Determinants of Health-related Quality of Life in Persons with Epilepsy Seen at a Tertiary Hospital in North Western Nigeria.

INTRODUCTION: There is a growing global concern about the effect of epilepsy on the Health-Related Quality of Life (HRQoL) of the sufferers. AIM: This study assessed the determinants of HRQoL in persons with epilepsy (PWE) in a tertiary hospital in North Western Nigeria. METHODOLOGY: A cross-sectional study was carried out on 103 patients with epilepsy aged ≥ 18 years attending Neurology clinic. Ethical clearance was obtained from the Health Research Ethics Committee of the institution. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was administered to the participants. Statistical significance was set with p value at 0.05. The determinants of HRQoL was obtained by using univariate and subsequent multivariate logistic regression analysis. RESULT: The mean age of patients was 33.4±15.8 years. There were 54(52.4%) males and 49 (47.6%) females. The significant determinants of HRQoLfound were time of last seizure episode (OR = 7.50, 95% CI = 1.36 -41.20, p = 0.021) and social support (OR = 21.5, 95% CI = 3.67 - 125.68, p = 0.001). Following multivariate logistic regression analysis, social support (OR = 29.51, 95% CI = 2.87 - 302.66, p = 0.004) appeared as the independent determinant of HRQoLin PWE. CONCLUSION: Social support was the main determining factor of HRQoL in epilepsy patients in this study. Therefore there is the need to ensure a comprehensive care which should include health education, adequate seizure control and social support for epilepsy patients to improve their HRQoL.

Effect of Epilepsy and Antiepileptic Drugs Therapy on Erythrocyte Malondialdehyde and Some Antioxidants in Persons with Epilepsy.

BACKGROUND: Antiepileptic drugs are necessary for successful treatment of epilepsy. Unfortunately, epilepsy itself and some antiepileptic drugs have been documented to provoke or worsen seizure frequency by altering blood levels of some oxidants and antioxidants in persons with epilepsy. OBJECTIVE: This study investigated the effect of epilepsy and antiepileptic drugs on blood levels of some oxidants and antioxidants. METHODOLOGY: This was a cross-sectional case-control study. Blood samples were obtained from 35 antiepileptic drug-experienced persons with epilepsy; 35 antiepileptic-naive persons with epilepsy; and 35 age- and- sex matched apparently healthy controls; and analysed for malondialdehyde and antioxidants (uric acid, superoxide dismutase, glutathione peroxidase and catalase) using enzyme-linked immunosorbent assay. RESULTS: One-hundred and five (105) subjects (35 patients on antiepileptic drugs, 35 newly diagnosed, antiepileptic drug-naive and 35 healthy controls) were investigated. The median ages of antiepileptic drug-experienced, antiepileptic drug-naive and healthy participants were 30.0, 26.0 and 37.0 years respectively. Persons with epilepsy had significantly higher blood levels of malondialdehyde and uric acid and lower levels of enzymatic antioxidants than healthy controls. Also, persons with epilepsy on antiepileptic drug polytherapy had signi-ficantly higher blood levels of malondialdehyde and uric acid and lower levels of enzymatic antioxidants than antiepileptic drug-naive persons with epilepsy and persons with epilepsy on antiepileptic drug monotherapy respectively. CONCLUSION: Epilepsy and antiepileptic drug significantly altered blood levels of malondialdehyde, uric acid and enzymatic antioxidants and/or their homeostatic kinetics.

Blood pressure control in long-term stroke survivors evaluated one year post stroke.

AIMS AND OBJECTIVES: Hypertension is the most common modifiable risk factor for stroke and treatment of hypertension has been known to reduce the risk of recurrent stroke. There are no studies done to evaluate the optimal blood pressure (BP) control in long-term stroke survivors in Nigeria. This study is aimed at determining the proportion of stroke survivors attending stroke prevention clinic who have optimal BP control of hypertension one year post stroke and to determine what factors are associated with the suboptimal BP control. PATIENTS AND METHODS: The subjects were consecutively presenting long term stroke survivors attending Neurology Outpatients'Clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. After informed consent, socio-demographic data and clinical characteristic were obtained from the patient using structured questionnaire. Admission stroke severity was obtained retrospectively using National Institute of Health Stroke Score (NIHSS). Modified Rankin scale (mRs) was used to assess the level of handicap . The presence of depression was determined using the Hamilton Depression Rating Scale (HDRS). Blood pressure was measured in the dominant, non-stroke arm of the patients using mercury sphygmomanometer. RESULTS: A total of 68 patients were studied with a mean age of 55.15±11.9 years. Most common co- morbid condition was diabetes mellitus. Only 3(4.4%) patients had a repeat stroke during the one year period. Twenty five (36.8%) of these patients still had sub-optimal BP control. Forty seven (69.1%) of these patients were on combination therapy (including angiotensin converting enzyme inhibitors and diuretics) and 18 (26.5%) were on calcium channel blockers alone. The difference in mean age of stroke survivors with optimal and sub-optima BP control was not statistically significant. However, the mean duration of formal education of the stroke survivors with optimally controlled blood pressure was significantly higher than those with sub-optimal BP control. Eighteen (26.5%) of long term stroke survivors had clinical depression. Significantly higher proportion of the clinically depressed patients had sub-optimal blood pressure at one year compared to those that were not depressed. Formally educated patients had a better blood pressure control compared to those without formal education. Following a multivariate logistic regression, the major independent determinants of sub-optimal blood pressure control at one year post stroke were presence of depression and low levels of formal educational attainment. CONCLUSION: majority of stroke survivors attending the ABUTH neurology outpatients clinic have suboptimal blood pressure control and major determinant of suboptimal BP control were presence of clinical depression and low formal educational status.

Aetiology and Precipitants of Epileptic Seizures among Nigerians Treated at Two Tertiary Hospitals in Kaduna State, Northern Nigeria.

BACKGROUND: Epilepsy is a common neurological illness in Nigeria with a prevalence of 5-37 per 1000 in a rural population. Several studies suggest that the prevalence of epilepsy is higher in developing than developed countries due to the preponderance of more risk factors in the former. This study investigated the aetiological factors and precipitants of epileptic seizures among patients attending outpatient clinics of two tertiary hospitals in Kaduna State, Northern Nigeria from October 2008 to April 2013. PATIENTS AND METHODS: Two hundred and forty two consecutive adult patients with history of at least 2 unprovoked afebrile seizures were investigated for seizure patterns, aetiological and precipitating factors through history, physical examinations, laboratory tests and electroencephalography. RESULTS: The male to female ratio of study population was 3 (69%): 1(31%), with respective mean ages of 29.5±12.4and 30.7 ± 16.0years. Their respective mean ages of onset of first seizures were 18.6 ±14.0and 20.9 ±17.4 years. 88% of seizures were of focal origin (complex partial, 80%; simple partial, 8%). Although the causes and precipitants were unknown in 41% and 68% of cases respectively; head injury, neonatal asphyxia and psychoactive substance abuse were prominent aetiological factors. CONCLUSION: Although majority of epileptic seizures in Kaduna State, Northern Nigeria were of focal origin, majority of causes and precipitants remained largely unknown.

Factors affecting epilepsy treatment outcomes in Nigeria.

OBJECTIVES: Epilepsy is a complex chronic illness with variable treatment outcomes determined by factors specific to each affected person. We investigated prognostic factors for epileptic seizure outcome after 2 years of anti-epileptic drug (AED) monotherapy. MATERIALS AND METHODS: Two hundred and thirty-four AED naïve epilepsy patients were started on AED monotherapy and monitored for 2 years for seizure control. Patients on AED polytherapy were excluded. Prognostic factors investigated were socio-demographics characteristics, age of onset of epilepsy, etiology and precipitants of seizures, presenting seizure types, duration of epilepsy before initiation of AED, family support for treatment, compliance to AED, and clinic attendance. RESULTS: Patients were 160 (68.4%) males and 74 (31.6%) females, with mean ages of 26.2 ± 10.4 and 30.7 ± 16.0 years, respectively. Mean age of onset of epilepsy was 19.0 ± 15.0 years. None of the patients was treated with AED for first seizures, although 75% received traditional and spiritual therapy. Majority were single and of low socioeconomic background, and treatment was funded mainly by parents/guardians. About 88% presented with partial seizures, and carbamazepine was the commonest AED used followed by phenytoin sodium. At the end of 2 years of AED, 147 (63%) achieved complete seizure control, and significant prognostic factors were female sex, age older than 20 years at presentation, secondary and tertiary education attainment, being employed, family support, regular clinic attendance, AED compliance, and generalized epilepsy. CONCLUSIONS: Patients with epilepsy are more likely to achieve complete seizure control when they are older, educated, and employed or supported by family members to buy their AEDs and attend clinics regularly.

The frequency and outcome of neuropathies among HIV/AIDS adults treated at a tertiary hospital in Kaduna State, Nigeria.

AIMS AND OBJECTIVES: Highly active antiretroviral therapy (HAART) has been shown to reduce AIDS- defining illnesses, including neuropathies. However, it has been postulated that an increase in age -, HIV- and HAART- related neurological complications will occur as HIV-infected persons live longer. This study investigated the frequency and outcome of neuropathies in relation to CD4+ cell count and HAART status of hospitalised HIV/AIDS patients in Shika. PATIENTS AND METHODS: Consecutive adult (e"15 years) non pregnant HIV- infected patients treated at Ahmadu Bello University Teaching Hospital Shika-Zaria from January 2006 to May 2013 with neuropathies were studied. Non HIV-infected patients with neurological disorders and HIV-infected patients without neuropathies were excluded. RESULTS: Of 5240 HIV/AIDS patients seen , 11% (566) presented with neuropathy at median CD4+ cell counts of 200 cells / ul, with yearly reduction of the frequency of patients with neuropathy from 3.9% in 2006 to 0.06% in 2013. Male: female ratio was 2:1 and respective mean years were 41.9±10.1: 45.3±17.4 (p<0.00). 253 (45%) were on HAART at presentation. 40 patients died and the mortality was associated with recurrent seizures, CD4+ cell counts d" 100 / ul, male sex, HAART-naivety and presence of co-morbidity and complications. CONCLUSIONS: The progressive reduction in the yearly frequency of neuropathy among HIV/AIDS patients suggests a beneficial effect of HAART on neuropathies. However, late presentation, low CD4+ cell counts and failure of patients to start HAART early were responsible for AIDS-related mortality thus highlighting the importance of early HIV screening and treatment.

Dermatomyositis associated with HIV-1 infection in a Nigerian adult female: a case report.

Human immunodeficiency virus (HIV) infection has been implicated as a trigger for various autoimmune diseases, one of which is dermatomyositis. This is a very rare autoimmune disease characterised by myopathy, typical cutaneous signs and variable systemic manifestations. To our knowledge, the association of this rare disease with HIV infection has not been previously reported in Nigeria. We therefore decided to report the case of a 40 year old HIV-1 infected Nigerian female who presented to us with muscle, skin, and systemic manifestations of dermatomyositis. Our aim is to show the effect of HIV infection, as well as HAART-induced immune reconstitution on the clinical course of dermatomyositis.

Prognosis and outcome of acute stroke in the University College Hospital Ibadan, Nigeria.

BACKGROUND: Many factors influence the outcome of acute stroke, the third leading cause of morbidity and mortality globally. OBJECTIVE: To identify the determinants of outcome of acute stroke. MATERIALS AND METHODS: A prospectively study of 66 adult patients who presented to the medical emergency unit of University College Hospital (U.C.H), Ibadan, in coma from acute stroke, from August 2004 to March 2005, was undertaken after obtaining ethical clearance and written consent of the patients' relations. RESULT: Acute stroke constituted 33% of medical coma, 3.2% of hospital emergencies, 1.0% of total hospital admissions, and 7.3% of medical deaths during the study period. The stroke subtypes were intracerebral hemorrhage (78.8%) and large cerebral infarction (21.2%) with respective case fatalities of 69.7% and 13.6% at 4 weeks. Males constituted 75.8% of the patient population with sex-specific mortality of 68.2%. The highest age specific mortality of 65.2% was in the 40-59 years group. The common risk factors were systemic hypertension, obesity, alcohol/substance abuse, and diabetes mellitus. Co-morbidities included aspiration pneumonia, recurrent seizures, hyperglycemia, and sepsis. CONCLUSION: Age above 39 years, male gender, systemic hypertension, early onset of coma after stroke, and presence of co-morbidities were associated with poor stroke outcome.

Causes of medical coma in adult patients at the University College Hospital, Ibadan Nigeria.

AIMS AND OBJECTIVES: Diseases of medical origin leading to coma account for 3-15% of emergency hospital admissions in developed countries. There is dearth of data on causes of medical coma in adults in Nigeria in particular and Africa in general. This study is to determine the causes of coma in adult patients admitted at the medical emergency unit and wards of the University College Hospital (UCH) Ibadan. PATIENTS AND METHODS: A prospective study of two hundred consecutive adult unconscious patients seen at the medical emergency unit of UCH, Ibadan, from August 2004 to March 2005, was undertaken using a structured clinical history and physical examination protocol, and results of relevant diagnostic investigations, including post-mortem. RESULTS: Medical causes of coma constituted 10% of all emergencies and 3% of total hospital admissions respectively during the 8-month period. Sixty six percent were males. The age group 20-59 years were affected most (76.5%). Four commonest causes were: Acute stroke 33%), diabetic emergencies (12.5%), uraemic encephalopathy and meningitides (11% each). Four least causes were cerebral malaria (1.0%), hypertensive encephalopathy, alcohol and gamalline poisoning (0.5% each). Four common predisposing factors which also had significant male predominance were systemic hypertension (38.5%), diabetes mellitus (14%), alcohol and substance abuse (12.5%), and HIV/AIDS (11.5%). CONCLUSIONS: Hypertensive stroke and diabetic coma constituted the commonest medical causes of coma. Thus preventive measures such as public health enlightenment campaigns for lifestyle modifications, routine blood pressure and glucose examinations are necessary to avert their disastrous consequences.

Entrance surface dose of the common radiological investigations in Abuth, Zaria.

The entrance surface Dose (ESD) was determined among patients who presented for routine radiological examinations using thermoluminescent dosimeter (TLD) chips placed on averagely built adult [(30 cm) chest width, 60-90kg weight and 20-40years)] by multiplying the incident dose/entrances dose by the back scattered factor [BSF] gotten from an experiment. The values obtained from ESD measurements are as follows 8.03 mGy for Abdomen, 0.13 mGy for chest AP, 0.69 mGy for chest lateral, 0.5 mGy for cervical spine; AP: 0.38 mGy for cervical spine lateral; 4.75 mGy for hip AP: 12.83 mGy for hip lateral: 5.74mGy for lumbar spine, AP lumbar spine lateral is 15.15 mGy. 1.38m Gy is for pelvis AP. 2.93mGy for skull AP/PA 1.2mGy for skull lateral, 5.46mGy for thorax AP, while the lateral is 14.90m Gy. The average dose value is 9.28mGy Range 0.13-14.90mGy (Percentage standard error; +/- 1.45). From this studies Radiation doses delivered for routine investigations are generally lower than IAEA reference doses. Using these values for optimization of radiation protection practices for patient should be ensured since it does not rule out options for stochastic radiation.

Effect of stavudine-based antiretroviral therapy on the severity of polyneuropathy in HIV/AIDS patients: a preliminary report from Zaria, Northern Nigeria.

BACKGROUND: Stavudine, a nucleoside reverse transcriptase inhibitor, used as first-line antiretroviral drug in many developing countries is said to exacerbate distal symmetrical polyneuropathy in HIV/AIDS patients. OBJECTIVE: To evaluate the severity of distal symmetrical polyneuropathy in HIV/AIDS patients on stavudine-based antiretroviral therapy. METHODS: Two hundred and twenty consecutive HIV-infected antiretroviral-naive adults who were eligible for antiretroviral therapy were studied. Each patient was evaluated using a questionnaire, which contained bio-data and distal neurologic symptoms/signs adapted from the subjective peripheral neuropathy screen and the Leeds assessment of neuropathic symptoms and signs pain score. Patients were then put on stavudine, lamivudine and nevirapine. For three months, after which each patient was re-evaluated using the same protocol. Patients with other risk factors for distal symmetrical polyneuropathy were excluded from the study. RESULTS: Three months of antiretroviral therapy reduced the mean neuropathic symptoms and signs scores from 0.71 ± 0.76 to 0.26 ± 0.47 (P=0.00) and 0.72 ± 0.57 to 0.58 ± 0.55 (P=0.00) respectively. The number of patients with symptoms and signs also reduced from 97.8% to 24.4% and 65.9% to 55.0% respectively while the mean CD4+ count rose from 194.3 ± 80.4 cells per mL to 416.1±191.2 cells per mL of blood. CONCLUSION: Three months of stavudine-based antiretroviral therapy reduces the severity of distal symmetrical neuropathy in HIV/AIDS patients, but more studies are needed to evaluate the long-term neuropathic effect of stavudine on Africans.

Neurobrucellosis--a case report and review of literature.

Neurobrucellosis is a rare form of systemic brucellosis, a disease acquired through ingestion of unpasteurized dairy products, which may manifest as stroke, encephalitis, meningitis, or psychiatric disorders. Presently there is no known report ofneurobrucellosis in Nigeria, although consumption of unpasteurized dairy products is not uncommon in this country. In this report we present a 28 year old spinster with history of significant ingestion of unpasteurized cow milk and brucellosis of the brain diagnosed in our centre through brain magnetic resonance imagining (MRI) and brucella antigen agglutination test. Because of the indolent nature of brucellosis infection, it should be suspected in individuals with pyrexia of unknown origin so that early detection and treatment could prevent long-term sequelae such as focal neurologic deficits, hydrocephalus and psychiatric illness.

Antiretroviral drug resistance--implications for HIV/AIDS reduction in sub-Saharan Africa and other developing countries.

BACKGROUND: The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV However, the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries, not much seem to be done in this regard in developing countries of Africa, Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. METHODS: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use, relevant journals and Medline search using the keywords-Antiretroviral drugs, drug resistance, HIV subtypes and resistance testing. RESULTS: The types, groups, subtypes, sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations, process (es) involved in development of primary and secondary antiretroviral drug resistance, including the role of HIV genetic polymorphisms, and transmitted resistance have been discussed. CONCLUSION: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world.

Challenges of HIV treatment in resource-poor countries: a review.

BACKGROUND: The human immunodeficiency virus/acquired immunodeficiency syndrome pandemic have posed a significant public health challenge to the global community. Massive therapeutic interventions with antiretroviral drugs are being undertaken, yet problems and challenges exist. This review examines these problems and challenges as they affect the treatment of HIV infection in resource-poor countries such as Nigeria. METHODS: The information was sourced from relevant literature using human immunodeficiency virus/acquired immunodeficiency syndrome journals, textbooks and Websites on human immunodeficiency virus/acquired immunodeficiency syndrome, highly active antiretroviral therapy, resource-poor countries as key words. RESULTS: Several studies have shown that the advent of highly active antiretroviral therapy in 1996 has significantly reduced morbidity and mortality among people living with HIV/AIDS (PLWHA). But in resource-poor countries, initiation and maintenance of highly active antiretroviral therapy has been associated with many challenges and problems such as: poor infrastructural base for the control programs; irregular or non availability of drugs; poor drug adherence; co-morbidities and opportunistic infections/malignancies; drug toxicities; drug/food and drug/drug interactions; laboratory monitoring of viral load; CD4 cell counts; full blood counts; electrolytes, kidney and liver functions. CONCLUSION: The review has shown that the solution to the pandemic lies in a multi-sectoral and holistic approach involving International and local agencies, and communities.

Antiretroviral drug resistance--implications for HIV/AIDS reduction in sub-Saharan Africa and other developing countries.

BACKGROUND: The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV. However, the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries, not much seem to be done in this regard in developing countries of Africa, Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. METHODS: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use, relevant journals and Medline search using the keywords--Antiretroviral drugs, drug resistance, HIV subtypes and resistance testing. RESULTS: The types, groups, subtypes, sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations, process (es) involved in development of primary and secondary antiretroviral drug resistance, including the role of HIV genetic polymorphisms, and transmitted resistance have been discussed. CONCLUSION: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world.

Antiretroviral Drug Resistance- Implications for HIV/AIDS Reduction in Sub-Saharan Africa

Background:The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV. However; the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries; not much seem to be done in this regard in developing countries of Africa; Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. Methods: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use; relevant journals and Medline search using the keywords- Antiretroviral drugs; drug resistance; HIV subtypes and resistance testing. Results: The types; groups; subtypes; sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations; process (es) involved in development of primary and secondary antiretroviral drug resistance; including the role of HIV genetic polymorphisms; and transmitted resistance have been discussed. Conclusion: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world

Prognosis of non traumatic coma: the role of some socio-economic factors on its outcome in Ibadan, Nigeria.

BACKGROUND: Coma occurring in the course of an illness, irrespective of cause, traditionally implies a poor prognosis and many factors may determine its outcome. These factors must be identified and possibly stratified in their order of importance. This research seeks to identify these factors and how they influenced the outcome of non-traumatic coma in our environment. METHODS: Two hundred consecutive patients, aged 18-79 years who met the inclusion criteria, the Glasgow coma scale (GCS) score of <8, history and physical findings suggestive of medical illness, no head trauma or sedation, were recruited into the study from August 2004 to March 2005 at the university College Hospital (UCH), Ibadan, after obtaining institutional ethical clearance and consent from patients' guardians. Detailed history of illness including the bio-data and time to present to the hospital and treatments given were noted. Thereafter, the clinical course of the patients was monitored daily for a maximum of 28 days during which the support of the family and/ or the hospital social welfare was evaluated. RESULTS: During the 8-month period of the study, 76% (152) of the patients died while 24% (48) survived. The following factors were associated with high mortality rate: inability to confirm diagnosis (100%), poor family support (97.1%), delay in making a diagnosis within 24 h (85.4%), poor family understanding of disease (84.1%), need for intensive care admission and management (83.3%), poor hospital social welfare support (82.4%), presentation to UCH after 6 h of coma (76.7%), and referral from private health facilities (75.7%). Others include substance abuse (100%) and seropositivity to HIV (96%) and hepatitis B surface antigen (92%) antibodies, among others. CONCLUSION: This study has demonstrated that socio-economic factors such as gender, occupation, risky lifestyle behaviors, late presentation or referral to hospital, late diagnosis and treatment, and poor family support contributed to poor outcome of nontraumatic coma. It is hoped that improvement, modification, or correction of these factors may improve coma outcome.

Prognosis of Non Traumatic Coma: The Role of some Socio-Economic Factors on its Outcome in Ibadan; Nigeria

Background : Coma occurring in the course of an illness; irrespective of cause; traditionally implies a poor prognosis and many factors may determine its outcome. These factors must be identified and possibly stratified in their order of importance. This research seeks to identify these factors and how they influenced the outcome of non-traumatic coma in our environment. Methods : Two hundred consecutive patients; aged 18-79 years who met the inclusion criteria; the Glasgow coma scale (GCS) score of 8; history and physical findings suggestive of medical illness; no head trauma or sedation; were recruited into the study from August 2004 to March 2005 at the University College Hospital (UCH); Ibadan; after obtaining institutional ethical clearance and consent from patients' guardians. Detailed history of illness including the bio-data and time to present to the hospital and treatments given were noted. Thereafter; the clinical course of the patients was monitored daily for a maximum of 28 days during which the support of the family and/ or the hospital social welfare was evaluated. Results : During the 8-month period of the study; 76(152) of the patients died while 24(48) survived. The following factors were associated with high mortality rate: inability to confirm diagnosis (100); poor family support (97.1); delay in making a diagnosis within 24 h (85.4); poor family understanding of disease (84.1); need for intensive care admission and management (83.3); poor hospital social welfare support (82.4); presentation to UCH after 6 h of coma (76.7); and referral from private health facilities (75.7). Others include substance abuse (100) and seropositivity to HIV (96) and hepatitis B surface antigen (92) antibodies; among others. Conclusion : This study has demonstrated that socio-economic factors such as gender; occupation; risky lifestyle behaviors; late presentation or referral to hospital; late diagnosis and treatment; and poor family support contributed to poor outcome of nontraumatic coma. It is hoped that improvement; modification; or correction of these factors may improve coma outcome