Impact of somatic comorbidities on quality of life of patients living with epilepsy in Sagamu, Nigeria.

PURPOSE: Somatic comorbidities are probably as important as the psychiatry comorbidities in people with epilepsy (PWE) although the former has received little attention especially in low- and middle-income countries where the incidence of epilepsy is high. The main objective of this study was to determine the frequencies of somatic comorbidities in PWE. We also compared quality of life of two groups of PWE: Those with somatic comorbidities and those without. METHODS: In this comparative cross-sectional study, consecutive adult patients with epilepsy above 18 years of age were recruited at the neurology outpatient clinic of Olabisi Onabanjo University Teaching Hospital from July 2010 through March 2011. Epilepsy-related data and somatic comorbidities were collated in this population. Health-related quality of life (HRQoL) and depression were also measured using QOLIE-31(version 1.0) and Becks depression inventory II (BDI-II), respectively. RESULTS: One hundred and two PWE were recruited with 31 (30.4%) having at least one somatic comorbidity. Hypertension (OR = 12.43), dyspepsia (OR = 8.16), and stroke (OR = undefined) were significantly prevalent among PWE who are ≥50 years old. Energy was significantly lower among patients with comorbidities, and patients with multiple comorbidities had worse quality of life than those with single comorbidity (P = 0.006). CONCLUSION: Somatic comorbidity is prevalent in this population with significant impact on their quality of life. We emphasize the need to screen for and reduce the numbers of somatic comorbidities in PWE as this can improve their quality of life.

Validation study of the Siriraj Stroke score in African Nigerians and evaluation of the discriminant values of its parameters: a preliminary prospective CT scan study.

BACKGROUND AND PURPOSE: CT scanning is important to identify stroke pathology and exclude mimics. Its poor availability in our environment makes the search for simple, reliable clinical-score imperative. This study aims to validate the Siriraj Stroke score (SSS) and determine the discriminant values of its parameters in the black population of African-Nigerians. METHODS: A prospective multicenter study was carried out on patients that presented with stroke and had brain CT scan done within 14 days of onset. An interviewer structured questionnaire was administered and SSS computed. The stroke-type was classified and compared with CT diagnosis. Data were analyzed using Epi-info-2002. RESULTS: 1122 patients presented with clinical features of stroke, of which only 101 (9%) could afford the cost of CT scan. Of these, 90 had CT-scan features consistent with acute stroke, 5 had cortical atrophy and 1 was normal. Thus, 96 patients were analyzed, of which 68 (71%) had cerebral ischemia and 28 (29%) had intracerebral hemorrhage. The 6 patients with no visible infarct on CT were regarded as cerebral infarction. The correlation between SSS, headache, vomiting, loss-of-consciousness and CT diagnosis achieved statistical significance, whereas atheroma markers and diastolic blood pressure did not. The SSS has an overall predictive accuracy of 80%. CONCLUSIONS: This preliminary study has shown that only 9% of our hospital stroke population had benefit of CT scan. The limited number of patients studied and their potential lack of representativeness, represent a funding issue to properly establish the performance of clinical scoring systems and assist in descriptive epidemiology of hospital and community-based stroke studies in resource-poor settings. However, in this study, the SSS diagnosis correlates significantly with CT diagnosis.

Nevirapine-related adverse events in a patient receiving a fixed-drug combination pill.

Nevirapine associated rash has been well described in the Caucasian population. With increasing access to antiretroviral treatment--especially a fixed dose combination--by people living with HIV/AIDS in developing countries, there is a need to emphasize the lead in doses of nevirapine. We strongly recommend a warning label on the bottle advising patients on the lead-in period and the signs and symptoms of significant rash.

Task-shifting training improves stroke knowledge among Nigerian non-neurologist health workers.

BACKGROUND: The increasing stroke burden in sub-Saharan Africa far outstrips the availability of skilled human resource to provide timely and efficient acute, rehabilitative and preventive services. The objective of this study was to examine the impact of a short-term task-shifting stroke training program on the stroke knowledge of a cohort of Nigerian non-neurologist health workers (NNHWs). METHODS: Utilizing a quasi-experimental design, NNHWs drawn from 53 local government areas of Ogun and Oyo states participated in an intensive, multicomponent one-day stroke workshop. Stroke knowledge was evaluated before and after the training using a self-administered questionnaire. RESULTS: Out of a total of 210 NNHWs who participated in the session, 116 (55.2%) completed the pre-workshop questionnaire survey of stroke knowledge while 191 (91.0%) completed the post-workshop questionnaire survey. There were no statistically significant differences in the distribution of the age, gender and professional categories of the two groups. The participants' knowledge was significantly increased at the end of the training about stroke risk factors (p<0.001), stroke symptoms (p<0.001) and how stroke develops (p=0.009). The proportion of respondents who understood the FAST mnemonic increased from 10.3% before the training to 90.6% at the end of the training (p<0.001). The professional category of participants was associated with knowledge gain about swallowing test and thrombolysis. CONCLUSION: Our data support the effectiveness of stroke-specific task-shifting training for non-neurologist health workers in a low resource setting. Interim studies with intermediate outcomes are needed to show that improved knowledge results in better care despite resource limitation. Randomized controlled trials will be useful to confirm findings and translate knowledge improvement into practical intervention.