Has Treatment Seeking Behaviour Changed in People Living with Epilepsy? Experience of People Living with Epilepsy Attending Adult Neurology Clinics in Enugu.

BACKGROUND: Over the years efforts has been made through public health education to change the knowledge, attitude and practice of epilepsy and seizures among the populace in Nigeria. One surrogate method of reviewing the impact of these educational interventions includes changes in treatment-seeking behavior of People Living With Epilepsy and the reasons for their choices of treatment. METHODS: This was a cross-sectional descriptive study. Data were collected from People Living With Epilepsy attending the medical outpatient clinics in two tertiary hospitals in Enugu, Enugu State southeast Nigeria. RESULTS: A total 276 people living with epilepsy were recruited with a mean age of 30.1 years and a median age of 25 years. After the onset of epilepsy, 76(27.5%) and 70(25.4%) visited general hospitals and teaching hospitals respectively, while prayer houses and traditional healing centers were first visited by 54(19.6%) and 40(14.5%) respectively. As a second choice of care 9(3.3%) and 13(4.7%) visited prayer houses and traditional healing centers. Only 42(15.2%) selected their treatment center because they were confident of getting a cure however, this was highest for those that visited traditional healing centers 11(27.5%). The age of onset of epilepsy positively correlated with selecting orthodox treatment at the choice of care, while occupational status negatively correlated with selecting orthodox care at the same period. CONCLUSIONS: Health care seeking behaviors among PLWE in Southeast Nigeria might have changed over the years as more people living with epilepsy were more likely to select orthodox treatment compared to non-orthodox means of treatment.

CONTEXTE: Au fil des ans, des efforts ont été déployés par le biais de l'éducation en santé publique pour changer les connaissances, les attitudes et les pratiques concernant l'épilepsie et les crises d'épilepsie parmi la population au Nigeria. Une méthode indirecte pour examiner l'impact de ces interventions éducatives comprend les changements dans le comportement de recherche de traitement des personnes vivant avec l'épilepsie et les raisons de leurs choix de traitement. MÉTHODES: Il s'agit d'une étude descriptive transversale. Les données ont été collectées auprès de personnes vivant avec l'épilepsie fréquentant les cliniques de consultations externes médicales dans deux hôpitaux tertiaires à Enugu, dans l'État d'Enugu, au sud-est du Nigeria. RÉSULTATS: Au total, 276 personnes vivant avec l'épilepsie ont été recrutées, avec un âge moyen de 30,1 ans et un âge médian de 25 ans. Après le début de l'épilepsie, 76 (27,5 %) et 70 (25,4 %) ont consulté respectivement des hôpitaux généraux et des hôpitaux universitaires, tandis que les lieux de prière et les centres de guérison traditionnelle ont été les premiers consultés par respectivement 54 (19,6 %) et 40 (14,5 %). Comme deuxième choix de soins, 9 (3,3 %) et 13 (4,7 %) ont consulté des lieux de prière et des centres de guérison traditionnelle. Seuls 42 (15,2 %) ont choisi leur centre de traitement parce qu'ils étaient confiants d'obtenir une guérison, cependant, ce taux était le plus élevé pour ceux qui ont consulté les centres de guérison traditionnelle (11 soit 27,5 %). L'âge de début de l'épilepsie était positivement corrélé avec la sélection d'un traitement orthodoxe comme choix de soins, tandis que le statut professionnel était négativement corrélé avec la sélection de soins orthodoxes au même moment. CONCLUSIONS: Les comportements de recherche de soins parmi les personnes vivant avec l'épilepsie dans le sud-est du Nigeria ont peut-être changé au fil des ans, car davantage de personnes vivant avec l'épilepsie étaient plus susceptibles de choisir un traitement orthodoxe par rapport aux moyens de traitement non orthodoxes. MOTS-CLÉS: Épilepsie, Comportement de recherche de soins, Guérisseurs traditionnels, Lieux de prière, Médecine orthodoxe, sud-est du Nigeria.

Audit of Stroke Admissions in a Tertiary Hospital in South East Nigeria.

INTRODUCTION: Stroke is one of the commonest causes of medical admissions and mortality in Nigeria. Documenting the pattern of stroke and risk factors for stroke is important not only for public health policy makers but also for physicians in implementing both primary and secondary preventive programs. OBJECTIVES: The aim of this study was therefore to document the pattern of stroke and risk factors for stroke in stroke patients admitted in a tertiary hospital in Enugu. METHODS: This was a cross-sectional descriptive study carried out at Enugu State University Teaching Hospital, Enugu. Data were analyzed using the SPSS version 26 (IBM Corporation, New York, USA). RESULTS: Data from 350 patients were included in the present study. The three commonest risk factors for stroke were diabetes (69.1%), hypertension (64.9%), and age 65 years and above (51.1%). A total of 74.9% of the patients had ischemic stroke and 25.1% had hemorrhagic stroke. Hemorrhagic stroke was significantly higher in patients < 50 years (46.5%) and people with hypertension, (31.7%). About 31.4% of the patients had two risk factors and 28.6% had three risk factors. Age 65 years and above positively correlated with having ischemic stroke and hypertension positively correlated with hemorrhagic stroke. When controlled for age, the correlation between hypertension and hemorrhagic stroke was still significant. CONCLUSION: The reported frequency of ischemic stroke was 74.9% and of hemorrhagic stroke was 25.1%. The commonest risk factors for stroke documented among stroke patients in a tertiary hospital in Enugu were diabetes, hypertension, and age 65 years and above. When controlled for age, the correlation between hypertension and hemorrhagic stroke was still significant.

INTRODUCTION: L'accident vasculaire cérébral (AVC) est l'une des causes les plus courantes d'admissions médicales et de mortalité au Nigeria. Il est important de documenter le profil des et les facteurs de risque des accidents vasculaires cérébraux sont importants non seulement pour le santé publique mais aussi pour les médecins dans la mise en œuvre des programmes de prévention primaire et secondaire. OBJECTIFS: L'objectif de cette étude était donc de documenter le modèle d'AVC et les facteurs de risque d'AVC chez les patients admis dans un hôpital tertiaire d'Enugu. MÉTHODES: Il s'agit d'une étude descriptive transversale menée à l'hôpital universitaire d'Enugu, Enugu. Les données ont été analysées à l'aide du SPSS version 26 (IBM Corporation, New York, USA). RÉSULTATS: Les données de 350 patients ont été incluses dans la présente étude. Les trois facteurs de risque d'accident vasculaire cérébral les plus courants étaient le diabète (69,1 %), l'hypertension (64,9 %) et l'âge de 65 ans et plus (51,1 %). Un total de 74,9 % des patients ont eu un AVC ischémique et 25,1 % un AVC hémorragique. L'AVC hémorragique était significativement plus élevé chez les patients < 50ans (46,5 %) et les personnes souffrant d'hypertension (31,7 %). Environ 31,4 % des patients présentaient deux facteurs de risque et 28,6 % trois facteurs de risque. Âge 65 ans et plus était positivement corrélé au fait d'avoir un AVC ischémique et l'hypertension était en corrélation positive avec l'AVC hémorragique. Après contrôle de l'âge, la corrélation entrel'hypertension et l'AVC hémorragique était toujours significative. CONCLUSION: La fréquence rapportée de l'accident vasculaire cérébral ischémique était de 74,9 %. et celle de l'AVC hémorragique était de 25,1 %. Les facteurs de risque les plus courants pour d'AVC documentés chez les patients victimes d'un AVC dans un hôpital tertiaire de Enugu étaient le diabète, l'hypertension et l'âge de 65 ans et plus. Lorsque l'âge, la corrélation entre l'hypertension et l'AVC hémorragique était toujours significative. MOTS CLÉS: AVC ischémique, AVC hémorragique, Facteurs de risque, Nigeria.

Prevalence and distribution of hypertension in overweight and obese subjects in an urban community in Enugu, South East Nigeria. A post hoc analysis.

BACKGROUND: Most recent studies in Nigeria have documented high prevalence of hypertension, diabetes, and obesity. Several mechanisms may link hypertension and obesity hence the high prevalences of both disorders in Nigeria. There are however no studies on the prevalence of hypertension among the obese in urban settings. AIMS: The aim of this study was to describe the prevalence and pattern of hypertension in overweight/obese individuals in a community. METHODS: We conducted a post-hoc analysis on obese subjects 20 years and above from two urban settlements within Enugu metropolis. For database management and statistical analyses, we used the SPSS version 22. RESULTS: Data from a total of 301 individuals with obesity who met the selection criteria were re-analyzed. A total of 198 (65.8%) individuals were found to have hypertension most of whom were newly diagnosed 110 (55.6%). The prevalence of hypertension was 65.8% and increased with age and BMI. CONCLUSION: Individuals with overweight/obesity have very high rates of hypertension. The prevalence of hypertension also increased with and BMI. Thus, there is need for targeted health education in adults to address the burden of obesity and hypertension to reduce the burden of cardiovascular disease in the community.

Predictors of autonomic dysfunction among predialysis chronic kidney disease patients in Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem with increasing incidence and mortality in Africa. Autonomic dysfunction (AD) has been implicated as a major contributor to the disease morbidity and mortality, but little is known about the predictors of this dysfunction in African populations. Understanding the predictors of this condition is necessary for early detection and management of CKDs. Objectives: This study was designed to determine the predictors of AD in CKD patients in Nigeria. MATERIALS AND METHODS: It was a cross-sectional study of CKD patients at University of Nigeria Teaching Hospital, Enugu, Nigeria. The CKD patients with AD were compared with those without AD and a normal control group. Autonomic function was assessed through noninvasive cardiovascular tests: measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing, HRR to Valsalva maneuvre, and HRR to respiration. Data on symptoms of CKD and AD were obtained using a validated questionnaire. RESULTS: The mean age of the CKD patients was 41.3 ± 1.5 (range: 21-69) years. Early hospital presentation is associated with significantly less risk of the development of AD (P < 0.001). Dizziness, nocturnal diarrhea, and impotence are the major markers/predictors of AD in CKD patients (P < 0.05). CONCLUSION: AD is common among predialysis CKD patients in Nigeria, and best predicted by the presence of postural dizziness, nocturnal diarrhea, and impotence in men. Physicians should, therefore, be on the lookout for these features for prompt and adequate management of cases.

Knowledge of medical students about epilepsy: Need for a change.

PURPOSE: Though most doctors in their professional life will provide care for people with epilepsy, many will not get further training in their professional life. There may be other barriers, perceived or not, to providing care to people living with epilepsy by doctors which need to be approached in the medical undergraduate curriculum and medical continuing education. The aim of this study was to determine the knowledge gaps of medical students on basic issues regarding epilepsy that could be useful in preparing training material for the students and continuous medical education for doctors working in the community. MATERIALS AND METHODS: This cross-sectional and descriptive study was carried out in one of the medical schools in Enugu metropolis. Data collection was done using a semi-structured validated questionnaire. RESULTS: Seizure was regarded as a movement disorder by 10.3% of the students. The rank of causes of epilepsy given by respondents was brain injury (88%), brain tumor (87%) genetics (62.3%), and strokes (55.1%). Significantly more students who did neurology posting correctly answered that stroke is a risk factor (P < 0.001), disagreed that sleep deprivation is a risk factor (P = 0.04), and recognized different seizure types (P < 0.001-0.002). The mean score was 17.8 ± 2.3% (71.2 ± 9.2%); significantly higher in those who did neurology posting. Students scored lowest on questions regarding risk factors and duration of treatment. CONCLUSION: The content of medical curriculum in Africa should emphasize not only the content of lectures on epilepsy but also the need for students to go through neurology posting during their training. The outcome would be both better knowledge and improved physician-patient relations.

Pattern and location of intracerebral hemorrhage in Enugu, South-East Nigeria: A review of 139 cases.

INTRODUCTION: The incidence rates and location of nontraumatic intracerebral hemorrhage (ICH) have been shown to vary between population and races. Knowledge of ICH patterns may give some insight into the etiology of ICH and help reduce its burden particularly among Africans where health infrastructure is poorly developed. We present a retrospective review of ICH using a modern neuroimaging technique. OBJECTIVES: To determine the pattern and location of ICH among patients presenting in a tertiary hospital in Enugu. METHODS: All the medical and computer tomography records of patients with a clinical diagnosis of hemorrhagic stroke with the location of hemorrhage clearly specified and complete patients' data were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained, and statistical analysis was done using SPSS version 19 (IBM Corporation, New York, USA). RESULTS: A total of 139 (17.4%) out of 799 scans done over the period under review were analyzed. The frequency of lobar and deep cerebral hemorrhages (LH and DCHs) was 46.8% and 53.2%, respectively. The most common types of hemorrhage in men and women were deep cerebral (52.2% and 55.3%, respectively). Five percent (7/139) of all hemorrhages occurred in the cerebellum. Age distribution of the location of ICH shows that LHs peaked at 16-39 years while DCHs peaked at 40-49 years. There was not statistically significant difference between mean ages of occurrence of LH and hemorrhages of other locations. CONCLUSION: Frequency of LH and DCH varied with age as LH peaked before the age of 40 while deep cerebral at 40-49 years. The age distribution of different types of ICH may suggest a higher role of other factors apart from hypertension. Further studies are required to establish the risk factors of LH and DCHs in our environment.

Profile of neurological admissions at the University of Nigeria Teaching Hospital Enugu.

BACKGROUND: The burden of Neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of Neurological diseases and the impediments to their management. We aim to determine the profile of neurological admissions and the challenges of managing these diseases at the University of Nigeria Teaching Hospital Enugu South East Nigeria. METHODS: Analysis of Neurological admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu from January 2003 to December 2007. RESULTS: Neurological admissions comprise about 14.8% of medical admissions. There were 640 (51%) males and 609 (49%) females. The spectrum of neurological diseases were stroke 64.9%, central nervous system infections (21.8% ), HIV related neurological diseases 3.5%, hypertensive encephalopathy (3.4%), dementia (3%), subarachnoid haemorrhage (2.2%), Guillian Barre syndrome (1.2%), Parkinson's disease (1.1%), myasthenia gravis (1.0%), motor neurone disease and peripheral neuropathy and accounted for 0.8% and 0.6% respectively. Overall, noninfectious disease accounted for 78.2% of neurological admissions while infectious diseases accounted for 11.8%. CONCLUSION: A wide spectrum of neurological diseases occurs in our setting. The high incidence of CNS infections indicates that efforts should be geared towards preventive measures. A major challenge to be addressed in the management of neurological diseases in our setting is the lack of specialized facilities.

Population-based prevalence of high blood pressure among adults in an urban slum in Enugu, South East Nigeria.

In sub-Saharan Africa (SSA), rapid urbanization and changing lifestyle have modified the profile and pattern of various medical disorders. Apart from high prevalence rates, recent trends with regard to hypertension in Africa include: low levels of awareness, treatment and control. Although a large number of studies provide data about hypertension in SSA, few studies focused on special populations such as urban slum dwellers. The WHO STEP-wise approach to surveillance of noncommunicable diseases was used to access the prevalence of hypertension among adults in one of the urban slums in Enugu. Out of the 811 individuals aged 20 years and above surveyed, 774 (95.4%) cases were analyzed. About 4.7% and 2.7% reported a past history of diabetes and stroke, respectively, whereas 15% had a positive family history of hypertension. The mean (95% confidence interval (CI)) body mass index (BMI) was 23.7 (23.2-24.2) kg m(-2) among males and 26.6 (25.7-26.7) kg m(-2) among females (P<0.0001). The prevalence of hypertension was 52.5% (95% CI: 48.9-56.0) and 55.4% (95% CI: 49.5-61.3) in males and 50.8% (95% CI: 46.4-55.1) in females (P=0.23). It increased with age peaking at 45-54 years in females and ⩾55 years in males. About 40.1% were aware of their hypertension and 28.8% of those aware had normal blood pressure. In regression analysis, systolic (R(2)=0.192) and diastolic (R(2)=0.129) blood pressures increased with age and BMI. The prevalence of high blood pressure among adults in Enugu slums is very high and a cause for concern, and calls for urgent attention.

Tropical Diabetic Hand Syndrome.

Any adult with diabetes in the tropics with hand cellulitis, infection and gangrene qualifies for tropical diabetic hand syndrome (TDHS). We reviewed a 39-year-old woman with a 3-week history of swelling of the left index finger following an insect bite. The swelling progressively increased in size, was very painful, and extended to the palm. There was no history or symptoms suggestive of chronic complications of diabetes. Random blood sugar on presentation was above 600 mg/dl using a glucometer. Examination revealed an edematous left palm draining pus from multiple sinuses, necrotic and gangrenous left index finger extending down to just above the thenar eminence. A diagnosis of TDHS in a patient with hyperosmolar state was made. She was managed accordingly and subsequently underwent aggressive debridement and desloughing. Two fingers were amputated and the wound was allowed to heal by secondary intention.

Knowledge, attitude and practice towards epilepsy among secondary school students in Enugu, southeast Nigeria.

PURPOSE: The purpose of this study was to determine the knowledge and attitude of secondary school students to epilepsy and its treatment that could pose as barriers in the treatment and care of epilepsy patients within the community. METHODS: This study was cross-sectional and descriptive in design using a self administered custom designed multiple choice questionnaire with sections on general information on epilepsy, awareness and perception of epilepsy, treatment of epilepsy/seizures and attitude towards people living with epilepsy. RESULTS: Out of 969 questionnaires analyzed, the majority of the students (87.6%) had heard of epilepsy as a disease. The commonest sources of information were the electronic media (36.4%) and family members (25.6%). More than half (59.4%) had witnessed a convulsion in the past and 8.9% had a family member with epilepsy. Jerking (50.6%) and loss of consciousness (47.4%) were identified as the commonest manifestations of epilepsy. Epilepsy was considered a psychiatric disorder by 51.9% and as an infectious disease by 40.6%. About 39.3% considered epilepsy to be due to spiritual causes, old age or poisoning/bad blood. A total of 63.1% regarded orthodox medicine and prayers as the best means to treat epilepsy, while 6.8% chose herbal remedies. Concerning first aid treatment, 50.6% agreed that an object should be inserted into the mouth, while 49.5% would call for medical help and 28.8% would remove the person from harm. On attitude, 64.9% would not keep a friend with epilepsy, 69.1% would not play with someone with epilepsy, 84.2% would not marry someone with epilepsy. 41.1% of the students said that people with epilepsy should neither marry while 42.2% say they should not have children. Only 39.1.5% had an overall positive attitude towards people living with epilepsy. CONCLUSIONS: There is a persisting poor knowledge, attitude and practice of epilepsy among secondary school students in SE Nigeria. Efforts should be made to include basic facts about disorders with social consequences such as epilepsy in school health education curriculum.