APOL1, CDKN2A/CDKN2B, and HDAC9 polymorphisms and small vessel ischemic stroke.

OBJECTIVE: Worldwide, the highest frequencies of APOL1-associated kidney variants are found in indigenous West Africans among whom small vessel disease (SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. MATERIALS AND METHODS: Cases were consecutively recruited consenting adults (aged 18 years or older) with neuroimaging-confirmed first clinical stroke. Stroke-free controls were ascertained using a locally validated version of the Questionnaire for Verifying Stroke-Free Status (QVSFS). Logistic regression models adjusting for known vascular risk factors were fitted to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 154) of SVD ischemic stroke and stroke-free (N = 483) controls. RESULTS: Apolipoprotein L1 (APOL1) rs73885319 (OR = 1.52; CI: 1.09-2.13, P-value = .013), rs2383207 in CDKN2A/CDKN2B (OR = 3.08; CI: 1.15-8.26, P -value = .026) and rs2107595 (OR = 1.70; CI: 1.12-2.60, P-value = .014) and rs28688791 (OR = 1.52; CI: 1.03-2.26, P-value = .036) in HDAC9 gene were associated with SVD stroke at 0.05 significance level. Polymorphisms in other genes did not show significant associations. CONCLUSION: This is the first report of a specific association of APOL1 with a stroke subtype. Further research is needed to confirm these initial findings and deepen understanding of the genetics of stroke in people of African ancestry with possible implications for other ancestries as all humans originated from Africa.

Prevalence and predictors of anxiety in an African sample of recent stroke survivors.

OBJECTIVES: Studies considering emotional disturbances in the setting of stroke have primarily focused on depression and been conducted in high-income countries. Anxiety in stroke survivors, which may be associated with its own unique sets of risk factors and clinical parameters, has been rarely investigated in sub-Saharan Africa (SSA). We assess the characteristics of anxiety and anxiety-depression comorbidity in a SSA sample of recent stroke survivors. MATERIALS AND METHODS: We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤1 month) stroke survivors in SSA. Anxiety in this patient population was measured using the Hospital Anxiety and Depression Scale (HADS), while the community screening instrument for dementia was used to evaluate cognitive functioning. Independent associations were assessed using logistic regression analysis. RESULTS: Among 391 participants, clinically significant anxiety (HADS anxiety score≥11) was found in 77 (19.7%). Anxiety was comorbid with depression in 55 (14.1%). Female stroke survivors were more likely than males to have anxiety (OR=2.4, 95% CI=1.5-4.0). Anxiety was significantly associated with the presence of cognitive impairment after adjusting for age, gender and education (OR=6.8, 95% CI=2.6-18.0). CONCLUSIONS: One in five recent stroke survivors in SSA has clinically significant anxiety, and well over 70% of those with anxiety also have depression. Future studies will need to determine what specific impact post-stroke anxiety may have on post-stroke clinical processes and outcomes.

Factors influencing gender based violence among men and women in selected states in Nigeria.

This study determined the factors associated with gender based violence among 3000 men and women in selected states in Nigeria. Respondents who had experienced physical violence were 806 (26.9%), comprising 353 (11.8%) males and 453 (15.1%) females (p<0.001). Respondents who had experienced sexual violence were 364 (12.1%) of which 221 (7.4%) were males and 143 (4.8%) were females (p<0.0001). Married female respondents were more likely to experience physical violence than single respondents (OR= 1.71, 95%CI: 1.15-2.53 p=0.008). In addition, lower risk of experiencing sexual violence among males was observed among those who do not drink alcohol. The study has shown that gender based violence still constitutes a problem in Nigeria, affecting women more than men. However, efforts should be geared towards addressing the factors that promote violence among both sexes through increased awareness and education.

Management practices of childhood malaria among caregivers in Ojo Military Cantonment, Lagos, Nigeria: implication for child survival.

The study explored home management practices for malaria by caregivers in the Military Cantonment, Ojo Lagos. Data was collected using pre-tested Focus Group Discussion guide and interviewer-administered questionnaire. The 400 survey respondents were selected using the systematic sampling method while the discussion participants were purposively selected. Data analysis was done using EPI Info statistical software and thematic approaches. The mean age of respondents was 29 +/- 15.2 years while 89.8% of respondents were biological parents of the index children. High prevalence of malaria all year round caused by mosquitoes bite was indicated by 281 (70.2%) respondents, while 73 (18.3%) of the respondents reported having lost a child under 5 years old to malaria related illnesses. Preventive practices were uncoordinated while awareness and use of ITNs is low. Home management practices of childhood malaria involved the immediate treatment with medicines available in the home. Sharing of left over drugs and herbs were common practices. Home treatment was preferred because of high costs 250 (62.5%), unfriendly attitude of workers 195 (48.8%) and long waiting time 194 (48.5%) in the health facilities. Based on the findings there is the need to institute an awareness programme aimed at improving prompt home management of malaria in the barracks.

Perception of Mothers and Selected Informal Maternity Caregivers Regarding Maternal Depression in Two Communities of Ibadan In Nigeria.

This article described the perception of young mothers and selected informal maternity caregivers with no known antecedents of depression residing in two communities in Ibadan, Nigeria about maternal depression. This study is qualitative in design. We purposively selected fifty-one pregnant women and nursing mothers (young mothers) within the communities and the clinics. Thirty-three informal caregivers (Community Birth attendants (CBAs), elderly mothers and men of reproductive age) were also selected. We utilized Focus Group Discussions (FGD), Key Informant Interviews (KIIs), open-ended interviews and document consultation to obtain information about maternal depression. Discussions and interviews were digitally recorded, transcribed verbatim and analyzed using thematic analysis with Nvivo version 15. Common phrases used to describe maternal depression were "severe worrying" and "chronic unhappiness". Young mothers opined that maternal depression was caused by lack of partner support while more of the men and elderly mothers felt spiritual causes were responsible. Symptoms of maternal depression described by the participants included prolonged loss of interest in pleasurable activities and being moody. Common consequences of maternal depression mentioned were premature onset of labour and low birth weight babies. The perceived help-seeking behaviour included special rituals and deliverance. CBAs mentioned referral to a psychiatrist as a last resort. Participants were aware of maternal depression and its symptoms, however, there were misconceptions about the causes which influenced the perceived help-seeking of elderly mothers and men. Health education interventions to dispel these misconceptions should therefore target the mothers and informal caregivers in the study area.

Need Assessment for Health Education Service Provision on Maternal Depression Among Primary Health Care Service Providers.

Maternal depression is gradually becoming a prevailing condition among women of reproductive age in Nigeria but there are little efforts towards addressing this problem. Need assessment for health education service provision on maternal depression therefore becomes necessary. Hence, this study assessed the needs of Primary Health Care (PHC) workers regarding the provision of routine health talk on maternal depression. This study was descriptive in design and it adopted a mixed method. Four Key Informant Interviews (KII) and a survey which involved 100 Health Workers (HWs) were carried out. KII participants were purposively selected from the 4 LGAs where volunteers were found and the 100 HWs were conveniently selected from all the Comprehensive Clinics (CCs) in the 5 LGAs. A KII guide and structured questionnaire were used to collect data and data were analyzed thematically, with descriptive statistics and chi-square. The mean age of the key informant's interviewees was 54±6.1years and the mean age of the survey respondents was 42±5.2 years. The interviewees identified HWs' inability to communicate maternal depression to the service users in appropriate local terms and non-availability of Information, Education and Communication (IEC) materials as barriers to giving health talk on maternal depression. Survey respondents identified certain needs with a statistical significance across cadres. Eighty-three (88.3%) identified training need, education aid materials 61.7%; p<0.05, maternal depression health education guide 27.7%; p<0.05 and need for more staff 22.3%. Training need, non-availability of maternal depression targeted educational materials and the need for more staff were the primary identified needs.

Health workers' perception about the supplemental immunization activities in Gombe local government area, Gombe state.

Polio immunisation has faced challenges of refusal from care givers in recent times despite the efforts put in to ensure its success. To identify the role of service providers in this attitudinal shift, a survey describing the perception of health workers about the supplemental immunization activities was carried out among 265 health workers who participated in the 3rd round of the 2003 sub-national immunization days in Gombe local government area (LGA) of Gombe state, Nigeria. Data was collected using pretested qualitative and quantitative instruments. Quantitative data was analysed using EPI Info statistical software and the qualitative using thematic areas. Results showed that 211 (79.6%) knew fecal-oral route as the commonest mode for poliovirus transmission, 231 (87.2%) knew the age for vaccination, 224 (84.5%) knew the correct use of vaccine vial monitor while 143 (53.9%) knew the correct action to take when a case of polio was identified. On perception, 22 (8.3%) perceived that OPV was harmful due to repeated administration, 26 (9.8%) perceived that OPV had sterility property, contained harmful materials 14 (5.3%) and HIV 11 (4.2%). Main reasons for immunisation rejection were sterility 115 (43.3%) and contamination with HIV 94 (35.5%). The study found that irrespective of adequate knowledge on transmission, misconceptions still exist among health workers on the polio vaccine. Based on this, there is the need for continuous training to remove the misconceptions concerning their perceptions and rumors about the vaccine and the programme.

Stroke Investigative Research and Education Network: Public Outreach and Engagement.

Stroke is becoming a leading cause of disability and death, and a major public health concern in Sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network (SIREN) seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other non-communicable diseases in SSA. One of the first steps to address this goal was to effectively engage the communities that suffer high burdens of disease in SSA. This paper describes the process of SIREN project's community engagement activities in Ghana and Nigeria. The aims of community engagement (CE) within SIREN are to: i) elucidate information about knowledge, attitudes, beliefs, and practices (KABP) about stroke and its risk factors from individuals of African ancestry in SSA; ii) educate the community about stroke and ways to decrease disabilities and deaths from stroke; and iii) recruit 3000 control research subjects to participate in a case-control stroke study. CE focused on three-pronged activities-constitution and interaction with Community Advisory Board (CABs), Focus Group Discussions (n=27) and community education and outreach programs (n=88). FGDs and outreach programs indicate that knowledge of stroke, as well as risk factors and follow-up evidence-based care is limited and often late. Almost all indicated that genetic testing could help health provider's better treat stroke and help scientists better understand the causes of stroke. Over 7000 individuals have received education on cardiovascular risk factors and about 5,000 have been screened for cardiovascular risk factors during the outreaches. The CE core within SIREN is a first of its kind public outreach engagement initiative to evaluate and address perceptions about stroke and genomics by patients, caregivers, and local leaders in SSA and has implications as a model for assessment in other high stroke risk populations.

Stroke genomics in people of African ancestry: charting new paths.

One in six people worldwide will experience a stroke in his/her lifetime. While people in Africa carry a disproportionately higher burden of poor stroke outcomes, compared to the rest of the world, the exact contribution of genomic factors to this disparity is unknown. Despite noteworthy research into stroke genomics, studies exploring the genetic contribution to stroke among populations of African ancestry in the United States are few. Furthermore, genomics data in populations living in Africa are lacking. The wide genomic variation of African populations offers a unique opportunity to identify genomic variants with causal relationships to stroke across different ethnic groups. The Stroke Investigative Research and Educational Network (SIREN), a component of the Human Health and Heredity in Africa (H3Africa) Consortium, aims to explore genomic and environmental risk factors for stroke in populations of African ancestry in West Africa and the United States. In this article, we review the literature on the genomics of stroke with particular emphasis on populations of African origin.

Attitude of infertile women to child adoption in Nigeria.

Infertility has serious consequences especially in Africa where a high premium is place on child bearing. An interviewer-administered questionnaire was administered on 396 consenting women seeking infertility treatment at the gynaecological clinic of the University College Hospital, Ibadan in an attempt to assess the attitude of infertile women in Nigeria to child adoption and its acceptability as a management option for infertility. Most (64%) believed its culturally unacceptable and only 17% will try it as an option. Sustained advocacy, community mobilization and enactment of supportive laws were some of the suggestions made by respondents to improve its uptake.

Experiences of Violence among Pregnant Women Attending Ante-Natal Clinics in Selected Hospitals in Abuja; Nigeria

Anecdotal records have shown that there is increasing prevalence of gender based violence in Nigeria. Little is known about the extent and magnitude of this phenomenon as it affects pregnant women. This study described the experiences of violence among pregnant women attending ante-natal clinics in Abuja; Nigeria using a cross-sectional design. A three-stage sampling technique was used to select 300 participants from six hospitals in the three out of the six Local Government Areas in the region. Data was collected using a pretested semi-structured questionnaire and analysed using descriptive statistics and chi-square tests. Forty three percent of the respondents had experienced at least one form of violence and 15.0 were experiencing violence in their current relationships. Main forms of violence ever experienced were psychological (38.0) and physical (36.4). Partners/husbands (70.2) and partner/husband relatives (29.8) were the perpetrators. Of the partner/husband's relatives; sisters-in-law (57.1) and partners' cousins (21.5) were the main perpetrators of the forms of violence experienced. Strategies employed to resolve violence conflict included dialogue with spouse (46.7); ignoring the experience (30.3); making up with sex (16.7); providing gifts and special dishes (5.0) and mediation by family members (1.3). Health promotion and education intervention strategies such as counselling; male involvement in sexual and reproductive health programs; advocacy for the promotion of women's health and right as well as use of appropriate culturally sensitive conflict resolution strategies are needed to ameliorate the situation