Browsing by Author "Akpa, O."

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Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans
(Elsevier Inc., 2020) Ojagbemi, A.; Akinyemi, J.; Owolabi, M.; Akinyemi, R.; Arulogun, O.; Gebregziabher, M.; Akpa, O.; Olaniyan, O.; Salako, B.; Ovbiagele, B.
Background: There is relatively limited information on the risk factors and outcome of new onset Post stroke Anxiety (PSA) in Low- and Middle-Income Countries. We estimated incidence, cumulative incidence, risk factors and outcome of new onset anxiety in the first year of stroke among African stroke survivors. Methods: We analyzed the dataset of a completed clinical trial comprising patients enrolled to test an intervention designed to improve one-year blood pressure control among recent ( one month) stroke survivors in Nigeria. Anxiety was measured using the Hospital Anxiety and Depression Scale. Outcomes were assessed using the modified Rankin Scale (mRS), Community screening instrument for dementia (CSID) and Health Related Quality of Life in Stroke Patients (HRQOLISP-26). Results: Among 322 stroke survivors who were free of anxiety at baseline, we found a one-year cumulative incidence of 34% (95% CI = 28.6 39.3). Rates were 36.2% (95% CI =29.6 42.7) for men and 29.2% (95% CI =19.9 38.3) for women. In multivariate Cox regression analyses, haemorrhagic stroke type was associated with higher risk of new onset PSA (Hazard Ratio=1.52, 95% CI =1.01 2.29). New onset PSA was independently associated with cognitive [(mean difference (MD) in CSID scores=1.1, 95% C.I=0.2, 1.9)] and motor decline (MD in mRS scores= 0.2, 95% C.I= 0.4, 0.02), as well as poorer quality of life overtime (MD in total HRQOLISP-26 scores=3.6, 95% C.I=1.0, 6.2). Conclusion: One in 3 stroke survivors in Nigeria had PSA at one year. Clinicians in SSA should pay special attention to survivors of haemorrhagic stroke as they are at higher risk of incident anxiety and therefore its consequences.
Psychiatric disorders and adherence to antiretroviral therapy among a population of HIV-infected adults in Nigeria
(Sage publications, 2016) Adejumo, O.; Oladeji, B.; Akpa, O.; Malee, K.; Baiyewu, O.; Ogunniyi, A.; Evans, S.; Berzins, B.; Taiwo, B.
Psychiatric disorders are common among HIV patients in Nigeria. Adherence is necessary to optimize the outcome of antiretroviral therapy. In this study, we aimed to identify associations between antiretroviral adherence measured by 1-week and 1-month self-reported missed doses, and psychiatric illness in a cohort previously assessed for psychiatric disorders using the Composite International Diagnostic instrument (CIDI). The study participants comprised 151 adults with major depression, anxiety or suicidal symptoms, and 302 matched-control participants. Two controls were randomly selected for each case within the same gender and education stratum. We compared participants with psychiatric disorders (WPDs) and without psychiatric disorders (NPDs) on selected demographic and clinical variables, in addition to adherence. Participants with 1 or more missed doses in the preceding month had twice the odds of having a major depressive episode as those with no missed doses during this period (OR 2.22, 95% CI 1.03, 4.79). This association remained significant after adjusting for selected risk factors. There was no statistically significant difference between WPD and NPD groups on either 1-week or 1-month adherence, or on age, marital status, occupational class, HIV viral load at enrollment or current CD4. Among Nigerian adults with HIV, suboptimal antiretroviral adherence is associated with, and could be a Corresponding author: Olurotimi Adejumo, Department of Psychiatry, University College Hospital, PMB 5116, Ibadan, Nigeria, Phone: +2348033778540, +13122167417, radejumo@yahoo.com. HHS Public Access Author manuscript Int J STD AIDS. Author manuscript; available in PMC 2016 October 01. Published in final edited form as: Int J STD AIDS. 2016 October ; 27(11): 938–949. doi:10.1177/0956462415600582. Author Manuscript Author Manuscript Author Manuscript Author Manuscript pointer to depression. Routine self-report adherence assessments may have potential utility for identifying individuals at risk among this population.
Statistical modelling Of HIV/AIDS epidemic in the North Central zone Of Nigeria
(Internet Scientific Publications, 2007) Akpa, O.; Oyeloja, B.
The objective of this work were to apply the UNAIDS Estimation and Projection Package (EPP) to HIV/AIDS epidemic in the north central zone of Nigeria, to propose a statistical model for the course of the epidemic in the zone and to generally investigate the level of trend inherent in the epidemic, over the years. We used HIV/AIDS surveillance data to model the situation for the rural and urban sentinel sites in the zones. Using the EPP as our point of reference, we proposed a statistical model (based on modifications made to the original back calculation methods) for the course of HIV/AIDS epidemic in the zone. Our result shows that the UNAIDS package is a great AID to HIV/AIDS modeling in Nigeria. The incidence rate was estimated to be 0.91 in 1997, 0.7% in 2000 and projected to be 0.63 in 2010. Also an estimated 378,870 people are expected to die due to the epidemic in the year 2010. The prevalence peaked later than the incidence which peaked around 1997, but this is expected to rise slowly after 2007. The mortality rate is relatively low among sites inside major towns (IMT) than those outside major town (OMT), but the situation is generally still on the rise.
The confirmatory factor structure of neurological soft signs in Nigerians with first episode
(Elsevier B.V., 2015) Ojagbemi, A.; Akpa, O.; Esan, O.B.; Emsley, R.; Gureje, O.
We describe empirically derived categories of NSS in first episode schizophrenia among indigenous Africans. A total of 84 Nigerian patients with the disease were assessed using the neurological evaluation scale. An exploratory factor analysis with orthogonal varimax rotation was first conducted and the factors derived based on a priori criteria were subjected to confirmatory analyses using SPSS 18.0 and AMOS 18.0. We tested four different competing models to identify the structure with the best fit to the data. The relationship of the derived NSS structure with the clinical characteristics of schizophrenia was then explored using the Pearson correlation method. The overall clinical status was assessed using the positive and negative syndrome scale and clinical global impression. Additional assessments included the pre-morbid adjustment scale and Calgary depression scale for schizophrenia. A three-factor structure in which stereognosis is prescribed to load into a ‘perceptual and motor sequencing’ category (audio–visual integration, fist-edge palm, rhythm tapping, extinction, right–left confusion) provided the best fit to the data (chi-square goodness of fittest=1.25; comparative fit index=0.95; root square means error of approximation
The confirmatory factor structure of neurological soft signs in Nigerians with first episode schizophrenia
(Elsevier BV, 2015) Ojagbemi, A.; Akpa, O.; Esan, O.; Emsley, R.; Gureje, O.
We describe empirically derived categories of NSS in first episode schizophrenia among indigenous Africans. A total of 84 Nigerian patients with the disease were assessed using the neurological evaluation scale. An exploratory factor analysis with orthogonal varimax rotation was first conducted and the factors derived based on a priori criteria were subjected to confirmatory analyses using SPSS 18.0 and AMOS 18.0. We tested four different competing models to identify the structure with the best fit to the data. The relationship of the derived NSS structure with the clinical characteristics of schizophrenia was then explored using the Pearson correlation method. The overall clinical status was assessed using the positive and negative syndrome scale and clinical global impression. Additional assessments included the pre-morbid adjustment scale and calgary depression scale for schizophrenia. A three factor structure in which stereognosis is prescribed to load into a ‘perceptual and motor sequencing’ category (audio–visual integration, fist-edge palm, rhythm tapping, extinction, right–left confusion) provided the best fit to the data (chi-square goodness of fit test = 1.25; comparative fit index = 0.95; root square means error of approximation < 0.001), and disorganization (r = 0.559, p < 0.001) psychopathologies. NSS in this sample are heterogeneous, but aggregates into three correlated categories with significant overlap with previously described classifications.
Unraveling the risk factors for spontaneous intra cerebral hemorrhage among West Africans
(American Academy of Neurology., 2020) Sarfo, F. S.; Ovbiagele, B.; Gebregziabher, M.; Akpa, O.; Akpalu, A.; Wahab, K.; Ogbole, G.; Akinyemi, R.; Obiako, R.; Komolafe, M.; Owolabi, L.; Lackland, D.; Arnett, D.; Tiwari, H.; Markus, H. S.; Akinyemi, J.; Oguntade, A.; Fawale, B.
"Abstract Objective To characterize risk factors for spontaneous intra cerebral hemorrhage (sICH) occurrence and severity among West Africans. Methods The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors. Results Of 2,944 adjudicated stroke cases, 854 were intra cerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were non lobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78–213.72); dyslipidemia, 2.95 (1.84–4.74); meat consumption, 1.55 (1.01–2.38); family history of CVD, 2.22 (1.41–3.50); non consumption of green vegetables, 3.61 (2.07–6.31); diabetes mellitus, 2.11 (1.29–3.46); stress, 1.68 (1.03–2.77); and current tobacco use, 14.27 (2.09–97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were non consumption of leafy green vegetables, 2.03 (1.43–2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00–1.01); presence of midline shift, 1.54 (1.11–2.13); lobar ICH, 1.72 (1.16–2.55); and supratentorial bleeds, 2.17 (1.06–4.46). Conclusions Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.