Estimating the prevalence of overweight and obesity in Nigeria in 2020: a systematic review and meta-analysis.

BACKGROUND: Targeted public health response to obesity in Nigeria is relatively low due to limited epidemiologic understanding. We aimed to estimate nationwide and sub-national prevalence of overweight and obesity in the adult Nigerian population. METHODS: MEDLINE, EMBASE, Global Health, and Africa Journals Online were systematically searched for relevant epidemiologic studies in Nigeria published on or after 01 January 1990. We assessed quality of studies and conducted a random-effects meta-analysis on extracted crude prevalence rates. Using a meta-regression model, we estimated the number of overweight and obese persons in Nigeria in the year 2020. RESULTS: From 35 studies (n = 52,816), the pooled crude prevalence rates of overweight and obesity in Nigeria were 25.0% (95% confidence interval, CI: 20.4-29.6) and 14.3% (95% CI: 12.0-15.5), respectively. The prevalence in women was higher compared to men at 25.5% (95% CI: 17.1-34.0) versus 25.2% (95% CI: 18.0-32.4) for overweight, and 19.8% (95% CI: 3.9-25.6) versus 12.9% (95% CI: 9.1-16.7) for obesity, respectively. The pooled mean body mass index (BMI) and waist circumference were 25.6 kg/m2 and 86.5 cm, respectively. We estimated that there were 21 million and 12 million overweight and obese persons in the Nigerian population aged 15 years or more in 2020, accounting for an age-adjusted prevalence of 20.3% and 11.6%, respectively. The prevalence rates of overweight and obesity were consistently higher among urban dwellers (27.2% and 14.4%) compared to rural dwellers (16.4% and 12.1%). CONCLUSIONS: Our findings suggest a high prevalence of overweight and obesity in Nigeria. This is marked in urban Nigeria and among women, which may in part be due to widespread sedentary lifestyles and a surge in processed food outlets, largely reflective of a trend across many African settings.KEY MESSAGESAbout 12 million persons in Nigeria were estimated to be obese in 2020, with prevalence considerably higher among women. Nutritional and epidemiological transitions driven by demographic changes, rising income, urbanization, unhealthy lifestyles, and consumption of highly processed diets appear to be driving an obesity epidemic in the country.

Prevalence of dementia in Nigeria: a systematic review of the evidence.

BACKGROUND: The burden of dementia is poorly understood in Nigeria. We sought to gather available epidemiologic evidence on dementia in Nigeria to provide country-wide estimates of its prevalence and associated risks. METHODS: We searched MEDLINE, EMBASE, Global Health, Africa Journals Online (AJOL) and Google Scholar for epidemiologic studies on dementia in Nigeria from 1990 to 2018. We pooled crude estimates using random effects meta-analysis. A meta-regression epidemiologic model, using the United Nations demographics for Nigeria, was used to estimate the absolute number of people living with dementia in Nigeria in 1995 and 2015. RESULTS: Our searches returned 835 studies, of which nine were selected. These included 10 820 individuals with a median age of 74.4 years. Heterogeneity (I 2 =98.8%, P<0.001) was high across studies. Five studies were conducted in the South-west, and four studies were rated as high quality. The pooled crude prevalence of dementia in Nigeria was 4.9% (95% CI: 3.0-6.9) with prevalence significantly higher in women (6.7%, 3.6-9.9) compared to men (3.1%, 1.2-5.0). Age 80+ (odds ratio (OR) 1.6, 1.3-1.9), female sex (OR 2.2, 1.4-3.4) and BMI ≤18.5 (OR 3.5, 1.2-10.1) were significant risks for dementia in Nigeria. Using our epidemiologic model, we estimated that the number of dementia cases increased by over 400% over a 20-year period, increasing from 63 512 in 1995 to 318 011 in 2015 among persons aged ≥60 years. CONCLUSION: Our findings suggest the prevalence and cases of dementia have increased in Nigeria over the last two decades. Population-wide response to dementia is lacking.

Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis.

BACKGROUND: The response to stroke in Nigeria is impaired by inadequate epidemiologic information. We sought to collate available evidence and estimate the incidence of stroke and prevalence of stroke survivors in Nigeria. METHODS: Using random effects meta-analysis, we pooled nationwide and regional incidence and prevalence of stroke from the estimates reported in each study. RESULTS: Eleven studies met our selection criteria. The pooled crude incidence of stroke in Nigeria was 26.0 (12.8-39.0) /100,000 person-years, with this higher among men at 34.1 (9.7-58.4) /100,000, compared to women at 21.2 (7.4-35.0) /100,000. The pooled crude prevalence of stroke survivors in Nigeria was 6.7 (5.8-7.7) /1000 population, with this also higher among men at 6.4 (5.1-7.6) /1000, compared to women at 4.4 (3.4-5.5) /1000. In the period 2000-2009, the incidence of stroke in Nigeria was 24.3 (95% CI: 11.9-36.8) per 100,000, with this increasing to 27.4 (95% CI: 2.2-52.7) per 100,000 from 2010 upwards. The prevalence of stroke survivors increased minimally from 6.0 (95% CI: 4.6-7.5) per 1000 to 7.5 (95% CI: 5.8-9.1) per 1000 over the same period. The prevalence of stroke survivors was highest in the South-south region at 13.4 (9.1-17.8) /100,000 and among rural dwellers at 10.8 (7.5-14.1) /100,000. CONCLUSION: Although study period does not appear to contribute substantially to variations in stroke morbidity in Nigeria, an increasing number of new cases compared to survivors may be due in part to limited door-door surveys, or possibly reflects an increasing mortality from stroke in the country.

Secular trends in the prevalence of female genital mutilation/cutting among girls: a systematic analysis.

BACKGROUND: Current evidence on the decline in the prevalence of female genital mutilation or cutting (FGM/C) has been lacking worldwide. This study analyses the prevalence estimates and secular trends in FGM/C over sustained periods (ie, 1990-2017). Its aim is to provide analytical evidence on the changing prevalence of FGM/C over time among girls aged 0-14 years and examine geographical variations in low-income and middle-income countries. METHODS: Analysis on the shift in prevalence of FGM/C was undertaken using the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data sets from Africa and Middle East. A random-effects model was used to derive overall prevalence estimates. Using Poisson regression models, we conducted time trends analyses on the FGM/C prevalence estimates between 1990 and 2017. FINDINGS: We included 90 DHS and MICS data sets for 208 195 children (0-14 years) from 29 countries spread across Africa and two countries in Western Asia. The prevalence of FGM/C among children varied greatly between countries and regions and also within countries over the survey periods. The percentage decline in the prevalence of FGM/C among children aged 0-14 years old was highest in East Africa, followed by North and West Africa. The prevalence decreased from 71.4% in 1995 to 8.0% in 2016 in East Africa. In North Africa, the prevalence decreased from 57.7% in 1990 to 14.1% in 2015. In West Africa, the prevalence decreased from 73.6% in 1996 to 25.4% in 2017. The results of the trend analysis showed a significant shift downwards in the prevalence of FGM/C among children aged 0-14 years in such regions and subregions of East Africa, North Africa and West Africa. East Africa has experienced a much faster decrease in the prevalence of the practice (trend=-7.3%, 95% CI -7.5% to -7.1%) per year from 1995 to 2014. By contrast, the decline in prevalence has been much slower in North Africa (trend=-4.4%, 95% CI -4.5% to -4.3%) and West Africa (trend=-3.0%, 95% CI -3.1% to -2.9%). CONCLUSION: The prevalence of FGM/C among children aged 0-14 years varied greatly between countries and regions and also within countries over the survey periods. There is evidence of huge and significant decline in the prevalence of FGM/C among children across countries and regions. There is a need to sustain comprehensive intervention efforts and further targeted efforts in countries and regions still showing high prevalence of FGM/C among children, where the practice is still pervasive.

Estimating the uptake of brain imaging and 30-days stroke mortality in Nigeria: A meta-analysis of hospital-based studies.

PURPOSE: This study aims to estimate the computed tomography (CT) and Magnetic resonance imaging (MRI) uptake, stroke subtypes and 30-days case-fatality in Nigeria. METHODS: Stroke diagnosis and mortality data were identified from relevant databases. A random effect meta-analysis was conducted to obtain the pooled percentage uptake of CT/MRI, including 30-days case fatality and a meta-regression-like epidemiological model was applied on all data points. FINDINGS: A total of 24 studies involving 5874 stroke patients conducted in predominantly tertiary referral hospitals met the inclusion criteria. The pooled CT/MRI uptake in the last seven years was 46.66% (95% CI = 15.35 to 77.98, 8 studies). There were significant variations in the prevalence of stroke subtypes. The pooled prevalence ischemic stroke was highest (55.32%, 95% CI 48.67 to 61.97, 16 studies), followed by intracerebral haemorrhage (ICH) (32.69%, 95% CI 25.54 to 39.83, 16 studies), subarachnoid haemorrhage (SAH) (3.76%, 95% CI 2.30 to 5.22, 14 studies). In addition, the stroke of undetermined aetiology was found to be 16.57% (95% CI, 7.44-25.70, 8 studies). Overall, the 24-h, one-week and 30-days case-fatality from stroke were 10.84% (95% CI, 4.48-17.20), 24.62% (95% CI, 17.20-32.04) and 33.28% (95% CI, 27.80-38.77), respectively. There was a moderate negative correlation between prevalence of brain imaging uptake and ischaemic stroke, albeit not statistically significant (Spearman rho = 0.333, p-value = .412). CONCLUSION: Uptake of CT/MRI procedure for stroke is poor in Nigeria. Although poverty, inaccessibility and influence of major risk factors remain pronounced, scaling up of effective strategies for stroke prevention and management should be a major public health policy priority in Nigeria.

Magnitude and pattern of hypertension in the Niger Delta: a systematic review and meta-analysis of community-based studies.

BACKGROUND: Emerging evidence found that health inequality in the Niger Delta region in Nigeria has continued to worsen due to epidemiological and environmental risks transitions. This study aims to provide an up-to-date review and the secular trends of hypertension prevalence in Niger Delta. METHODS: We systematically searched databases of MEDLINE, EMBASE, African index Medicus and African Journal online from inception to December 30, 2016 for population-based studies providing prevalence estimates of hypertension in the Niger Delta. Eligible studies were included in a random-effect meta-analysis of prevalence and secular trend. The review was reported according to MOOSE guideline. RESULTS: Overall, 34 eligible studies comprising of data on 32715 participants with mean-age of 38.43 ± 2.0 years were identified and included in the meta-analysis. The pooled result showed that across study settings, the prevalence of hypertension in rural population tended to be higher than those in urban areas, 32.0% (95% confidence interval (CI) 25.13-39.28) vs 24.07% (95% CI 18.13-30.58), however, the difference did not reach a statistical significant level, (P < 0.183). The overall mean SBP was 130.15 (95% CI 126.85-133.45) mmHg, and the DBP was 80.72 (95% CI 78.45-82.95). The estimates also vary significantly in men compared to women; 30.26% (95% CI 23.76-37.17) vs 22.99% (17.60-28.86), P < 0.0001, and among those older than 65 years compared to those aged 45-64 years, and more than 2-fold compared to those between 15-44 years, P < 0.001. We also observed a continuous increase in prevalence of hypertension in the region (trend = 0.139, P = 0.0001), such that for every 10 years increase in participants' mean age, the prevalence of hypertension increases by 10.43% (95% CI 5.73-15.14), P < 0.001. CONCLUSIONS: This study found evidence that hypertension is a major public health issue in the Niger Delta communities suggesting a positive relationship between socio-economic and lifestyle factors. Improved surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure, remains an important public health priority.

Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region.

The burden of stroke has been projected to increase in low-and middle-income countries due to the ongoing epidemiological transition. However, community-based stroke prevalence studies are sparse in sub-Saharan Africa particularly in Nigeria. This study aimed to provide a comparative estimate of the prevalence of stroke survivors in the rural Niger Delta region. A three-phased door-to-door survey was conducted using WHO modified instruments. In the first-phase, 2028 adults (≥18years) participants randomly selected from two rural communities were screened by trained health research assistants for probable stroke. In the second phase, suspected cases were screened with stroke-specific tool. Positive cases were made to undergo complete neurological evaluation by two study neurologist in phase-three. Stroke diagnosis was based on clinical evaluation using WHO criteria. Overall, 27 (8 first-ever and 19 recurrent cases) stroke survivors with crude prevalence of 13.31/1000 (95% CI, 8.32-18.31) and a non-significant difference in prevalence between the two study communities were found, (P=0.393I). In addition, age-adjusted prevalence of stroke survivors was 14.6/1000 person, about 7-folds higher than previous estimates outside the Niger Delta region. The prevalence increases significantly with advancing in age, P<0·001. Among others, hypertension (92.59%) was the commonest risk factor and comorbidity found. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure, remains a public health priority.

Stroke survivors in low- and middle-income countries: A meta-analysis of prevalence and secular trends.

PURPOSE: To provide an up-to-date estimate on the changing prevalence of stroke survivors, and examines the geographic and socioeconomic variations in low and middle-income countries (LMICs). METHODS: We searched MEDLINE, EMBASE, SCOPUS and Web of Science databases and systematically reviewed articles reporting stroke prevalence and risk factors from inception to July 2015. Pooled prevalence estimates and secular trends based on random-effects models were conducted across LMICs, World Bank regions and income groups. RESULTS: Overall, 101 eligible community-based studies were included in the meta-analysis. The pooled crude prevalence of stroke survivors was highest in Latin America and Caribbean (21.2 per 1000, 95% CI 13.7 to 30.29) but lowest in sub-Saharan Africa (3.5 per 1000, 95% CI 1.9 to 5.7). Steepest increase in stroke prevalence occurred in low-income countries, increasing by 14.3% annually while the lowest increase occurred in lower-middle income countries (6% annually), and for every 10years increase in participants' mean age, the prevalence of stroke survivors increases by 62% (95% CI 6% to 147%). CONCLUSION: The prevalence estimates of stroke survivors are significantly different across LMICs in both magnitude and secular trend. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed.

The Burden of Hypertension in an Oil- and Gas-Polluted Environment: A Comparative Cross-Sectional Study.

BACKGROUND: Evidence of positive association between traffic-related air pollution and elevated blood pressure has been published widely. However, the risk of hypertension and prolonged exposure to crude oil pollution and gas flares remains unexplored. METHODS: We recruited 2,028 residents (aged 18-80) in a cross-sectional survey of both oil/gas polluted and nonpolluted communities in the Niger Delta region of Nigeria. Prevalence and risk of hypertension, anthropometric indices, lifestyle and sociodemographic factors, and cardiovascular comorbidities were examined and compared between the 2 groups. Hypertension was defined as blood pressure ≥140/90mm Hg or on antihypertensive medication. Both univariate and multivariate logistic regression models were used to examine factors associated with hypertension. Model fits statistics were used to assess the parsimonious model and predictive power. RESULTS: More than one-third of participants were hypertensive (37.4%). Half of the participants were from oil-polluted areas (51%). Only 15% of participants reported family history of hypertension. In the adjusted model, participants living in oil-polluted areas were almost 5 times as likely to have developed hypertension (adjusted odds ratio (aOR) = 4.85, 95% confidence interval (CI): 1.84-12.82) compared to participants in unpolluted areas. Age modifies the association between pollution status and risk of hypertension. For every 10 years increase in the age of the participants, the odds of developing hypertension increased by 108% (aOR = 2.08, 95% CI: 1.77-2.43). CONCLUSION: The results suggested that exposure to oil/gas pollution may be associated with an increased risk of hypertension. Our findings need to be further investigated in longitudinal studies.