No abstract

Background:Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa.Materials and Methods:We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke.Results:Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant.Conclusions:A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke.

Alcohol is consumed in almost all countries worldwide. Heavy drinking can reduce the body’s sensitivity to insulin, which can trigger type 2 diabetes mellitus. Diabetes can complicate chronic pancreatitis, which is overwhelmingly caused by heavy alcohol drinking. Alcohol is also high in calories, with heavy drinkers liable to obesity and a higher risk of type 2 diabetes mellitus. Similarly, cigarette smoking is associated with increased risk of type 2 diabetes mellitus among both middle-aged and elderly men and women. Nigeria is one of the three largest tobacco markets in Africa with a population of almost 13 million smokers. Northeast Nigeria ranks 3rd among the six geopolitical zones, with a smoking rate of 6.1%. In this study, we evaluated the risks of diabetes mellitus associated with alcohol consumption and cigarette smoking in Gombe State, Northeast Nigeria. This cross-sectional survey was conducted in a two-stage cluster sampling scheme based on existing administrative divisions. Study subjects were males and females aged 16 years and older who resided in the Jekadafari Ward of Gombe Metropolis. Subjects were excluded from this study if they were less than 16 years of age, pregnant women or suffered chronic conditions such as chronic kidney disease, chronic liver disease or chronic lung diseases based on clinical history and laboratory results. The calculated sample size was 1600 based on a 3.1% prevalence rate of DM, with a power of 85% and precision of 5%. We obtained complete data on 1302 subjects, of whom 50 (3.8%) had DM. (5.1% in males and 2.86% in females). Alcohol use was prevalent among 365 (28.03%) subjects, and was higher in males (49.4%) compared to females (11.4%). The risk of DM was significantly higher among alcoholusers compared to non-users, with an odds ratio of 4.1 (95%CI: 2.3- 7.3; P=0.0001). Eighty-eight subjects were cigarette smokers, of whom 87 were males and only one was female. We found no significant association between cigarette smoking and DM (OR=0.34, 95%CI 0.05-2.48; P=0.29). The overall prevalence of DM was 3.9%. Alcohol consumption, but not cigarette smoking, was associated with a higher risk of DM in this study.

Bochdalek hernias are extremely rare in adults with only a few cases known worldwide. This is a case of 50-year-old, male who presented at Ear, Nose and Throat clinic of our hospital with symptoms of odynophagia, sore throat, unproductive cough, sneezing, facial fullness and headache. No associated other systemic symptoms. The nasal examination revealed engorged inferior turbinates in the nose bilaterally with septal spur to the left. Chest X-ray done showed a rounded opacity of a soft tissue mass in left middle to lower zone; middle mediastinum adjacent to left lower heart border. Computerised Tomography scan showed a fairly oval hypodense non-enhancing soft mass seen in the left hemithorax with conclusion of part of omentum in the chest due to Bochdalek hernia. He was given treatment for the allergic rhinosinusitis. Due to non-availability of cardiothoracic surgeon in our hospital, the patient was counselled on the problem and danger that may arise and asked to see a cardiothoracic surgeon in the country’s capital city for possible repair of the defect.

Stroke education programs at schools and colleges help to promote public knowledge of stroke, but the impact in Nigeria is not well known. This study assessed stroke-related knowledge and attitudes among university students in Nigeria, where health studies are parts of college curricula. This was a cross-sectional study of students at three universities in Northeast Nigeria. Using questionnaire survey, we assessed biographical data and participant knowledge of the primary site, warning signs and risk factors of stroke. Responses were graded on a knowledge score, where ≥2.5 points indicated adequate knowledge. Data were analyzed with the SPSS version 21 program. We studied 824 participants, 67.1% males. Males were older than females (mean age ± SD: 27.42±5.58 years versus 26.27±5.31 years; P = 0.009; 95% CI: 0.29 – 1.99) and 14.5% participants had stroke lectures during general studies. Major sources of stroke knowledge were personal discussions (44.6%) and internet websites (24.5%). Only 15.7% participants correctly identified the brain as the primary site of stroke, while knowledge of one or more stroke warning signs and risk factors were noted in 42.2% and 49.6%, respectively. Mean knowledge score was 1.08 ± 0.99. Adequate knowledge of stroke was noted in 13.2% participants, and was higher in females (17.7% versus 10.7%; P = 0.01). Logistic regression analysis showed significant associations between adequate knowledge of stroke with female sex (OR 1.8; 95% CI: 1.2 – 2.8; P = 0.008) and a history of stroke in close relatives (OR 1.7; 95% CI: 1.1 – 2.6; P = 0.025) but not with age, academic discipline or stroke lectures. University students in Northeast Nigeria have low knowledge of stroke, which is worse in males. Although health issues are taught at universities, little is taught on stroke, suggesting a need to prioritize stroke knowledge in the university curriculum.