The epidemiology of stroke in Africa: A systematic review of existing methods and new approaches

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.     

A study of irritable bowel syndrome diagnosed by manning criteria in an African population

Symptoms of irritable bowel syndrome (IBS) using the Manning Criteria were sought by a questionnaire administered to 400 (male-female ratio 3:1) apparently healthy medical students. With a response rate of 84%, 230 (65.5%) reported more than six episodes of abdominal pain in the preceding year (1992–1993). Contrary to expectation, 100 (43.5%) reported symptoms consistent with the diagnosis of IBS. The one-year period prevalence of the syndrome was 30% overall, with prevalence figures of 24% for males and 48% for females (P<0.01). There was no difference in the type of diet (mainly high-fiber diets) consumed by subjects with and without IBS. About two thirds of the subjects with IBS had sought medical advice during the study period; the consultation behavior was influenced by factors such as the presence of other symptoms. This is the first detailed evidence in a random sample of an African population showing symptoms consistent with a diagnosis of IBS to be very common. It casts doubt on the assumption generated by other workers that IBS is rare among native Africans.     

Left Ventricular Geometric Patterns in Normotensive Type 2 Diabetic Patients in Nigeria: An Echocardiographic Study

Left ventricular hypertrophy has been linked with diabetes mellitus and abnormal glucose tolerance in several studies. Most previous studies have been carried out in the western world with dearth of data in native Africans. A total of 122 type 2 diabetic patients with a mean age of 55.0±8.5 years and another 90 normal patients with a mean age of 55.4±8.7 years were recruited for the study. Two-dimensional guided M-mode echocardiography was performed on each patient. In the diabetic patients, 49.2% had normal geometry, 23.0% had concentric hypertrophy, 13.0% had concentric remodeling, and 14.8% had eccentric hypertrophy. In the control group, 72.2% had normal geometry, 4.4% had concentric hypertrophy, 11.2% had concentric remodeling, and 12.2% had eccentric hypertrophy. In a multiple regression analysis, there was significant difference in the geometric pattern of the diabetics and controls (χ²=11.09, P <.001). Diabetes mellitus is independently associated with left ventricular structural changes in Nigerian diabetics.     

The Role of Computed Tomography in the Diagnostic Work‐Up of Headache Patients in Nigeria

Objective.— To determine the yield of computed tomography (CT) scan of the brain in the evaluation of patients presenting with headache at the University of Port Harcourt Teaching Hospital (UPTH). Background.— Headache is a pain in the head or upper neck. It is one of the most common locations of pain in the body that leads patients to see a physician. CT scan is invaluable as an imaging tool in assessment of intracranial lesions that may present with headache. Methods.— The records of all the patients referred from a variety of inpatient and outpatient settings to the radiology department of UPTH with the main complaint of headache for brain (CT) scan were identified. Data extracted include referral source, indication for CT, age, sex, presenting complaint, duration of headache, and CT findings. The data were analyzed using SPSS 14.0 statistical package. Results.— A total of 80 patients with chronic or recurrent headache met the selection criteria. The age range was 16 to 85 years with a mean of 39.8 ± 14.62 years. There were 36 males and 44 females with male to female ratio of 1 : 1.2. About half of the patients were ≤45 years. Of the total number, 72 (90%) patients had normal CT findings, 2 (2.5%) had cerebral atrophy, 2 (2.5%) had cerebral edema, 2 (2.5%) had intracerebral hematoma while 1 (1.25%) patient each had cerebral infarction and subdural hematoma, respectively. There was no case of brain tumor. Conclusions.— The yield of correctable abnormalities from routine CT scan of the brain in headache patients with normal neurologic findings is low and does not justify its use in a resource poor country. (Headache 2010;50:1346‐1352)