A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

BACKGROUND: Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African. OBJECTIVES: To develop Afrocentric risk-scoring models for stroke occurrence. MATERIALS AND METHODS: We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (ß) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off. RESULTS: For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%). CONCLUSIONS: The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.

Adulticidal Susceptibility Evaluation of Aedes albopictus Using New Diagnostic Doses in Penang Island, Malaysia.

Insecticide-based vector control approaches are facing challenges due to the development of resistance in vector mosquitoes. Therefore, a proper resistance surveillance program using baseline lethal concentrations is crucial for resistance management strategies. Currently, the World Health Organization's (WHO) diagnostic doses established for Aedes aegypti and Anopheles species are being used to study the resistance status of Aedes albopictus. In this study, we established the diagnostic doses for permethrin, deltamethrin, and malathion using a known susceptible reference strain. Five field-collected populations were screened against these doses, following the WHO protocol. This study established the diagnostic dose of malathion at 2.4%, permethrin at 0.95%, and deltamethrin at 0.28%, which differ from the WHO doses for Aedes aegypti and Anopheles spp. Among the insecticides tested on the 5 wild populations, only deltamethrin showed high effectiveness. Different susceptibility and resistance patterns were observed with permethrin, malathion, and dichloro-diphenyl-trichloroethane (DDT) at 4%. This study may assist the health authorities to improve future chemical-based vector control operations in dengue-endemic areas.

Sleep health of healthcare workers in Kano, Nigeria.

BACKGROUND: The relevance of sleep in the life of a human being cannot be overemphasized in terms of physical and mental well-being. Among several factors that can affect the sleep health of an individual occupation have been found to play a prominent role. The literature is still scanty with regard to sleep studies in our environment. AIM: This study aims to assess the sleep health of tertiary healthcare workers in Kano Nigeria and find, if any, its determining or related factors. MATERIAL AND METHODS: This study was cross-sectional questionnaire-based survey and involved all consenting staff members of Aminu Kano Teaching Hospital, Kano, Nigeria. The Pittsburgh Sleep Quality Index Questionnaire was used to assess the sleep health of the participants. RESULTS: The participants' ages ranged from 18 to 65 years and have a mean age of 38.94 ± 8.07 years. There were 119 (74.4%) males and 41 (25.4%) females with a M:F ratio of 3:1 (χ2 = 19.415; P = 0.000). Among the 155 participants who completed all the aspects of the Pittsburgh Sleep Quality Index questionnaires, the overall sleep quality of the study population was found to be significantly poor [good sleepers = 71 (45.8%), poor sleepers = 84 (54.2%), χ2 = 116.4; P = 0.000]. Considering the various occupational groups working in the hospital, poor sleep was commonest among the nurses 35 (42.7%). Furthermore, among the nurses, poor sleep was significantly commoner in those on shift work 27 (77.1%) than those not on shift work 8 (22.9%); χ2 = 36.2; P = 0.000. Multivariate logistic regression analysis showed that age, sex, and duration in service were not significant predictors of poor sleep quality among the participants [odds ratio (OR) = 1.013, 95% confidence interest (CI) = 0.948-1.084, P = 0.698; OR = 0.691, 95% CI = 0.293-1.631, P = 0.399; and OR = 0.993, 95% CI = 0.932-1.058 P = 0.840, respectively). CONCLUSIONS: Our study found that a significant proportion of healthcare workers and particularly nurses had poor sleep quality. Also, age, sex, and duration in service were not significant predictors of poor sleep quality among the participants.

Age-Stage, Two-Sex Life Table Characteristics of Aedes albopictus and Aedes Aegypti in Penang Island, Malaysia.

The life table developmental attributes of laboratory colonies of wild strains of Aedes albopictus and Aedes aegypti were analyzed and compared based on the age-stage, two-sex life table. Findings inclusive in this study are: adult preoviposition periods, total preoviposition period, mean intrinsic rate of increase (r), mean finite rate of increase (λ), net reproductive rates (R0), and mean generation time (T). The total preadult development time was 9.47 days for Ae. albopictus and 8.76 days for Ae. aegypti. The life expectancy was 19.01 days for Ae. albopictus and 19.94 days for Ae. aegypti. Mortality occurred mostly during the adult stage. The mean development time for each stage insignificantly correlated with temperature for Ae. albopictus (r  =  -0.208, P > 0.05) and (r  =  -0.312, P > 0.05) for Ae. aegypti. The population parameters suggest that Ae. albopictus and Ae. aegypti populations are r-strategists characterized by a high r, a large R0, and short T. This present study provides the first report to compare the life parameters of Ae. albopictus and Ae. aegypti strains from Penang island, Malaysia.

Revised Discriminating Lethal Doses For Resistance Monitoring Program on Aedes albopictus Against Temephos and Malathion in Penang Island, Malaysia.

Dengue vector control still heavily relies on the use of chemical insecticides, and the widespread use of insecticides has led to resistance in mosquitoes. The diagnostic dose is a key part of resistance monitoring. The present study corroborates the discriminating lethal doses of temephos and malathion based on dose-response of known susceptible strain of Aedes albopictus following the World Health Organization (WHO) diagnostic test procedure. Late 3rd and early 4th instars were tested with a range of larvicides to determine the lethal concentrations (LC50 and LC99) values. A slightly higher diagnostic dose of 0.020 mg/liter as compared with the WHO-established value of 0.012 mg/liter was observed for temephos. Meanwhile, a malathion diagnostic dose of 0.200 mg/liter is also reported here since there are no such reported values by WHO. Doubling the LC99 values of susceptible strains, 3 of the 5 wild-collected populations showed resistance to temephos and 2 showed incipient resistance; all 5 populations showed incipient resistance to malathion. The revised and established lethal diagnostic dose findings from the current work are crucial to elaborate on the variation in susceptibility of Ae. albopictus in future resistance monitoring programs in Malaysia.

Assessing desertification vulnerability and mitigation strategies in northern Nigeria: A comprehensive approach.

Desertification constitutes a grave threat to the environmental and socio-economic stability of desertification frontline states in Northern Nigeria. From 2003 to 2020, this research comprehensively analyzes desertification vulnerability, integrating parameters such as NDVI, LST, TVDI, MSAVI, and Albedo. Key factors contributing to land degradation are identified, along with the spatial patterns and trends of desertification over the two-decade period. The consequences are profound, with Northern Nigeria's ecosystem experiencing a steady decline in vegetation cover. Agriculture, vital to the region's economy, faces increased aridity and reduced arable land, jeopardizing food security. Diminishing water resources exacerbates scarcity issues, placing additional strain on communities. These environmental changes lead to severe socio-economic implications, including displacement, loss of livelihoods, and heightened vulnerability to climate-related risks. Urgent, comprehensive, and strategic interventions are imperative. Policy recommendations underscore revising and enforcing land use regulations, promoting sustainable agricultural practices, and establishing monitoring systems to guide decision-making. This research contributes practical strategies to enhance the resilience of desertification frontline states, safeguard livelihoods, and align with Nigeria's sustainable development objectives. Findings from the study indicate that only a tiny percentage (6.7 %) of the study area remains unaffected by desertification. Moreover, 13.3 % exhibit light vulnerability, 20 % demonstrate moderate exposure, and 60 % fall into the severe (26.7 %) and compelling (33.3 %) vulnerability categories. These statistics underscore the gravity of desertification in the study area, emphasizing the urgent need for effective mitigation measures to address its impact comprehensively.

Novel functional insights into ischemic stroke biology provided by the first genome-wide association study of stroke in indigenous Africans.

BACKGROUND: African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network (SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke in indigenous Africans. METHODS: Cases were consecutively recruited consenting adults (aged > 18 years) with neuroimaging-confirmed ischemic stroke. Stroke-free controls were ascertained using a locally validated Questionnaire for Verifying Stroke-Free Status. DNA genotyping with the H3Africa array was performed, and following initial quality control, GWAS datasets were imputed into the NIH Trans-Omics for Precision Medicine (TOPMed) release2 from BioData Catalyst. Furthermore, we performed fine-mapping, trans-ethnic meta-analysis, and in silico functional characterization to identify likely causal variants with a functional interpretation. RESULTS: We observed genome-wide significant (P-value < 5.0E-8) SNPs associations near AADACL2 and miRNA (MIR5186) genes in chromosome 3 after adjusting for hypertension, diabetes, dyslipidemia, and cardiac status in the base model as covariates. SNPs near the miRNA (MIR4458) gene in chromosome 5 were also associated with stroke (P-value < 1.0E-6). The putative genes near AADACL2, MIR5186, and MIR4458 genes were protective and novel. SNPs associations with stroke in chromosome 2 were more than 77 kb from the closest gene LINC01854 and SNPs in chromosome 7 were more than 116 kb to the closest gene LINC01446 (P-value < 1.0E-6). In addition, we observed SNPs in genes STXBP5-AS1 (chromosome 6), GALTN9 (chromosome 12), FANCA (chromosome 16), and DLGAP1 (chromosome 18) (P-value < 1.0E-6). Both genomic regions near genes AADACL2 and MIR4458 remained significant following fine mapping. CONCLUSIONS: Our findings identify potential roles of regulatory miRNA, intergenic non-coding DNA, and intronic non-coding RNA in the biology of ischemic stroke. These findings reveal new molecular targets that promise to help close the current gaps in accurate African ancestry-based genetic stroke's risk prediction and development of new targeted interventions to prevent or treat stroke.

Clinical and neuroimaging factors associated with 30-day fatality among indigenous West Africans with spontaneous intracerebral hemorrhage.

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub-Saharan Africa remains to be characterized in large epidemiological studies. We aimed to determine factors associated with 30-day fatality among West African patients with ICH. METHODS: The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study conducted at 15 sites in Nigeria and Ghana. Adults aged ≥18 years with spontaneous ICH confirmed with neuroimaging. Demographic, cardiovascular risk factors, clinical features and neuroimaging markers of severity were assessed. The independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio (OR) and 95% confidence interval (CI). RESULTS: Among 964 patients with ICH, 590 (61.2%) were males with a mean age (SD) of 54.3(13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality among ICH patients include: Elevated mean National Institute of Health Stroke Scale(mNIHSS);(OR 1.06; 95% CI 1.02-1.11), aspiration pneumonitis; (OR 7.17; 95% CI 2.82-18.24), ICH volume > 30mls; OR 2.68; 95% CI 1.02-7.00)) low consumption of leafy vegetables (OR 0.36; 95% CI 0.15-0.85). CONCLUSION: This study identified risk and protective factors associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans.

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.