Sociodemographic factors in anaemia in pregnancy in south-western Nigeria

Background: Anaemia in pregnancy persists, especially in third world countries where poor diet, low levels of literacy, infections, infestations and cultural practices predispose pregnant women to being anaemic. The aim of this study was to determine the prevalence of anaemia in pregnancy and to identify the possible associations between socio-economic status and anaemia in pregnancy among antenatal care seekers at Baptist Medical Centre, Ogbomoso, Oyo State, Nigeria.Method: A total of 350 pregnant women were recruited at booking from the antenatal clinic of the hospital. A standardised questionnaire was administered to collect sociodemographic data. The subjects were stratified into upper, middle and lower socio-economic groups according to a scoring system designed by Olusanya et al. for Nigeria and other African countries.Anaemia is defined as a haemoglobin level of less than 11 g/dl by the World Health Organization.Results: The prevalence of anaemia in pregnancy was 58.0% in the study population. Anaemia prevalence was significantly higher among the subjects in the middle and lower socio-economic classes: 78.3% and 80.3% respectively (P < 0.05). The majority of the severely anaemic subjects (80.0%) were from the lower social class.Conclusion: The prevalence of anaemia in pregnancy was found to be high in this population. Low socio-economic status is significantly associated with increased prevalence and severity of anaemia. It is recommended that the socio-economic situation of women be improved. This no doubt will help to reduce anaemia in pregnancy

Hypertension prevalence and awareness among a health workforce in Nigeria

Hypertension is now being widely reported in Africa and it is a major factor in the high mortality of adults in sub-Saharan Africa. Unfortunately hypertension is often unnoticed and undiagnosed because it is usually asymptomatic. As such, many people with hypertension are unaware of their condition. The aim of the study was to determine the prevalence of hypertension and related risk factors and to assess the level of awareness of hypertensive status among the health workers. This study is a descriptive survey carried out among the health workers at the Baptist Medical Centre Ogbomoso, Nigeria. A total of 324 consenting health workers of the institution were enrolled for the study. A standardized questionnaire was used to collect socio-demographic data. Measurements of blood pressure, weight and height were carried out and body mass indices were calculated.The prevalence of hypertension is 20.1% in the studied population. A strong association was found between the prevalence of hypertension and increasing age, body mass index, alcohol consumption and duration of employment. Awareness of hypertensive status was good as 64.7% of the hypertensive subjects in this study were aware of their status.There is a higher awareness of hypertensive status among the health workers in this study than in the general populace. Approximately a third of the health workers were however unaware of their hypertensive status. This demonstrates the asymptomatic nature of the disease and as such routine screening is very important even among health workers.KEY WORDS: Awareness; Health workers; Hypertension; Nigeria; Prevalenc

Time of presentation of stroke patients for CT imaging in a Nigerian tertiary hospital

Background: Neuroimaging is the cornerstone for guiding thrombolytic and interventional therapy for stroke. Beneficial outcome can only be obtained within a rather short time of less than 3-4.5 hours of symptom onset. Challenges in developing countries like Nigeria often lead to delayed presentation of stroke patients in hospitals. We sought to study the time and pattern of presentation of stroke patients for CT imaging in a Nigerian tertiary hospital.Methods: Of the 271 stroke patients who had cranial CT between 2008 and 2010, eighty-three (30.6%) with full retrievable CT records, were included in this study. They were categorized into six time groups cross-tabulated with their CT findings.Results: Forty-two patients (50.6%) had cerebral infarction while 23 (27.7%) had haemorrhagic stroke. However, 18 (21.7%) patients had apparently normal CT findings. The mean presentation time for CT imaging was 70 hours (SD ±94 hours). Only 31% of all stroke patients presented for CT imaging within 12 hours, and none, within 3 hours. Forty-six percent did not present within 24 hours of symptom onset. Significantly more patients with ischemic stroke (72.3%) than hemorrhagic stroke (27.7%) presented after 12 hours of ictus (X2 = 4.027 d=1, P =0.045). Age (X2=0.008, P =0.931) and gender (X21.742, d=1,P =0.187) had no statistically significant relationship with the time of presentation for CT imaging.Conclusion: None of our patients met the time criteria for thrombolytic therapy. Ischemic stroke patients presented for imaging later than patients with intracerebral haemorrhage. There is a need to increase the awareness regarding early recognition, presentation and diagnosis of stroke for timely intervention in Nigeria.Keywords: Time, Stroke, CT Imaging, Nigeri

Age, sex, and setting in the etiology of stroke study (ASSESS): Study design and protocol

RATIONALE: Stroke etiology and risk factors vary by age, sex, setting (hospital or community-based) and by region. Identifying these differences would improve our understanding of stroke etiology, diagnosis, and treatment. AIM: The Age, Sex and Setting in the Etiology of Stroke Study (ASSESS) is a multicenter cohort study to assess differences in stroke etiology. METHODS AND DESIGN: Data from all centers will be categorized according to age, sex, setting, stroke subtypes. Centers with extensive hospital- or community-based data regarding stroke from Argentina, Australia, Canada, India, Iran, Italy, Ghana, Nigeria, Thailand, the United Kingdom and the United States have agreed to participate so far. STUDY OUTCOMES: The primary outcome includes differences in stroke etiology in study centers. The secondary outcomes include stroke incidence, risk factors, preventive strategies, and short- and long-term outcomes. CONCLUSION: ASSESS will enable comparisons of data from different regions to determine the age and sex distribution of the most common causes of stroke in each setting. This will help clinicians to tailor the assessment and treatment of stroke patients on the basis of their specific local characteristics. It will also empower stroke epidemiologists to design preventive measures by targeting the specific characteristics of each population

Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome.

Objective: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS). Materials and methods: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student\u2019s t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant. Results: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values. Conclusion: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome

Novel functional insights into ischemic stroke biology provided by the first genome-wide association study of stroke in indigenous Africans

\ua9 The Author(s) 2024. Background: African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network (SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke in indigenous Africans. Methods: Cases were consecutively recruited consenting adults (aged > 18 years) with neuroimaging-confirmed ischemic stroke. Stroke-free controls were ascertained using a locally validated Questionnaire for Verifying Stroke-Free Status. DNA genotyping with the H3Africa array was performed, and following initial quality control, GWAS datasets were imputed into the NIH Trans-Omics for Precision Medicine (TOPMed) release2 from BioData Catalyst. Furthermore, we performed fine-mapping, trans-ethnic meta-analysis, and in silico functional characterization to identify likely causal variants with a functional interpretation. Results: We observed genome-wide significant (P-value < 5.0E−8) SNPs associations near AADACL2 and miRNA (MIR5186) genes in chromosome 3 after adjusting for hypertension, diabetes, dyslipidemia, and cardiac status in the base model as covariates. SNPs near the miRNA (MIR4458) gene in chromosome 5 were also associated with stroke (P-value < 1.0E−6). The putative genes near AADACL2, MIR5186, and MIR4458 genes were protective and novel. SNPs associations with stroke in chromosome 2 were more than 77 kb from the closest gene LINC01854 and SNPs in chromosome 7 were more than 116 kb to the closest gene LINC01446 (P-value < 1.0E−6). In addition, we observed SNPs in genes STXBP5-AS1 (chromosome 6), GALTN9 (chromosome 12), FANCA (chromosome 16), and DLGAP1 (chromosome 18) (P-value < 1.0E−6). Both genomic regions near genes AADACL2 and MIR4458 remained significant following fine mapping. Conclusions: Our findings identify potential roles of regulatory miRNA, intergenic non-coding DNA, and intronic non-coding RNA in the biology of ischemic stroke. These findings reveal new molecular targets that promise to help close the current gaps in accurate African ancestry-based genetic stroke’s risk prediction and development of new targeted interventions to prevent or treat stroke

Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers.

OBJECTIVES: There is growing recognition around the importance of multimorbidity in low-income and middle-income country (LMIC) settings, and specifically the need for pragmatic intervention studies to reduce the risk of developing multimorbidity, and of mitigating the complications and progression of multimorbidity in LMICs. One of many challenges in completing such research has been the selection of appropriate outcomes measures. A 2018 Delphi exercise to develop a core-outcome set for multimorbidity research did not specifically address the challenges of multimorbidity in LMICs where the global burden is greatest, patterns of disease often differ and health systems are frequently fragmented. We, therefore, aimed to summarise and critically review outcome measures suitable for studies investigating mitigation of multimorbidity in LMIC settings. SETTING: LMIC. PARTICIPANTS: People with multimorbidity. OUTCOME MEASURES: Identification of all outcome measures. RESULTS: We present a critical review of outcome measures across eight domains: mortality, quality of life, function, health economics, healthcare access and utilisation, treatment burden, measures of 'Healthy Living' and self-efficacy and social functioning. CONCLUSIONS: Studies in multimorbidity are necessarily diverse and thus different outcome measures will be appropriate for different study designs. Presenting the diversity of outcome measures across domains should provide a useful summary for researchers, encourage the use of multiple domains in multimorbidity research, and provoke debate and progress in the field