Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study.

BACKGROUND: Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria. METHODS: The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs. FINDINGS: Overall, 814 (21·8%) of the 3739 patients admitted with stroke died as inpatients: 476 (18·1%) of 2635 with ischaemic stroke and 338 (30·6%) of 1104 with intracerebral haemorrhage. The variability in the odds of stroke fatality that could be attributed to the system-level factors across study sites assessed using model intracluster correlation coefficient was substantial at 7·3% (above a 5% threshold). Stroke units were available at only five of 16 centres. The aRRs of six patient-level factors associated with stroke fatality were: low vegetable consumption, 1·19 (95% CI 1·07-1·33); systolic blood pressure, 1·02 (1·01-1·04) for each 10 mm Hg rise; stroke lesion volume more than 30 cm3, 1·48 (1·22-1·79); National Institutes of Health Stroke Scale (NIHSS) score, 1·20 (1·13-1·26) for each 5-unit rise; elevated intracranial pressure, 1·75 (1·31-2·33); and aspiration pneumonia, 1·79 (1·16-2·77). INTERPRETATION: Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted. FUNDING: US National Institutes of Health. TRANSLATIONS: For the Twi, Yoruba and Hausa translations of the abstract see Supplementary Materials section.

Childhood and Infant exposure to famine in the Biafran war is associated with hypertension in later life: the Abia NCDS study.

There are very few studies in Africans investigating the association between early life exposure to malnutrition and subsequent hypertension in adulthood. We set out to investigate this potential association within an adult cohort who were born around the time of the Biafran War (1968-1970) and subsequent famine in Nigeria. This was a retrospective analysis of Abia State Non-Communicable Diseases and Cardiovascular Risk Factors (AS-NCD-CRF) Survey, a community-based, cross-sectional study that profiled 386 adults (47.4% men) of Igbo ethnicity born in the decade between January 1965 and December 1974. Based on their date of birth and the timing of the famine, participants were grouped according to their exposure to famine as children (Child-Fam) or in-utero fetus/infant (Fet-Inf-Fam) or no exposure (No-Fam). Binomial logit regression models were fitted to determine the association between famine exposure and hypertension in adulthood. Overall, 130 participants had hypertension (33.7%). Compared to the No-Fam group (24.4%), the prevalence of hypertension was significantly elevated in both the Child-Fam (43% - adjusted OR 2.47, 95% CI 1.14-5.36) and Fet-Inf-Fam (44.6% - adjusted OR 2.54, 95% CI 1.33-4.86) groups. The risk of hypertension in adulthood was highest among females within the Child-Fam group. However, within the Fet-Inf-Fam group males had a equivalently higher risk than females. These data suggest that early life exposure to famine and malnutrition in Africa is associated with a markedly increased risk of hypertension in adulthood; with sex-based differences evident. Thus, the importance of avoiding armed conflicts and food in-security in the region cannot be overstated. The legacy effects of the Biafran War clearly show the wider need for ongoing programs that support the nutritional needs of African mothers, infants and children as well as proactive surveillance programs for the early signs of hypertension in young Africans.

Magnitude and pattern of facility-based disrespect and abusive treatment of women during childbirth in Abia State, Nigeria.

Objectives: To ascertain the prevalence and pattern of reported facility-based disrespect and abuse of women during labour in Abia State, South-East, Nigeria. Design: A cross-sectional questionnaire-based study. Setting: One urban and one rural healthcare facility in Abia State- Federal Medical Centre, Umuahia and Nigerian Christian Hospital (NCH) Nlagu, respectively. Participants: A total of 312 women who were recently delivered of their babies in the two facilities in Abia State and attending postnatal clinics were sampled for the survey. Main Outcome Measure: Disrespect and abuse D&A) during labour among women who give birth in healthcare facilities in Abia State. Result: In all, over half (54.5%) of the women experienced disrespect and abuse in Abia State (50% urban and 63.5% in rural areas). The commonest form of disrespect and abuse was non-confidential care (22.9%). The commonest disrespectful and abusive care received was lack of privacy in the labour ward (18.3%). Conclusion: The study recorded a high prevalence of reported facility-based disrespect and abuse of women during delivery in Abia State. Training and re-training healthcare providers to promote respectful care, advocacy to policy makers and healthcare stakeholders on the development of respectful maternal care policies and further research in the area are needed. Funding: No funding was obtained for this study.

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.

Evaluation of Female Sexual Function in Persons With Type 2 Diabetes Mellitus Seen in a Tertiary Hospital in Southeast Nigeria With Emphasis on its Frequency and Predictors.

Women with diabetes are at increased risk of sexual problems. However, this problem is underreported; hence, the need for this study. This was a cross sectional case-controlled study. Seventy-five consenting females with type 2 diabetes mellitus (T2DM) were enrolled from the Diabetes Clinic of the Federal Medical Center, Umuahia, while 75 persons, which included hospital workers and female companions of subjects, were recruited as a control group. Sexual dysfunction in both groups was diagnosed and characterized using the female sexual function index (FSFI). Data obtained from this study was presented as Mean ± SD and analyzed using SPSS 17 software. The mean age of the T2DM group and control were 44.5 years and 38.9 years, respectively. The mean total female sexual score was 22.10 ± 6.66 in the T2DM subjects, while in the control subjects it was 22.43 ± 5.29. This was not statistically significant. The FSFI scores in the desire, lubrication, and orgasm domains were all lower in the diabetic women and this was statistically significant (p < 0.05). The domains of pain and arousal were also lower in the diabetic women, although this was not statistically significant (p > 0.05). The proportion of diabetic females who reported problems in the arousal, lubrication, orgasm, and pain domains was higher (40.0, 36.4, 32.7, 29.1) than the controls (27.9, 16.2, 14.7, 19.1; p < 0.05). The prevalence of female sexual dysfunction in our study was high. Similarly, the FSFI score was low in women with diabetes when compared with controls. The domains of arousal, pain, orgasm, and satisfaction were the most affected in subjects with DM. Age, marital status, body mass index, fasting blood sugar, and hypertension were predictive of sexual dysfunction in the diabetic women.

Prevalence and Risk Factors for Diabetes Mellitus in A State in South East Nigeria: Results of a Population Based House to House Survey.

BACKGROUND: Population based studies on diabetes mellitus (DM) are scarce in Nigeria. INTRODUCTION: This was a population-based house to house survey aimed at determining the prevalence of DM and assessing the risk factors associated with DM in a state in Southeast Nigeria. METHODS: This was a cross-sectional observational study in which 1680 adults were recruited using a multistage sampling method to randomly select not more than two suitable participants of both sex in each household from four enumeration areas (EAs) in each local government area (LGA) and the three senatorial zones in the state. A modified World Health Organization (WHO) Stepwise Approach to Surveillance questionnaire was used for data collection and random blood glucose (RBG) was measured after anthropometric assessment. Test statistics used were chi-square, t-test, and logistic regression. RESULTS: The overall prevalence of DM in this study was 3.3%. A positive family history of DM was significantly higher in patients with diabetes: 18.2% vs. 9.6% (p=0.036). The mean (SD) of weight, body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in patients with DM(p=0.001,<0.001,<0.001,<0.001, respectively).The odd ratio (95% CI) of a person>35years developing DM was 3.89(1.11-13.60). The OR (95% CI) for waist-hip ratio (WHR) was 3.04 (1.02-9.03) and family history of DM had an OR of 2.62(0.88-6.50). The odd of developing DM is positively associated with age>35years, increased WHR, WC, family history of DM, BMI>25Kg/m2, and HC. The odd of developing DM was negatively associated with smoking. CONCLUSION: The prevalence of DM in this study was 3.3%. A BMI>25 kg/m2, WHR >0.85, family history of DM, HC, and older age were associated with significantly higher prevalence.

Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action.

INTRODUCTION: Stroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA. PURPOSE: In this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education. METHODS: Stroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman's Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes. RESULTS AND DISCUSSION: The major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana.

Interventions to increase use of services; Mental Health Awareness in Nigeria.

BACKGROUND: Mental health services in Nigeria consist mainly of large government psychiatric hospitals and there are very few mental health professionals to serve the large population of the country. However, more recently, community mental health services, which have been shown to improve access to care and clinical outcomes are beginning to develop in some locations. Despite efforts to promote more accessible services, low levels of knowledge about effective treatment of mental disorders means that even where these services are available, a very small proportion of people utilise these services. Therefore interventions to increase service use are an essential component of health system. METHODS: This intervention was designed to increase use of a mental health services through the work of community-based Village Health Workers. Fifteen Village Health Workers in each Local Government Area (district) were selected and trained to create mental health awareness in communities. Their function also include identification and referral of persons with mental illness to trained mental health nurses in the clinics. Attendance data prior to and after intervention were collected and compared. RESULTS: The incident rate for initial period of intervention is five times higher than the baseline rate (95% CI; 3.42-7.56; p < 0.001) though this diminished in the long term, levelling off above initial baseline. CONCLUSIONS: This study demonstrated that addition of awareness raising using volunteers in communities as part of health programme implementation can increase services use by a population. Mechanisms such as informing populations of the existence of a service which they were previously lacking; explanation of causation of mental illness and achieving community leaders' support for a new service can make investment in services more efficient by increasing attendance.

Urban-Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs.

BACKGROUND: Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. METHODS: This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization's STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. RESULTS: In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. CONCLUSIONS: Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system.

Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria.

OBJECTIVE/BACKGROUND: Tuberculosis (TB) is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies. METHODS: A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations. RESULTS: Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive (NSP), although the increasing trend was not statistically significant (χ(2)=1.8; p<.179)]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant (χ(2)=1.48; p<.224). Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% (all forms). Compared to the baseline, there was an increase of 31% (all forms) and 22% (NSP) in the evaluation population. CONCLUSION: Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification.

Reaching the underserved: Active tuberculosis case finding in urban slums in southeastern Nigeria.

BACKGROUND: Nigeria ranks 10th among 22 high TB burden countries with low TB case detection that relies on passive case finding. Although there is increasing body of evidence that active case finding (ACF) has improved TB case finding in urban slums in some parts of the world, this strategy had not been implemented in Nigeria despite the pervasiveness of urban slums in the country. OBJECTIVE: To assess the yield and profile of TB in urban slums in Nigeria through ACF. METHODS: A prospective, implementation study was conducted in three urban slums of southeastern Nigeria. Individuals with TB symptoms were identified through targeted screening using a standardized questionnaire and investigated further for TB. Descriptive and bivariate analyses were performed using SPSS. RESULTS: Among 16,743 individuals screened for TB, 6361 (38.0%) were identified as TB suspects; 5894 suspects were evaluated for TB. TB was diagnosed in 1079 individuals, representing 6.4% of the screened population and 18.3% of those evaluated for TB. Of the 1079 cases found, 97.1% (n=1084) had pulmonary TB (PTB), and majority (65%) had new smear-positive TB. Children (<15years) accounted for 6.7% of the cases. Also, 22.6% (216) of the cases were HIV co-infected, among whom 55.1% (n=119) were females. The average number of individuals needed to screen to find a case of TB was 16. CONCLUSIONS: There is high prevalence of TB in Nigeria slum population. Targeted screening of out-patients, TB contacts, and HIV-infected patients should be optimized for active TB case finding in Nigeria.

Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria.

OBJECTIVE: Knowing tuberculosis (TB) patients' satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients' satisfaction with TB services in southern Nigeria. MATERIALS AND METHODS: A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction. RESULTS: Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility. CONCLUSION: Patient- and health system-related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing.

Ebola epidemic--the Nigerian experience.

The current West African ebola epidemic has been described as the most unprecedented in the history of the disease. Nigeria reported its first case of the disease in July, 2014, at the end of the epidemic 20 people were infected and eight of them died. The epidemic resulted in increased knowledge of the disease as well as some misconceptions, increase in household and community hygiene practice and change in social interaction between affected individuals and the community. Prompt response by the government, with the support of international partners and proactive engagement of public health measures resulted in the rapid control of the epidemic; an experience the country hopes to leverage upon in subsequent epidemics.

Abia State HIV epidemic and response: challenges and prospects.

Since the first seroprevalence survey in 1999, the HIV prevalence in Abia State has increased from 1.8% to 7.3% in 2010. The state is currently experiencing a generalized epidemic, with most transmission occurring through heterosexual low-risk sex. Drivers of the epidemic include low knowledge of HIV prevention, low risk perception, predominantly male factor-driven risky sexual behavior, and low condom use. This study reviewed the state HIV epidemic trend in relation to response, sought to identify the gaps between the epidemic and response, and recommended measures to strengthen the state response.

Perception of quality of maternal healthcare services among women utilising antenatal services in selected primary health facilities in Anambra State, Southeast Nigeria.

BACKGROUND: This is a cross-sectional descriptive study aimed at assessing antenatal care service attendees' perception of quality of maternal healthcare (MHC) services in Anambra State, southeast Nigeria. MATERIALS AND METHODS: A total of 310 pregnant women utilising antenatal care (ANC) services in three purposively selected primary health centres (PHCs) in rural communities in Anambra State were studied. Reponses were elicited from the participants selected consecutively over a 4-month period, using a pre-tested, semi-structured interviewer-administered questionnaire on socio-demographic characteristics, utilisation and perception of MHC services. Data collected were analysed using SPSS version 17. RESULTS: Findings showed that utilisation of facility for both antenatal (97.0%; 95% CI, 94.4-98.4%) and natal services (92.7%; 95% CI 89.2-95.2%) were quite high. Generally, most of the women were satisfied with MHC services (89.7%). Most of them were satisfied with the staff attitude (85.1%), waiting time (84.1%) and cost of services (79.5%). Being ≥30 years (X (2) = 4.61, P = 0.032), married (X (2) = 9.70, P = 0.008) and multiparous (X (2) = 9.14, P = 0.028), as well as utilisation of formal health facility for antenatal (X (2) = 26.94, P = 0.000) and natal (X (2) = 33.42, P = 0.000) services were associated with satisfaction with maternal health services. CONCLUSIONS: The study showed high level of satisfaction with quality of maternal health services among antenatal attendees and highlights the need to strengthen interventions that increase uptake of formal MHC services.

Diagnosis of smear-negative tuberculosis in Nigeria: Do health care workers adhere to the national guidelines?

OBJECTIVE: The study sought to assess the extent to which healthcare workers (HCWs) adhere to the National Tuberculosis Program (NTP) guidelines for the diagnosis of smear negative tuberculosis in Nigeria. METHOD: This was a cross-sectional retrospective desk analysis of case files of 280 smear negative pulmonary TB in six States in southern Nigeria. RESULTS: About 93% of the 280 patients had their first set of sputum smear microscopy tests done, but only 3.6% had the second set of diagnostic tests as prescribed by the NTP guidelines. Only 45.7% (128/280) received broad spectrum antibiotics after their first smear microscopy. 98% had a chest X-ray done, while 93.6% (262/280) had HIV counseling and testing (HCT), out of which 45.0% were HIV positive. Overall, only 2 patients (0.7%) were diagnosed in strict compliance with the NTP guidelines. There was no significant difference in the pattern of diagnosis of smear negative TB cases and smear positive TB cases. CONCLUSION: The adherence of HCWs to the NTP guidelines for diagnosis of smear negative TB is apparently sub-optimal and needs improvement.

Socioeconomic status and obesity in Abia State, South East Nigeria.

BACKGROUND AND OBJECTIVES: Obesity is a major risk factor for cardiovascular disease in developed and emerging economies. There is a paucity of data from Nigeria on the association between socioeconomic status and obesity. The aim of this study is to highlight that association in Abia State, South East Nigeria. MATERIAL AND METHODS: This was a cross-sectional survey in South East Nigeria. Participating subjects were recruited from the three senatorial zones of Abia state. A total of 2,487 adults took part in the study. The subjects were classified based on their monthly income and level of educational attainment (determinants of obesity). Monthly income was classified into three groups: low, middle, and upper income, while educational level was classified into four groups: no formal education, primary, secondary, and tertiary education. Body mass index of subjects was determined and used for defining obesity. Data on blood pressure and other anthropometric measurements were also collected using a questionnaire, modified from the World Health Organization STEPwise Approach to Chronic Disease Risk Factor Surveillance. RESULTS: Overall, the prevalence of obesity in low, middle, and upper income groups was 12.2%, 16%, and 20%, respectively. The overall prevalence of obesity in individuals with no formal education, primary, secondary, and tertiary education was 6.3%, 14.9%, 10.5%, and 17.7%, respectively. Educational status was found to be significantly associated with obesity in women, but not in men, or in the combined group. However, level of income was observed to be significantly associated with obesity in men, women, and in the combined group. CONCLUSION: Sociodemographic and socioeconomic factors are important determinants of obesity in our study population, and therefore may be indirectly linked to the prevalence and the outcomes of cardiovascular disease in Nigeria.

Blood pressure gradients and cardiovascular risk factors in urban and rural populations in Abia State South Eastern Nigeria using the WHO STEPwise approach.

BACKGROUND: Developing countries of sub-Saharan Africa (SSA) face a double burden of non-communicable diseases (NCDs) and communicable diseases. As high blood pressure (BP) is a common global cardiovascular (CV) disorder associated with high morbidity and mortality, the relationship between gradients of BP and other CV risk factors was assessed in Abia State, Nigeria. METHODS: Using the WHO STEPwise approach to surveillance of chronic disease risk factors, we conducted a population-based cross-sectional survey in Abia state, Nigeria from August 2011 to March 2012. Data collected at various steps included: demographic and behavioral risk factors (Step 1); BP and anthropometric measurements (Step 2), and fasting blood cholesterol and glucose (Step 3). RESULTS: Of the 2983 subjects with complete data for analysis, 52.1% were females and 53.2% were rural dwellers. Overall, the distribution of selected CV disease risk factors was diabetes (3.6%), hypertension (31.4%), cigarette smoking (13.3%), use of smokeless tobacco (4.8%), physical inactivity (64.2%) and being overweight or obese (33.7%). Presence of hypertension, excessive intake of alcohol, smoking (cigarette and smokeless tobacco) and physical inactivity occurred more frequently in males than in females (p<0.05); while low income, lack of any formal education and use of smokeless tobacco were seen more frequently in rural dwellers than in those living in urban areas (p<0.05). The frequency of selected CV risk factors increased as BP was graded from optimal, normal to hypertension; and high BP correlated with age, gender, smokeless tobacco, overweight or obesity, annual income and level of education. CONCLUSION: Given the high prevalence of hypertension in this part of Nigeria, there is an urgent need to focus on the reduction of preventable CV risk factors we have observed to be associated with hypertension, in order to effectively reduce the burden of NCDs in Africa.

Prevalence of abdominal obesity in Abia State, Nigeria: results of a population-based house-to-house survey.

BACKGROUND AND OBJECTIVE: Abdominal obesity is associated with the risk of developing disorders, such as diabetes and hypertension. The objective of this study was to investigate the prevalence of abdominal obesity in Abia State, Nigeria. MATERIALS AND METHODS: We carried out a cross-sectional study aimed at ascertaining the prevalence of abdominal obesity in Abia State, Nigeria. Participants in the study were recruited from communities in the three senatorial zones in the state. Screening for abdominal obesity was carried out in these subjects using waist circumference (the National Cholesterol Education Program Third Adult Treatment Panel criteria were used). The World Health Organization Stepwise Approach to Surveillance of chronic disease risk factors was used. Body mass index, anthropometric measurements, and other relevant data were also collected. RESULTS: Data on waist circumference were obtained from 2,807 subjects. The prevalence of obesity using body mass index in the population was 11.12%. In men and women, it was 7.73%, and 14.37%, respectively. The prevalence of abdominal obesity in the population was 21.75%. In men and women, it was 3.2% and 39.2%, respectively. CONCLUSION: The prevalence of abdominal obesity is high in Nigeria, and needs to be monitored because it is associated with increased cardiovascular risk.

Prevalence and determinants of hypertension in Abia State Nigeria: results from the Abia State Non-Communicable Diseases and Cardiovascular Risk Factors Survey.

OBJECTIVE: Hypertension is the most common non-communicable disease and risk factor for heart failure, stroke, chronic kidney disease and ischemic heart disease in sub-Saharan Africa. Few population-based studies have been conducted recently in Nigeria and, in Abia State, no previous study has been conducted on the prevalence and correlates of hypertension among the populace. The purpose of our study was, therefore, to determine the prevalence and determinants of high blood pressure in Abia State, southeastern Nigeria. We hypothesise that high blood pressure burden is high in Abia State. DESIGN: The study was a community based cross-sectional house-to-house survey aimed at ascertaining the burden/prevalence of hypertension in the state as well as identifying related risk factors associated with them. SETTING: The study was conducted in rural and urban communities in Abia State, Nigeria. PARTICIPANTS: Participants in the study were men and women aged > or =15 years and were recruited from the three senatorial zones in the state. MAIN OUTCOMES: A total of 2,999 respondents were selected for the survey and, 2,983 consented to be interviewed giving a response rate of 99.5%. The data for 2,928 participants were suitable for analysis. Of these, 1,399 (47.8%) were men. The mean age of the population was 41.7 +/- 18.5 years (range 18-96 years). About 54% of the population were < or =40 years. Ninety percent had at least primary education with about 47% having completed secondary education. Expectedly, 96% of the respondents were Ibos, the predominant tribe in the southeastern part of the country. Women had significantly higher BMI than the men. Similarly, waist circumference was also larger in women but waist-to-hip ratio was only significantly higher in women in the urban areas compared to those in rural areas. Thirty-one percent of all participants had systolic hypertension (33.5% in men and 30.5% in women). This sex difference was statistically different in the urban area. On the other hand, diastolic hypertension was 22.5% in all the population (23.4% in men and 25.4% in women). Age and indices of obesity were the strongest predictors of blood pressure. CONCLUSION: The prevalence of hypertension was high in our study both in rural and urban settings. The major determinants of blood pressure in our participants included age, sex, indices of obesity and pulse rate.