Pattern and determinants of self-reported enacted stigma among rural dwellers living with epilepsy attending a tertiary health facility in Enugu State Nigeria.

PURPOSE: Epilepsy related stigma is a barrier to recovery and has been linked to a broad range of psychosocial consequences and has the potential to influence the provision of care to people with epilepsy. Understanding the determinants of enacted stigma in epilepsy is relevant in the understanding of the burden of epilepsy in Nigeria. METHOD: Using a semi-structured questionnaire, a cross-sectional descriptive study was conducted among rural dwellers receiving treatment for epilepsy in a tertiary referral specialist hospital in Enugu, south east Nigeria. RESULTS: The participants consisted of 108 patients, 63% of whom were males. Most patients 99(91.7%) reported experiencing stigma in the past. The commonest forms of enacted stigma were being regarded as having 'spiritual attack' 88(81.5%) and restraining from interacting with others 49(45.4%). Most individuals who received nonorthodox treatment 55(55.6%) experienced stigma. Severely stigmatized individuals were more likely to be females. Age of onset of epilepsy, use of non-orthodox treatment, seizures occurrence in public places and the presence of physical injuries positively correlated with enacted stigma. CONCLUSIONS: The burden of epilepsy related enacted stigma is high among rural dwellers attending a tertiary medical outpatient clinic in Enugu, southeast Nigeria.

Monotherapy with amlodipine or hydrochlorothiazide in patients with mild to moderate hypertension: Comparison of their efficacy and effects on electrolytes.

BACKGROUND: Amlodipine and hydrochlorothiazide (HCTZ) are commonly prescribed in Nigeria either as a monotherapy or in combination with other drugs. The present study was designed to investigate the antihypertensive efficacy of monotherapy with amlodipine or HCTZ and their effects on electrolyte profile in patients with mild to moderate hypertension. METHODS: A single-blind randomized clinical study was used; fifty patients newly diagnosed with mild to moderate hypertension (aged 33 to 60 years) were recruited and divided into two groups: amlodipine or hydrochlorothiazide each comprising of 25 subjects. The subjects received 5mg of amlodipine or 25mg of hydrochlorothiazide in their respective group once daily for 4 weeks. Blood pressure, serum and urine electrolytes were measured at baseline and weekly throughout the experiment. RESULTS: At the end of follow up, amlodipine reduced systolic and diastolic blood pressure significantly more (p<0.001) than HCTZ. At the end of follow up, blood pressure was reduced to normal in 80% of the subjects in amlodipine group compared to 50% in HCTZ. Amlodipine had no significant effect on electrolyte profile of subjects unlike HCTZ which significantly changed both their serum and urine electrolytes. CONCLUSIONS: Monotherapy with amlodipine was more effective than HCTZ in black patients with mild to moderate hypertension and in addition maintained electrolyte balance.

Does consumption of an aqueous extract of Hibscus sabdariffa affect renal function in subjects with mild to moderate hypertension?

Hibiscus sabdariffa (HS) has been traditionally used as a herbal medicine in Nigeria mainly because of its antihypertensive action. In view of the recent increase in the prevalence of renal failure, we have investigated the effect of HS consumption on renal function in Nigerians with mild to moderate hypertension. A total of 78 newly diagnosed but untreated subjects with mild to moderate hypertension attending the medical outpatients unit of Enugu State University Teaching Hospital (Enugu, Nigeria) were recruited for the study. These subjects were randomly divided into three equally sized groups that received HS or lisinopril (treatment groups) or placebo (control group), once daily for 4 weeks. Indices of renal function (urine volume and creatinine clearance) were measured at baseline and weekly throughout the study period. HS and lisinopril significantly increased (P < 0.001) urine volume compared to placebo, and HS significantly (P < 0.001) increased urine volume more than lisinopril. HS significantly increased (P < 0.001) creatinine clearance compared to placebo whereas lisinopril did not. These results indicate that HS consumption improved indices of renal function in our study population of Nigerians with mild to moderate hypertension.

Prevalence of active convulsive epilepsy in an urban slum in Enugu South East Nigeria.

PURPOSE: To determine the prevalence of active convulsive epilepsy and treatment gap in two Urban slums in Enugu South East Nigeria. METHODS: A 3 phase cross-sectional descriptive study was done to survey individuals ≥ 15 years in 2 slums in Enugu, South East Nigeria. RESULTS: The prevalence of epilepsy was 6.0 (95% CI: 5.9-6.0) per 1000 (men 4.4/1000, 95% CI: 2.3-6.4, women 7.8/1000, 95% CI: 4.9-10.4), p=0.06. The peak age of active convulsive epilepsy was 40-44 years (11.2 per 1000) with two smaller peaks at 25-29 and ≥ 50 years. The age and sex adjusted prevalence using WHO standard population and 2006 Nigerian census population were 5.9 per 1000 (95% CI: 4.0-7.9) and 5.4 per 1000 (95% CI: 3.4-7.4). CONCLUSION: The prevalence of epilepsy is high in urban slums in Enugu. Nationwide studies should be done to find out the true prevalence in the country.

Effects of aqueous extract of Hibiscus sabdariffa on the renin-angiotensin-aldosterone system of Nigerians with mild to moderate essential hypertension: A comparative study with lisinopril.

OBJECTIVES: The present study investigated the effects of aqueous extract of Hibiscus sabdariffa (HS) on the three basic components of renin-angiotensin-aldosterone system: Plasma renin, serum angiotensin-converting enzyme (ACE), and plasma aldosterone (PA) in mild to moderate essential hypertensive Nigerians and compared with that of lisinopril, an ACE inhibitor. MATERIALS AND METHODS: A double-blind controlled randomized clinical study was used. Seventy-eight newly diagnosed but untreated mild to moderate hypertensive subjects attending Medical Outpatients Clinic of Enugu State University Teaching Hospital, Enugu were recruited for the study. Those in Group A received placebo (150 mg/kg/day), Group B were given lisinopril (10 mg once daily) while those in Group C received aqueous extract of HS (150 mg/kg/day). After 4 weeks of treatment, the levels of plasma renin, serum ACE, and PA were determined. RESULTS: HS and lisinopril significantly (P < 0.001) reduced PA compared to placebo by 32.06% and 30.01%, respectively. Their effects on serum ACE and plasma renin activity (PRA) were not significant compared to placebo; they reduced ACE by 6.63% and 5.67% but increased plasma PRA by 2.77% and 5.36%, respectively. CONCLUSION: HS reduced serum ACE and PA in mild to moderate hypertensive Nigerians with equal efficacy as lisinopril. These actions are possibly due to the presence of anthocyanins in the extract.