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102. Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression

Author

Ojagbemi, Akin, primary, Akinyemi, Joshua, additional, Wahab, Kolawole, additional, Owolabi, Lukman, additional, Arulogun, Oyedunni, additional, Akpalu, Josephine, additional, Akpalu, Albert, additional, Ogbole, Godwin, additional, Akinsanya, Cynthia, additional, Wasiu, Adeniyi, additional, Tito-Ilori, Moyinoluwa, additional, Adekunle, Fakunle, additional, Lyrea, Ruth, additional, Akpa, Onoja, additional, Akinyemi, Rufus, additional, Sarfo, Fred, additional, Owolabi, Mayowa, additional, and Ovbiagele, Bruce, additional

Published
2020
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103. Natural history of motor symptoms in Parkinson’s disease and the long-duration response to levodopa

Author

Cilia, Roberto, primary, Cereda, Emanuele, additional, Akpalu, Albert, additional, Sarfo, Fred Stephen, additional, Cham, Momodou, additional, Laryea, Ruth, additional, Obese, Vida, additional, Oppon, Kenneth, additional, Del Sorbo, Francesca, additional, Bonvegna, Salvatore, additional, Zecchinelli, Anna Lena, additional, and Pezzoli, Gianni, additional

Published
2020
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104. Unraveling the Risk factors for Spontaneous Intracerebral Hemorrhage and its Severity among West Africans (1564)

Author

Owolabi, Mayowa, primary, Sarfo, Fred, additional, Gebregziabher, Mulugeta, additional, Akpa, Onoja, additional, Akpalu, Albert, additional, Wahab, Kolawole, additional, Ogbole, Godwin, additional, Akinyemi, Rufus, additional, Komolafe, Morenikeji, additional, Obiako, Reginald, additional, Owolabi, Lukman, additional, Lackland, Daniel, additional, Arnett, Donna, additional, Tiwari, Hemant, additional, Markus, Hugh, additional, and Ovbiagele, Bruce, additional

Published
2020
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105. Echocardiographic Abnormalities and Determinants of 1-month Outcome of Stroke Among West Africans in the SIREN Study (1606)

Author

Owolabi, Mayowa, primary, Adeoye, Abiodun, additional, Joshua, Akinyemi, additional, Ogah, Okechukwu, additional, Akinyemi, Rufus, additional, Gebregziabher, Mulugeta, additional, Wahab, Kolawole, additional, Fakunle, Adekunle, additional, Akintunde, Adeseye, additional, Adebayo, Oladimeji, additional, Aje, Akinyemi, additional, Tiwari, Hemant, additional, Arnett, Donna, additional, Agyekum, Francis, additional, Appiah, Lambert, additional, Amusa, Ganiyu, additional, Olunuga, Taiwo, additional, Akpa, Onoja, additional, Sarfo, Fred, additional, Akpalu, Albert, additional, Jenkins, Carolyn, additional, Lackland, Daniel, additional, Owolabi, Lukman, additional, Komolafe, Morenikeji, additional, Faniyan, Mercy, additional, Arulogun, Oyedunni, additional, Obiako, Reginald, additional, and Ovbiagele, Bruce, additional

Published
2020
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106. Conceptual framework for establishing the African Stroke Organization

Author

Akinyemi, Rufus, primary, Sarfo, Fred, additional, Abd-Allah, Foad, additional, Ogun, Yomi, additional, Belo, Mofou, additional, Francis, Patty, additional, Mateus, M Bettencourt, additional, Bateman, Kathleen, additional, Naidoo, Pamela, additional, Charway-Felli, Augustina, additional, Akpalu, Albert, additional, Wahab, Kolawole, additional, Napon, Christian, additional, Arulogun, Oyedunni, additional, Ebenezer, Ad Adams, additional, Ekeng, Gloria, additional, Scola, George, additional, Hamzat, Kolapo, additional, Zimba, Stanley, additional, Ossou-Nguiet, Paul Macaire, additional, Ademokoya, Julius, additional, Adebayo, Philip, additional, Ayele, Biniyam Alemayehu, additional, Vaz, Deise Catamo, additional, Ogbole, Godwin, additional, Barasukan, Patrice, additional, Melifonwu, Rita, additional, Onwuekwe, Ikenna, additional, Belson, Sarah, additional, Damasceno, Albertino, additional, Okubadejo, Njideka, additional, Njamnshi, Alfred K, additional, Ogeng’o, Julius, additional, Walker, Richard W, additional, Diop, Amadou Gallo, additional, Ogunniyi, Adesola, additional, Kalaria, Rajesh, additional, Sandercock, Peter, additional, Davis, Stephen, additional, Brainin, Michael, additional, Ovbiagele, Bruce, additional, and Owolabi, Mayowa, additional

Published
2020
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109. Unraveling the Ethical, Legal, and Social Implications of Neurobiobanking and Stroke Genomic Research in Africa: A Study Protocol of the African Neurobiobank for Precision Stroke Medicine ELSI Project

Author

Akinyemi, Rufus O., primary, Jenkins, Carolyn, additional, Nichols, Michelle, additional, Singh, Arti, additional, Wahab, Kolawole, additional, Akpalu, Albert, additional, Sarfo, Fred S., additional, Owolabi, Lukman F., additional, Obiako, Reginald, additional, Akinyemi, Joshua, additional, Ojebuyi, Babatunde, additional, Adigun, Muyiwa, additional, Musbahu, Rabiu, additional, Bello, Abiodun, additional, Titiloye, Musibau, additional, Calys-Tagoe, Benedict, additional, Ogunronbi, Mayowa, additional, Uvere, Ezinne, additional, Laryea, Ruth, additional, Fakunle, Adekunle, additional, Adeleye, Osi, additional, Olorunsogbon, Olorunyomi, additional, Ojo, Adebayo, additional, Adesina, Deborah, additional, Mensah, Nathaniel, additional, Oguike, Wisdom, additional, Coleman, Nathaniel, additional, Mande, Aliyu, additional, Uthman, Muhammed, additional, Kalaria, Rajesh N., additional, Jegede, Ayodele, additional, Owolabi, Mayowa, additional, Ovbiagele, Bruce, additional, and Arulogun, Oyedunni, additional

Published
2020
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110. Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

Author

Sarfo, Fred S., Ovbiagele, Bruce, Akpa, Onoja, Akpalu, Albert, Wahab, Kolawole, Obiako, Reginald, Komolafe, Morenikeji, Owolabi, Lukman, Ogbole, Godwin, Calys-Tagoe, Benedict, Fakunle, Adekunle, Sanni, Taofeek, Mulugeta, Gebregziabher, Abdul, Salaam, Akintunde, Adeseye A., Olowookere, Samuel, Uvere, Ezinne O., Ibinaiye, Philip, Akinyemi, Joshua, and Uwanuruochi, Kelechukwu

Published
2022
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111. Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression.

Author

Ojagbemi, Akin, Akinyemi, Joshua, Wahab, Kolawole, Owolabi, Lukman, Arulogun, Oyedunni, Akpalu, Josephine, Akpalu, Albert, Ogbole, Godwin, Akinsanya, Cynthia, Wasiu, Adeniyi, Tito-Ilori, Moyinoluwa, Adekunle, Fakunle, Lyrea, Ruth, Akpa, Onoja, Akinyemi, Rufus, Sarfo, Fred, Owolabi, Mayowa, and Ovbiagele, Bruce

Subjects
MENTAL depression, DISEASE risk factors, LOGISTIC regression analysis, EDIBLE greens, STROKE patients
Abstract

Objectives: Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in Africa. Methods: We evaluated information collected as part of the Stroke Investigative Research and Education Network (SIREN) study, a multicentre, case-control study conducted at 15 sites in Ghana and Nigeria. Prestroke depression status was ascertained in stroke survivors using a validated self-report tool, while PSD was assessed using a stroke specific screening tool for depression ("HRQOLISP-E"). Independent associations were investigated using complementary log-log regression and binary logit models. Results: Among 1,977 participants, prestroke depression was found in 141 (7.1%). In multivariate analyses, prestroke depression was significantly associated with tachycardia (OR = 2.22, 95% CI = 1.37-3.56) and low consumption of green leafy vegetables (OR = 1.91, 95% CI = 1.12-3.24). Forty-one (29.1%) of the prestroke depression sub-sample developed PSD. However, prestroke depression was not significantly associated with PSD. Conclusion: The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with depression who have multiple, additional, risks of stroke. [ABSTRACT FROM AUTHOR]

Published
2022
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113. Symbolic legislation and the regulation of stroke biobanking and genomics research in Sub-Saharan Africa.

Author

Adigun, Muyiwa, Ojebuyi, Babatunde Raphael, Akinyemi, Joshua, Wahab, Kolawole, Akpalu, Albert, Sarfo, Fred S., Owolabi, Lukman F., Musbahu, Rabiu, Bello, Abiodun, Obiako, Reginald, Ogunronbi, Mayowa, Singh, Arti, Nichols, Michelle, Jenkins, Carolyn, Jegede, Ayodele, Kalaria, Rajesh, Owolabi, Mayowa, Ovbiagele, Bruce, Arulogun, Oyedunni, and Akinyemi, Rufus

Subjects
BIOBANKS, GENOMICS, ETHICS, STROKE
Abstract

Stroke is a major cause of death in Sub-Saharan Africa (SSA) and genetic factors appear to play a part. This led to the development of stroke bio-banking and genomics research in SSA. Existing stroke studies have focused on causes, incidence rates, fatalities and effects. However, scant attention has been paid to the legal issues about stroke bio-banking and genomics research in the sub-region. Therefore, this article examines how genomics research and stroke bio-banking in SSA can be regulated through legislation. The article reports that there are germane issues to be addressed such as appropriate consent model, commercial use of biological samples, ownership right in biological samples and return of research results but that the position of the law on these issues is not satisfactory because there is no statute directly regulating them while existing regulations in these countries are either absent, outdated, conservative or difficult to navigate. The article, therefore, applies the theory of symbolic legislation and argues for legislative intervention through a positive symbolic approach. It recommends that the statute to be enacted should only address policy issues by way of legal rules without being detailed while the understanding of the rules should be fostered in explanatory notes. The explanatory notes should contain examples borne of decided cases, cases settled out of court and the ethical guidelines prepared by Human Heredity and Health in Africa (H3 Africa). Where they are inadequate, recourse may be had to other ethical guidelines subject to the demands of local circumstances. [ABSTRACT FROM AUTHOR]

Published
2021
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114. Electroencephalographic features of convulsive epilepsy in Africa: A multicentre study of prevalence, pattern and associated factors

Author

Kariuki, Symon M., White, Steven, Chengo, Eddie, Wagner, Ryan G., Ae-Ngibise, Kenneth A., Kakooza-Mwesige, Angelina, Ngugi, Anthony K., Sander, Josemir W., Neville, Brian G., Newton, Charles R., Wagner, Ryan, Twine, Rhian, Connor, Myles, Olivé, F. Xavier Gómez, Collinson, Mark, Kahn, Kathleen, Tollman, Stephen, Masanja, Honratio, Mathew, Alexander, Kakooza, Angelina, Pariyo, George, Peterson, Stefan, Ndyomughenyi, Donald, Odhiambo, Rachael, Chabi, Martin, Bauni, Evasius, Kamuyu, Gathoni, Odera, Victor Mung ala, Mageto, James O., Ae-Ngibise, Ken, Akpalu, Bright, Akpalu, Albert, Agbokey, Francis, Adjei, Patrick, Owusu-Agyei, Seth, Bottomley, Christian, Kleinschmidt, Immo, Doku, Victor C K, Odermatt, Peter, Neville, Brian, Nutman, Thomas, Wilkins, Patricia, and Noh, John

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Adolescent, Clinical Neurology, Electroencephalography, Article, Temporal lobe, Young Adult, 03 medical and health sciences, symbols.namesake, Epilepsy, 0302 clinical medicine, Physiology (medical), Prevalence, medicine, Humans, Active convulsive epilepsy, 030212 general & internal medicine, Poisson regression, Young adult, Child, Seizure frequency, medicine.diagnostic_test, business.industry, Electroencephalographic features, Middle Aged, medicine.disease, Sensory Systems, Confidence interval, 3. Good health, Risk factors, Neurology, Relative risk, Africa, symbols, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Highlights • Electroencephalographic abnormalities are common in Africans with epilepsy, with an adjusted prevalence of 2.7 (95% confidence interval, 2.5–2.9) per 1000 population. • Electroencephalographic abnormalities are associated with preventable factors such as adverse perinatal events and frequent seizures. • Electroencephalography is helpful in identifying focal epilepsy in Africa, where timing of focal aetiologies is problematic and there is a lack of neuroimaging services., Objective We investigated the prevalence and pattern of electroencephalographic (EEG) features of epilepsy and the associated factors in Africans with active convulsive epilepsy (ACE). Methods We characterized electroencephalographic features and determined associated factors in a sample of people with ACE in five African sites. Mixed-effects modified Poisson regression model was used to determine factors associated with abnormal EEGs. Results Recordings were performed on 1426 people of whom 751 (53%) had abnormal EEGs, being an adjusted prevalence of 2.7 (95% confidence interval (95% CI), 2.5–2.9) per 1000. 52% of the abnormal EEG had focal features (75% with temporal lobe involvement). The frequency and pattern of changes differed with site. Abnormal EEGs were associated with adverse perinatal events (risk ratio (RR) = 1.19 (95% CI, 1.07–1.33)), cognitive impairments (RR = 1.50 (95% CI, 1.30–1.73)), use of anti-epileptic drugs (RR = 1.25 (95% CI, 1.05–1.49)), focal seizures (RR = 1.09 (95% CI, 1.00–1.19)) and seizure frequency (RR = 1.18 (95% CI, 1.10–1.26) for daily seizures; RR = 1.22 (95% CI, 1.10–1.35) for weekly seizures and RR = 1.15 (95% CI, 1.03–1.28) for monthly seizures)). Conclusions EEG abnormalities are common in Africans with epilepsy and are associated with preventable risk factors. Significance EEG is helpful in identifying focal epilepsy in Africa, where timing of focal aetiologies is problematic and there is a lack of neuroimaging services.

Published
2016

115. Stroke Among Young West Africans: Evidence from the SIREN Large Multi-site Case-Control Study

Author

Sarfo, Fred Stephen, Ovbiagele, Bruce, Gebregziabher, Mulugeta, Wahab, Kolawole, Akinyemi, Rufus, Akpalu, Albert, Akpa, Onoja, Obiako, Reginald, Owolabi, Lukman, Jenkins, Carolyn, and Owolabi, Mayowa

Subjects
Adult, Male, Heart Diseases, Nigeria, Middle Aged, Intracranial Arteriosclerosis, Ghana, Magnetic Resonance Imaging, Article, Brain Ischemia, Diet, Stroke, Intracranial Embolism, Risk Factors, Case-Control Studies, Cerebral Small Vessel Diseases, Hypertension, Vegetables, Diabetes Mellitus, Humans, Female, Tomography, X-Ray Computed, Intracranial Hemorrhages, Stress, Psychological, Dyslipidemias
Abstract

Stroke in lower and middle-income countries affects a young and productive age group. Data on factors associated with stroke in the young are sorely lacking from lower and middle-income countries. Our objective is to characterize the nature of stroke and its risk factors among young West Africans aged50 years old.The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Nigeria and Ghana. Cases included adults aged ≥18 years with computed tomography/magnetic resonance imaging-confirmed stroke. Controls were age-and gender-matched stroke-free adults recruited from the communities in catchment areas of cases. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed. We used conditional logistic regression to estimate odds ratios and population attributable risks with 95% confidence intervals.Five hundred fifteen (24.3%) out of 2118 cases enrolled were50 years old. Among subjects50 years old, hemorrhagic stroke proportion was 270 (52.5%) versus 245 (47.5%) for ischemic strokes. Etiologic subtypes of ischemic strokes included large artery atherosclerosis (40.0%), small vessel disease (28.6%), cardioembolism (11.0%), and undetermined (20.4%). Hypertension (91.7%), structural lesions (3.4%), and others (4.9%) were causally associated with hemorrhagic stroke. Six topmost modifiable factors associated with stroke in descending order of population attributable risk (95% confidence interval) were hypertension: 88.7% (82.5%-94.8%), dyslipidemia: 48.2% (30.6%-65.9%), diabetes mellitus: 22.6% (18.7%-26.5%), low green vegetable consumption: 18.2% (-6.8%-43.2%), stress: 14.5% (4.9%-24.1%), and cardiac disease: 8.4% (5.8%-11.1%).The high and rising burden of stroke among young Africans should be curtailed via aggressive, population-wide vascular risk factor control.

Published
2018

116. Echocardiographic Abnormalities and Determinants of 1‐Month Outcome of Stroke Among West Africans in the SIREN Study

Author

Adeoye, Abiodun M., primary, Ovbiagele, Bruce, additional, Akinyemi, Joshua O., additional, Ogah, Okechukwu S., additional, Akinyemi, Rufus, additional, Gebregziabher, Mulugeta, additional, Wahab, Kolawole, additional, Fakunle, Adekunle G., additional, Akintunde, Adeseye, additional, Adebayo, Oladimeji, additional, Aje, Akinyemi, additional, Tiwari, Hemant K., additional, Arnett, Donna, additional, Agyekum, Francis, additional, Appiah, Lambert T., additional, Amusa, Ganiyu, additional, Olunuga, Taiwo O., additional, Onoja, Akpa, additional, Sarfo, Fred S., additional, Akpalu, Albert, additional, Jenkins, Carolyn, additional, Lackland, Daniel, additional, Owolabi, Lukman, additional, Komolafe, Morenikeji, additional, Faniyan, Moyinoluwalogo M., additional, Arulogun, Oyedunni, additional, Obiako, Reginald, additional, and Owolabi, Mayowa, additional

Published
2019
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118. The burden of stroke in Africa: a glance at the present and a glimpse into the future

Author

Owolabi, Mayowa O, Arulogun, Oyedunni, Melikam, Sylvia, Adeoye, Abiodun M, Akarolo-Anthony, Sally, Akinyemi, Rufus, Arnett, Donna, Tiwari, Hemant, Gebregziabher, Mulugeta, Jenkins, Carolyn, Lackland, Daniel, Ovbiagele, Bruce, Akpalu, Albert, Sagoe, Kwamena, Stephen Sarfo, Fred, Obiako, Reginald, and Owolabi, Lukman

Subjects
Cost of Illness, Cardiovascular Topics, Incidence, Africa, prevalence, Age Factors, Humans, epidemiology, Quality-Adjusted Life Years, Global Health, stroke, mortality
Abstract

Summary 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.

Published
2015

119. Factors associated with hypertension among stroke‐free indigenous Africans: Findings from the SIREN study.

Author

Akpa, Onoja M., Okekunle, Akinkunmi P., Ovbiagele, Bruce, Sarfo, Fred S., Akinyemi, Rufus O., Akpalu, Albert, Wahab, Kolawole W., Komolafe, Morenikeji, Obiako, Reginald, Owolabi, Lukman F., Ogbole, Godwin, Fawale, Bimbo, Fakunle, Adekunle, Asaleye, Christianah M., Akisanya, Cynthia O., Hamisu, Dambatta A., Ogunjimi, Luqman, Adeoye, Abiodun, Ogah, Okechukwu, and Lackland, Dan

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. [ABSTRACT FROM AUTHOR]

Published
2021
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121. Conceptual framework for establishing the African Stroke Organization.

Author

Akinyemi, Rufus, Sarfo, Fred, Abd-Allah, Foad, Ogun, Yomi, Belo, Mofou, Francis, Patty, Mateus, M Bettencourt, Bateman, Kathleen, Naidoo, Pamela, Charway-Felli, Augustina, Akpalu, Albert, Wahab, Kolawole, Napon, Christian, Arulogun, Oyedunni, Ebenezer, Ad Adams, Ekeng, Gloria, Scola, George, Hamzat, Kolapo, Zimba, Stanley, and Ossou-Nguiet, Paul Macaire

Subjects
STROKE, UBUNTU (Philosophy), AFRICAN philosophy, CAPACITY building, TEAMS in the workplace
Abstract

Africa is the world's most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu "I am because we are, " the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa. [ABSTRACT FROM AUTHOR]

Published
2021
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122. The Medical System in Ghana

Author

Drislane, Frank W., Akpalu, Albert, and Wegdam, Harry H.J.

Subjects
Education, Medical, parasitic diseases, West Africa, tropical medicine, Humans, Focus: Global Health and Development, Disease, Health Care Costs, medical education, Ghana, Delivery of Health Care
Abstract

Ghana is a developing country in West Africa with a population of about 25 million. Medical illnesses in Ghana overlap with those in developed countries, but infection, trauma, and women's health problems are much more prominent. Medical practice in rural Africa faces extremely limited resources, a multiplicity of languages (hundreds in Ghana), and presentation of severe illnesses at later stages than seen elsewhere. Despite these limitations, Ghana has established a relatively successful national medical insurance system, and the quality of medical practice is high, at least where it is available. Ghana also has a well-established and sophisticated administrative structure for the supervision of medical education and accreditation, but it has proven very difficult to extend medical training to rural areas, where health care facilities are particularly short of personnel. Physicians are sorely needed in rural areas, but there are few because of the working conditions and financial limitations. Hospital wards and clinics are crowded; time per patient is limited. This article details some of the differences between medical practice in Ghana and that in wealthier countries and how it functions with very limited resources. It also introduces the medical education and training system in Ghana. The following article describes an attempt to establish and maintain a residency training program in General Medicine in a rural area of Ghana.

Published
2014

123. Establishment of a General Medicine Residency Training Program in Rural West Africa

Author

Drislane, Frank W., Akpalu, Albert, and Wegdam, Harry H.J.

Subjects
Africa, Western, Education, Medical, Graduate, Hospitals, Rural, education, West Africa, residency training program, Humans, Internship and Residency, Focus: Global Health and Development, general medicine, Rural Health, tropics
Abstract

Ghana, a developing country in West Africa, has major medical burdens in taking care of a large population with limited resources. Its three medical schools produce more than 200 graduates per year, but most emigrate to developed lands after training. Ghana is working to educate and retain locally trained physicians, but it is difficult to get them to work in rural settings where the need is greatest. This article details the establishment of a General Medicine residency at a 150-bed hospital in rural Ghana. Early training comprises 6 months each in Medicine, Surgery, OB/GYN, and Pediatrics; the hospital in Techiman also has a Surgery residency. House officers choose the program for more hands-on experience than they can get in larger centers. They perform many tasks, including surgery, sooner and more independently than do residents in developed countries. The training program includes a morning report, clinical teaching rounds, and rotations on in-patient wards and in the Emergency Department and clinics. Teaching focuses on history, physical examination, good communication, and proper follow-up, with rigorous training in the OR and some clinical research projects pertinent to Ghana. Trainees work hard and learn from one another, from a dedicated faculty, and by evaluating and treating very sick patients. Ghana's rural residencies offer rigorous and attractive training, but it is too soon to tell whether this will help stem the "brain drain" of young physicians out of West Africa.

Published
2014

124. Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action

Author

Jenkins, Carolyn, primary, Ovbiagele, Bruce, additional, Arulogun, Oyedunni, additional, Singh, Arti, additional, Calys-Tagoe, Benedict, additional, Akinyemi, Rufus, additional, Mande, Aliyu, additional, Melikam, Ezinne Sylvia, additional, Akpalu, Albert, additional, Wahab, Kolawole, additional, Sarfo, Fred Stephen, additional, Sanni, Taofeeq, additional, Osaigbovo, Godwin, additional, Tiwari, Hemant K., additional, Obiako, Reginald, additional, Shidali, Vincent, additional, Ibinaiye, Philip, additional, Akpalu, Josephine, additional, Ogbole, Godwin, additional, Owolabi, Lukman, additional, Uvere, Ezinne, additional, Taggae, Raelle, additional, Adeoye, Abiodun Moshood, additional, Gebregziabher, Mulugeta, additional, Akintunde, Adeseye, additional, Adebayo, Oladimeji, additional, Oguntade, Ayodipupo, additional, Bisi, Ayotunde, additional, Ohagwu, Kenneth, additional, Laryea, Ruth, additional, Olowoniyi, Peter, additional, Yahaya, Isah Suleiman, additional, Olowookere, Samuel, additional, Adeyemi, Frederick, additional, Komolafe, Morenikeji, additional, Fawale, Michael Bimbola, additional, Sunmonu, Taofiki, additional, Onyeonoro, Ugochukwu, additional, Imoh, Lucius Chidiebere, additional, Oguike, Wisdom, additional, Olunuga, Taiye, additional, Kolo, Phillip, additional, Ogah, Okechukwu S., additional, Efidi, Richard, additional, Chukwuonye, Ijezie, additional, Bock-Oruma, Andrew, additional, Owusu, Dorcas, additional, Odo, Chidi Joseph, additional, Faniyan, Moyinoluwalogo, additional, Ohnifeman, Osimhiarherhuo Adeleye, additional, Ajose, Olabanji, additional, Ogunjimi, Luqman, additional, Johnson, Shelia, additional, Ganiyu, Amusa, additional, Olowoyo, Paul, additional, Fakunle, Adekunle Gregory, additional, Tolulope, Afolaranmi, additional, Farombi, Temitope, additional, Obiabo, Monica Oghome, additional, and Owolabi, Mayowa, additional

Published
2018
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126. Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study

Author

Akinyemi, Rufus O, primary, Sarfo, Fred S, additional, Akinyemi, Joshua, additional, Singh, Arti, additional, Onoja Akpa, Matthew, additional, Akpalu, Albert, additional, Owolabi, Lukman, additional, Adeoye, Abiodun M., additional, Obiako, Reginald, additional, Wahab, Kolawole, additional, Sanya, Emmanuel, additional, Komolafe, Morenikeji, additional, Ogbole, Godwin, additional, Fawale, Michael, additional, Adebayo, Philip, additional, Osaigbovo, Godwin, additional, Sunmonu, Taofiki, additional, Olowoyo, Paul, additional, Chukwuonye, Innocent, additional, Obiabo, Yahaya, additional, Adeniji, Olaleye, additional, Fakunle, Gregory, additional, Melikam, Ezinne, additional, Saulson, Raelle, additional, Yaria, Joseph, additional, Uwanruochi, Kelechi, additional, Ibinaiye, Phillip, additional, Amusa, Ganiyu Adeniyi, additional, Yahaya, Isah Suleiman, additional, Dambatta, Abdullahi Hamisu, additional, Faniyan, Mercy, additional, Olowoniyi, Peter, additional, Bock-Oruma, Andrew, additional, Joseph, Odo Chidi, additional, Oguntade, Ayodipupo, additional, Kolo, Philip, additional, Laryea, Ruth, additional, Lakoh, Sulaiman, additional, Uvere, Ezinne, additional, Farombi, Temitope, additional, Akpalu, Josephine, additional, Oyinloye, Olalekan, additional, Appiah, Lambert, additional, Calys-Tagoe, Benedict, additional, Shidali, Vincent, additional, Tabari, Nasir Abdulkadir, additional, Adebayo, Oladimeji, additional, Efidi, Richard, additional, Adeleye, Osi, additional, Owusu, Dorcas, additional, Ogunjimi, Luqman, additional, Aridegbe, Olumayowa, additional, Imoh, Chidiebere Lucius, additional, Sanni, Taofeeq, additional, Gebreziabher, Mulugeta, additional, Hemant, Tiwari, additional, Arulogun, Oyedunni, additional, Ogunniyi, Adesola, additional, Jenkins, Carolyn, additional, Owolabi, Mayowa, additional, and Ovbiagele, Bruce, additional

Published
2018
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127. Public private partnership in in-service training of physicians: the millennium development goal 6-partnership for African clinical training (M-PACT) approach

Author

Oleribe, Obinna Ositadimma, primary, Salako, Babatunde Lawal, additional, Akpalu, Albert, additional, Anteyi, Emmanuel, additional, Ka, Mamadou Mourtalla, additional, Deen, Gibrilla, additional, Akande, Temilola, additional, Abellona U, Mei Ran, additional, Lemoine, Maud, additional, McConnochie, Mairi, additional, Foster, Matthew, additional, Walker, Richard, additional, Taylor-Robinson, Simon David, additional, and Jawad, Ali, additional

Published
2018
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128. Prevalence and risk factors for Active Convulsive Epilepsy in Kintampo, Ghana

Author

Ae-Ngibise, Kenneth Ayuurebobi, Akpalu, Bright, Ngugi, Anthony, Akpalu, Albert, Agbokey, Francis, Adjei, Patrick, Punguyire, Damien, Bottomley, Christian, Newton, Charles, and Owusu-Agyei, Seth

Subjects
Active Epilepsy, risk factors, sub-Saharan Africa, Ghana
Abstract

Introduction: Epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region. Methods: We conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana. Results: 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95%CI) 9.5-10.7). In children aged

Published
2016

129. Interleukin–6 ( IL-6 ) rs1800796 and cyclin dependent kinase inhibitor ( CDKN2A/CDKN2B ) rs2383207 are associated with ischemic stroke in indigenous West African Men

Author

Akinyemi, Rufus, primary, Arnett, Donna K., additional, Tiwari, Hemant K., additional, Ovbiagele, Bruce, additional, Sarfo, Fred, additional, Srinivasasainagendra, Vinodh, additional, Irvin, Marguerite Ryan, additional, Adeoye, Abiodun, additional, Perry, Rodney T., additional, Akpalu, Albert, additional, Jenkins, Carolyn, additional, Owolabi, Lukman, additional, Obiako, Reginald, additional, Wahab, Kolawole, additional, Sanya, Emmanuel, additional, Komolafe, Morenikeji, additional, Fawale, Michael, additional, Adebayo, Philip, additional, Osaigbovo, Godwin, additional, Sunmonu, Taofiki, additional, Olowoyo, Paul, additional, Chukwuonye, Innocent, additional, Obiabo, Yahaya, additional, Akpa, Onoja, additional, Melikam, Sylvia, additional, Saulson, Raelle, additional, Kalaria, Raj, additional, Ogunniyi, Adesola, additional, and Owolabi, Mayowa, additional

Published
2017
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131. Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans

Author

Adeoye, Abiodun M., primary, Ogah, Okechukwu S., additional, Ovbiagele, Bruce, additional, Akinyemi, Rufus, additional, Shidali, Vincent, additional, Agyekum, Francis, additional, Aje, Akinyemi, additional, Adebayo, Oladimeji, additional, Akinyemi, Joshua O., additional, Kolo, Philip, additional, Appiah, Lambert Tetteh, additional, Iheonye, Henry, additional, Kelechukwu, Uwanuruochi, additional, Ganiyu, Amusa, additional, Olunuga, Taiwo O., additional, Akpa, Onoja, additional, Olagoke, Ojo Olakanmi, additional, Sarfo, Fred Stephen, additional, Wahab, Kolawole, additional, Olowookere, Samuel, additional, Fakunle, Adekunle, additional, Akpalu, Albert, additional, Adebayo, Philip B., additional, Nkromah, Kwadwo, additional, Yaria, Joseph, additional, Ibinaiye, Philip, additional, Ogbole, Godwin, additional, Olumayowa, Aridegbe, additional, Lakoh, Sulaiman, additional, Calys-Tagoe, Benedict, additional, Olowoyo, Paul, additional, Innocent, Chukwuonye, additional, Tiwari, Hemant K., additional, Arnett, Donna, additional, Godwin, Osaigbovo, additional, Ayotunde, Bisi, additional, Akpalu, Josephine, additional, Obiora, Okeke, additional, Joseph, Odo, additional, Omisore, Adeleye, additional, Jenkins, Carolyn, additional, Lackland, Daniel, additional, Owolabi, Lukman, additional, Isah, Suleiman, additional, Dambatta, Abdu H., additional, Komolafe, Morenikeji, additional, Bock-Oruma, Andrew, additional, Melikam, Ezinne Sylvia, additional, Imoh, Lucius Chidiebere, additional, Sunmonu, Taofiki, additional, Gebregziabher, Mulugeta, additional, Olabisi, Oluyemisi, additional, Armstrong, Kevin, additional, Onyeonoro, Ugochukwu U., additional, Sanya, Emmanuel, additional, Agunloye, Atinuke M., additional, Ogunjimi, Luqman, additional, Arulogun, Oyedunni, additional, Farombi, Temitope H., additional, Obiabo, Olugbo, additional, Obiako, Reginald, additional, Owolabi, Mayowa, additional, and As part of the HAfrica Consortium, On behalf of the SIREN Team, additional

Published
2017
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132. Exploring Overlaps Between the Genomic and Environmental Determinants of LVH and Stroke: A Multicenter Study in West Africa

Author

Adeoye, Abiodun M., primary, Ovbiagele, Bruce, additional, Kolo, Philip, additional, Appiah, Lambert, additional, Aje, Akinyemi, additional, Adebayo, Oladimeji, additional, Sarfo, Fred, additional, Akinyemi, Joshua, additional, Adekunle, Gregory, additional, Agyekum, Francis, additional, Shidali, Vincent, additional, Ogah, Okechukwu, additional, Lackland, Dan, additional, Gebregziabher, Mulugeta, additional, Arnett, Donna, additional, Tiwari, Hemant K., additional, Akinyemi, Rufus, additional, Olagoke, Ojo Olakanmi, additional, Oguntade, Ayodipupo Sikiru, additional, Olunuga, Taiwo, additional, Uwanruochi, Kelechi, additional, Jenkins, Carolyn, additional, Adadey, Patrick, additional, Iheonye, Henry, additional, Owolabi, Lukman, additional, Obiako, Reginald, additional, Akinjopo, Samuel, additional, Armstrong, Kevin, additional, Akpalu, Albert, additional, Fakunle, Adekunle, additional, Saulson, Raelle, additional, Aridegbe, Mayowa, additional, Olowoyo, Paul, additional, Osaigbovo, Godwin, additional, Akpalu, Josephine, additional, Fawale, Bimbo, additional, Adebayo, Philip, additional, Arulogun, Oyedunni, additional, Ibinaiye, Philip, additional, Agunloye, Atinuke, additional, Ishaq, Naser, additional, Wahab, Kolawole, additional, Akpa, Onoja, additional, Adeleye, Omisore, additional, Bock-Oruma, Andrew, additional, Ogbole, Godwin, additional, Melikam, Sylvia, additional, Yaria, Joseph, additional, Ogunjimi, Luqman, additional, Salaam, Abdul, additional, Sunmonu, Taofiki, additional, Makanjuola, Akintomiwa, additional, Farombi, Temitope, additional, Laryea, Ruth, additional, Uvere, Ezinne, additional, Kehinde, Salaam, additional, Chukwuonye, Innocent, additional, Azuh, Paschal, additional, Komolafe, Morenikeji, additional, Akintunde, Adeseye, additional, Obiabo, Olugbo, additional, Areo, Olusegun, additional, Kehinde, Issa, additional, Amusa, Adeniyi G., additional, Owolabi, Mayowa, additional, and HAfrica Consortium, SIREN Team as part of, additional

Published
2017
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135. Prevalence and risk factors for Active Convulsive Epilepsy in Kintampo, Ghana

Author

Ae-Ngibise, Kenneth Ayuurebobi, Akpalu, Bright, Ngugi, Anthony, Akpalu, Albert, Agbokey, Francis, Adjei, Patrick, Punguyire, Damien, Bottomley, Christian, Newton, Charles, and Owusu-Agyei, Seth

Subjects
parasitic diseases
Abstract

INTRODUCTION: Epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region. METHODS: We conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana. RESULTS: 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95% CI) 9.5-10.7). In children aged

Published
2015

136. Incidence, Remission and Mortality of Convulsive Epilepsy in Rural Northeast South Africa

Author

Wagner, Ryan G, Bottomley, Christian, Ngugi, Anthony K, Ibinda, Fredrick, Gómez-Olivé, F Xavier, Kahn, Kathleen, Tollman, Stephen, Newton, Charles R, SEEDS Writing Group, Wagner, Ryan, Twine, Rhian, Connor, Myles, Collinson, Mark, Masanja, Honratio, Mathew, Alexander, Kakooza, Angelina, Pariyo, George, Peterson, Stefan, Ndyo-mughenyi, Donald, Odhiambo, Rachael, Chengo, Eddie, Chabi, Martin, Bauni, Evasius, Kamuyu, Gathoni, Odera, Victor Mung'ala, Mageto, James O, Ae-Ngibise, Ken, Akpalu, Bright, Akpalu, Albert, Agbokey, Francis, Adjei, Patrick, Owusu-Agyei, Seth, Kleinschmidt, Immo, Doku, Victor CK, Odermatt, Peter, Neville, Brian, Sander, Josemir W, White, Steve, Nutman, Thomas, Wilkins, Patricia, and Noh, John

Subjects
Adult, Male, Rural Population, medicine.medical_specialty, Pediatrics, Adolescent, Science, Population, Context (language use), Disease, South Africa, Young Adult, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Risk Factors, Cause of Death, Environmental health, Epidemiology, Humans, Medicine, 030212 general & internal medicine, Mortality, Child, education, education.field_of_study, Multidisciplinary, business.industry, Incidence, Incidence (epidemiology), Mortality rate, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, medicine.disease, 3. Good health, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Cross-Sectional Studies, Population Surveillance, Life expectancy, Female, business, 030217 neurology & neurosurgery, Research Article
Abstract

BackgroundEpilepsy is one of the most common neurological conditions globally, estimated to constitute 0.75% of the global burden of disease, with the majority of this burden found in low- and middle- income countries (LMICs). Few studies from LMICs, including much of sub-Saharan Africa, have described the incidence, remission or mortality rates due to epilepsy, which are needed to quantify the burden and inform policy. This study investigates the epidemiological parameters of convulsive epilepsy within a context of high HIV prevalence and an emerging burden of cardiovascular disease.MethodsA cross-sectional population survey of 82,818 individuals, in the Agincourt Health and Socio-demographic Surveillance Site (HDSS) in rural northeast South Africa was conducted in 2008, from which 296 people were identified with active convulsive epilepsy. A follow-up survey was conducted in 2012. Incidence and mortality rates were estimated, with duration and remission rates calculated using the DISMOD II software package.ResultsThe crude incidence for convulsive epilepsy was 17.4/100,000 per year (95%CI: 13.1-23.0). Remission was 4.6% and 3.9% per year for males and females, respectively. The standardized mortality ratio was 2.6 (95%CI: 1.7-3.5), with 33.3% of deaths directly related to epilepsy. Mortality was higher in men than women (adjusted rate ratio (aRR) 2.6 (95%CI: 1.2-5.4)), and was significantly associated with older ages (50+ years versus those 0-5 years old (RR 4.8 (95%CI: 0.6-36.4)).ConclusionsThe crude incidence was lower whilst mortality rates were similar to other African studies; however, this study found higher mortality amongst older males. Efforts aimed at further understanding what causes epilepsy in older people and developing interventions to reduce prolonged seizures are likely to reduce the overall burden of ACE in rural South Africa.

Published
2015

137. Correction to: African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): novel strategies for accelerating hypertension control in Africa

Author

Owolabi, Mayowa, Olowoyo, Paul, Mocumbi, Ana, Ogah, Okechukwu S., Odili, Augustine, Wahab, Kolawole, Ojji, Dike, Adeoye, Abiodun M., Akinyemi, Rufus, Akpalu, Albert, Obiako, Reginald, Sarfo, Fred S., Bavuma, Charlotte, Beheiry, Hind Mamoun, Ibrahim, Moshen, El Aroussy, Wafaa, Parati, Gianfranco, Dzudie, Anastase, Singh, Sandhya, Akpa, Onoja, Kengne, Andre Pascal, Okekunle, Akinkunmi Paul, de Graft Aikins, Ama, Agyemang, Charles, Ogedegbe, Gbenga, Ovbiagele, Bruce, Garg, Renu, Campbell, Norman R. C., Lackland, Daniel T., Barango, Prebo, Slama, Slim, Varghese, Cherian V., Whelton, Paul K., and Zhang, Xin-Hua

Published
2024
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139. Mucuna pruriens for Parkinson's disease: Low-cost preparation method, laboratory measures and pharmacokinetics profile

Author

Cassani, Erica, primary, Cilia, Roberto, additional, Laguna, Janeth, additional, Barichella, Michela, additional, Contin, Manuela, additional, Cereda, Emanuele, additional, Isaias, Ioannis U., additional, Sparvoli, Francesca, additional, Akpalu, Albert, additional, Budu, Kwabena Ofosu, additional, Scarpa, Maria Teresa, additional, and Pezzoli, Gianni, additional

Published
2016
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140. Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa

Author

Kariuki, Symon M, Matuja, William, Akpalu, Albert, Kakooza-Mwesige, Angelina, Chabi, Martin, Wagner, Ryan G, Connor, Myles, Chengo, Eddie, Ngugi, Anthony K, Odhiambo, Rachael, Bottomley, Christian, White, Steven, Sander, Josemir W, Neville, Brian GR, Newton, Charles RJC, SEEDS writing group, Twine, Rhian, Gómez Olivé, F Xavier, Collinson, Mark, Kahn, Kathleen, Tollman, Stephen, Masanja, Honratio, Mathew, Alexander, Pariyo, George, Peterson, Stefan, Ndyomughenyi, Donald, Bauni, Evasius, Kamuyu, Gathoni, Odera, Victor Mung'ala, Mageto, James O, Ae-Ngibise, Ken, Akpalu, Bright, Agbokey, Francis, Adjei, Patrick, Owusu-Agyei, Seth, Kleinschmidt, Immo, Doku, Victor CK, Odermatt, Peter, Nutman, Thomas, Wilkins, Patricia, and Noh, John

Abstract

PURPOSE: Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences. METHODS: We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to discover risk factors, clinical features, and consequences of epilepsy. We used logistic regression to determine the epilepsy factors associated with medical comorbidities. KEY FINDINGS: Half (51%) of the 2,170 people with ACE were children and 69% of seizures began in childhood. Focal features (EEG, seizure types, and neurologic deficits) were present in 58% of ACE cases, and these varied significantly with site. Status epilepticus occurred in 25% of people with ACE. Only 36% received antiepileptic drugs (phenobarbital was the most common drug [95%]), and the proportion varied significantly with the site. Proximate causes of ACE were adverse perinatal events (11%) for onset of seizures before 18 years; and acute encephalopathy (10%) and head injury prior to seizure onset (3%). Important comorbidities were malnutrition (15%), cognitive impairment (23%), and neurologic deficits (15%). The consequences of ACE were burns (16%), head injuries (postseizure) (1%), lack of education (43%), and being unmarried (67%) or unemployed (57%) in adults, all significantly more common than in those without epilepsy. SIGNIFICANCE: There were significant differences in the comorbidities across sites. Focal features are common in ACE, suggesting identifiable and preventable causes. Malnutrition and cognitive and neurologic deficits are common in people with ACE and should be integrated into the management of epilepsy in this region. Consequences of epilepsy such as burns, lack of education, poor marriage prospects, and unemployment need to be addressed.

Published
2013

141. Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project.

Author

Akinyemi, Rufus O., Akinwande, Kazeem, Diala, Samuel, Adeleye, Osi, Ajose, Abiodun, Issa, Kehinde, Owusu, Dorcas, Boamah, Isaac, Yahaya, Isah Suleiman, Jimoh, Abdulraheem Olayemi, Imoh, Lucius, Fakunle, Gregory, Akpalu, Albert, Sarfo, Fred, Wahab, Kolawole, Sanya, Emmanuel, Owolabi, Lukman, Obiako, Reginald, Osaigbovo, Godwin, and Komolafe, Morenikeji

Abstract

Africa was previously insufficiently represented in the emerging discipline of biobanking despite commendable early efforts. However, with the Human, Heredity, and Health in Africa (H3Africa) initiative, biorepository science has been bolstered, regional biobanks are springing up, and awareness about biobanks is growing on the continent. The Stroke Investigative Research and Educational Network (SIREN) project is a transnational, multicenter, hospital and community-based study involving over 3000 cases and 3000 controls recruited from 16 sites in Ghana and Nigeria. SIREN aims to explore and unravel the genetic and environmental factors that interact to produce the peculiar phenotypic and clinical characteristics of stroke as seen in people of African ancestry and facilitate the development of new diagnostics, therapeutics, and preventative strategies. The aim of this article is to describe our experience with the development of the procedure for collection, processing, storage, and shipment of biological samples (blood, serum, plasma, buffy coat, red cell concentrates, and DNA) and brain imaging across coordinating and participating sites within the SIREN Project. The SIREN network was initiated in 2014 with support and funding from the H3Africa Initiative. The SIREN Biobank currently has 3015 brain images, 92,950 blood fractions (serum, plasma, red cell concentrates, and buffy coat) accrued from 8450 recruited subjects, and quantified and aliquoted good-quality DNA extracts from 6150 study subjects. This represents an invaluable resource for future research with expanding genomic and trans-omic technologies. This will facilitate the involvement of indigenous African samples in cutting-edge stroke genomics and trans-omics research. It is, however, critical to effectively engage African stroke patients and community members who have contributed precious biological materials to the SIREN Biobank to generate appropriate evidence base for dealing with ethical, legal, and social issues of privacy, autonomy, identifiability, biorights, governance issues, and public understanding of stroke biobanking in the context of unique African culture, language, and belief systems. [ABSTRACT FROM AUTHOR]

Published
2018
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145. Are there differences in perceptions, preferences and attitudes towards disclosure of genetic testing for Stroke? A qualitative study among stroke-free SIREN-SIBS genomics study participants.

Author

Arulogun, Oyedunni, Nichols, Michelle, Jenkins, Carolyn, Fakunle, Adekunle Gregory, Akpa, Onoja, Sarfo, Fred S., Akpalu, Albert, Wahab, Kolawole, Obiako, Reginald, Komolafe, Morenikeji, Owolabi, Lukman, Osaigbovo, Godwin O., Okekunle, Akinkunmi Paul, Akinyemi, Joshua, Ogbole, Godwin, Calys-Tagoe, Benedict, Adeleye, Adeniji, Mensah, Yaw, Asowata, Osahon Jeffery, and Adeoye, Abiodun M.

Abstract

This study explored perceptions, preferences and attitudes towards disclosure of genetic testing results for stroke among stroke-free controls (and their family members) in the SIREN-SIBS Genomics Study, healthcare providers and policymakers. We conducted a qualitative thematic analysis of key informant interviews with 61 participants recruited from community advisory boards (30) and health care providers (31) across seven sites in Nigeria and Ghana. Major findings illustrate differences in the knowledge of genetic testing with superior knowledge among health care professionals. Relatives and religious leaders were opined as the best to receive the disclosure as they would be able to break the news to the patient in a culturally sensitive manner to reduce the likely resultant emotional outburst. Poor level of awareness of national guidelines for disclosing genetic results exist. Key facilitating factors for disclosure are education, enabling environment, involvement of religious and community leaders, campaigns, and possible treatment options. Disclosure inhibitors include inadequate information, fear of marital break-up or family displacement, fear of stigmatization, fear of isolation, religious beliefs, health worker attitude, and lack of preparedness to accept results. These necessitate culturally sensitive interventions for continuing education, increased awareness and sustained engagement to equip all stakeholders in genetic testing disclosure process. [ABSTRACT FROM AUTHOR]

Published
2023
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146. Beliefs on epilepsy in Northern Ghana

Author

Adjei, Patrick, primary, Akpalu, Albert, additional, Laryea, Ruth, additional, Nkromah, Kojo, additional, Sottie, Cynthia, additional, Ohene, Sammy, additional, and Osei, Akwasi, additional

Published
2013
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149. Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans.

Author

Sarfo, Fred Stephen, Ovbiagele, Bruce, Akinyemi, Joshua, Akpa, Onoja, Akpalu, Albert, Wahab, Kolawole, Ogbole, Godwin, Obiako, Reginald, Komolafe, Morenikeji, Owolabi, Lukman, Osaigbovo, Godwin, Jenkins, Carolyn, Fakunle, Adekunle, Adeoye, Abiodun, Lackland, Dan, Arnett, Donna, Tiwari, Hemant K., Olunuga, Taiwo, Uvere, Ezinne, and Fawale, Bimbo

Abstract

There are limited data from Africa on the burden and associations between pre-diabetes (pre-DM), diabetes mellitus (DM) and stroke occurrence in a region experiencing a profound rise in stroke burden. To characterize the associations between stroke and dysglycemic status among West Africans. 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 clinical and radiological evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular factors were performed. Pre-diabetes was defined as HBA1c of 5.7%-6.4% or Fasting blood glucose (FBG) 5.6-7.0 mmol/L and DM as HBA1c >6.5% or FBG>7.0 mmol/L. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. Among 2,935 stroke cases the mean age was 60.0 ± 14.2 years with 55.2% being males. By glycemic status, 931 (31.7%) were euglycemic, 633 (21.6%) had Pre-diabetes and 1371 (46.7%) had DM. Of the age- and sex-matched stroke-free controls 69.2% were euglycemic, 13.3% had pre-DM and 17.5% had DM. Pre-DM [aOR (95% CI): 3.68(2.61-5.21)] and DM [4.29 (3.19-5.74)] were independently associated with stroke. The aOR of Pre-DM for ischemic stroke 3.06 (2.01–4.64)] was lower than 4.82 (3.37-6.89) for DM. However, the aOR of Pre-DM for hemorrhagic stroke 6.81 (95% CI: 3.29 – 14.08)] was higher than 3.36 (1.94–5.86) for DM. Furthermore, the aOR of pre-DM for ischemic stroke subtypes were 9.64 (1.30-71.57) for cardio-embolic stroke, 3.64 (1.80–7.34) for small-vessel occlusive disease and 4.63 (0.80-26.65) for large-vessel disease. Pre-DM is strongly and independently associated with stroke in Africans. Improving glycemic control through screening, healthy lifestyle and pharmacotherapy at a population level may be strategic in reducing the rising burden of stroke in Africa. [ABSTRACT FROM AUTHOR]

Published
2022
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150. Phenotyping Stroke in Sub-Saharan Africa: Stroke Investigative Research and Education Network (SIREN) Phenomics Protocol.

Author

akpalu, albert, Sarfo, Fred Stephen, Ovbiagele, Bruce, akinyemi, Rufus, Gebregziabher, Mulugeta, Obiako, Reginald, Owolabi, Lukman, Sagoe, Kwamena, Jenkins, Carolyn, arulogun, Oyedunni, adamu, Sheila, appiah, Lambert T., adadey, Martin a., agyekum, Francis, Quansah, Joseph a., Mensah, Yaw B., adeoye, abiodun M., Singh, arti, Tosin, aridegbe O., and Ohifemen, Osimhiarherhuo

Abstract

Background: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research. Methods: SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patients with first stroke within 10 days of onset in whom neurovascular imaging will be performed. Etiological and topographical stroke subtypes will be documented for all cases. Controls will be hospital- and community-based participants, matched to cases on the basis of gender, ethnicity, and age (±5 years). Information will be collected on known and proposed emerging risk factors for stroke. Study Significance: SIREN is the largest study of stroke in Africa to date. It is anticipated that it will shed light on the phenotypic characteristics and risk factors of stroke and ultimately provide evidence base for strategic interventions to curtail the burgeoning burden of stroke on the sub-continent. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Published
2015
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