Browsing by Author "Uvere E."

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Multilingual Validation of the Questionnaire for Verifying Stroke-Free Status in West Africa
(Lippincott Williams & Wilkins, 2016) Sarfo F.; Gebregziabher M.; Ovbiagele B.; Akinyemi R.; Owolabi L.; Obiako R.; Akpa O.; Armstrong K.; Akpalu A.; Adamu S.; Obese V.; Boa-Antwi N.; Appiah L.; Arulogun O.; Mensah Y.; Adeoye A.; Tosin A.; Adeleye O.; Tabi-Ajayi E.; Phillip I.; Sani A.; Isah S.; Tabari N.; Mande A.; Agunloye A.; Ogbole G.; Akinyemi J.; Laryea R.; Melikam S.; Uvere E.; Adekunle G.; Kehinde S.; Azuh P.; Dambatta A.; Ishaq N.; Saulson R.; Arnett D.; Tiwari H.; Jenkins C.; Lackland D.; Owolabi M.
Background and Purpose—The Questionnaire for Verifying Stroke-Free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological, and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages, Yoruba, Hausa and Akan, for ascertainment of stroke-free status of control subjects enrolled in an on-going stroke epidemiological study in West Africa. Methods—Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records, and neuroimaging (gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. Results—The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by gold standard, 98% were determined to have had stroke, whereas of 219 without stroke 87% were determined to be stroke-free by QVSFS. Negative predictive value of the QVSFS across the 3 languages was 0.97 (range, 0.93–1.00), sensitivity, specificity, and positive predictive value were 0.98, 0.82, and 0.80, respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen k=0.92. Conclusions—QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa.
Prevalence and predictors of anxiety in an African sample of recent stroke survivors
(2017) Ojagbemi A.; Owolabi M.; Akinyemi R.; Arulogun O.; Akinyemi J.; Akpa O.; Sarfo F. S.; Uvere E.; Saulson R.; Hurst S.; Ovbiagele B.
Objectives: Studies considering emotional disturbances in the setting of stroke have primarily focused on depression and been conducted in high-income countries. Anxiety in stroke survivors, which may be associated with its own unique sets of risk factors and clinical parameters, has been rarely investigated in sub-Saharan Africa (SSA). We assess the characteristics of anxiety and anxiety-depression comorbidity in a SSA sample of recent stroke survivors. Materials and methods: We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤1 month) stroke survivors in SSA. Anxiety in this patient population was measured using the Hospital Anxiety and Depression Scale (HADS), while the community screening instrument for dementia was used to evaluate cognitive functioning. Independent associations were assessed using logistic regression analysis. Results: Among 391 participants, clinically significant anxiety (HADS anxiety score≥11) was found in 77 (19.7%). Anxiety was comorbid with depression in 55 (14.1%). Female stroke survivors were more likely than males to have anxiety (OR=2.4, 95% CI=1.5-4.0). Anxiety was significantly associated with the presence of cognitive impairment after adjusting for age, gender and education (OR=6.8, 95% CI=2.6-18.0). Conclusions: One in five recent stroke survivors in SSA has clinically significant anxiety, and well over 70% of those with anxiety also have depression. Future studies will need to determine what specific impact post-stroke anxiety may have on post processes and outcomes.
Randomized trial of an intervention to improve blood pressure control in stroke survivors
(American Heart Association, Inc., 2020) Owolabi M. O.; Gebregziabher M.; Akinyemi R. O.; Akinyemi J. O.; Akpa O.; Olaniyan O.; Salako B. L.; Arulogun O.; Tagge R.; Uvere E.; Fakunle A.; Ovbiagele B.
BACKGROUND: We conducted the first-of-its kind randomized stroke trial in Africa to test whether a THRIVES (Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke) intervention improved blood pressure (BP) control among patients with stroke. METHODS AND RESULTS: Intervention comprised a patient global risk factor control report card, personalized phone text-messaging, and educational video. Four hundred patients recruited from 4 distinct medical facilities in Nigeria, aged ≥18 years with stroke-onset within one-year, were randomized to THRIVES intervention and control group. The control group also received text messages, and both groups received modest financial incentives. The primary outcome was mean change in systolic BP (SBP) at 12 months. There were 36.5% females, 72.3% with ischemic stroke; mean age was 57.2±11.7 years; 93.5% had hypertension and mean SBP was 138.33 (23.64) mmHg. At 12 months, there was no significant difference in SBP reduction from baseline in the THRIVES versus control group (2.32 versus 2.01 mmHg, P=0.82). In an exploratory analysis of subjects with baseline BP >140/90 mmHg (n=168), THRIVES showed a significant mean SBP (diastolic BP) decrease of 11.7 (7.0) mmHg while control group showed a significant mean SBP (diastolic BP) decrease of 11.2 (7.9) mmHg at 12 months. CONCLUSIONS: THRIVES intervention did not significantly reduce SBP compared with controls. However, there was similar significant decrease in mean BP in both treatment arms in the subgroup with baseline hypertension. As text-messaging and a modest financial incentive were the common elements between both treatment arms, further research is required to establish whether these measures alone can improve BP control among stroke survivors
Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria
(Elsevier B.V, 2017) Wahab K. W.; Owolabi M.; Akinyemi R.; Jenkins C.; Arulogun O.; Akpa O.; Gebregziabher M.; Uvere E.; Saulson R.; Ovbiagele B.
Background: Given the paucity of neurologists in Sub-Saharan Africa (SSA), task-shifting post-stroke care to nurses could be a viable avenue for enhancing post-stroke outcomes. This pilot study assessed the feasibility and short-term impact of a nurse-led intervention to manage blood pressure (BP) control in recent stroke survivors in Nigeria. Methods: A randomized pilot trial allocated patients within one month of an index stroke from two participating hospitals in Nigeria to either nurse-led group clinic or standard care for 14 days. Key study endpoints were successful execution of the protocol, subject retention, and short-term BP effects. Results: There were no significant differences between the intervention (n = 17) and control (n = 18) groups at baseline. At the post-intervention clinic, patient retention rate was 100%. In the intervention group, both the systolic and diastolic BPs measured at home were lower than the clinic BPs post-interven tion (127 ± 12.88/78.13 ± 19.26 mmHg versus 137.50 ± 23.05/84.06 ± 9.67 mmHg; p = 0.05). However, there was no significant change in clinic blood pressure (BP) recordings in both the intervention and control groups. Conclusion: It is possible to initiate a nurse-led group clinic intervention to address BP management among stroke survivors in SSA with good early retention of participants. A larger and longer-term trial is being planned.
The epidemiology of stroke in Africa: A systematic review of existing methods and new approaches
(Wiley Periodicals, Inc., 2017) Owolabi M.; Olowoyo P.; Popoola F.; Lackland D.; Jenkins C.; Arulogun O.; Akinyemi R.; Akinyemi O.; Akpa O.; Olaniyan O.; Uvere E.; Kehinde I.; Selassie A.; Gebregziabher M.; Tagge R.; Ovbiagele B.
Accurate epidemiological surveillance of the burden of stroke is direly needed to facilitate the development and evaluation of effective interventions in Africa. The authors therefore conducted a systematic review of the methodology of stroke epidemiological studies conducted in Africa from 1970 to 2017 using gold standard criteria obtained from landmark epidemiological publications. Of 1330 articles extracted, only 50 articles were eligible for review grouped under incidence, prevalence, case-fatality, health-related quality of life, and disability-adjusted life-years studies. Because of various challenges, no study fulfilled the criteria for an excellent stroke incidence study. The relatively few stroke epidemiology studies in Africa have significant methodological flaws. Innovative approaches leveraging available information and communication technology infrastructure are recommended to facilitate rigorous epidemiological studies for accurate stroke surveillance in Africa.