Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study.

BACKGROUND: Hypertension is preeminent among the vascular risk factors for stroke occurrence. The wide gaps in awareness, detection, treatment, and control rates of hypertension are fueling an epidemic of stroke in sub-Saharan Africa. PURPOSE: To quantify the contribution of untreated, treated but uncontrolled, and controlled hypertension to stroke occurrence in Ghana and Nigeria. METHODS: The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n = 3684) with age- and sex-matched stroke-free controls (n = 3684). We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with risk of stroke occurrence. We assessed the adjusted odds ratio and population-attributable risk of hypertension treatment control status associated with stroke occurrence. RESULTS: The frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension and controlled hypertension among stroke cases were 4.0%, 47.7%, 37.1%, and 9.2% vs 40.7%, 34.9%, 15.9%, and 7.7% respectively among stroke-free controls, p < 0.0001. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15-8.41) and 35.4% (33.4-37.4); treated but uncontrolled hypertension was 9.95 (7.60-13.02) and 35.9% (34.2-37.5); and controlled hypertension 5.37 (3.90-7.41) and 8.5% (7.6-9.5) respectively. Untreated hypertension contributed a PAR of 47.5% to the occurrence of intracerebral hemorrhage vs 29.5% for ischemic stroke. The aOR of untreated hypertension for stroke occurrence was 13.31 (7.64-23.19) for <50 years; 7.14 (4.51-11.31) for 50-64 years; and 3.48 (2.28-5.30) for 65 years or more. CONCLUSION: The contribution of untreated hypertension and treated but uncontrolled hypertension to stroke occurrence among indigenous Africans is substantial. Implementing targeted interventions that address gaps in hypertension prevention and treatment, involving the local population, healthcare providers, and policymakers, can potentially substantially reduce the escalating burden of strokes in Africa.

Dietary patterns associated with hypertension among stroke-free indigenous Africans: insights from the Stroke Investigative Research and Educational Network study.

BACKGROUND: The dietary factors associated with the high burden of hypertension among indigenous Africans remain poorly understood. We assessed the relationship between dietary patterns and hypertension among indigenous Africans. METHOD: In this study, 1550 participants with hypertension matched (for age: ±â€Š5 years, sex and ethnicity) with 1550 participants without hypertension were identified from the stroke-free population in the Stroke Investigative Research and Educational Network study in Ghana and Nigeria. Food consumption was assessed using a food frequency questionnaire, and dietary information was summarized using principal component analysis to identify seven dietary patterns. Conditional logistic regression was applied to compute the odds ratio (OR) and 95% confidence interval (CI) for the risk of hypertension by tertiles of dietary patterns adjusting for age, education, income, smoking, alcohol use, physical inactivity, family history of cardiovascular diseases, obesity and salt intake at a two-sided P less than 0.05. RESULTS: Multivariable-adjusted OR [95% confidence interval (CI)] for risk of hypertension by second and third tertiles [using the lowest (first) tertile as reference] of dietary patterns were 0.62 (0.48-0.80), 0.70 (0.54-0.90) for whole grains and fruit drinks; 0.87 (0.68-1.12), 0.83 (0.64-1.08) for fruits; 0.85 (0.65-1.10), 0.97 (0.75-1.26) for vegetables, legumes and potatoes; 0.78 (0.60-1.00), 0.84 (0.65-1.08) for fried foods and sweetened drinks; 1.13 (0.88-1.45), 0.80 (0.62-1.03) for poultry product and organ meat; 1.11 (0.86-1.43), 0.88 (0.68-1.14) for red meat; and 1.14 (0.88-1.48), 1.09 (0.84-1.43) for processed foods ( P  < 0.05). CONCLUSION: A higher adherence to dietary consumption of whole grains and fruits was inversely associated with low odds of hypertension in this population.

Factors associated with frequency of fruit and vegetable consumption among selected sub-Saharan African populations: evidence from the Cardiovascular H3Africa Innovation Resource Project.

BACKGROUND: Frequent fruit and vegetable consumption is considered a promising dietary behaviour that protects health. However, most existing studies about the factors associated with this phenomenon among Africans are based on single-country reports, apart from one meta-regression combining smaller studies. This study harmonized large datasets and assessed factors associated with the frequency of fruit and vegetable consumption in this population. METHODS: Individual-level data on sociodemographics, lifestyle and diet from 20 443 participants across five African countries (Burkina Faso, Ghana, Kenya, South Africa and Nigeria), from the Stroke Investigative Research and Educational Network (SIREN) and Africa Wits-INDEPTH partnership for Genomic Research (AWI-Gen) studies, were harmonized. Total frequency of fruit and vegetable consumption (in portions/week) was classified as 'low' (≤6), 'moderate' (7-14) and 'high' (≥15). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with the total frequency of fruit and vegetable consumption (using 'low' consumption as the reference) were estimated using multinomial regression models. RESULTS: Mean age of participants was 54.3 ± 11.8 years, 10 641 (52.1%) were female, and the median (interquartile range) frequency of total fruit and vegetable consumption was 10.0 (4.0, 21.0) portions/week. Participants with a family history of cardiovascular disease [moderate (aOR, 0.92; 95% CI, 0.85, 1.00) and high (aOR, 0.85; 95% CI, 0.78, 0.92)], current smokers [moderate (aOR, 0.83; 95% CI, 0.74, 0.94) and high (aOR, 0.78; 95% CI, 0.69, 0.88)], current alcohol users [moderate (aOR, 0.92; 95% CI, 0.85, 1.00) and high (aOR, 0.82; 95% CI, 0.76, 0.89)] and physically inactive participants [moderate (aOR, 0.85; 95% CI, 0.75, 0.96) and high (aOR, 0.80; 95% CI, 0.70, 0.90)] were less likely to consume fruits and vegetables frequently. CONCLUSION: Africans with lifestyle risk factors for cardiovascular disease were less likely to consume fruit and vegetables frequently.

Association of second-hand smoking with sleep quality among adults in Ibadan, Nigeria: a cross-sectional evaluation of data from the COMBAT-CVDs study.

PURPOSE: Sleep quality (SQ) is essential in the overall well-being and quality of life, but little is known about the association of secondhand smoking (SHS) with SQ. This study assessed the relationship between SHS and SQ among adults who had never smoked in Ibadan, Nigeria. METHODS: We identified 3193 respondents who had never smoked or used any form of tobacco product in the Community-based Investigation of the Risk Factors for Cardiovascular Diseases in the Ibadan and suburbs (COMBAT-CVDs) study. SHS was self-reported, SQ assessed using a sleep quality scale, and SQ scores were classified by the quartile distributions of SQ scores in this sample as good (< 7), moderate (7-13), fair (14-20), and poor (≥ 21), and logistic regression models were used to estimate the multivariable-adjusted odds ratio and 95% confidence interval (CI) of the association between SHS and SQ in a two-sided test at P < 0.05. RESULTS: The mean (SD) of age in this sample was 34.8 ± 15.1 years; 1621 (50.8%) were females, and 848 (26.6%) experienced SHS. The multivariable-adjusted odds by categories of SQ scores (using good SQ as reference) in the light of SHS were OR: 1.64 (95%CI 1.28, 2.12) for moderate SQ, OR: 1.88 (95%CI 1.46, 2.42) for fair SQ and OR: 2.14 (95%CI 1.66, 2.75) for poor SQ; P < 0.0001 after adjusting for relevant covariates. The sex- and age groups- stratified analyses revealed similar trends. CONCLUSION: SHS is associated with higher odds of poor SQ in this study. Culturally relevant interventions for mitigating exposure to SHS might improve SQ and overall quality of life, particularly among vulnerable populations.

Secondhand smoke exposure is independently associated with stroke among non-smoking adults in West Africa.

BACKGROUND: Stroke is a leading cause of disability and mortality worldwide, but little is known about the contribution of secondhand smoke exposure (SHSE) to stroke epidemiology among indigenous Africans. OBJECTIVE: To evaluate the association of SHSE with stroke among indigenous Africans. METHODS: We analyzed the relationship of SHSE with stroke among 2990 case-control pairs of adults who had never smoked (identified in the SIREN study) using conditional logistic regression at a two-sided P < 0.05. RESULTS: Multivariable-adjusted odds ratio and 95% confidence interval; 1.25 (1.04, 1.50; P = 0.02) revealed SHSE was positively associated with stroke independent of stroke subtypes. CONCLUSION: Culturally relevant primary prevention strategies targeted at SHSE might be promising in preventing stroke among Africans.

Frequent vegetable consumption is inversely associated with hypertension among indigenous Africans.

AIMS: The relationship between vegetable consumption and hypertension occurrence remains poorly characterized in sub-Saharan Africa. This study assessed the association of vegetable consumption with odds of hypertension among indigenous Africans. METHODS AND RESULTS: We harmonized data on prior vegetable consumption and hypertension occurrence (defined as one of the following conditions; systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg or previous diagnosis or use of antihypertensive medications) from 16 445 participants across five African countries (Nigeria, South Africa, Kenya, Ghana and Burkina Faso) in the Stroke Investigative Research and Educational Network and Africa Wits-INDEPTH partnership for Genomic studies. Vegetable consumption (in servings/week) was classified as 'low' (<6). 'moderate' (6-11), 'sufficient' (12-29), and 'high' (≥30). Odds ratios (ORs) and 95% confidence interval (CI) of hypertension were estimated by categories of vegetable consumption (using 'low' consumption as reference), adjusting for sex, age in years, family history of cardiovascular diseases, education, smoking, alcohol use, physical inactivity, body mass index, diabetes mellitus and dyslipidaemia using logistic regressions at P < 0.05. The mean age of participants was 53.0 ( ± 10.7) years, and 7552 (45.9%) were males, whereas 7070 (42.9%) had hypertension. In addition, 6672(40.6%) participants had 'low' vegetable consumption, and 1758(10.7%) had 'high' vegetable consumption. Multivariable-adjusted OR for hypertension by distribution of vegetable consumption (using 'low' consumption as reference) were 1.03 (95% CI: 0.95, 1.12) for 'moderate' consumption; 0.80 (0.73, 0.88) for 'sufficient', and 0.81 (0.72, 0.92) for 'high' consumption, P-for-trend <0.0001. CONCLUSION: Indigenous Africans who consumed at least 12 servings of vegetables per week were less likely to be found hypertensive, particularly among males and young adults.

Investigating the transmission dynamics of SARS-CoV-2 in Nigeria: A SEIR modelling approach.

This study was designed to investigate the transmission dynamics of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to inform policy advisory vital for managing the spread of the virus in Nigeria. We applied the Susceptible-Exposed-Infectious-Recovered (SEIR)-type predictive model to discern the transmission dynamics of SARS-CoV-2 at different stages of the pandemic; incidence, during and after the lockdown from 27th March 2020 to 22nd September 2020 in Nigeria. Our model was calibrated with the COVID-19 data (obtained from the Nigeria Centre for Disease Control) using the "lsqcurvefit" package in MATLAB to fit the "cumulative active cases" and "cumulative death" data. We adopted the Latin hypercube sampling with a partial rank correlation coefficient index to determine the measure of uncertainty in our parameter estimation at a 99% confidence interval (CI). At the incidence of SARS-CoV-2 in Nigeria, the basic reproduction number (R0 ) was 6.860; 99%CI [6.003, 7.882]. R0 decreased by half (3.566; 99%CI [3.503, 3.613]) during the lockdown, and R0 was 1.238; 99%CI [1.215, 1.262] after easing the lockdown. If all parameters are maintained (as in after easing the lockdown), our model forecasted a gradual and perpetual surge through the next 12 months or more. In the light of our results and available data, evidence of human-to-human transmission at higher rates is still very likely. A timely, proactive, and well-articulated effort should help mitigate the transmission of SARS-CoV-2 in Nigeria.

Secondhand smoke exposure and dyslipidemia among non-smoking adults in the United States.

Dyslipidemia is a major public health challenge worldwide and whether secondhand smoke exposure (SHSE) is associated with dyslipidemia is yet to be understood. This study evaluated the relationship between SHSE and odds of dyslipidemia among adults in the United States. We identified 3064 adults who had never smoked in the 2015-2016 National Health and Nutrition Examination Survey and estimated the odds ratio and 95% confidence interval for the relationship between SHSE and odds of dyslipidemia using a multivariable adjusted-logistic regression at a two-sided p < 0.05. Overall, the mean age of respondents was 46.4 ± 18.0 years, 59.6% had dyslipidemia and 36.2% had SHSE. The odds of dyslipidemia among individuals with SHSE were 1.148 (1.147, 1.149) in the overall sample, 1.214 (1.214, 1.215) among women and 1.165 (1.163, 1.167) among men. The odds trended similarly independent of age groups: 1.130 (1.129, 1.131) for young adults (<60 years) and 1.304 (1.300, 1.308) for old adults (≥60 years). SHSE was associated with higher odds of dyslipidemia with higher odds among women and old adults. Primary intervention(s) targeted at reducing SHSE may show benefits in reducing the odds of dyslipidemia, and longitudinal studies would be necessary to clarify the association between SHSE and dyslipidemia.

Association of Environmental tobacco smoke exposure with depression among non-smoking adults.

BACKGROUND: Depression is a psychological dysfunction that impairs health and quality of life. However, whether environmental tobacco smoke exposure (ETSE) is associated with depression is poorly understood. This study was designed to evaluate the association of ETSE with depression among non-smoking adults in the United States. METHOD: Using the 2015-2016 United States National Health and Nutrition Examination Survey (NHANES), we identified 2623 adults (females - 64.2%, males - 35.8%) who had never smoked and applied multivariable adjusted-logistic regression to determine the adjusted odds ratio (aOR) and 95% confidence interval (CI) at P < 0.05 for the association of ETSE with depression adjusting for relevant confounders. RESULTS: Mean age of respondents was 46.5 ± 17.9 years, 23.5% reported ETSE, and 4.7% reported depression. Also, aORs for the association of ETSE with depression were 1.992 (1.987, 1.997) among females and 0.674 (0.670, 0.677) among males. When we examined the association by age groups, the aORs were 1.792 (1.787, 1.796) among young adults (< 60 years) and 1.146 (1.140, 1.152) among older adults (≥60 years). CONCLUSIONS: We found that ETSE was associated with higher odds of depression among females but not among males.

Dietary intakes of green leafy vegetables and incidence of cardiovascular diseases.

AIM: Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. This study sought to determine the specific effect of GLV intake on the incidence of CVD. METHODS: Previously published cohort studies on GLV intake and incidence of CVD were retrieved through a systematic search of Google Scholar, EMBASE, MEDLINE, HINARI and Cochrane Library. A methodological evaluation of studies was carried out using the network of Ottawa scale, and a fixed-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI). Heterogeneity was determined using the I2 statistic. Sensitivity analysis was done using the leave-one-study-out technique. All statistical analysis was carried out at p < 0.05 using RevMan 5.4. RESULTS: The pooled RR (95% CI) of incident CVD events from 17 studies was 0.93 (0.92-0.95). Specifically, GLV intake was inversely related with incident cerebral infarction (RR: 0.92; 95% CI: 0.88-0.96), heart disease (RR: 0.93; 95% CI: 0.87-0.99) and other CVD events (RR: 0.95; 95% CI: 0.93-0.98). CONCLUSIONS: GLV intake was associated with a lower incidence of CVD, and may be a promising primary-prevention strategy against CVD events. The findings are especially important in LMICs where the burden of CVD remains high.

The copy number variation and stroke (CaNVAS) risk and outcome study.

BACKGROUND AND PURPOSE: The role of copy number variation (CNV) variation in stroke susceptibility and outcome has yet to be explored. The Copy Number Variation and Stroke (CaNVAS) Risk and Outcome study addresses this knowledge gap. METHODS: Over 24,500 well-phenotyped IS cases, including IS subtypes, and over 43,500 controls have been identified, all with readily available genotyping on GWAS and exome arrays, with case measures of stroke outcome. To evaluate CNV-associated stroke risk and stroke outcome it is planned to: 1) perform Risk Discovery using several analytic approaches to identify CNVs that are associated with the risk of IS and its subtypes, across the age-, sex- and ethnicity-spectrums; 2) perform Risk Replication and Extension to determine whether the identified stroke-associated CNVs replicate in other ethnically diverse datasets and use biomarker data (e.g. methylation, proteomic, RNA, miRNA, etc.) to evaluate how the identified CNVs exert their effects on stroke risk, and lastly; 3) perform outcome-based Replication and Extension analyses of recent findings demonstrating an inverse relationship between CNV burden and stroke outcome at 3 months (mRS), and then determine the key CNV drivers responsible for these associations using existing biomarker data. RESULTS: The results of an initial CNV evaluation of 50 samples from each participating dataset are presented demonstrating that the existing GWAS and exome chip data are excellent for the planned CNV analyses. Further, some samples will require additional considerations for analysis, however such samples can readily be identified, as demonstrated by a sample demonstrating clonal mosaicism. CONCLUSION: The CaNVAS study will cost-effectively leverage the numerous advantages of using existing case-control data sets, exploring the relationships between CNV and IS and its subtypes, and outcome at 3 months, in both men and women, in those of African and European-Caucasian descent, this, across the entire adult-age spectrum.

Passive smoking exposure and the risk of hypertension among non-smoking adults: the 2015-2016 NHANES data.

BACKGROUND: Hypertension is a major public health problem and a prominent risk factor for cardiovascular diseases. However, whether passive smoking exposure (PSE) is associated with the risk of hypertension is scarcely understood. This study assessed the association between PSE and the risk of hypertension among adults (≥18 years) in the United States of America. METHODS: Three thousand and sixty-seven adults were identified from the 2015-2016 National Health and Nutrition Examination Survey and the association between PSE and hypertension (adjusting for relevant confounders) was examined using multivariable adjusted-logistic regression analysis at P < 0.05. RESULTS: Mean age of respondents was 46.5 ± 17.9 years. Overall, 23.7% of respondents reported PSE and 32.6% were hypertensives (of which only 14.3% were aware of their hypertensive state) Also, adjusted odds of hypertension for participants with PSE was 1.038 (1.037, 1.040), P < 0.0001, in the overall population. Also, PSE aggravated odds of hypertension among young adults - < 60 years (aOR: 1.095, 95CI%: 1.094 to 1.097), P < 0.0001, and old adults - ≥60 years (aOR: 1.110, 95% CI: 1.108 to 1.113), P < 0.0001. Similarly, PSE was associated with increased odds of hypertension among women (aOR: 1.240, 95% CI: 1.238 to 1.242), P < 0.0001 but not among men (aOR: 0.755, 95% CI: 0.754 to 0.757), P < 0.0001. CONCLUSIONS: PSE was independently associated with the risk of hypertension particularly among women, young and old adults. A multi-ethnic longitudinal cohort may help ascertain causality and provide more evidence for appropriate interventions.

Lipid profile and risk of ovarian tumours: a meta-analysis.

BACKGROUND: Existing data from several reports on the association between lipid profile and ovarian tumour (OT) suggests divergent conclusions. Our aim was to examine whether circulating lipid profile: total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) differed between cases and non-cases of OT. METHODS: Electronic repositories; PUBMED, EMBASE and Cochrane library were explored through December 2019 to retrieve published articles for inclusion in the meta-analysis after quality assessment. Heterogeneity was assessed using I2 statistics, the effect of individual studies on the overall effect size was tested using sensitivity analysis and funnel plot was used to evaluate publication bias. RESULTS: Twelve studies, involving 1767 OT cases and 229,167 non-cases of OT were included in this meta-analysis and I2 statistics ranged between 97 and 99%. Mean circulating TC (- 16.60 [- 32.43, - 0.77]mg/dL; P = 0.04) and HDL (- 0.25[- 0.43, - 0.08]mmol/L; P = 0.005) were significantly lower among OT cases compared to non-OT cases. CONCLUSION: Decreased TC and HDL profiles were observed among subjects with OT in this collection of reports. The implications of TC and HDL in tumour manifestations and growth need to be validated in a large multi-ethnic longitudinal cohort adjusting for relevant confounders.

Substance use and Psychosocial Functioning of Adolescents in Benue State, Nigeria: Assessing the role of age.

AIM: To assess whether Substance Use (SU) is associated with Psychosocial Function (PF) among adolescent. METHODS: Using a self-administered validated instrument, we obtained information on demographic, SU (defined as self-reported affirmative use of one or more of any form of alcoholic drinks, cigarettes, hemps etc) and PF [using the adolescent psychosocial functioning inventory comprising of three subscales; optimism and coping strategies (OCS), behaviour and relationship problems (BRP) and general psychosocial dysfunction designed (GPD)] among 2272 apparently healthy adolescents. PF was categorized as 'elevated' if the psychosocial functioning index (PFI) score were >75th percentile, otherwise, 'not elevated' and multivariable-adjusted logistic regression was used to compute odds ratio (OR) and 95% confidence interval (CI) of SU for elevated PF risk. In addition, we applied Johnson Neyman (JN) technique to identifying the JN significance regions at which age moderated the SU-PF relationship at a statistical significance of two-sided P<0.05. RESULTS: Prevalence of SU and elevated PF was 50.7% and 79.8% respectively. Prevalence of elevated PF differed insignificantly by sex, but the proportion of adolescent with elevated PFI on SU (82.6%) was significantly higher (P<0.001) compared to those with elevated PFI but not on SU (76.9%). Multivariable-adjusted odds of decreased OCS risk given SU exposure was; OR (95%CI): 1.3791 (1.1458-1.6698), P=0.0007. Similarly, multivariable-adjusted odds of elevated PF risk in the light of SU exposure was; OR (95%CI): 1.4286 (1.1617-1.7567), P=0.0007. Furthermore, the JN significance regions for moderated regression analyses of odds of decreased OCS risk was between 10.4years [OR (95%CI): 0.5820 (0.1411-1.0228), P=0.0097] and 16.7years [OR (95%CI): 0.3025 (0.0001-0.6050), P=0.0500]. CONCLUSION: Adolescents on SU are about one and half times at risk of psychosocial dysfunction and age significantly attenuated the SU-decreased OCS risk link particularly in early adolescence.

The Factor Structure of the Adapted WHO Quality of Life BREF questionnaire in a sample of adolescents in Nigeria.

INTRODUCTION: The World Health Organization's Quality of Life Instrument (WHOQOL-BREF) is widely validated and popularly used in assessing perceived quality of life (QOL) of adolescents and the general population. Though the WHOQOL-BREF has been used in some studies in Nigeria, its theoretical structure has not been comprehensively investigated. This study examined the factor structure of the Adopted WHOQOL-BREF questionnaire and it theoretical structure in a large sample of adolescents in Nigeria. METHODS: Data on demographic characteristics and QOL were extracted from 1,963 adolescents who participated in a state-wide study on psychosocial functioning and quality of life of adolescents in Benue State, Nigeria. Descriptive statistics were used to present the distribution of the data while Cronbach's alpha and Polychoric ordinal alpha were used to describe the internal consistency (reliability) of the adapted WHOQOL-BREF and alpha value of 0.700 was considered reliable. Structural analysis was performed to extract the underlying factors while confirmatory factor analyses were used to assess some hypothesized structure of the adapted WHO-QOL BREF. Relative Chi-square test (χ2/df) value ≤3.0 was regarded a good fit while multiple fit indexes with values ≥0.90 (for acceptable fit) were used for assessing diverse aspects of the models. All analyses were performed at 5% significance level using IBM SPSS statistics version 20, R package and AMOS version 21. RESULTS: Participants were mostly male (54.8%) and 14.7±1.4 years old with 51.0% residing in rural areas. The overall internal consistency of the 4-factor model was 0.862 (for Cronbach's Alpha) and 0.989 (for Polychoric Alpha) while the 2-factor model had 0.870 (for Cronbach's Alpha) and 0.990 (for Polychoric Alpha). The Cattelle's Scree plot, Horn's parallel analysis and the confirmatory factor analysis revealed a 2-factor model as the best model for the WHO-QOL BREF. The 23-item 2-factor structure had a relative Chi-square test value χ2/df < 3 = 2.98, p < 0.001 with all fit indices within the acceptable range. CONCLUSION: The adapted WHO QOL BREF can be safely used to assess quality of life among Adolescents in Nigeria and related settings. Using the two factors extracted in the present study may yield better results in settings similar to the present study location.

Modelling the factor structure of the Child Depression Inventory in a population of apparently healthy adolescents in Nigeria.

BACKGROUND: Childhood and adolescent depression is common and often persists into adulthood with negative implications for school performances, peer relationship and behavioural functioning. The Child Depression Inventory (CDI) has been used to assess depression among adolescents in many countries including Nigeria but it is uncertain if the theoretical structure of CDI appropriately fits the experiences of adolescents in Nigeria. This study assessed varying theoretical modelling structure of the CDI in a population of apparently healthy adolescents in Benue state, Nigeria. METHODS: Data was extracted on CDI scale and demographic information from a total of 1, 963 adolescents (aged 10-19 years), who participated in a state wide study assessing adolescent psychosocial functioning. In addition to descriptive statistics and reliability tests, Exploratory Factor Analysis (EFA) and Confirmatory Factor analysis (CFA) were used to model the underlying factor structure and its adequacy. The suggested new model was compared with existing CDI models as well as the CDI's original theoretical model. A model is considered better, if it has minimum Root Mean Square Error of Approximation (RMSEA<0.05), Minimum value of Discrepancy (CMIN/DF<3.0) and Akaike information criteria. All analyses were performed at 95% confidence level, using the version 21 of AMOS and the R software. RESULTS: Participants were 14.7±2.1 years and mostly male (54.3%), from Monogamous homes (67.9%) and lived in urban areas (52.2%). The measure of the overall internal consistency of the 2-factor CDI was α = 0.84. The 2-factor model had the minimum RMSEA (0.044), CMIN/DF (2.87) and least AIC (1037.996) compared to the other five CDI models. CONCLUSION: The child depression inventory has a 2-factor structure in a non-clinical general population of adolescents in Nigeria. Future use of the CDI in related setting may consider the 2-factor model.

Correlates of the Quality of life of Adolescents in families affected by HIV/AIDS in Benue State, Nigeria.

It was estimated that over 260,000 children are living with HIV/AIDS while close to 2 million are directly or indirectly affected by the disease in Nigeria. Improvements in treatments for infected children have been documented in the literature but there is a gross knowledge gap on the impact of HIV/AIDS on the quality of life and psychosocial functioning (PSF) of affected children in Nigeria. We comparatively explored the association of quality of life with PSF and other factors among adolescents in families affected by HIV/AIDS (FAHA) and in families not affected by HIV/AIDS (FNAHA). Data was extracted for 960 adolescents from a State wide cross-sectional study in which participants were selected through multistage sampling techniques. Data was collected using questionnaires consisting of demographic information, adapted WHO-QOL BREF and the Strength & Difficulty Questionnaire (SDQ). The quality of life scores were categorized into Poor, Moderate and High based on the amount of standard deviation away from the mean while the SDQ scores were categorized into normal, borderline and abnormal based on the SDQ scoring systems. Chi-square test and independent t-test were used for bivariate analyses while logistic regression was used for multivariate analyses at 5% level of significance. Proportion with poor quality of life (27.0%) was significantly higher among adolescents in FAHA than in FNAHA (p=0.0001). Adolescents in FAHA (OR:2.32; 95%CI:1.67-4.09) were twice more likely to have poor quality of life than those in FNAHA. In FAHA, adolescents on the borderline of PSF (OR:2.19; 95%CI:1.23-3.89) were twice more likely to have poor quality of life than those with normal PSF. Adolescents in FAHA have poorer quality of life than those in FNAHA and also face additional burdens of psychosocial dysfunctions. Interventions focusing on functional social support and economic empowerment will benefit adolescents in FAHA in the studied location.

Sociodemographic Factors Related to Quality of Life Among Premenopausal Women in Ibadan, Nigeria.

Quality of life (QoL) of premenopausal women (PW) was assessed using primary data collected between September and December 2011. A 26-item questionnaire (WHO-QoL BREF) was administered to 285 apparently healthy women selected from two local government areas in Ibadan. The scores were categorized into poor (≤ 79.53) and good (>79.53) QoL. Multiple logistic regressions were used to study factors associated with QoL. The mean score for the overall QoL (OQoL) was 65.18 ± 11.35 (range = 81.25). The Cronbach's alpha for all domains as well as the OQoL were within an acceptable range. The proportion of women with good OQoL was significantly higher in the urban areas (18.2 percent) than in the rural areas (9.2 percent) (p < .05). The proportion of respondents with good OQoL was significantly higher for women aged <20 years (37.5 percent) than older women (p < .01). Teenage participants were almost ten times as likely to have a good social relationship than participants above 35 years of age (odds ratio: 9.52; 95% confidence interval: 1.83-49.40). The authors' results suggest that the WHO-QoL BREF is a reliable instrument for measuring QoL among PW in Nigeria. Younger PW and women in the urban areas were more likely to have good QoL.

The Adolescents' Psychosocial Functioning Inventory (APFI): scale development and initial validation using Exploratory and Confirmatory Factor Analysis.

Most of the existing measures of psychosocial functioning among adolescents are developed outside Lower-middle-income countries (LMIC). Measures relevant to the LMIC setting will provide opportunity to assess the functioning of adolescents in these settings based on their background or context. The Adolescents' Psychosocial Functioning Inventory (APFI) which addresses relevant challenges and expectations of adolescents in the LMIC settings was developed to bridge this gap in knowledge. A total of 753 adolescents from purposively selected secondary schools participated in this study. Preliminary analyses were performed using descriptive statistics. The underlying factor structure of the APFI was explored using Exploratory and confirmatory Factor Analysis. Chi-square Goodness of Fit (CGF) and other fit indices were used to assess model fit. Cronbachs alpha was used to assess the reliability of the items and subscales of the APFI. The final model derived from the factor analyses yielded a 23-item three-factor model that provided the best fit to the data. Estimate of overall reliability of the APFI scale was α = 0.83 while all three factors/subscales: Optimism and Coping Strategy (OCS), Behaviour and Relationship Problems (BRP), and General Psychosocial Dysfunctions (GPD) had moderate to high reliability (α = 0.59 for OCS, α = 0.57 for BRP and α = 0.90 for GPD). The CGF yielded χ2/df < = 1.58 while all other fit indices were in the acceptable range. The three-factor model APFI is a reliable measure for assessing psychosocial functioning among adolescents in the LMIC.