FACULTY OF PUBLIC HEALTH
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Item Hypertension Knowledge and Willingness of Government Officials in a Southwestern Nigerian City to Self-Monitor Blood Pressure(SAGE, 2019) Adebanjo , M. A.; Oluwasanu, M. M.; Arulogun, O. S."Self-monitoring of blood pressure (BP) is indispensable for the prevention and management of hypertension. Attitude and willingness to self-monitor BP have not been well investigated in Nigeria. This study investigated hypertension knowledge, attitude, and willingness of government officials in a southwestern Nigerian city to self-monitor BP. The study was a descriptive cross-sectional survey and 280 respondents completed a pretested, semistructured questionnaire. Data were analyzed using descriptive statistics and v2 test. Mean age was 35.7 10.6 years, 57.5% were women and 72.1% had tertiary education. Majority (65.7%) had poor knowledge about hypertension, only 1.8% recognized its symptomless nature. Majority (77.9%) had positive attitude toward being trained to self-monitor BP, while 82.1% were willing to buy self-monitoring devices. Hypertension knowledge was associated with age and marital status (p <.05), while attitude was associated with willingness to self-monitor BP (p <.05). Population-wide, educational interventionsshould be intensified to improve hypertension knowledge and enhance skills to self-monitor BP."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 Differential impact of risk factors on stroke occurrence among men versus women in West Africa The SIREN Study(American Heart Association, Inc., 2019) Akpalu A.; Gebregziabher M.; Ovbiagele B.; Sarfo F.; Iheonye H.; Akinyemi R.; Akpa O.; Tiwari H. K.; Arnett D.; Wahab K.; Lackland D.; Abiodun A.; Ogbole G.; Jenkins C.; Arulogun O.; Akpalu J.; Obiako R.; Olowoyo P.; Fawale M.; Komolafe M.; Osaigbovo G.; Obiabo Y.; Chukwuonye I.; Owolabi L.; Adebayo P.; Sunmonu T.; Owolabi M.Background and Purpose—The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods—SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results—Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for stroke with adjusted odds ratios (95% CI) among females versus males, respectively, were hypertension [29.95 (12.49–71.77) versus 16.1 0(9.19–28.19)], dyslipidemia [2.08 (1.42–3.06) versus 1.83 (1.29–2.59)], diabetes mellitus [3.18 (2.11–4.78) versus 2.19 (1.53–3.15)], stress [2.34 (1.48–3.67) versus 1.61 (1.07–2.43)], and low consumption of green leafy vegetables [2.92 (1.89–4.50) versus 2.00 (1.33–3.00)]. However, salt intake and income were significantly different between males and females. Six modifiable factors had a combined population attributable risk of 99.1% (98.3%–99.6%) among females with 9 factors accounting for 97.2% (94.9%–98.7%) among males. Hemorrhagic stroke was more common among males (36.0%) than among females (27.6%), but stroke was less severe among males than females. Conclusions—Overall, risk factors for stroke occurrence are commonly shared by both sexes in West Africa favoring concerted interventions for stroke prevention in the region.Item 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.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 Can common carotid intima media thickness serve as an indicator of both cardiovascular phenotype and risk among black Africans?(Sage publications, 2014) Owolabi, M. O.; Agunloye, A. M.; Umeh, E. O.; Akpa, O. M.Background: It is not known whether common carotid intima media thickness (CIMT) can serve as a surrogate marker of cardiovascular risk among black Africans. Therefore, we examined whether CIMT differed significantly among individuals with distinct cardiovascular phenotype and correlated significantly with traditional cardiovascular risk factors in a black African population Methods: CIMT was measured in 456 subjects with three distinct cardiovascular phenotypes – 175 consecutive Nigerian African stroke patients, 161 hypertensive patients without stroke and 120 normotensive non-smoking adults. For each pair of cardiovascular phenotypes, c-statistics were obtained for CIMT and traditional vascular risk factors (including age, gender, weight, waist circumference, smoking, alcohol, systolic and diastolic blood pressures, fasting plasma glucose, fasting total cholesterol). Pearson’s correlation coefficients were calculated to quantify bivariate relationships. Findings: Bilaterally, CIMT was significantly different among the three cardiovascular phenotypes (right: p < 0.001, F ¼ 33.8; left: p < 0.001, F ¼ 48.6). CIMT had a higher c-statistic for differentiating stroke versus normotension (c ¼ 0.78 right; 0.82 left, p < 0.001) and hypertension versus normotension (c ¼ 0.65 right; 0.71 left, p < 0.001) than several traditional vascular risk factors. Bilaterally, combining all subjects, CIMT was the only factor that correlated significantly (right: 0.12 r 0.41, 0.018 p < 0.0001; left: 0.18 r 0.41, 0.005 p < 0.0001) to all the traditional cardiovascular risk factors assessed. Conclusion: Our findings support CIMT as a significant indicator of both cardiovascular risk and phenotype among adult black Africans. However, specific thresholds need to be defined based on prospective studies.Item Obesity and hypertension amongst traders in Ijebu Ode, Nigeria(2015-01) Oladoyinbo, C. A.; Ekerette, N. N.; Ogunubi, T. I.Market traders spend most hours of the day sitting down and involved in many other sedentary activities, conditions which increase the risk of chronic diseases. This study was designed to determine the prevalence of obesity and hypertension amongst market men and women in Ijebu- Ode, Nigeria. A cross-sectional study involving 157 (52.3%) males and 143 (47.7%) females was conducted. Body mass index (BMI) was derived from weight and height measurements; waist circumference (WC) measurement was taken to assess abdominal obesity. Blood pressure was measured using a digital sphygmomanometer. The mean(±S.E) age in the study was 39.04(0.658) years, mean(±S.E) BMI, SBP and DBP were 26.36(0.32)kgm-2, 116.64(1.27)mmHg and 79.50(0.86)mmHg respectively. Based on BMI, the prevalence of overweight and obesity were 25.3% and 26.7%. About 52.0% of the respondents had abdominal obesity. Prevalence of both general and abdominal obesity were significantly higher among females than males (p<0.05). The overall prevalence of hypertension was 16.0%. Body Mass Index was significantly related to both systolic and diastolic blood pressure (p<0.05). Obesity and hypertension among market men and women in Ijebu-Ode constitute health issues of public health importance. Sensitization on prevention and control of these disorders is important to protect those in this community from obesity related health challenges.