FACULTY OF PUBLIC HEALTH
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Item Regional Patterns and Association between Obesity and Hypertension in Africa evidence from the H3 Africa CHAIR Study(Wolters Kluwer Health, Inc., 2020) Akpa, O. M.; Made, F.; Ojo, A.; Ovbiagele, B.; Adu, D.; Motala, A. A.; Mayosi, B. M.; Adebamowo, S. N.; Engel, M. E.; Tayo, B.; Rotimi, C.; Salako, B.; Akinyemi, R.; Gebregziabher, M.; Sarfo, F.; Wahab, K.; Agongo, G.; Alberts, M.Abstract—Hypertension and obesity are the most important modifiable risk factors for cardiovascular diseases, but their association is not well characterized in Africa. We investigated regional patterns and association of obesity with hypertension among 30044 continental Africans. We harmonized data on hypertension (defined as previous diagnosis/ use of antihypertensive drugs or blood pressure [BP]≥140/90 mmHg/BP≥130/80 mmHg) and obesity from 30 044 individuals in the Cardiovascular H3Africa Innovation Resource across 13 African countries. We analyzed data from population-based controls and the Entire Harmonized Dataset. Age-adjusted and crude proportions of hypertension were compared regionally, across sex, and between hypertension definitions. Logit generalized estimating equation was used to determine the independent association of obesity with hypertension (P value<5%)Participants were 56% women; with mean age 48.5±12.0 years. Crude proportions of hypertension (at BP≥140/90 mmHg) were 47.9% (95% CI, 47.4–48.5) for Entire Harmonized Dataset and 42.0% (41.1–42.7) for population-based controls and were significantly higher for the 130/80 mmHg threshold at 59.3% (58.7–59.9) in population-based controls. The age-adjusted proportion of hypertension at BP≥140/90 mmHg was the highest among men (33.8% [32.1–35.6]), in western Africa (34.7% [33.3–36.2]), and in obese individuals (43.6%; 40.3–47.2). Obesity was independently associated with hypertension in population-based controls (adjusted odds ratio, 2.5 [2.3–2.7]) and odds of hypertension in obesity increased with increasing age from 2.0 (1.7–2.3) in younger age to 8.8 (7.4–10.3) in older age. Hypertension is common across multiple countries in Africa with 11.9% to 51.7% having BP≥140/90 mmHg and 39.5% to 69.4% with BP≥130/80 mmHg. Obese Africans were more than twice as likely to be hypertensive and the odds increased with increasing age. (Hypertension. 2020;75:00-00. DOI: 10.1161/HYPERTENSIONAHA.119.14147.)Item Multilevel analysis of psychosocial functioning of Adolescents in families affected by HIV/AIDS in Benue state, Nigeria(Biomedical Communications Group, 2018) Akpa, O. M.Methods The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years) with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years) recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs) and population attributable risks (PARs) with 95% CIs.Item A random effect logistic regression model of major depressive disorder among ageing Nigerians(Scientific & Academic Publishing, 2016) Idowu, O. P.; Yusuf, O. B.; Akpa, O. M.; Gureje, O.Major Depressive Disorder (MDD) is a major public health problem in Nigeria and has severely devastating effects on the elderly. Previous studies on MDD among elderly Nigerians have utilized cross sectional designs which are descriptive in nature and have not investigated differences in setting and time-occurrence of MDD. Therefore this study employed a random effect logistic regression model to determine the relative effects/contributions of individual and environmental factors in the occurrence of MDD. A secondary analysis of a four-year longitudinal data from the Ibadan Study of Ageing was conducted. A total of 2,149 elderly Nigerians participated in the study between 2003 and 2009. The Geriatric Depression Scale was used to assess MDD and consequently classified as “present” for scores ranging from 10 to 30 and “absent” for scores ranging from 0 to 9. A random effect logistic regression model was fitted to determine factors predicting MDD. Odds ratios (OR), 95% confidence intervals, and Intra-class Correlation Coefficients (ICC) for each random effect was estimated. The overall prevalence of MDD was 27.28%. Significant predictors of MDD included “no-contact with family members” (OR=2.9, 95%CI: 1.26-6.70), “no-contact with friends” (OR=1.32, 95%CI: 1.05-1.67)), non-participation in family activities (OR=2.07, 95%CI: 1.63-2.43), non-participation in community activities (OR=1.93, 95%CI: 1.54-2.43), and good quality of health (OR=0.25, 95%CI: 0.15-0.27). Disparities in the occurrence of MDD among the elderly were attributable to enumeration areas (6%) and the individuals (22%). Social isolation factors and self-reported quality of health are significant predictors of MDD among elderly Nigerians.Item Psychometric properties and confirmatory structure of the strengths and difficulties questionnaire in a sample of adolescents in Nigeria.(Scientific & Academic Publishing, 2016) Akpa, O. M.; Afolabi, R. F.; Fowobaj, K. R.Though the SDQ has been used in selected studies in Nigeria, its theoretical structure has not been fully and appropriately investigated in the setting. The present study employs Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to investigate the theoretical structure of the self-reported version of the SDQ in a sample of adolescents in Benue state, Nigeria. A total of 1,244 adolescents from different categories of secondary schools in Makurdi and Vandekya Local government areas of Benue state participated in the study. Preliminary data analyses were performed using descriptive statistics while the theoretical structure of the SDQ was assessed using EFA and CFA. Model fits were assessed using Chi-square test and other fit indices at 5% significance level. Participants were 14.19±2.45 (Vandekya) and 14.19±2.45 (Makurdi) years old. Results of the EFA and CFA revealed a 3-factor oblique model as the best model for the sample of adolescents studied ( χ2/ df =2.20, p <0.001) with all fit indices yielding better results. A correlated 3-factor model fits the present data better than the 5-factor theoretical model of the SDQ. The use of the original 5-factor model of the SDQ in the present setting should be interpreted with caution.Item Knowledge and practice of pain management among nurses in labour wards in Ibadan, Nigeria(MA Healthcare, 2016) Ojerinde, O. E.; Onibokun, A.; Akpa, O. M.Background: It is not clear whether awareness of pain management has influenced the management of labour pain by nurse/midwives in Ibadan, Nigeria. Many women in labour do not get optimal pain relief, despite awareness of the importance of pain management. Aims: This study aimed to assess knowledge and practice of labour pain management among nurse/midwives in Ibadan. Methods: This cross-sectional study included 87 nurse/ midwives on duty in labour rooms of three hospitals in Ibadan, Nigeria. Data were collected using semi-structured questionnaires. Descriptive statistics, Pearson’s and Kendall’s correlation coefficients were used for data analysis. All analyses were performed using IBM SPSS version 20.0 at 5% level of significance. Findings: Two thirds of respondents (66.7%) had a moderate level of knowledge, and 34.5% managed labour pain through back massage/psychotherapy. Knowledge of pain management was associated with level of education (τ =0.82; P (τ =0.82; P<0.001) while good practice of pain management was associated with good knowledge (r =0.49; P<0.001). The association between good practice and years of working experience just failed to be statistically significant (P=0.06). Conclusions: Nurse/midwives in Ibadan have moderate knowledge of labour pain management. Participants in this study primarily used back massage and psychotherapy. There is need for improvement in knowledge of labour pain management through continuing education for nurse/midwives in Ibadan.Item Noise Levels from selected religious centres and perceived non-auditory health effects experienced by residents in Owo Town, Ondo State, Nigeria(Pan-African Journal of Health and Environmental Science., 2015) Oluwatoyin O. M.; Ana, G.R.E.E.; Akpa, O. M.In recent times urban noise pollution has grown in magnitude and scope causing palpable effects on public life. Whereas studies have shown the pattern of noise pollution from traffic and industrial sources, little is known about noise from religious settings. We determined the noise levels and then assessed its non-auditory effects on residents. Twelve religious centers: Islamic worship centres (IWC) and Christian worship centres (CWC) were purposively selected based on potential noise generation capacities. Noise level measurements from the religious centers were taken at three timesofthe day (5-8am, l lam-2pmand5-8pm) using AEMC sound meter for 8 consecutive weeks. Values obtained were compared with WHO guidelines limit. Information on perceived non-auditory health problems was obtained with an interviewer semi-structured questionnaire from consenting residents. Data were analyzed using descriptive statistics, ANOVA and T-test at 5% level of significance. The highest mean noise level 83.6±7.5dB was recorded between 5-8am at IWC. Mean noise levels (69. l±9.2dB) at the 12 religious centers were above WHO guideline limits for noise exposure (55dB) in residential environments. Most of the participants (42.8%) had sleep disturbance and 28.1% were highly annoyed as a result of religious noise. Other non-auditory health problems were loss of concentration (17.5%), speech interference (12.8%) and aggressiveness (12.5%). Residents living contiguous to religious houses are highly vulnerable to non-auditory health effects due to their exposure to excessive noise. Health education to the religious bodies on the adverse effects of excessive noise in the residential environment is advocated.Item Correlates of the quality of life of adolescents in families affected by HIV/AIDS in Benue State, Nigeria.(Routledge Taylor & Francis Group, 2015) Akpa, O. M.; Bamgboye, E. A.It was estimated that over 260,000 children are living with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) while close to 2 million are directly or indirectly affected by the disease in Nigeria. Improvements in treatments for infected children have been documented in the literature but there is gross knowledge gap on the impact of HIV/AIDS on the quality of life and psychosocial functioning (PSF) of affected children in Nigeria. We comparatively explored the association of quality of life with PSF and other factors among adolescents in families affected by HIV/AIDS (FAHA) and in families not affected by HIV/AIDS (FNAHA). Data were extracted for 960 adolescents from a State wide cross-sectional study in which participants were selected through multistage sampling techniques. Data were collected using question naires consisting of demographic information, adapted World Health Organization Quality of Life-BREF and the strength & difficulty questionnaire (SDQ). The quality of life scores were categorized into poor, moderate, and high based on the amount of standard deviation away from the mean while the SDQ scores were categorized into normal, borderline, and abnormal based on the SDQ scoring systems. The chi-square test and the independent t-test were used for bivariate analyses while the logistic regression was used for multivariate analyses at the 5% level of significance. The proportion with poor quality of life (27.0%) was significantly higher among adolescents in FAHA than in FNAHA (p = 0.0001). Adolescents in FAHA (OR:2.32; 95%CI: 1.67—4.09) were twice more likely to have poor quality of life than those in FNAHA. In FAHA, adolescents on the borderline of PSF (OR:2.19; 95%CI: 1.23-3.89) were twice more likely to have poor quality of life than those with normal PSF. Adolescents in FAHA have poor quality of life than those in FNAHA and also face additional burden of psychosocial dysfunctions. Interventions focusing on functional social support and economic empowerment will benefit adolescents in FAHA in the studied location.Item Carotid IMT is more associated with stroke than risk calculators(John Wiley & Sons Ltd., 2015) Owolabi, M. O.; Akpa, O. M.; Agunloye, A. M.Background – It is unclear whether a natural marker of atherosclerosis (carotid intima-media thickness: CIMT) or calculated risk score is more associated with stroke. We therefore comparatively examined the relationship between CIMT as well as two cardiovascular risk calculators (Omnibus Risk Score -ORS and Framingham Risk Score- FRS) and the occurrence of stroke among hypertensive African patients. Methods – CIMT was measured in 555 consecutive consenting hypertensive adults (377 stroke patients and 178 strokefree subjects). The 10-year cardiovascular risk was calculated for each participant with the FRS and ORS. The strengths of association between FRS, ORS, CIMT, and stroke occurrence were examined using logistic regression. The discriminative capacity of FRS, ORS, and CIMT for stroke occurrence was assessed with c-statistics. Results – Higher average CIMT (OR 11.71; 95% CI 1.65–83.07; P = 0.01) was strongly associated with stroke after adjusting for age, sex, blood pressure, serum cholesterol, and blood sugar. Neither the FRS (OR: 1.03; CI: 0.89–1.19, P = 0.68) nor the ORS (OR: 1.08; CI: 0.90–1.30; P = 0.41) was significantly associated with stroke. CIMT had a higher c-statistic for differentiating stroke patients from hypertensive controls (right: c = 0.63, P < 0.001; left: c = 0.67, P < 0.001; average: c = 0.66, P < 0.001) than some conventional risk factors. Neither FRS (P = 0.39) nor ORS (P = 0.55) was able to independently differentiate between stroke and hypertensive patients. Conclusion – CIMT, but neither FRS nor ORS, is independently associated with stroke among Nigerian African hypertensive patients. CIMT may be a better tool for estimating the overall risk of stroke than FRS or ORS in this population.Item Sociodemographic factors related to quality of life among premenopausal women in Ibadan, Nigeria(Taylor & Francis Group, LLC, 2015) Okekunle A. P.; Akpa, O. M.; Akinyele, I. O.Quality of life (QoL) of premenopausal women (PW) was assessed using primary data collected between September and December 2011. A 26-item questionnaire (WHO-QoL BREF) was administered to 285 apparently healthy women selected from two local government areas in Ibadan. The scores were categorized into poor (≤79.53) and good (>79.53) QoL. Multiple logistic regressions were used to study factors associated with QoL. The mean score for the overall QoL (OQoL) was 65.18 ± 11.35 (range = 81.25). The Cronbach’s alpha for all domains as well as the OQoL were within an acceptable range. The proportion of women with good OQoL was significantly higher in the urban areas (18.2 percent) than in the rural areas (9.2 percent) (p < .05). The proportion of respondents with good OQoL was significantly higher for women aged < .01). Teenage participants were almost ten times as likely to have a good social relationship than participants above 35 years of age (odds ratio: 9.52; 95% confidence interval: 1.83–49.40). The authors’ results Received June 29, 2013; revised August 18, 2014; accepted August 28, 2014. Address correspondence to Akinkunmi Paul Okekunle, BSc, MPH, Department of Human Nutrition, Faculty of Public Health, College of Medicine, University of Ibadan, 900001 Ibadan, Oyo State, Nigeria. E-mail: akinokekunle@gmail.com 646 Downloaded by [Texas A & M International University] at 03:05 06 November 2015 Sociodemographic Factors Related to Quality of Life 647 suggest that the WHO-QoL BREF is a reliable instrument for measuring QoL among PW in Nigeria. Younger PW and women in the urban areas were more likely to have good QoL.Item Sociodemographic factors related to quality of life among premenopausal women in Ibadan, Nigeria(Taylor & Francis Group, LLC, 2015) Okekunle A. P.; Akpa, O. M.; Akinyele, I. O.Quality of life (QoL) of premenopausal women (PW) was assessed using primary data collected between September and December 2011. A 26-item questionnaire (WHO-QoL BREF) was administered to 285 apparently healthy women selected from two local government areas in Ibadan. The scores were categorized into poor (≤79.53) and good (>79.53) QoL. Multiple logistic regressions were used to study factors associated with QoL. The mean score for the overall QoL (OQoL) was 65.18 ± 11.35 (range = 81.25). The Cronbach’s alpha for all domains as well as the OQoL were within an acceptable range. The proportion of women with good OQoL was significantly higher in the urban areas (18.2 percent) than in the rural areas (9.2 percent) (p < .05). The proportion of respondents with good OQoL was significantly higher for women aged < .01). Teenage participants were almost ten times as likely to have a good social relationship than participants above 35 years of age (odds ratio: 9.52; 95% confidence interval: 1.83–49.40). The authors’ results Received June 29, 2013; revised August 18, 2014; accepted August 28, 2014. Address correspondence to Akinkunmi Paul Okekunle, BSc, MPH, Department of Human Nutrition, Faculty of Public Health, College of Medicine, University of Ibadan, 900001 Ibadan, Oyo State, Nigeria. E-mail: akinokekunle@gmail.com 646 Downloaded by [Texas A & M International University] at 03:05 06 November 2015 Sociodemographic Factors Related to Quality of Life 647 suggest that the WHO-QoL BREF is a reliable instrument for measuring QoL among PW in Nigeria. Younger PW and women in the urban areas were more likely to have good QoL.