| | - Gibrilla Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Edward Barrett
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Julia Fox-Rushby
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Israel Johnson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Iain J. Marshall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jessica O'Hara
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Anthony Rudd
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Albert Sama
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Christella Scott
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Hatem Wafa
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jurate Wall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Caroline Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, United Kingdom
| | - Charles Wolfe
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Durodami Radcliffe Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Mary Sackley
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,Division of Stroke Medicine, University of Nottingham, Nottingham, United Kingdom
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Charles E, Maryjane U, Martins N, Ginikachi O. Association of stroke risk factors with personality and discrete emotions. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Matizirofa L, Chikobvu D. Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression. BMC Public Health 2021; 21:1560. [PMID: 34404386 PMCID: PMC8369801 DOI: 10.1186/s12889-021-11592-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In South Africa (SA), stroke is the second highest cause of mortality and disability. Apart from being the main killer and cause of disability, stroke is an expensive disease to live with. Stroke costs include death and medical costs. Little is known about the stroke burden, particularly the stroke direct costs in SA. Identification of stroke costs predictors using appropriate statistical methods can help formulate appropriate health programs and policies aimed at reducing the stroke burden. Analysis of stroke costs have in the main, concentrated on mean regression, yet modelling with quantile regression (QR) is more appropriate than using mean regression. This is because the QR provides flexibility to analyse the stroke costs predictors corresponding to quantiles of interest. This study aims to estimate stroke direct costs, identify and quantify its predictors through QR analysis. METHODS Hospital-based data from 35,730 stroke cases were retrieved from selected private and public hospitals between January 2014 and December 2018. The model used, QR provides richer information about the predictors on costs. The prevalence-based approach was used to estimate the total stroke costs. Thus, stroke direct costs were estimated by taking into account the costs of all stroke patients admitted during the study period. QR analysis was used to assess the effect of each predictor on stroke costs distribution. Quantiles of stroke direct costs, with a focus on predictors, were modelled and the impact of predictors determined. QR plots of slopes were developed to visually examine the impact of the predictors across selected quantiles. RESULTS Of the 35,730 stroke cases, 22,183 were diabetic. The estimated total direct costs over five years were R7.3 trillion, with R2.6 billion from inpatient care. The economic stroke burden was found to increase in people with hypertension, heart problems, and diabetes. The age group 55-75 years had a bigger effect on costs distribution at the lower than upper quantiles. CONCLUSIONS The identified predictors can be used to raise awareness on modifiable predictors and promote campaigns for healthy dietary choices. Modelling costs predictors using multivariate QR models could be beneficial for addressing the stroke burden in SA.
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Affiliation(s)
- Lyness Matizirofa
- Department of Statistics, College of Science, Engineering and Technology, University of South Africa, Florida Campus, 28 Pioneer Avenue, Roodeport, Johannesburg, 1709, South Africa.
| | - Delson Chikobvu
- Department of Mathematical Statistics and Actuarial Science, Faculty of Natural and Agricultural Sciences, University of the Free State, P.O. Box 339, Bloemfontein, South Africa
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Sarfo FS, Akinyemi J, Akpalu A, Wahab K, Yaria J, Adebayo O, Komolafe M, Obiako R, Owolabi L, Osaigbovo GO, Jenkins C, Mensah Y, Ogbole G, Calys-Tagoe B, Adebayo P, Appiah L, Singh A, Fakunle A, Uvere E, Hemant T, Balogun O, Adeleye O, Fawale B, Abdulwasiu A, Ogunjimi L, Akinola O, Arulogun O, Donna A, Ogah O, Akinyemi R, Ovbiagele B, Owolabi MO. Frequency and factors associated with post-stroke seizures in a large multicenter study in West Africa. J Neurol Sci 2021; 427:117535. [PMID: 34130063 PMCID: PMC8325635 DOI: 10.1016/j.jns.2021.117535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa. PURPOSE To assess the frequency and factors associated with PSS by stroke types across 15 hospitals in Nigeria and Ghana. METHODS We analyzed data on all stroke cases recruited into the Stroke Investigative Research and Educational Network (SIREN). We included adults aged ≥18 years with radiologically confirmed ischemic stroke (IS) or intracerebral hemorrhage (ICH). PSS were defined as acute symptomatic seizures occurring at stroke onset and/or during acute hospitalization up until discharge. We used logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. RESULTS Among 3344 stroke patients, 499 (14.9%) had PSS (95% CI: 13.7-16.2%). The mean duration of admission in days for those with PSS vs no PSS was 17.4 ± 28.6 vs 15.9 ± 24.7, p = 0.72. There were 294(14.1%) PSS among 2091 ischemic strokes and 159(17.7%) among 897 with ICH, p = 0.01. The factors associated with PSS occurrence were age < 50 years, aOR of 1.59 (1.08-2.33), National Institute of Health Stroke Score (NIHSS), 1.29 (1.16-1.42) for each 5 units rise and white cell count 1.07 (1.01-1.13) for each 10^3 mm3 rise. Factors associated with PSS in ischemic were NIHSS score, aOR of 1.17 (1.04-1.31) and infarct volume of 10-30 cm3 aOR of 2.17(1.37-3.45). Among ICH, associated factors were alcohol use 5.91 (2.11-16.55) and lobar bleeds 2.22 (1.03-4.82). CONCLUSION The burden of PSS among this sample of west Africans is substantial and may contribute to poor outcomes of stroke in this region. Further longitudinal studies are required to understand the impact on morbidity and mortality arising from PSS in Africa.
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Affiliation(s)
- Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | - Morenike Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | - Yaw Mensah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Philip Adebayo
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Arti Singh
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Ezinne Uvere
- College of Medicine, University of Ibadan, Nigeria
| | - Tiwari Hemant
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Shagamu, Ogun State, Nigeria
| | - Onasanya Akinola
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Shagamu, Ogun State, Nigeria
| | | | - Arnette Donna
- College of Public Health, University of Kentucky, USA
| | | | - Rufus Akinyemi
- Federal Medical Centre, Abeokuta, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, University of Ibadan, Nigeria.
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94
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Melak AD, Wondimsigegn D, Kifle ZD. Knowledge, Prevention Practice and Associated Factors of Stroke Among Hypertensive and Diabetic Patients - A Systematic Review. Risk Manag Healthc Policy 2021; 14:3295-3310. [PMID: 34408515 PMCID: PMC8364969 DOI: 10.2147/rmhp.s324960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/03/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Because of the inadequate level of public awareness of the disease, the incidence of stroke has been sharply rising. Eventually, due to the prehospital delay, many stroke cases could not be eligible for thrombolysis thereby poor rehabilitative outcome has been tremendously increased. Thus, this study aimed to review the level of knowledge, prevention practice, and associated factors of stroke among hypertensive and diabetic patients. METHODS A systematic review of primarily published articles (2010-2020) related to knowledge and prevention practices of stroke was performed by searching online electronic databases like PubMed, Google Scholar, Refseek, Science direct, ResearchGate, and manual Google search by using the keywords and MeSH terms. Studies conducted on knowledge and prevention practices amongst hypertensive and/or diabetic patients were included. RESULTS Out of 531 searched studies, 42 articles were identified to be reviewed. The reported overall knowledge of stroke was ranging from 4.4% to 79%. Knowledge to the signs/symptoms of stroke was 23.6% to 87%. However, 15% to 77% of subjects were also reported that they did not know any sign of stroke. The range of risk factor knowledge was 10.5% to 86.6%. The reported level of stroke prevention practice was 2.4% to 72% but physical activity and weight reduction practice were relatively low. Inadequate level of knowledge and prevention practice of stroke was related to elderly, female gender, uneducated, unmarried, rural residents, economically low, comorbidity and unemployed individuals. CONCLUSION The current finding revealed that the level of knowledge and prevention practice of stroke was inadequate. Hence, the finding highlights health educational programs should be planned as an important avenue to enhance stroke awareness among the high-risk populations.
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Affiliation(s)
- Abreham Degu Melak
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmacology, Gondar, Ethiopia
| | - Dawit Wondimsigegn
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmaceutics and Social Pharmacy, Gondar, Ethiopia
| | - Zemene Demelash Kifle
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmacology, Gondar, Ethiopia
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95
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Abstract
OBJECTIVES Prior neuropsychiatric disturbances are risk factors for stroke. There is a knowledge gap on the predictors of prestroke psychopathology, as well as their association with stroke outcomes in survivors living in low- and middle-income countries (LMICs). We estimated prevalence, predictors, and association of prestroke neuropsychiatric symptoms with poststroke depression (PSD), disability, and mortality. DESIGN Prospective observation. SETTING Nigeria. PARTICIPANTS Adult ischemic and hemorrhagic stroke survivors. MEASUREMENTS Prestroke psychopathology were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Outcomes were assessed using validated tools, including the Centre for Epidemiologic Studies - Depression Scale (CES-D 10) and modified Rankin scale (mRS). Independent associations were investigated using regression models with Bonferroni corrections, and presented as standardized mean differences (SMD) and odds ratios (OR) within 95% confidence intervals (CI). RESULTS Among 150 participants, prestroke neuropsychiatric symptoms were found in 78 (52%). In multivariate logistic regression analyses, prestroke sleep disturbance was associated with systemic hypertension (OR = 5.39, 95% CI = 1.70-17.08). Prestroke neuropsychiatric symptoms independently predicted worse motor disability scores (SMD = 0.92, 95% CI = 0.21-1.62) and greater odds of poststroke mortality (OR = 2.7, 95% CI = 1.1-7.0) at 3 months. However, prestroke depression was not significantly associated with PSD. CONCLUSION Prestroke sleep disturbances was associated with systemic hypertension, a key index of high cardiovascular risk profile and stroke. The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with sleep symptoms who have multiple, additional, risks of stroke.
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96
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Akpalu A, Adjei P, Nkromah K, Poku FO, Sarfo FS. Neurological disorders encountered at an out-patient clinic in Ghana's largest medical center: A 16-year review. eNeurologicalSci 2021; 24:100361. [PMID: 34377844 PMCID: PMC8327338 DOI: 10.1016/j.ensci.2021.100361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background With a rising age of its population, sub-Saharan Africa(SSA) is currently experiencing an unprecedented rise in burden of neurological disorders. There is limited data on the demographic profile of neurological diseases in SSA. Objective To describe the spectrum of neurological disorders at the adult neurology clinic at Ghana's leading medical center. Methods This retrospective study was conducted at the adult neurology clinic at the Korle Bu Teaching Hospital between 2003 and 2019. We retrospectively reviewed charts of all cases seen at the clinic over the period to document main neurological diagnosis, and captured age and sex of participants. Neurologic diseases were classified using the revised International Statistical Classification of Diseases and Related Health Problems ICD 11 tool. Results There were 7950 patients sought consultation over the period with 7076 having a primary neurological disorder. The mean age ± SD of patients included in the analysis was 43.0 ± 19.8 years with 3777 (53.4%) being males. The frequencies of the top 5 neurological disorders were epilepsy (23.0%), peripheral neuropathies (19.6%), movement disorders (14.7%), cerebrovascular diseases (11.1%) and headache disorders (7.7%). Neurocognitive disorders, autoimmune demyelinating disorders of the nervous system, and motor neuron disorders were infrequently observed. Conclusion A wide spectrum of neurological disorders were encountered in this clinic, similar to previous report from other centers in SSA. There is an urgent need to build local capacity to provide optimal care to meet the demand of the rising burden of neurological diseases in Ghana.
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Affiliation(s)
- Albert Akpalu
- University of Ghana Medical School, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Patrick Adjei
- University of Ghana Medical School, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Foster Osei Poku
- Korle Bu Teaching Hospital, Accra, Ghana.,Akwatia Hospital, Ghana
| | - Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Kumasi, Ghana
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97
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Ackah M, Yeboah CO, Ameyaw L. Risk factors for 30-day in-hospital mortality for in-patient with stroke in sub-Saharan Africa: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e049927. [PMID: 34301662 PMCID: PMC8311307 DOI: 10.1136/bmjopen-2021-049927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION While individual studies have reported on in-hospital stroke mortality rates in sub-Saharan Africa (SSA), the estimates are highly variable and inconclusive, buttressing the need for precise and reliable estimations. To overcome these inconsistencies, a well-structured systematic review and meta-analytical models are necessary. However, to the best of our knowledge, there is no published systematic review and meta-analysis on risk factors for 30-day mortality for in-hospital patients with stroke in SSA. METHOD AND ANALYSIS We will include all retrospective and prospective facility-based observational studies reporting on the incidence and/or risk factors for in-hospital stroke mortality in SSA. Electronic databases such as PubMed, Google scholar and Africa Journal Online (AJOL) will be searched for potentially relevant studies on in-hospital stroke mortality and risk factors in SSA. The search will be limited to studies conducted from January 1990 to December 2020. Two independent authors will screen titles and abstract to find studies that meet the prespecified eligibility criteria for inclusion in the review. The incidence of 30-day in hospital stroke mortality will be pooled. Meta-regression will be used to assess the factors associated with in-hospital stroke mortality in SSA. If possible, subgroup analysis will be performed based on subregion, publication year and study design, and quality score to determine possible source of heterogeneity. If possible, a sensitivity analysis will be performed to determine the robustness of the estimates obtained from the meta-analysis. ETHICS AND DISSEMINATION Ethical approval is not required as this is a secondary research and will use reported data in scientific literature. A full manuscript will be submitted to a reputable peer-review journal for publication. PROSPERO REGISTRATION NUMBER CRD42021227367.
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Affiliation(s)
- Martin Ackah
- Department of Physiotherapy, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Cynthia Osei Yeboah
- Department of Physiotherapy, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Louise Ameyaw
- School of public Health, University of Ghana College of Health Sciences, Accra, Greater Accra, Ghana
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98
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Lu H, Tan Z, Liu Z, Wang L, Wang Y, Suo C, Zhang T, Jin L, Dong Q, Cui M, Jiang Y, Chen X. Spatiotemporal trends in stroke burden and mortality attributable to household air pollution from solid fuels in 204 countries and territories from 1990 to 2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 775:145839. [PMID: 33631580 DOI: 10.1016/j.scitotenv.2021.145839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
Exposure to household air pollution from solid fuels (HAP) is associated with stroke. However, few studies have assessed stroke burden attributable to HAP globally and made comparisons across countries. We aimed to estimate the spatiotemporal trends in stroke burden and mortality attributable to household air pollution from solid fuels (HAP) in 204 countries and territories from 1990 to 2019. Data on stroke burden and mortality attributable to HAP from 1990 to 2019 were obtained from Global Burden of Disease Study 2019. We estimated the numbers and age-standardized rates (ASRs) of stroke disability-adjusted life years (DALYs) and mortality (ASDR and ASMR) by sex, age, and subtype, at global, regional, and national levels. Estimated annual percentage change (EAPC) was calculated to evaluate the temporal trends in ASDR and ASMR from 1990 to 2019. In 2019, globally, 14.7 million DALYs and 0.6 million deaths were caused by stroke attributable to HAP. The corresponding ASDR and ASMR increased with age, were highest in males and for intracerebral hemorrhage, with highest ASRs in the low sociodemographic index (SDI) regions and Solomon Islands, and varied greatly at the national level. From 1990 to 2019, the corresponding EAPCs in ASDR and ASMR were -4.00 (95% confidence interval [CI]: -4.21 to -3.80) and -4.12 (95% CI: -4.37 to -3.87), respectively. Stroke burden attributable to HAP decreased in all age groups. Females had a lower decreasing trend in ASDR and ASMR, compared with males. The decline was more significant for subarachnoid hemorrhage, while proportions of ischemic stroke in the numbers of stroke burden increased worldwide and in all SDI regions. Although most of countries and territories were in a decreasing trend in ASRs over the past three decades, Zimbabwe and Philippines showed an undesirable increased trend. Stroke burden attributable to HAP is still pronounced in males, old-age populations, low-income countries, and for intracerebral hemorrhage. Despite its decreasing spatiotemporal trends in most countries, continued efforts on HAP control are needed to reduce related stroke burden, especially in those countries with increased trends.
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Affiliation(s)
- Heyang Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ziyi Tan
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai 200438, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China
| | - Zhenqiu Liu
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai 200438, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China
| | - Liping Wang
- Department of Medical Evaluation, Air Force Medical Center, Chinese PLA, Beijing 100089, China
| | - Yingzhe Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chen Suo
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai 200438, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China
| | - Yanfeng Jiang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai 200438, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China.
| | - Xingdong Chen
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China; State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai 200438, China; Fudan University Taizhou Institute of Health Sciences, Taizhou 225312, Jiangsu, China.
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99
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Dawod J, Coull BM. Chronic Kidney Disease and Risk of Stroke. Resolved Chronic Kidney Disease is A Biomarker Rather Than A Risk Factor for Stroke. J Stroke Cerebrovasc Dis 2021; 30:105869. [PMID: 34074582 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the last approximate 15 years some have suggested that chronic kidney disease (CKD) is a risk factor for stroke in and of itself. The assertion that CKD is a risk factor for stroke requires more scrutiny. It is possible that CKD is a reflection of severity of conditions such as hypertension and diabetes that are themselves among the most treatable risk factors for stroke or it is possible that the effects of CKD change vascular and related physiological functions and therefor directly contribute to increased risk of stroke and it is also possible that treatments for advance CKD such has hemodialysis could contribute to increased risk of stroke as secondary effects of the treatment methods. To addresses these issues as participant in the Brain & Kidney Conference 2020 debate on this issue we were assigned the task of arguing that "Resolved: CKD is not a risk factor for stroke. METHODS We performed a structured literature review in Pub Med of the currently generally accepted recognized risk factors for stroke as well as publications relating CKD and risk of stroke. RESULTS We found that CKD and stroke is highly confounded by the cause of CKD such that the highest incidence of stroke happens in persons whose CKD is related to HTN and diabetes mellitus. Non-vascular causes of CKD have a much lower stroke incidence than those with vascular causes of CKD. When the major clinical risk factors are controlled for the relative risk of stroke drops dramatically by more than 35% to an odds ratio of only 1.1. We also found that in large population studies looking at the potential benefits of addressing treatable risk factors for stroke to reduce the incidence of stroke, CKD was either not mentioned or had a low contribution margin for treatment benefit. CONCLUSIONS In general CKD is not a major risk factor for stroke but we argue that it is a biomarker of severity of vascular injury especially among individuals with hypertension and diabetes mellitus. Techniques for managing CKD such as hemodialysis may be related to increased risk of stroke and the contribution of CKD to intracerebral hemorrhage and brain microhemorrhages deserves more study and these were not addressed in detail in this debate.
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Affiliation(s)
- Judy Dawod
- Department of Neurology, University of Pennsylvania, Philadelphia, Pa.
| | - Bruce M Coull
- Department of Neurology and Medicine, University of Arizona COM- Tucson, Tucson, Az 85724.
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100
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Wahab KW, Kolo PM, Odili A, Iwuozo E, Ifebunandu N, Ademiluyi B, Okunola O, Sani MU, Akinlade M, Isezuo S, Ale OK, Beaney T, de la Rosa CN, Clarke J, Poulter NR, Omotoso AB. May Measurement Month 2019: an analysis of blood pressure screening results from Nigeria. Eur Heart J Suppl 2021; 23:B114-B116. [PMID: 34248435 PMCID: PMC8263085 DOI: 10.1093/eurheartj/suab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study is to estimate the frequency of undetected hypertension across the six geopolitical zones of Nigeria. We conducted an opportunistic screening of adults aged at least 18 years in the month of May 2019. Participants were recruited by trained volunteers using the May Measurement Month protocol. Blood pressure (BP) was measured using validated digital and mercury sphygmomanometers. We defined hypertension as BP ≥140/90 mmHg or the use of BP-lowering medication. A total of 3646 participants (52.8% females) with a mean age of 44.5 ± 15.7 years were screened. Hypertension was present in 39.2% of the participants but only 55. 4% of these were on antihypertensive medications. Only 46.8% hypertensives who were on medications had their BP controlled (<140/90 mmHg). Previous history of hypertension in pregnancy, alcohol intake and smoking were associated with increased mean systolic and diastolic BPs. The frequency of Nigerians with hypertension is high while only about half of those on antihypertensive medications are controlled. A multi-pronged approach to reduce the burden of hypertension is needed.
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Affiliation(s)
- Kolawole W Wahab
- Department of Medicine, University of Ilorin, Ilorin 240001, Nigeria
| | - Philip M Kolo
- Department of Medicine, University of Ilorin, Ilorin 240001, Nigeria
| | - Augustine Odili
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
| | - Emmanuel Iwuozo
- Department of Medicine, Benue State University, Makurdi, Nigeria
| | - Ngozi Ifebunandu
- Department of Medicine, Federal Medical Centre, Abakaliki, Nigeria
| | | | - Oluyomi Okunola
- Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Bayero University, Kano, Nigeria
| | - Mathias Akinlade
- Department of Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | - Simeon Isezuo
- Department of Medicine, Usmanu Dan Fodiyo University, Sokoto, Nigeria
| | - Olagoke K Ale
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | | | - Jonathan Clarke
- Department of Mathematics, Huxley Building, South Kensington Campus, Imperial College London, London SW7 2AZ, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Ayodele B Omotoso
- Department of Medicine, University of Ilorin, Ilorin 240001, Nigeria
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