Has Treatment Seeking Behaviour Changed in People Living with Epilepsy? Experience of People Living with Epilepsy Attending Adult Neurology Clinics in Enugu.

BACKGROUND: Over the years efforts has been made through public health education to change the knowledge, attitude and practice of epilepsy and seizures among the populace in Nigeria. One surrogate method of reviewing the impact of these educational interventions includes changes in treatment-seeking behavior of People Living With Epilepsy and the reasons for their choices of treatment. METHODS: This was a cross-sectional descriptive study. Data were collected from People Living With Epilepsy attending the medical outpatient clinics in two tertiary hospitals in Enugu, Enugu State southeast Nigeria. RESULTS: A total 276 people living with epilepsy were recruited with a mean age of 30.1 years and a median age of 25 years. After the onset of epilepsy, 76(27.5%) and 70(25.4%) visited general hospitals and teaching hospitals respectively, while prayer houses and traditional healing centers were first visited by 54(19.6%) and 40(14.5%) respectively. As a second choice of care 9(3.3%) and 13(4.7%) visited prayer houses and traditional healing centers. Only 42(15.2%) selected their treatment center because they were confident of getting a cure however, this was highest for those that visited traditional healing centers 11(27.5%). The age of onset of epilepsy positively correlated with selecting orthodox treatment at the choice of care, while occupational status negatively correlated with selecting orthodox care at the same period. CONCLUSIONS: Health care seeking behaviors among PLWE in Southeast Nigeria might have changed over the years as more people living with epilepsy were more likely to select orthodox treatment compared to non-orthodox means of treatment.

CONTEXTE: Au fil des ans, des efforts ont été déployés par le biais de l'éducation en santé publique pour changer les connaissances, les attitudes et les pratiques concernant l'épilepsie et les crises d'épilepsie parmi la population au Nigeria. Une méthode indirecte pour examiner l'impact de ces interventions éducatives comprend les changements dans le comportement de recherche de traitement des personnes vivant avec l'épilepsie et les raisons de leurs choix de traitement. MÉTHODES: Il s'agit d'une étude descriptive transversale. Les données ont été collectées auprès de personnes vivant avec l'épilepsie fréquentant les cliniques de consultations externes médicales dans deux hôpitaux tertiaires à Enugu, dans l'État d'Enugu, au sud-est du Nigeria. RÉSULTATS: Au total, 276 personnes vivant avec l'épilepsie ont été recrutées, avec un âge moyen de 30,1 ans et un âge médian de 25 ans. Après le début de l'épilepsie, 76 (27,5 %) et 70 (25,4 %) ont consulté respectivement des hôpitaux généraux et des hôpitaux universitaires, tandis que les lieux de prière et les centres de guérison traditionnelle ont été les premiers consultés par respectivement 54 (19,6 %) et 40 (14,5 %). Comme deuxième choix de soins, 9 (3,3 %) et 13 (4,7 %) ont consulté des lieux de prière et des centres de guérison traditionnelle. Seuls 42 (15,2 %) ont choisi leur centre de traitement parce qu'ils étaient confiants d'obtenir une guérison, cependant, ce taux était le plus élevé pour ceux qui ont consulté les centres de guérison traditionnelle (11 soit 27,5 %). L'âge de début de l'épilepsie était positivement corrélé avec la sélection d'un traitement orthodoxe comme choix de soins, tandis que le statut professionnel était négativement corrélé avec la sélection de soins orthodoxes au même moment. CONCLUSIONS: Les comportements de recherche de soins parmi les personnes vivant avec l'épilepsie dans le sud-est du Nigeria ont peut-être changé au fil des ans, car davantage de personnes vivant avec l'épilepsie étaient plus susceptibles de choisir un traitement orthodoxe par rapport aux moyens de traitement non orthodoxes. MOTS-CLÉS: Épilepsie, Comportement de recherche de soins, Guérisseurs traditionnels, Lieux de prière, Médecine orthodoxe, sud-est du Nigeria.

Audit of Stroke Admissions in a Tertiary Hospital in South East Nigeria.

INTRODUCTION: Stroke is one of the commonest causes of medical admissions and mortality in Nigeria. Documenting the pattern of stroke and risk factors for stroke is important not only for public health policy makers but also for physicians in implementing both primary and secondary preventive programs. OBJECTIVES: The aim of this study was therefore to document the pattern of stroke and risk factors for stroke in stroke patients admitted in a tertiary hospital in Enugu. METHODS: This was a cross-sectional descriptive study carried out at Enugu State University Teaching Hospital, Enugu. Data were analyzed using the SPSS version 26 (IBM Corporation, New York, USA). RESULTS: Data from 350 patients were included in the present study. The three commonest risk factors for stroke were diabetes (69.1%), hypertension (64.9%), and age 65 years and above (51.1%). A total of 74.9% of the patients had ischemic stroke and 25.1% had hemorrhagic stroke. Hemorrhagic stroke was significantly higher in patients < 50 years (46.5%) and people with hypertension, (31.7%). About 31.4% of the patients had two risk factors and 28.6% had three risk factors. Age 65 years and above positively correlated with having ischemic stroke and hypertension positively correlated with hemorrhagic stroke. When controlled for age, the correlation between hypertension and hemorrhagic stroke was still significant. CONCLUSION: The reported frequency of ischemic stroke was 74.9% and of hemorrhagic stroke was 25.1%. The commonest risk factors for stroke documented among stroke patients in a tertiary hospital in Enugu were diabetes, hypertension, and age 65 years and above. When controlled for age, the correlation between hypertension and hemorrhagic stroke was still significant.

INTRODUCTION: L'accident vasculaire cérébral (AVC) est l'une des causes les plus courantes d'admissions médicales et de mortalité au Nigeria. Il est important de documenter le profil des et les facteurs de risque des accidents vasculaires cérébraux sont importants non seulement pour le santé publique mais aussi pour les médecins dans la mise en œuvre des programmes de prévention primaire et secondaire. OBJECTIFS: L'objectif de cette étude était donc de documenter le modèle d'AVC et les facteurs de risque d'AVC chez les patients admis dans un hôpital tertiaire d'Enugu. MÉTHODES: Il s'agit d'une étude descriptive transversale menée à l'hôpital universitaire d'Enugu, Enugu. Les données ont été analysées à l'aide du SPSS version 26 (IBM Corporation, New York, USA). RÉSULTATS: Les données de 350 patients ont été incluses dans la présente étude. Les trois facteurs de risque d'accident vasculaire cérébral les plus courants étaient le diabète (69,1 %), l'hypertension (64,9 %) et l'âge de 65 ans et plus (51,1 %). Un total de 74,9 % des patients ont eu un AVC ischémique et 25,1 % un AVC hémorragique. L'AVC hémorragique était significativement plus élevé chez les patients < 50ans (46,5 %) et les personnes souffrant d'hypertension (31,7 %). Environ 31,4 % des patients présentaient deux facteurs de risque et 28,6 % trois facteurs de risque. Âge 65 ans et plus était positivement corrélé au fait d'avoir un AVC ischémique et l'hypertension était en corrélation positive avec l'AVC hémorragique. Après contrôle de l'âge, la corrélation entrel'hypertension et l'AVC hémorragique était toujours significative. CONCLUSION: La fréquence rapportée de l'accident vasculaire cérébral ischémique était de 74,9 %. et celle de l'AVC hémorragique était de 25,1 %. Les facteurs de risque les plus courants pour d'AVC documentés chez les patients victimes d'un AVC dans un hôpital tertiaire de Enugu étaient le diabète, l'hypertension et l'âge de 65 ans et plus. Lorsque l'âge, la corrélation entre l'hypertension et l'AVC hémorragique était toujours significative. MOTS CLÉS: AVC ischémique, AVC hémorragique, Facteurs de risque, Nigeria.

Population-based prevalence of high blood pressure among adults in an urban slum in Enugu, South East Nigeria.

In sub-Saharan Africa (SSA), rapid urbanization and changing lifestyle have modified the profile and pattern of various medical disorders. Apart from high prevalence rates, recent trends with regard to hypertension in Africa include: low levels of awareness, treatment and control. Although a large number of studies provide data about hypertension in SSA, few studies focused on special populations such as urban slum dwellers. The WHO STEP-wise approach to surveillance of noncommunicable diseases was used to access the prevalence of hypertension among adults in one of the urban slums in Enugu. Out of the 811 individuals aged 20 years and above surveyed, 774 (95.4%) cases were analyzed. About 4.7% and 2.7% reported a past history of diabetes and stroke, respectively, whereas 15% had a positive family history of hypertension. The mean (95% confidence interval (CI)) body mass index (BMI) was 23.7 (23.2-24.2) kg m(-2) among males and 26.6 (25.7-26.7) kg m(-2) among females (P<0.0001). The prevalence of hypertension was 52.5% (95% CI: 48.9-56.0) and 55.4% (95% CI: 49.5-61.3) in males and 50.8% (95% CI: 46.4-55.1) in females (P=0.23). It increased with age peaking at 45-54 years in females and ⩾55 years in males. About 40.1% were aware of their hypertension and 28.8% of those aware had normal blood pressure. In regression analysis, systolic (R(2)=0.192) and diastolic (R(2)=0.129) blood pressures increased with age and BMI. The prevalence of high blood pressure among adults in Enugu slums is very high and a cause for concern, and calls for urgent attention.

Clinical and Laboratory Predictors of Articular Disorders Among HIV-infected Patients Seen at Teaching Hospital Southeast Nigeria.

BACKGROUND: HIV infection may be associated with different arthropathies that are often underdiagnosed. There is also paucity of reported studies of relationship between clinical and laboratory features of HIV-infected patients and articular disorders. AIMS: To determine the predictors of articular disorders among HIV-infected patients seen at tertiary hospital Nigeria. SUBJECTS AND METHODS: Hospital-based cross-sectional descriptive study. Subjects were recruited from outpatient clinics of the study centers. Persons aged 16 years and above were recruited via stratified sampling method. Subjects with trauma, degenerative arthritis, malignancy, hepatitis B surface antigen and anti-hepatitis C virus positivity or previously known to have pulmonary tuberculosis or rheumatological disorders were excluded. Pretest-improved semi-structured questionnaire was administered to the recruited 480 subjects comprising 240 HIV positive subjects (HPS) and 240 HIV-negative subjects (HNS). Blood for relevant laboratory tests and radiographs were done where necessary. Diagnosis of articular disorder was based on American College of Rheumatology and European Spondyloarthropathy Study Group classification guidelines. Statistical Package for Social Sciences version 15 (SPSS Inc., Chicago, IL, USA) was used for data entry, validation, and analysis. RESULTS: Of the 480 participants, both HPS and HNS were made up of 95 males and 145 females. There was statistically significant difference between the frequency of occurrence of articular disorders among the HPS of 37.1% (89/240) and the HIV-negative controls of 16.2% (39/240) (χ(2) = 26.63 P = <0.01). Arthralgia frequency of 29.6% (71/240), HIV-associated arthritis 4.6%, (11/240) (Reiter's disease 1.3% (3/240), undifferentiated spondyloarthropathy 1.3%, (3/240) and gout 0.4% (1/240) (were seen among the HPS. Only arthralgia was found among HNS. Erythrocyte sedimentation rate (ESR) and age were the best predictors of arthralgia presence. CD4+ T-cell count was predictive of HIV-associated arthritis. CONCLUSIONS: Articular disorders are commoner among HIV patients than HNS. ESR and age were the best predictors of Arthralgia presence among HIV-infected patients. CD4+ T-cell count was predictive of HIV-associated arthritis.