Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

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.

High risk sexual behavior among adolescent senior secondary school students in Nigeria.

BACKGROUND: The consequences of high risk sexual practices (HRSP) are enormous among adolescent senior secondary school students. They therefore need to have sufficient knowledge of HRSP. AIM OBJECTIVES: The study gauged the level of knowledge and perceptions of high risk sexual behavior among senior secondary school students in Ilorin, Nigeria with a view to improving their understanding of the current trends in HRSP.This was a quantitative, cross-sectional, descriptive study of adolescent secondary school students in Ilorin East Local Government Area. Multi - stage sampling method involving 3 stages was used. A semi-structured interviewer administered questionnaire was used to obtain data. Informed consent of respondents was obtained. The data was analyzed using SPSS windows software package version 17. RESULTS: Majority, 305 (69.5%) of the students were between 16 - 20 years. The major source of information was from movies, 42.5%, and the internet, 24.7%. Twenty-three percent (23.1%) had poor knowledge of HRSP. Thirty-eight percent (38.1%) did not consider indiscriminate sexual intercourse as HRSP while 27.9% still believed that unprotected sexual practice is safe. Thirty-four percent (34.2%) did not know that sex with multiple partners is a HRSP while 34.4% did not know that oral -genital sex is unsafe. Over thirty-two (32.9%) perceived that engaging in sex made them mature among peers. Twenty-four (24.7%) did not perceive any danger in keeping multiple sexual partners while 15.3% would still engage in unprotected sex. CONCLUSION: The students had relatively poor knowledge and perceptions of HRSP. Quite a number did not consider indiscriminate sexual intercourse as HRSP. An appreciable number did not perceive any danger in keeping multiple sexual partners or beingengaged in unprotected sex. Counselling on the dangers of HRSP should be a component of the school health services so as to curb the complications of HRSP in our secondary schools.

Prevalence and correlates of hypertension-outcome of a free medical screening in Oke-Ogun area of Oyo state, Nigeria, West Africa.

Literature abounds on prevalence of hypertension in Nigeria and urban areas of Oyo state but none in Oke-Ogun geopolitical zone, which constitutes 10 local governments of the 33 in Oyo state, despite the fact that they have high genetic and environmental predisposition to developing high blood pressure. The purpose of the study was to determine the prevalence of high blood pressure and associated risk factors among indigenes of Oke-ogun, Oyo state. A total of 10,000 respondents were recruited using proportionate sampling techniques. Hypertension was defined according to Joint National Committee-8 criteria. The fasting plasma glucose of the respondents were classified as normal (≤6 mmol/L), prediabetes (6.1-6.9 mmol/L), and diabetes (≥7 mmol/L). Body mass index was calculated as weight (kg)/height (m2) and classified as malnutrition/underweight (<16-18.49), normal (18.5-24.9), overweight (25-29.9), and obese (30-≥40). Data were analyzed using descriptive statistics, Chi-square and binary logistic regression tests at P < .05. The mean systolic and diastolic blood pressure was 138 ± 27.81 and 86.13 ± 14.39 respectively. The overall prevalence of hypertension was 38.5%. 64.1% were diabetics. 63.4% had no formal education. Majority (82.95%) earned less than N18,000 ($59) per month. 43.3% had family history of hypertension. There is high prevalence of hypertension among the people of Oke-ogun, in Oyo state. Their low socioeconomic status, low educational background, malnutrition, and genetic predisposition were identified risk factors.

Social Determinants of Depression: Social Cohesion, Negative Life Events, and Depression Among People Living with HIV/Aids in Nigeria, West Africa.

BACKGROUND: People Living with HIV/AIDS (PLWHA) continue to face persistent and deep rooted social barriers. Incidentally, studies in social determinants of depression are very limited, necessitating this study, which examined social determinants of depression and the impact of these determinants on depression. METHODS: This was a hospital based, cross sectional descriptive study of three hundred adult HIV/AIDS patients, attending the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, Nigeria. Depressive symptoms were measured by the PHQ-9 rating scale. Three variables of social determinants of depression: socio-economic status (years of school and self-reported economic status of family), social cohesion, and negative life events were examined. RESULTS: The self-reported economic status of the family varied from good 35(11.7%), average 162(54%), and poor among 103(34.3%) of the respondents. Social cohesion was low in 199(66.3%), fair in 65(21.7%) and high among 36(12%) of the respondents. There was significant association between social cohesion, negative life events, and depression. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Income was the most significant socio-economic determinant. Majority had very low social cohesion and more negative life events, while those with below average years of schooling were more depressed. These are statistically significant. Social determinants of depression should be given a lot of emphasis, when addressing the issue of depression, if we are to meaningfully tackle this increasing scourge in our society.