Medicolegal autopsies in North Central Nigeria

Mandong, BM; Manasseh, A N; Ugwu, B T

doi:10.4314/eamj.v83i11.9480

Cited by 29 publications

(61 citation statements)

References 15 publications

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“…On the other hand, while the risk factors for occlusive atherosclerotic syndromes are not fully understood in black Africa [2,72], autopsy data [3,4,[49][50][51][52][53][54][55]consistently show that heart attack, stroke and other occlusive atherosclerotic disorders are less common health consequences of hypertension and type 2 diabetes despite rising cholesterol level in the Nigeria population. This could mean that atherosclerosis in Nigerians with type 2 diabetes and/or hypertension may not be a high risk phenomenon that progressively results in occlusive clinical syndromes requiring additional interventions beyond blood pressure reduction and or diabetes control [11,24,26,[73][74].…”

Section: Disease Mechanisms Of Hypertension/diabetesmentioning

confidence: 99%

“…This can stimulate demand and expand customer base for this indication in the wider population but what is not often mentioned is that the types of stroke and heart conditions that commonly occur in Nigeria are rarely due to occlusive atherosclerosis but almost invariably result from uncontrolled blood pressure in over 90% of cases and this is usually in those with hypertension and or type 2 diabetes [3,4,[49][50][51][52][53][54][55]. At the current price of five naira per tablet per day, this amount can pay for up to five days of antihypertensive therapy with low dose thiazide diuretics which is capable of lowering blood pressure to targets that optimally diminish the risk of untimely deaths and other cardiovascular events particularly in many black people, at least initially [39,90,91].…”

Section: Price-ringing and Cartelmentioning

confidence: 99%

“…In the case of Nigeria, health market, despite some reports [44,45] of more cases of CAD in recent decades, accumulated data [3,4,[46][47][48][49][50][51][52][53][54][55] continue to show that atherosclerotic disorders remain infrequent. Specifically, though diagnostic tests e.g.…”

Section: Introductionmentioning

confidence: 99%

“…This could mean that atherosclerosis in Nigerians with type 2 diabetes and/or hypertension may not be a high risk phenomenon that progressively results in occlusive clinical syndromes requiring additional interventions beyond blood pressure reduction and or diabetes control [11,24,26,[73][74]. This large body of compelling autopsy data [3,4,[49][50][51][52][53][54][55] consistently shows that often less than 10% of people in Nigeria dying from hypertension and or type 2 diabetes had occlusive atherosclerotic diseases as the cause of death and this figure has remained largely the same in the last 40-50 years. This is not to say that stroke, heart diseases and other cardiovascular conditions are uncommon in local clinical practice.…”

Section: Disease Mechanisms Of Hypertension/diabetesmentioning

confidence: 99%

“…Specifically, though diagnostic tests e.g. coronary angiography required to confirm suspected cases may be lacking in many academic hospitals, autopsy data [3,4,[49][50][51][52][53][54][55] consistently show that occlusive atherosclerotic disorders remain an uncommon complication in people dying from type 2 diabetes and hypertension in Nigeria.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Aspirin and Diabetes Care in Nigeria: Treatment or Exploitation?

Eo¹,

Oyejola²

2015

J Clinic Res Bioeth

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Cardiovascular disorders have become leading drivers of untimely deaths almost everywhere. Such deaths are however declining globally due to effective interventions. Low dose aspirin contributes to this reduction when used appropriately through minimization of the risk of coronary heart disease and other occlusive atherosclerotic syndromes that can complicate type 2 diabetes/or hypertension. One local study published in 2004 indicated that aspirin was prescribed for 33% of patients with type 2 diabetes. Since then, aspirin prescription, as part of standard therapy for type 2 diabetes/or hypertension, has risen steadily with some studies reporting this to be 66%-88%; These figures more than double those reported in jurisdictions overseas where occlusive atherosclerotic disorders commonly complicate type 2 diabetes and/or hypertension. Even so, recent transnational data show that cardiovascular deaths linked to type 2 diabetes and or hypertension are not abating in sub-Saharan Africa as in many other regions. This can suggest that interventions in black Africa, if any, maybe less than effective in comparison to areas where health outcomes are improving. Significantly, type 2 diabetes and/or hypertension can behave differently in many black groups within Africa such that occlusive atherosclerotic disorders are less common health consequences even with rising cholesterol levels. In the case of Nigeria, the evidence of cardiovascular health benefits of aspirin, as extensively described in groups overseas, appears hard to find for local cohorts. Indeed what the available data strongly suggest is that effective control of blood pressure is a higher treatment priority for saving Nigerian lives than interventions aimed at retarding the atherosclerotic process. Given these observations, the question ought to be asked whether or not low dose aspirin in type 2 diabetes/hypertension therapies, as locally practiced, is the best way of optimizing limited resources in saving Nigerian lives. This paper examines the evidence.

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