ABSTRACT
Background: Globally, acute stroke is one of the leading causes of preventable emergency hospital admissions. It is emerging as an important cause of disability and mortality among adult Nigerian Africans in the emergency department(ED) of Nigerian hospitals. Aim: The study was designed at reviewing epidemiology of acute stroke syndrome in the adult ED of a tertiary hospital in South-east Nigeria. Study Design: This was a retrospective descriptive study. Place and Duration of Study: The study was carried out on patients with acute stroke syndrome at the ED of Federal Medical Centre, Umuahia, Nigeria over a five year period from January 2008 to December 2012. Methods: The sources of data were from medical records, patients’ case notes; ED admission registers and nurses report books. Information collected were age, sex, place of the incidence, time of presentation to the ED, duration of symptoms at presentation, month (season) of occurrence, type of stroke, number of episodes and associated clinical conditions. Operationally, time of presentation to the ED was categorized into two: day time was defined inclusively as time period from 6.00 am to 6.00 pm while night time referred exclusively to the time period from 6.00 pm to 6.00 am Nigerian time. Early presentation to the ED meant that the victim arrived the ED of the hospital inclusively within 1 hour of the occurrence of the acute stroke while those that arrived after 1 hour were defined as late presentation to the hospital. Results: The age ranged from 36 years to 95 years with mean age of 68.2±7.4 years. There were 155 (58.3%) males and 111 (41.7%) females with male to female ratio of 1.4: 1. The incident predominantly occurred at home (77.8%), 239 (89.8%) had duration of symptoms more than 1 hour at presentation, 162 (60.9%) presented during the night time, 158 (59.4%) occurred during dry season, 157 (59.1%) had repeat episode, 199 (74.8%) were ischemic stroke and the most commonly associated clinic-medical condition was hypertension (80.1%). Conclusion: There was variability in the epidemiology of stroke with ischemic stroke being the pre-eminent type and hypertension the most associated clinical condition. The incident occurred predominantly among male gender, elderly patients, at home, during dry season and most of the patients presented late to the ED and at night time. Interventional strategies aimed at risk reduction, early presentation to dedicated and responsible stroke units and centres are advocated.
ABSTRACT
Background: Research studies have shown that age is an independent risk factor for metabolic syndrome (MetS). However, as eco-demographic structure and function of Nigeria changes, geriatric Nigerians tend to adopt lifestyles that promote the emergence of metabolic syndrome. Aim: This study was aimed at determining the prevalence of metabolic syndrome and its associated risk factors in a sub-population of geriatric Nigerians in a primary care clinic of a tertiary hospital in South-eastern Nigeria. Study Design: This was a cross sectional study carried out on a sub-population of 225 geriatric Nigerians. Place and Duration of Study: The study was done in the primary care clinic of Federal Medical Centre, Umuahia, Nigeria between May 2012 and October 2012. Methodology: Two hundred and twenty five geriatric patients aged ≥ 60 years were screened for MetS using International Diabetes Federation (IDF) criteria: An Individual was considered to have MetS in the presence of waist circumference ≥94 cm for men and ≥80 cm for women plus any two or more of the following: systolic and/or diastolic blood pressure ≥130/85 mmHg and/or hypertension on treatment; fasting plasma glucose ≥ 100 mg/dL and/or diabetes mellitus on treatment; triglyceride level ≥150 mg/dL and/or hypertriglyceridaemia on treatment and high density lipoprotein (HDL-C) cholesterol <40 mg/dL for men or <50 mg/dL for women and/or HDL-C dyslipidaemia on treatment. The data collected included basic demographic and nutri-behavioural variables using structured, pretested and interviewer administered questionnaire. Results: The prevalence of MetS was 44.0%. MetS was significantly associated with female sex (P=.036), not engaged in any occupation (P=.043), and physical inactivity (P=.001). The most significant predictor of MetS was physical inactivity (P=.001, OR=2.30 (1.08-5.63). The geriatric patients with MetS were two times more likely to be physically inactive compared to their non-MetS counterparts. Conclusion: MetS occurs in a sub-population of geriatric Nigerians in primary care and is associated with female sex, not engaged in any occupation, and physical inactivity. Screening for MetS alongside its determinants should be considered for geriatric Nigerians in primary care.
ABSTRACT
Background: Evidence has demonstrated the metabolic relationship between dyslipidaemia and hypertension which are independent cardio-metabolic risk factors. As socio-economic and environmental dynamics in rural Nigeria changes, geriatric Nigerians tend to adopt lifestyles that predispose to atherosclerotic cardiovascular diseases. Aim: This study was designed to determine the risk factors of dyslipidaemia in a cohort of geriatric Nigerians with essential hypertension in a rural hospital in Eastern Nigeria. Study Design: This was a cross sectional study conducted on a cohort of 122 geriatric Nigerians with essential hypertension. Place and Duration of Study: The study was conducted in a rural hospital in Eastern Nigeria between June 2008 and June 2011. Methodology: Risk factor variables were examined using a pretested, structured and intervieweradministered questionnaire. Hypertension and dyslipidaemia were defined using JNC VII and The Third Report of National Cholesterol Education Panel in adult (ATP III) criteria respectively. Results: The risk factors significantly associated with dyslipidaemia were advanced old age (p=.039), abdominal obesity (p=.022) and physical inactivity (p=.042). The abdominally obese patients were three times more likely to have dyslipidaemia compared to the non-abdominally obese patients. Conclusion: Risk factors of dyslipidaemia exist in geriatric Nigerians with essential hypertension. Dyslipidaemia was significantly associated with advanced old age, abdominal obesity and physical inactivity. These risk factors should be considered alongside the complex of other cardio-metabolic risk factors during clinical encounter with geriatric hypertensives.
ABSTRACT
Background: Despite the evidence that lifestyle modifications (LSMs) play important role in glycaemic control, adherence to healthy lifestyles has been variable in Nigeria and this has great impact on the success or failure of pharmacological care. Aim: The study was designed to determine adherence to LSMs among ambulatory type 2 diabetic Nigerians in a resource-poor setting of a primary care clinic in Eastern Nigeria. Study Design: This was a primary care clinic-based cross-sectional study done on consecutively sampled 120 adult type 2 diabetic patients who were on management for diabetes mellitus for at least 3 months at the primary care clinic of a tertiary hospital in Nigeria. Place and Duration of Study: The study was carried out at the primary care clinic of a tertiary hospital in South-Eastern Nigeria from April 2011 to December 2011. Methodology: Instrument of data collection was pretested, structured and intervieweradministered questionnaire. Each item of lifestyle was scored on a five points Likert scale ordinal responses of always, most times, sometimes, rarely and none. Adherence to lifestyle modifications was assessed in the previous 12 months for alcohol and tobacco use and 7 days for physical activity, dietary fruits, vegetables, fats and oil consumptions. Each of the domains of lifestyle was given a score of one point for healthy lifestyle and zero point for unhealthy lifestyle. Type 2 diabetic patients who scored 6 points in all the evaluated domains were adherent. Awareness of LSMs and Specific adherence to lifestyle factors were also determined. Results: The awareness and overall adherence rates to LSMs were 88.3% and 22.5% respectively Specifically, adherence was highest with the non-tobacco use (100.0%) followed by adequate dietary vegetables consumptions (96.7%) and non-use of alcohol (90.8%). Other adherence rates were consumptions of adequate dietary fruits (51.7%), dietary fat and oils (23.3%) and physical activity (22.5%). Adherence was significantly associated with young age <40 years (p=0.039). Conclusion: The awareness of LSMs was high but was not translated to comparative adherence. The adherence to non-tobacco use was rated highest and physical activity the lowest. Young age <40 years was significantly associated with adherence. Targeting the domains of inadequate adherence for improvement is a primary care imperative especially in resource-poor settings where there are limited options for healthy living
ABSTRACT
Background: Lifestyle modifications (LSMs) are indispensable in blood pressure control among hypertensive patients. However, the extent to which patients lifestyles (LS) coincide with clinical prescriptions has become an important management challenge in primary care. Aim: To describe adherence to LSMs among adult hypertensive Nigerians with essential hypertension in a primary care clinic of a tertiary hospital in resource-poor environment of Eastern Nigeria. Study Design: A primary care clinic-based descriptive cross-sectional study carried out on 140 adult patients with essential hypertension who were on treatment for at least 6 months at the primary care clinic. Place and Duration of study: The study was carried out at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria between April 2011 and November 2011. Methodology: Data was collected using pretested, structured and intervieweradministered questionnaire. Each item of LS was scored on a five points Likert scale ordinal responses of always, most times, sometimes, rarely and none. Adherence to LSMs was assessed in the 30 days preceding the study and measured from the following domains: physical activity, alcohol and tobacco use, dietary fruits, vegetables, salt and fat consumptions. Each of the domains of LS was given a score of one point for healthy LS and zero point for unhealthy LS. Operationally, patients who scored 7 points in all the assessed domains were considered adherent. Specific adherence to LS factors was also determined. Results: The overall adherence rate was 16.4%. Specifically, adherence was highest with the uses of tobacco (100.0%) followed by dietary salt (94.3%) and alcohol (90.7%). Other adherence rates were consumptions of dietary vegetables (75.7%), dietary fruits (66.2%), dietary fat and oils (64.2%) and physical activity (16.4%). Adherence was significantly associated with the female gender (p=.036). Conclusion: This study has shown that adherence to LSMs was 16.4% with no smoking rated highest and physical activity the lowest. Female gender was significantly associated with adherence. There is need to sustain the current level of adherence on smoking while efforts should be made to improve on identified domains of inadequate adherence.
ABSTRACT
Background: Abdominal obesity once considered an aesthetic rather than a pathological condition is now recognized as a principal risk factor for metabolic syndrome and magnifies the risk of cardiovascular diseases. As the case detection rate of abdominal obesity increases in Nigeria determining its predictors remain relevant for proactive control intervention. Aim: This study was designed to determine the predictors of abdominal obesity among adult Nigerians in a resource-poor environment of a rural hospital in Eastern Nigeria. Study Design: A hospital based case-control study carried out on 700 adult patients aged 18-91 years who were screened for abdominal obesity using the third report of National Cholesterol Education Panel (NCEP) in adult (ATP III) criterion and 350 patients who had waist circumference (WC) ≥102cm and ≥88cm for men and women respectively and met the inclusion criteria were matched for age and sex with 350 non-obese, non-hypertensive and non-diabetic control. Place and Duration of Study: The study was carried out at a rural hospital in Eastern Nigeria between June 2008 and June 2011. Methodology: Predictor variables were assessed using a pretested, structured and interviewer-administered questionnaire. Hypertension and diabetes mellitus were defined using JNC 7 and American Diabetic Association criteria respectively. Results: Abdominal obesity was significantly associated with physical inactivity (p=.002) and family history of obesity (p=.036). The most significant predictor of abdominal obesity was physical inactivity (OR=4.19, p=.001). The abdominally obese patients were four times more likely to be physically inactive compared to their non-abdominally obese counterparts. Conclusion: This study has shown that the predictors of abdominal obesity among the study population were physical inactivity and family history of obesity. The interventional control programs for abdominal obesity should consider these predictive variables alongside the complex of other cardiovascular risk factors.