FACULTY OF PUBLIC HEALTH

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Author: search.filters.author.Ovbiagele B.Subject: search.filters.subject.Stroke

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    Dominant modifiable risk factors for stroke in Ghana and and Nigeria (SIREN): a case-control study
    (Elsevier Ltd., 2018) Owolabi M. O.; Sarfo F. S.; Akinyemi R. O.; Gebregziabher M.; Akpa O.; Akpalu A.; Wahab K.; Obiako R.; Owolabi L.; Ovbiagele B.
    Background Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub Saharan Africa. 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. Findings Between Aug 28, 2014, and June 15, 2017, we enrolled 2118 case-control pairs (1192 [56%] men) with mean ages of 59•0 years (SD 13•8) for cases and 57•8 years (13•7) for controls. 1430 (68%) had ischaemic stoke, 682 (32%) had haemorrhagic stroke, and six x (<1%) had discrete ischaemic and haemorrhagic lesions. 98•2% (95% CI 97•2–99•0) of adjusted PAR of stroke was associated with 11 potentially modifiable risk factors with ORs and PARs in descending order of PAR of 19•36 (95% CI 12•11–30•93) and 90•8% (95% CI 87•9–93•7) for hypertension, 1•85 (1•44–2•38) and 35•8% (25•3–46•2) for dyslipidaemia, 1•59 (1•19–2•13) and 31•1% (13•3–48•9) for regular meat consumption, 1•48 (1•13–1•94) and 26•5% (12•9–40•2) for elevated waist-to-hip ratio, 2•58 (1•98–3•37) and 22•1% (17•8–26•4) for diabetes, 2•43 (1•81–3•26) and 18•2% (14•1–22•3) for low green leafy vegetable consumption, 1•89 (1•40–2•54) and 11•6% (6•6–16•7) for stress, 2•14 (1•34–3•43) and 5•3% (3•3–7•3) for added salt at the table, 1•65 (1•09–2•49) and 4•3% (0•6–7•9) for cardiac disease, 2•13 (1•12–4•05) and 2•4% (0•7–4•1) for physical inactivity, and 4•42 (1•75–11•16) and 2•3% (1•5–3•1) for current cigarette smoking. Ten of these factors were associated with ischaemic stroke and six with haemorrhagic stroke occurrence. Interpretation Implementation of interventions targeting these leading risk factors at the population level should substantially curtail the burden of stroke among Africans.
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    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.