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Ramoni, R, R Asher S, White J, Vaderhobli R, Ogunbodede E, Walji M, Riedy C, Kalenderian E.  2016.  Honoring Dental Patients' Privacy Rule Right of Access in the Context of Electronic Health Records, 2016/06/01. Journal of dental education. 80:691-696. Abstract

A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

Conference Paper
Odediran, S, Windapo A, Ojo G, A. M.  2015.  ICT Knowledge Diffusion in the Nigerian Quantity Surveying Education, 07. Abstract
Journal Article
Nwhator, SO, Winfunke-Savage K, Ayanbadejo PO, O Jeboda S.  Submitted.  Smokers’ melanosis in a Nigerian population: a preliminary study. Journal of Contemporary Dental Practice. 8:68–75., Number 5 Abstract
Liu, Q, Atere CT, Shahbaz M, Wei X, Pausch J, Wu J, Ge T.  2022.  Vertical and horizontal shifts in soil microbial biomass and community composition based on long-term fertilization regimes in paddy soil profiles. Applied Soil Ecology. 169:104248
Sarfo, F, Akpa O, Ovbiagele B, Akpalu A, Wahab K, Komolafe M, Obiako R, Owolabi L, Osaigbovo G, Jenkins C, Ogbole G, Fakunle A, Tiwari H, Arulogun O, Arnett D, Asowata O, Ogah O, Akinyemi R, Owolabi M.  2021.  Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa, 2021/07/01. 428:117573. Abstract
Wuraola, F, Famurewa B, Olasehinde O, Odujoko O, Adesina O, Aregbesola S.  2021.  From the breast to the upper jaw: A rare case of metastatic breast cancer, 2021/05/11. 14:60-63. Abstract

Breast cancer is the commonest malignancy in women globally. Metastasesof advanced breast carcinoma to bones, lungs and liver are well known but
spread to maxillary bone presenting as maxillary sinus and palatal swelling is
rare. We present a case of advanced breast carcinoma in a female Nigerian with
clinical, radiological and histopathological features of lung and right maxillary
bone metastases. To the best of our knowledge, this is the first reported case of
metastatic breast cancer to the lungs and maxilla in Nigeria. The debilitating
sequelae of advanced untreated breast carcinoma in a resource limited setting
with suboptimal comprehensive cancer care are highlighted.

Jimoh, M, Okunlola G, Wahab A, Oseni OM, Rufai A.  2021.  Proximate and mineral analysis and antinutrient and antimicrobial properties of Talinum triangulare (Talinaceae) and Celosia argentea (Amaranthaceae), 2021/01/22. 26:449-455. Abstract

Talinum triangulare and Celosia argentea are two common underutilized leafy vegetables in Nigeria. This work was carried out to determine the mineral, proximate, and antinutritional contents of the plants, which were estimated by standard methods. Antibacterial activity of the leaf aqueous and ethanolic extracts was also evaluated against some bacteria. Results obtained from the study have shown that the two plants had constituents that show them as a good source of nutritional and medicinal benefits.

Akpa, OM, Okekunle AP, Ovbiagele B, Sarfo FS, Akinyemi RO, Akpalu A, Wahab KW, Komolafe M, Obiako R, Owolabi LF, Ogbole G, Fawale B, Fakunle A, Asaleye CM, Akisanya CO, Hamisu DA, Ogunjimi L, Adeoye A, Ogah O, Lackland D, Uvere EO, Faniyan MM, Asowata OJ, Adeleye O, Aridegbe M, Olunuga T, Yahaya IS, Olaleye A, Calys-Tagoe B, Owolabi MO.  2021.  Factors associated with hypertension among stroke-free indigenous Africans: Findings from the SIREN study, 2021. Journal of Clinical Hypertension. 23(4) Abstract

Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hypertension among community-dwelling stroke-free population in Ghana and Nigeria. Data for 4267 community-dwelling stroke-free controls subjects in the Stroke Investigative Research and Education Network (SIREN) study in Nigeria and Ghana were used. Participants were comprehensively assessed for sociodemographic, lifestyle and metabolic factors using standard methods. Hypertension was defined as a previous diagnosis by a health professional or use of an anti-hypertensive drug or mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Logistic regression analysis was used to estimate adjusted odds ratios (aOR) of hypertension and their 95% confidence intervals (CI) at p <.05. Overall, 56.7% of the participants were hypertensive with a higher proportion among respondents aged ≥60 years (53.0%). Factors including physical inactivity (aOR: 9.09; 95% CI: 4.03 to 20.53, p <.0001), diabetes (aOR: 2.70; CI: 1.91 to 3.82, p <.0001), being ≥60 years (aOR: 2.22; 95% CI: 1.78 to 2.77, p <.0001), and family history of CVD (aOR 2.02; CI: 1.59 to 2.56, p <.0001) were associated with increased aOR of hypertension. Lifestyle factors were associated with hypertension in the current population of community-dwelling stroke-free controls in west Africa. Community-oriented interventions to address sedentary lifestyles may benefit this population and reduce/prevent hypertension and stroke among them.

Sarfo, FS, Akpa O, Ovbiagele B, Akpalu A, Wahab K, Komolafe M, Obiako R, Owolabi L, Osaigbovo GO, Jenkins C, Ogbole G, Fakunle A, Tiwari HK, Arulogun O, Arnett DK, Asowata O, Ogah O, Akinyemi RO, Owolabi MO.  2021.  Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa, 2021. Journal of the Neurological Sciences. 428 Abstract

Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50–65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82–71.58) and 4.13 (2.64–6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82–96.80) and aOR of 28.93 (15.10–55.44) was highest among the middle-age group. Diabetes with PAR of 32.29%(27.52–37.05) and aOR of 3.49 (2.56–4.75); meat consumption with PAR of 42.34%(32.33–52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02–21.60) and aOR of 2.23 (1.60–3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusion There is a differential influence of age on the associations of major risk factors with stroke in this West African cohort. Targeting modifiable factors predominant within an age group may be more effective as a stroke prevention strategy.

Akpa, O, Sarfo FS, Owolabi M, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Ogbole G, Tiwari HK, Jenkins C, Fakunle AG, Olowookere S, Uvere EO, Akinyemi J, Arulogun O, Akpalu J, Tito-Ilori MM, Asowata OJ, Ibinaiye P, Akisanya C, Oyinloye OI, Appiah L, Sunmonu T, Olowoyo P, Agunloye AM, Adeoye AM, Yaria J, Lackland DT, Arnett D, Laryea RY, Adigun TO, Okekunle AP, Calys-Tagoe B, Ogah OS, Ogunronbi M, Obiabo OY, Isah SY, Dambatta HA, Tagge R, Ogenyi O, Fawale B, Melikam CL, Onasanya A, Adeniyi S, Akinyemi R, Ovbiagele B.  2021.  A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study, 2021. Journal of Stroke and Cerebrovascular Diseases. 30(10) Abstract

Background: Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African. Objectives: To develop Afrocentric risk-scoring models for stroke occurrence. Materials and Methods: We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (β) to develop an additive risk scoring system on a scale of 0–100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off. Results: For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74–79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74–81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73–84%). Conclusions: The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.

Watila, MM, Balarabe SA, Komolafe M, Igwe SC, Bimbo Fawale M, van Diessen E, Nyandaiti YW, Singh G, Winkler AS, Sander JW.  2021.  Translation and validation of an epilepsy-screening questionnaire in three Nigerian languages, 2021. Epilepsy and Behavior. 114 Abstract

Objective: We describe the development, translation and validation of epilepsy-screening questionnaires in the three most popular Nigerian languages: Hausa, Igbo and Yoruba. Methods: A 9-item epilepsy-screening questionnaire was developed by modifying previously validated English language questionnaires. Separate multilingual experts forward- and back-translated them to the three target languages. Translations were discussed with fieldworkers and community members for ethnolinguistic acceptability and comprehension. We used an unmatched affected-case versus unaffected-control design for the pilot study. Cases were people with epilepsy attending the tertiary hospitals where these languages are spoken. The controls were relatives of cases or people attending for other medical conditions. An affirmative response to any of the nine questions amounted to a positive screen for epilepsy. Results: We recruited 153 (75 cases and 78 controls) people for the Hausa version, 106 (45 cases and 61 controls) for Igbo and 153 (66 cases and 87 controls) for the Yoruba. The sensitivity and specificity of the questionnaire were: Hausa (97.3% and 88.5%), Igbo (91.1% and 88.5%) and Yoruba (93.9% and 86.7%). The three versions reliably indicated epilepsy with positive predictive values of 85.9% (Hausa), 85.4% (Igbo) and 87.3% (Yoruba) and reliably excluded epilepsy with negative predictive values of 97.1% (Hausa), 93.1% (Igbo) and 95.1% (Yoruba). Positive likelihood ratios were all greater than one. Conclusions: Validated epilepsy screening questionnaires are now available for the three languages to be used for community-based epilepsy survey in Nigeria. The translation and validation process are discussed to facilitate usage and development for other languages in sub-Saharan Africa.

Nepogodiev, D, Baiocchi G, Blanco-Colino R, Wuraola F, Ghosh D, Gujjuri R, Harrison E, Lule H, Kaafarani H, Leventoğlu S, McLean K, Mengesha MG, Faustin N, Outani O, Ots R, Pockney P, Qureshi A, Roslani A, Satoi S, Garcia-moreno F.  2021.  Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study, 06. Anaesthesia. 76:748-758. Abstract
Olasehinde, O, Alatise O, Omisore A, Wuraola F, Odujoko O, Romanoff A, Akinkuolie A, Arowolo O, Adisa A, Knapp G, Famurewa O, Omisile I, Onabanjo E, Constable J, Omoniyi‐Esan G, Adesunkanmi A‐R, Lawal O, Kingham T.  2021.  Contemporary management of breast cancer in Nigeria: Insights from an institutional database, 01. International Journal of Cancer. 148 Abstract
Akpa, O, Okekunle A, Ovbiagele B, Sarfo F, Akinyemi R, Akpalu A, Wahab K, Komolafe M, Obiako R, Owolabi L, Ogbole G, Fawale M, Fakunle A, Asaleye M, Akisanya C, Hamisu D, Ogunjimi L, Adeoye A, Ogah O, the Consortium.  2021.  Factors associated with hypertension among stroke‐free indigenous Africans: Findings from the SIREN study, 01. The Journal of Clinical Hypertension. 23 Abstract
Knapp, GC, Tansley G, Olasehinde O, Wuraola F, Adisa A, Arowolo O, Olawole MO, Romanoff AM, Quan ML, Bouchard-Fortier A, Alatise OI, Kingham PT.  2021.  Geospatial access predicts cancer stage at presentation and outcomes for patients with breast cancer in southwest Nigeria: A population-based study. . Cancer . 127(9):1432-1438.Website
Olasehinde, O, Alatise O, Omisore A, Wuraola F, Odujoko O, Romanoff A, Akinkuolie A, Arowolo O, Adisa A, Knapp G, others.  2021.  Contemporary management of breast cancer in Nigeria: Insights from an institutional database. International Journal of Cancer. 148:2906–2914., Number 12: Wiley Online Library Abstract
Adesunkanmi, AHO, Ubom AE, Olasehinde O, Wuraola FO, Ijarotimi OA, Okon NE, Ikimalo JI, Fasubaa OB, Adesunkanmi ARK.  2021.  Impact of the COVID-19 pandemic on surgical residency training: perspective from a low-middle income country. World Journal of Surgery. 45:10–17., Number 1: Springer Abstract
Wada, OZ, Oloruntoba EO, Adejumo M, Aluko OO.  2020.  {Classification of Sanitation Services and Students' Sanitation Practices among Schools in Lagos, Nigeria}, sep. Environment and Natural Resources Research. 10:55–68., Number 3 AbstractWebsite

The paucity of information on the number of accessible sanitation facilities in secondary schools in developing countries has hindered efforts in attaining sustainable development in this area. Therefore, this study was designed to bridge that gap. The cross-sectional study utilized a 4-stage sampling technique to select 386 students from schools in Badagry, Lagos. Pre-tested questionnaire and observational checklists were used to obtain data. Data were analyzed using descriptive statistics and logistic regression at 5% level of significance. Respondents’ mean age was 15.8±1.5 years and 55.2% were female. On-site observation revealed that all the schools had improved sanitation facilities, while 37% of the available toilet compartments were inaccessible to the students. Majority (85%) of the facilities provided limited service, while 15% provided basic service. The student to toilet ratio for the public school girls and boys were 3191:1 and 642:1 respectively, while the private school had a ratio of 257:1 and 289:1 for girls and boys respectively. Some of the sanitation practices observed in the schools were open defecation (35.4%), toilet avoidance (21%), and prolonged urine and feacal retention (57.4%). Students from the public school were about 3 times more likely to practice open defecation (OR=2.87; CI=1.160-7.095). Also, male students were more likely to practice open defecation (OR=1.72; CI=1.125-2.615). All the schools did not meet the school sanitation standard of 1 toilet to 30 boys/girls set by the Federal Government of Nigeria. Sustainable sanitation-interventions and maintenance schemes are required to safeguard the health of the students and the community at large.

Maduabuchi, IR, Patrick OK, Wilson EO.  2020.  Relationship Marketing Practices in Community Pharmacies in Nigeria, nov. Malaysian Journal of Pharmaceutical Sciences. 18:33–45., Number 2: Penerbit Universiti Sains Malaysia AbstractWebsite
Wang, H, Abbas K, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abolhassani H, Guimarães Abreu L, Abrigo M, Abushouk A, Adabi M, Adair T, Adebayo O, Isaac A, Adekanmbi V, Adeoye A, Adetokunboh O, Advani S.  2020.  Global age-sex-specific fertility,mortality,healthy life expectancy (HALE) and population estimates in 204 countries and territories 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019, 2020/10/17. 396:1160-1203. Abstract
Gomez, F, Folayan M, Betancourt M, Kumar G, Wolf T, Priv-Doz M, Fontana M, Campus G.  2020.  Global Impact of COVID -19 on Service Delivery and Vulnerable Populations' Access to Dental Care, 2020/10/01. 48:39-48. Abstract
Wiens, K, Lindstedt P, Blacker B, Johnson K, Baumann M, Schaeffer L, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I, Abegaz K, Abejie A, Guimarães Abreu L, Abrigo M, Abualhasan A, Accrombessi M, Acharya D, Adabi M, Adamu A.  2020.  Mapping geographic inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17, 2020/07/22. 8:e1038-1060. Abstract
Sarfo, FS, Ovbiagele B, Matthew OA, Akpalu A, Wahab K, Obiako R, Owolabi L, Asowata O, Ogbole G, Komolafe M, Akinyemi R, Owolabi M.  2020.  Antecedent febrile illness and occurrence of stroke in West Africa: The SIREN study, 2020. Journal of the Neurological Sciences. 418 Abstract

Background: Acute infections have been posited as potential precipitants or triggers of the occurrence of stroke among adults with traditional vascular risk factors. We evaluated associations between stroke occurrence and reported febrile illness within 4 weeks (potential antecedent infections) among West Africans. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with radiologically confirmed strokes. Controls were stroke-free adults matched with cased by age, gender and ethnicity. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. Participants were asked for evidence of any febrile illness within the past 4 weeks. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. Results: Among 3588 stroke cases recruited in Ghana and Nigeria between August 2014 and July 2018, 363 cases (10.1%) reported having a febrile illness within the 4 weeks prior to stroke occurrence. Having an antecedent infection was associated with stroke occurrence with an unadjusted OR of 1.19 (1.00–1.51) but aOR of 0.83 (0.59–1.17) upon adjusting for traditional vascular risk factors. Stress, aOR of 4.69 (2.59–8.50) and consumption of green vegetables 2.27 (1.35–2.85) were associated with antecedent febrile illness. Conclusion: 1 in 10 stroke cases reported antecedent history of febrile illness prior to occurrence of stroke but no independent association was observed in this study. Infectious exposures may be important triggers of cardiovascular events requiring further exploratory studies to better understand the role of this emerging risk factor.

Ojo, OO, Abubakar SA, Iwuozo EU, Nwazor EO, Ekenze OS, Farombi TH, Akinyemi RO, Williams UE, Bello AH, Wahab KW, Iyagba AM, Arigbodi O, Erameh CO, Komolafe MA, Fawale MB, Onwuegbuzie GA, Obiabo YO, Taiwo FT, Agu CE, Ekeh BC, Osaigbovo GO, Achoru CO, Arabambi B, Adeniji O, Nwani PO, Nwosu CM, Ademiluyi BA, Oyakhire SI, Nyandaiti Y, Rabiu M, Chapp-Jumbo EN, Balarabe SA, Otubogun FM, Obehighe EE, Kehinde AJ, Ani-Osheku I, Imarhiagbe FA, Dike FO, Adebowale AA, Agabi OP, Akpekpe JE, Ali MW, Odeniyi OA, Odiase FE, Abiodun OV, Olowoyo P, Osemwegie N, Oshinaike OO, Owolabi LF, Zubair YA, Rizig M, Okubadejo NU.  2020.  The Nigeria Parkinson Disease Registry: Process, Profile, and Prospects of a Collaborative Project, 2020. Movement Disorders. 35(8) Abstract

Background: Clinical disease registries are useful for quality improvement in care, benchmarking standards, and facilitating research. Collaborative networks established thence can enhance national and international studies by generating more robust samples and credible data and promote knowledge sharing and capacity building. This report describes the methodology, baseline data, and prospects of the Nigeria Parkinson Disease Registry. Methods: This national registry was established in November 2016. Ethics approval was obtained for all sites. Basic anonymized data for consecutive cases fulfilling the United Kingdom Parkinson's Disease Brain Bank criteria (except the exclusion criterion of affected family members) are registered by participating neurologists via a secure registry website ( using a minimal common data capture format. Results: The registry had captured 578 participants from 5 of 6 geopolitical zones in Nigeria by July 2019 (72.5% men). Mean age at onset was 60.3 ± 10.7 years; median disease duration (interquartile range) was 36 months (18–60.5 months). Young-onset disease (<50 years) represented 15.2%. A family history was documented in 4.5% and 7.8% with age at onset <50 and ≥ 50, respectively. The most frequent initial symptom was tremor (45.3%). At inclusion, 93.4% were on treatment (54.5% on levodopa monotherapy). Per-capita direct cost for the registry was $3.37. Conclusions: This is the first published national Parkinson's disease registry in sub-Saharan Africa. The registry will serve as a platform for development of multipronged evidence-based policies and initiatives to improve quality of care of Parkinson's disease and research engagement in Nigeria. © 2020 International Parkinson and Movement Disorder Society.

Sarfo, FS, Ovbiagele B, Gebregziabher M, Akpa O, Akpalu A, Wahab K, Ogbole G, Akinyemi R, Obiako R, Komolafe M, Owolabi L, Lackland D, Arnett D, Tiwari H, Markus HS, Akinyemi J, Oguntade A, Fawale B, Adeoye A, Olugbo O, Ogunjimi L, Osaigbovo G, Jenkins C, Chukwuonye I, Ajose O, Oyinloye L, Mutiso F, Laryea R, Calys-Tagoe B, Salaam A, Amusa G, Olowookere S, Imoh C, Mande A, Arulogun O, Adekunle F, Appiah L, Balogun O, Singh A, Adeleye O, Ogah O, Makanjuola A, Owusu D, Kolo P, Adebayo O, Agunloye A, Shidali V, Faniyan M, Lakoh S, Diala S, Iheonye H, Efidi C, Sanya E, Sunmonu T, Akintunde A, Owolabi M.  2020.  Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans, 2020. Neurology. 94(10) Abstract

ObjectiveTo characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.MethodsThe Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.ResultsOf 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78-213.72); dyslipidemia, 2.95 (1.84-4.74); meat consumption, 1.55 (1.01-2.38); family history of CVD, 2.22 (1.41-3.50); nonconsumption of green vegetables, 3.61 (2.07-6.31); diabetes mellitus, 2.11 (1.29-3.46); stress, 1.68 (1.03-2.77); and current tobacco use, 14.27 (2.09-97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43-2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00-1.01); presence of midline shift, 1.54 (1.11-2.13); lobar ICH, 1.72 (1.16-2.55); and supratentorial bleeds, 2.17 (1.06-4.46).ConclusionsPopulation-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.