Prevalence of hypertension in a rural community in southeastern Nigeria; an opportunity for early intervention.

Hypertension is a leading cause of non-communicable morbidity in Sub Saharan Africa. Recent studies suggest and increase in the prevalence of hypertension in rural Sub-Saharan Africa. Using a three-phase approach, a structured questionnaire was used to determine the prevalence of hypertension in a rural settlement is Enugu State, Southeast Nigeria. Blood pressure measurement was done according to the guidelines of the European Society of Hypertension. Out of 1576 participants aged 18 years and above, 1082 (68.7%) completed the full survey, their blood pressure was measured, and data analyzed. The prevalence of hypertension in this study was 27.6%, (95%CI 25-30.4), similar in males 29.2, (95%CI 24.7-30.4) and females 26.8%, (95%CI 23.5-30.2). p = 0.39. The prevalence of hypertension increased with age reaching a peak of 32.8% (95%CI 26.2-40) in the 40-49 age group, however this was not statistically significant P = 0.22. This age-related increase in the prevalence of hypertension tended towards significance in males (p = 0.05) but not in females (p = 0.44). Awareness of hypertension was 7.2%. Systolic blood pressure positively correlated with older age, higher blood glucose levels and waist-hip ratio. Diastolic blood pressure correlated with the type of work the patients is involved in and blood glucose levels. In conclusion, the prevalence of hypertension in a rural southeastern Nigeria community was 27.6%, however awareness was very low (7.9%). Most participants had mild hypertension thus offering a window of opportunity for public health educators in preventing the complications of hypertension. There is therefore the need for awareness campaigns to be intensified in rural communities.

Reported Incidence of Cluster Seizures in Persons with Epilepsy Experience from Two Tertiary Hospitals in Enugu Southeast Nigeria.

Background: Repetitive seizures are neurological emergencies which may occur in people with epilepsy. Ascertaining the incidence of these episodes of such seizures in the community is wrought with many challenges and few reports exist in sub-Saharan Africa, a region with a high burden of epilepsy. The aim of this study was to describe the caregiver reported frequency of acute recurrent seizures in people with epilepsy attending neurology outpatient clinic in Enugu. Methods: This cross-sectional study was performed in the medical out-patient clinics in Enugu Nigeria. Data were collected using a structured questionnaire from an existing epilepsy register. Cluster seizures were defined as frequent repetitive seizures (two or more) occurring more than usual within a week. Epilepsy was defined based on ILAE criteria. Results: A total of 73(45.3%) reported a lifetime history of cluster seizures; similar in males 39(48.1%) and females 34(45.9%). P=0.73. About36.4% and 38.2% of PWE who had a history of traumatic brain injury and stroke had also experienced at least one SC. A large proportion of PWE with SC also had experienced status epilepticus in the past. Seizure cluster was correlated by older age of onset, having various forms of seizures and longer seizure freedom. Conclusions: The reported lifetime history of cluster seizures among people with epilepsy attending a tertiary hospital clinic is high. This may suggest both poor seizure control and severity. Careful patient education will improve both adherence and emergency management of epilepsy to reduce the morbidity of epilepsy in the community.

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.

Levetiracetam-induced rage and suicidality: Two case reports and review of literature.

BACKGROUND: Levetiracetam-induced rage is a rare neurobehavioral adverse effect of levetiracetam that is characterized by seething rage, uncontrollable anger, fits of fury, depression, violence, and suicidal tendencies. It occurs more in patients with prior mood or psychotic disturbances. No such case has been reported in Nigeria. METHOD: We report two cases of levetiracetam-induced rage. The first patient was a 29-year-old male with a 14-year history of intractable posttraumatic epilepsy. He was initially placed on sodium valproate and phenobarbitone and later had phenobarbitone replaced with levetiracetam. Within the first week of initiating levetiracetam, he became aggressive, bursted into fits of fury, and attacked his siblings. Levetiracetam was stopped, and the seething rage ceased only to reappear when it was reintroduced; hence, the complete withdrawal of levetiracetam. Naranjo probability score for adverse drug reaction was 8. RESULTS: The second patient was a 23-year-old lady who developed seething rage and made several attempts to kill herself with a knife following addition of levetiracetam to the clonazepam and carbamazepine that she was taking for treatment-resistant epilepsy. Withdrawal and reintroduction of levetiracetam by the relatives led to cessation and reemergence, respectively, of the rage and suicidal tendencies. Naranjo score was 8. Levetiracetam was discontinued. CONCLUSION: Neuropsychiatric evaluation for prior mood or psychiatric disorders in those initiating levetiracetam therapy is suggested alongside monitoring for early features of levetiracetam-induced rage by both caregivers and physicians. This will help stem the morbidity and potential mortality associated with this life-threatening adverse drug reaction.

Prevalence of primary headaches in an urban slum in Enugu South East Nigeria: a door-to-door survey.

OBJECTIVE/BACKGROUND: This study aims to determine the prevalence of primary headache disorders using the second edition of international classification of headache disorders among urban slum dwellers. Headache is a common neurological disorder and one of the most common reasons for visiting the neurology clinics in Nigeria. Low socioeconomic status has been linked with primary headaches. Factors that may precipitate and sustain headaches are common in Africa especially in urban slums. There are limited population based data on the prevalence of headache from Nigeria and other African countries. METHODS: A 3 phase cross-sectional descriptive study was done to survey at least 40% of the adult population (Igbos) living in an urban slum using the International Classification of Headache Disorders 2nd Edition (ICHD-I) criteria using a validated Igbo language adaptation (translation and back-translation into Igbo language) of a World Health Organization protocol for screening neurological disorders in the community. RESULTS: The lifetime prevalence of headache of any type was 66.7% (95% confidence interval [CI] 64.2-69.2), significantly higher in females (70.2% [95% CI 67.0-73.4]) than in males (62.3% [95% CI 58.5-66.1]; P = .0.002). The prevalence of primary headaches was also significantly lower in males than in females (44.9% [95% CI 45.5-53.3] vs 53.2% (95% CI 49.3-57.1), P = .002). Female (52.1%) drinkers had a statistically higher prevalence of primary headaches than male drinkers (43.6%; P = .004). The prevalence of migraine was 6.4% (95% CI 5.1-7.7); 7.5% (95% CI 5.6-9.4) in females and 5% (95% CI 3.3-6.7) in males (P = .058). Migraine with aura was similar in both males and females. Migraine without aura was significantly higher in females (5.7%) than males (3.1%) (P = .022). Tension-type headache (TTH) had an overall prevalence of 13.8% (95% CI 11.3-16.3), males 12.2% (95% CI 9.7-14.7), and females 15.1% (95% CI 12.6-17.6; P = .118.) The peak decade for all primary headaches was 20-29 years for males (49.8%) and 60-69 years for females (57.5%). CONCLUSION: Headache is a common health problem in an urban slum in Enugu south east Nigeria where 66.7% of participants had experienced headache in their lifetime, and 49.4% had experienced primary headaches. The prevalence of migraine and TTH were 6.4% (5% in males and 7.5% in females) and 13.8% (12.2% in males and 15.1% in females), respectively. The peak ages of migraine and tension-type headache were 30-39 and 60-69 years, respectively. The prevalence of primary headaches was significantly higher among subjects who used alcohol significantly.

Knowledge, attitude and practice of epilepsy among community residents in Enugu, South East Nigeria.

PURPOSE: The understanding of the opinions of the Nigerian public about epilepsy and its treatment is relevant to the reduction of the large treatment gap that exists in management of the condition. The major aim of this study was to determine the knowledge and attitudes of urban dwellers to epilepsy and its treatment and to identify the gaps in knowledge that could pose as barriers in the treatment and care of epilepsy patients within the community. METHOD: This cross-sectional and descriptive study was carried out in one of the districts of Enugu metropolis, Nigeria. Data collection was by means of a semi-structured validated questionnaire. RESULTS: The mean score in knowledge was low, 48.1±18.8%; higher in females (50.6±18.6%, p=0.03 and those who had witnessed seizures in the past 49.7±18.8, p<0.01. On attitudes, 61.8% of the respondents accepted that it is right if sufferers married but most (93.2%) would not marry them and 87.2% would not allow them to have children or make a new acquaintance by working or playing with them (72.8%). There were no significant differences in the attitude scores of respondents with different levels of education. CONCLUSION: The level of knowledge of epilepsy in among urban dwellers in SE Nigeria is low and fraught with misconceptions and gaps. There were no significant differences in the attitude scores of respondents with different levels of education. There is a need for a multi-faceted educational interventions directed at improving the awareness and understanding of the condition by all segments of the society.