Multilingual Validation of the Questionnaire for Verifying Stroke-Free Status in West Africa.

BACKGROUND AND PURPOSE: The Questionnaire for Verifying Stroke-Free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological, and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages, Yoruba, Hausa and Akan, for ascertainment of stroke-free status of control subjects enrolled in an on-going stroke epidemiological study in West Africa. METHODS: Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records, and neuroimaging (gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by gold standard, 98% were determined to have had stroke, whereas of 219 without stroke 87% were determined to be stroke-free by QVSFS. Negative predictive value of the QVSFS across the 3 languages was 0.97 (range, 0.93-1.00), sensitivity, specificity, and positive predictive value were 0.98, 0.82, and 0.80, respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen k=0.92. CONCLUSIONS: QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa.

Seeking evidence to support efforts to increase use of antenatal care: a cross-sectional study in two states of Nigeria.

BACKGROUND: Antenatal care (ANC) attendance is a strong predictor of maternal outcomes. In Nigeria, government health planners at state level and below have limited access to population-based estimates of ANC coverage and factors associated with its use. A mixed methods study examined factors associated with the use of government ANC services in two states of Nigeria, and shared the findings with stakeholders. METHODS: A quantitative household survey in Bauchi and Cross River states of Nigeria collected data from women aged 15-49 years on ANC use during their last completed pregnancy and potentially associated factors including socio-economic conditions, exposure to domestic violence and local availability of services. Bivariate and multivariate analysis examined associations with having at least four government ANC visits. We collected qualitative data from 180 focus groups of women who discussed the survey findings and recommended solutions. We shared the findings with state, Local Government Authority, and community stakeholders to support evidence-based planning. RESULTS: 40% of 7870 women in Bauchi and 46% of 7759 in Cross River had at least four government ANC visits. Women's education, urban residence, information from heath workers, help from family members, and household owning motorized transport were associated with ANC use in both states. Additional factors for women in Cross River included age above 18 years, being married or cohabiting, being less poor (having enough food during the last week), not experiencing intimate partner violence during the last year, and education of the household head. Factors for women in Bauchi were presence of government ANC services within their community and more than two previous pregnancies. Focus groups cited costly, poor quality, and inaccessible government services, and uncooperative partners as reasons for not attending ANC. Government and other stakeholders planned evidence-based interventions to increase ANC uptake. CONCLUSION: Use of ANC services remains low in both states. The factors related to use of ANC services are consistent with those reported previously. Efforts to increase uptake of ANC should focus particularly on poor and uneducated women. Local solutions generated by discussion of the evidence with stakeholders could be more effective and sustainable than externally driven interventions.

An Analysis of the Effect of Stroke on Health-Related Quality of Life of Older Adults With Coronary Heart Disease Who Take Aspirin.

OBJECTIVE: The aim of this study was to examine the impact of coronary heart disease (CHD) on health-related quality of life (HRQoL) among individuals taking aspirin, as well as to explore the potential association between stroke and CHD on HRQoL. METHOD: A total of 17,106 respondents aged 50 years and above who reported using aspirin on "some days" or "daily" were included in the analysis. Among them, 4,036 individuals had a history of coronary heart disease. We utilized the Chi-square test to assess the proportion of individuals with CHD who reported poor self-rated health and experienced poor HRQoL in four domains: physical health, mental health, physical and mental health combined, and the number of days limited by poor health. Logistic regression was employed to investigate the interaction between stroke and CHD concerning the quality of life. RESULT: Among adults aged 50 years and above using aspirin, those with CHD tended to be older (68.7 years ± 0.37 vs 66.6 ± 0.24), had a higher proportion of male respondents (60.0% vs 45.1%), and were mostly of white ethnicity (77.4% vs 76.2%). The group with CHD reported significantly poorer self-rated health compared to those without CHD (52.1% vs 25.6%, p<0.001), along with a higher prevalence of poor physical health (55.3% vs 42.7%, p<0.001) and poor mental health (50.2% vs 40.4%, p = 0.033) in comparison to aspirin users without CHD. However, there was no statistically significant association between stroke and CHD concerning the impact on all domains of quality of life (p>0.05). CONCLUSION: Our findings indicate that individuals aged 50 years and above with CHD who are using aspirin experience a lower quality of life in both the physical and mental health domains when compared to their counterparts without CHD. Furthermore, there was no significant interaction between stroke and CHD in relation to the impact on HRQoL in this study.

Variations in the Serum Sialic Acid Profiles of Malaria Patients in Zaria, Nigeria: A Cross-Sectional Study.

PURPOSE: Understanding some variations in specialized molecules during malaria could facilitate adequate monitoring of patients and reduce the fatalities caused by the disease. The present study reports changes in the levels of free serum sialic acid (FSSA) among Plasmodium-infected individuals in Zaria, Nigeria, in a cross-sectional study with 170 individuals. METHODS: The FSSA and total sialic acid (TSA) in the blood were determined using the thiobarbituric acid method and the white blood cells (WBC) count, haemoglobin concentration and packed cell volumes were assessed using an automated haematological analyser. RESULTS: The results showed that, in the patients aged > 5 years the level of TSA was significantly elevated (P < 0.05) compared to apparently healthy age-matched controls whereas TSA was slightly lower in patients aged < 5 years compared to controls. The ratio of FSSA to TSA was not different between patients aged > 5 years compared to their age-matched controls whereas FSSA/TSA was significantly elevated (P < 0.05) in patients aged < 5 years compared to their aged-matched controls. The level of FSSA/TSA in the patients aged < 5 years was not correlated with parasite density, white blood cell count, haemoglobin concentration or packed cell volume. CONCLUSION: We concluded that, metabolism and/or physiology of serum sialo-glycoconjugates is affected by malaria and FSSA is mainly elevated in children < 5 years of age but not among older patients suggesting the possible usefulness of FSSA in the analysis of uncomplicated malaria in under five children.

A review of the utilization of fine needle aspiration in clinical practice and research in Nigeria.

BACKGROUND: Research and publications are critical to advancements in the quality of healthcare delivery. This article attempts to highlight the prospects and challenges of fine needle aspiration (FNA) cytology as a tool for research in Nigeria. MATERIALS AND METHODS: Data available in local and international bibliographic databases for the period 1986-2005 (20 years) were collated and analyzed. RESULTS: The theme of Nigerian FNA-focused studies correlated with the recognized disease patterns in the country which are tuberculous lymphadenitis, breast tumors and Burkitt's lymphoma. The accuracy of FNA in these situations was high and comparable to the experience in developed countries. It was found that the total number of articles published during two contiguous periods (1986-1995 and 1996-2005) had increased from 5 to 18. Also, in majority of cases, the articles were not published in specialized pathology journals. CONCLUSIONS: The utilization of FNA is apparently lagging in Nigeria. Given its potential in resource-constrained settings, we are of the opinion that it should be used more often in clinical and translational research.

Dataset on the perceptions of ordinary people on the persistence of bribery practices in Nigeria.

This dataset provides the perceptions of ordinary people on the relationship between societal acceptance of bribery, anti-bribery measures, socio-economic impacts of bribery, demographic factors and persistence of bribery practices. A multi-stage sampling technique was used to target the respondents. A total of 887 grassroots respondents participated, out of which 836 responses were used for quantitative data analyses. Statistical Packages for Social Sciences (SPSS) version 23 and SmartPLS3.0 were used to determine the reliability and validity of the data. The data is useful to the authorities in formulating strategies to deal decisively with the issues of bribery practices in Nigeria.

Fine needle aspiration cytology in Nigeria.

OBJECTIVE: Fine needle aspiration cytology (FNAC) is a simple, safe and cheap method for the screening and diagnosis of a variety of inflammatory and neoplastic conditions. Being a relatively new diagnostic technique in Nigeria, scant information had been published on it. We conducted a nationwide study to describe the availability, organization and utilization of FNA in the country. STUDY DESIGN: A descriptive cross-sectional survey was done to describe the current state of the develop ment of FNAC in Nigeria. The respondents were pathologists and heads of pathology departments in leading medical institutions. RESULTS: It was found that the practice of cytology is widely disseminated throughout the country, with a growing number of pathologists who have taken an interest in cytology. But FNA in Nigeria faces many important challenges, not the least of which is the lack of opportunities for local training and continuing education in cytology. CONCLUSION: In our opinion, there is an immediate need for a comprehensive approach to cytopathology education in Nigeria.

Local audit of diagnostic surgical pathology as a tool for quality assurance.

BACKGROUND: Internal audit has been rarely done for quality assurance of histology laboratories in Nigeria. We reviewed the steps involved in the production of reports with a view to assessing the performance of the histopathology laboratory of Aminu Kano Teaching Hospital, Nigeria. METHODS: A randomly selected 2 per cent sample of the total histology workload of the center for the year ending December 2005 amounting to 2877 cases was systematically reviewed. RESULTS: Analysis of the accumulated data showed a concordance rate of 94.8% between the original and review histological diagnoses, comparable to other published studies. Significant defects were observed to be due to missing demographic information on request forms (22.8%), poor technical quality of slide sections (18.4%) and typographical errors by typists (12.3%) In a minority of cases microscopic description was inadequate or inappropriate (7.0%) and some were inaccurate (2.7%). The turnaround time ranged from 2 to 16 days (mean 6.2 days) with results of 75.8 per cent of the specimens completed within 7 days. CONCLUSION: From the study we have shown that local audit is feasible in Nigerian laboratories and is an excellent method for detecting errors and improving performance in Surgical Pathology to optimize the scarce resources available to patient care in our country.

Uses and limitations of fine needles aspiration cytology in the diagnostic work-up of patients with superficial lymphadenopathy.

Lymph node fine needle aspirations in 93 patients were studied to ascertain the usefulness of FNA cytology in determining the therapeutic approach. Cytologic results were compared with histologic diagnoses in 35 cases that underwent both aspiration and excisional biopsy. The cases with histological diagnoses included 17 (28.3%) of the 60 cytologically benign cases, 6 (75.0%) of the 8 cytologically suspicious cases, 10 (55.5%) of the 18 cytologically malignant cases and 2 (28.6%) of the 7 cytologically unsatisfactory cases. FNA in the present series showed a sensitivity of 90.0 per cent and specificity of 82.3 percent. It is concluded from this data that FNA can be an accurate, inexpensive and quick method of initial diagnosis in superficial lymphadenopathy.