Objective : Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa.
Methods : We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures.
Results : Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown.
Conclusions : While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.

/pdf/the-burden-of-stroke-in-africa-a-glance-at-the-present-and-a-ztymyoqqgz.pdf

The burden of stroke in Africa: a glance at the present and a glimpse into the future.

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.

https://www.hedu-africa.org/uploads/files/Blood_pressure,_prevalence_of_hypertension_and_hypertension.pdf

Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review.

Introduction Cardiovascular diseases (CVDs) are the most common cause of non-communicable disease mortality in sub-Saharan African (SSA) countries. Gaps in knowledge of CVD conditions and their risk factors are important barriers in effective prevention and treatment. Yet, evidence on the awareness and knowledge level of CVD and associated risk factors among populations of SSA is scarce. This review aimed to synthesize available evidence of the level of knowledge of and perceptions towards CVDs and risk factors in the SSA region. Methods Five databases were searched for publications up to December 2016. Narrative synthesis was conducted for knowledge level of CVDs, knowledge of risk factors and clinical signs, factors influencing knowledge of CVDs and source of health information on CVDs. The review was registered with Prospero (CRD42016049165). Results Of 2212 titles and abstracts screened, 45 full-text papers were retrieved and reviewed and 20 were included: eighteen quantitative and two qualitative studies. Levels of knowledge and awareness for CVD and risk factors were generally low, coupled with poor perception. Most studies reported less than half of their study participants having good knowledge of CVDs and/or risk factors. Proportion of participants who were unable to identify a single risk factor and clinical symptom for CVDs ranged from 1.8% in a study among hospital staff in Nigeria to a high of 73% in a population-based survey in Uganda and 7% among University staff in Nigeria to 75.1% in a general population in Uganda respectively. High educational attainment and place of residence had a significant influence on the levels of knowledge for CVDs among SSA populations. Conclusion Low knowledge of CVDs, risk factors and clinical symptoms is strongly associated with the low levels of educational attainment and rural residency in the region. These findings provide useful information for implementers of interventions targeted at the prevention and control of CVDs, and encourages them to incorporate health promotion and awareness campaigns in order to enhance knowledge and awareness of CVDs in the region.

/pdf/knowledge-and-awareness-of-and-perception-towards-2fm7xd8zbl.pdf

Knowledge and awareness of and perception towards cardiovascular disease risk in sub-Saharan Africa: A systematic review.

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.

/pdf/stroke-in-africa-profile-progress-prospects-and-priorities-3dfwon842y.pdf

Stroke in Africa: profile, progress, prospects and priorities.

Background: Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. Objectives: To review the clinical patterns, risk-factors, and outcome of stroke in a tertiary hospital in rural Nigeria and examine the rural-urban variation of stroke hospitalization in Nigeria. Materials and Methods: We carried out a retrospective study of patients who had a clinical diagnosis of stroke at the Federal Medical Centre, Ido-Ekiti, South-western Nigeria between November 2006 and October 2009. Results: A total of 101 patients who had stroke were admitted during this review period, accounting for 4.5% of medical admission and 1.3% of total hospital admission. Women accounted 52.5% of cases, with a male to female ratio of 1 : 1.1. Their mean age was 68 ± 12 years. Stroke occurrences increased with age, as almost half (49.5%) of the cases were aged 70 years and majority (84.2%) of them were in low socioeconomic class. The mean hospital stay for stroke treatment was 12 ± 9 days, Glasgow coma score on admission was 11 ± 4. Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; and indeterminate, 1.0%. Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking (22.8%) were the common identifi able risk factors for stroke. Of all the patients, 69% had 2 risk factors for stroke. Thirty-day case fatality was 23.8%; it increases with age and was higher among men than women (29.2 vs 18.9%) and in patients with diagnosis of hemorrhagic stroke (34.3 vs 18.5%). The numbers of identifi able risk factors of stroke has no effect on the 30-day case fatality. When compared with stroke in urban areas of Nigeria, we found no differences in frequency of hospitalization (1.3 vs 0.9 – 4%) and the major risk factor (hypertension). Hemorrhagic stroke was more common in urban than in the rural community (45.2 – 51 vs 34.7%) and the 30-day case fatality was lower in the rural community (23.8 vs 37.6 – 41.2%). Conclusion: Stroke is also a common neurological condition in rural Nigeria, in view of the fact that almost 70% of the patients had 2 risk factors of stroke. We recommend that, sustainable, community-friendly intervention programmes are incorporated into the health care system for the early prevention, recognition, and modifi cation of the risk factors in persons prone to the disease.

/pdf/a-review-of-stroke-admissions-at-a-tertiary-hospital-in-5fsha45nt5.pdf

A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria

Background : We sought to determine the prevalence of echocardiographically determined left ventricular systolic dysfunction in asymptomatic hypertensive subjects seen in Abeokuta, Nigeria.
Methods : Echocardiography was performed in 832 consecutive hypertensive subjects referred for cardiac evaluation over a three-year period.
Results : Data were obtained in 832 subjects (50.1% women) aged 56.0 ± 12.7 years (men 56.9 ± 13.3 years, women 55.0 ± 12.0 years, range 15-88). The prevalence of left ventricular systolic dysfunction (LVSD) was 18.1% in the study population (mild LVSD = 9.6%, moderate LVSD = 3.7% and severe LVSD = 4.8%). In a multivariate analysis, male gender, body mass index and LV mass were the predictors of LVSD.
Conclusion : Significant numbers of hypertensive subjects in this study had varying degrees of left ventricular systolic dysfunction. Early introduction of disease-modifying drugs in these patients, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers may retard or prevent the progression to overt heart failure.

/pdf/prevalence-of-asymptomatic-left-ventricular-systolic-55d5qyd9k1.pdf

Prevalence of asymptomatic left ventricular systolic dysfunction in hypertensive Nigerians: echocardiographic study of 832 subjects.

Pneumomediastinum otherwise known as mediastinal emphysema refers to the presence of air within the mediastinum while subcutaneous emphysema refers to the presence of air in the subcutaneous tissue and this may involve the face, neck or trunk [1]. The term, pneumomediastinum, was introduced into medical literature by Hamman in 1939[2]. Both conditions are relatively uncommon but important complications of bronchial asthma. The first definitive case of asthma complicated by subcutaneous emphysema was reported in a child in 1850 even though Laennec, as early as 1819, had recognized symptoms and signs of subcutaneous emphysema [3]. Extravasations of air in extra-pulmonary tissues may also manifest as pneumopericardium or pneumothorax and may as well complicate, apart from asthma, perforation or rupture of oesophagus (Boerhaaves syndrome), rupture of trachea or main bronchi, or conditions resulting in raised intrathoracic pressure [valsalva manouvre as in vaginal delivery, weight lifting, vomiting, strenuous exercise], following paraquat intoxication, dental procedures, blunt or penetrating trauma or soft tissue infection. It may also complicate gastrointestinal instrumentation such as endoscopy, colonoscopy and laparoscopic surgery [4].

We present an index case of pneumomediastinum and subcutaneous emphysema complicating an acute exacerbation of asthma in a young male Nigerian in order to sensitize clinicians about the occurrence of this rare complication of bronchial asthma in our environment. The pathophysiologic mechanisms and treatment approach are also reviewed in the light of current literature.

/pdf/pneumomediastinum-and-subcutaneous-emphysema-complicating-47fqosd4dw.pdf

Pneumomediastinum and subcutaneous emphysema complicating acute exacerbation of bronchial asthma.

Background and purpose:  Stroke is a growing public health problem worldwide. Hospital workers are sources of knowledge on health issues including stroke. The present study aimed at assessing the knowledge and perception of a sample of Nigerian hospital workers about stroke.



Methods:  Hospital-based, cross-sectional survey. Respondents selected by systematic random sampling were interviewed using a 29-item pre-tested, structured, semi-closed questionnaire.



Results:  There were 370 respondents (63% female, mean age: 34.4 ± 7.5 years; 61% non-clinical workers). Twenty-nine per cent of respondents did not recognize the brain as the organ affected. Hypertension (88.6%) was the commonest risk factor identified; 13.8% identified evil spirit/witchcraft as a cause of stroke, whilst one-sided body weakness (61.9%) was most commonly identified as warning symptom. Hospital treatment was most preferred by 61.1% of respondents whilst spiritual healing was most preferred by 13.0%. In the bivariate analysis, higher level of education and being a clinical worker correlated with better stroke knowledge (P < 0.001).



Conclusion:  This study demonstrates gaps in the knowledge of these hospital workers about stroke, and treatment choice influenced by cultural and religious beliefs. Health education is still important, even, amongst health workers and stroke awareness campaigns may need to involve faith-based organizations.

Knowledge and perception of stroke amongst hospital workers in an African community

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Prevalence of asymptomatic left ventricular systolic dysfunction in hypertensive Nigerians: echocardiographic study of 832 subjects.

Pneumomediastinum and subcutaneous emphysema complicating acute exacerbation of bronchial asthma.

Knowledge and perception of stroke amongst hospital workers in an African community