To determine the prevalence and relationship between prehypertension and hypertension, we studied 782 ethnic Hausa and Fulanis (men, 409; women, 373) aged 38.9 ± 13.9 years recruited by multistage cluster sampling. Demographic, anthropometry, metabolic and JNC VII-based blood pressure categories were obtained and analysed using univariate and multivariate models. The prevalence rates of prehypertension and hypertension were 58.7% (men 59.2%, women 58.2%) and 24.8% (men 25.9%, women 23.6%), respectively. Only 16.5% of the population had JNC VII defined optimum blood pressure. Compared to hypertension, prehypertension had earlier onset (second versus third decade) and peak (fourth versus fifth decade) of life. The peak and trough prevalence of hypertension and prehypertension, respectively were observed in the 5th decade of life. Obesity, abnormalities of glucose metabolism and insulin resistance were the major factors associated with prehypertension and hypertension. Multivariate analysis identified obesity and impaired glucose tolerance as independent predictors of hypertension. Of those with hypertension, 13.9% were aware of their high blood pressure status of which 85.7% were commenced on treatment and 12.5% achieved blood pressure control. Overall, 1.5% of the study population had blood pressure o140/90 mm Hg. It is concluded that less than 20% of people of Hausa and Fulani ethnicities had optimum blood pressure. These are predominantly in their second decade of life suggesting that rise in blood pressure begins early in this population. The fifth decade of life may represent a period of transition from prehypertension to hypertension.

Background:Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk.Methods:We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC.Results:The optimal WC cut-point was 81.2 cm (95% CI 78.5–83.8 cm) and 81.0 cm (95% CI 79.2–82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63–65) than in men (53%, 95% CI 51–55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4–2.9, for men and 2.2, 95% CI 2.0–2.3, for women).Conclusion:The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.

IntroductionStroke has become a problem of public health importance worldwide. Knowledge and practices related to stroke prevention among hypertensive and diabetic patients are important in the control of the disease. In Nigeria, recent reports indicate an emerging epidemic of stroke. This study aimed to determine the knowledge and practices related to stroke prevention among hypertensive and diabetic patients in Sokoto, Nigeria.MethodsThis was a cross-sectional study among 248 patients attending hypertension and diabetes clinic of Specialist Hospital, Sokoto, Nigeria, selected by systematic sampling technique. A semi-structured questionnaire was used to collect data on the research variables. Data were analyzed using IBM SPSS version 20 statistical package.ResultsThe mean age of respondents was 48.21 ± 15.07 years and they were predominantly females (65.7%). The respondents had good knowledge of stroke (70.3%), organs or parts of body affected by stroke (89.1%), signs or symptoms of stroke (87.0%), stroke risk factors (86.6%) and stroke prevention (90.8%). Formal education was the sole predictor of good knowledge of signs or symptoms of stroke (aOR = 3.99, 95% CI = 1.58-10.13, p = 0.004), stroke risk factors (aOR = 4.24, 95% CI = 1.68-10.67, p = 0.002) and stroke prevention (aOR = 3.45, 95% CI = 1.09-10.93, p = 0.035). Stroke prevention practices were sub-optimal and significantly associated with formal education and being employed.ConclusionThese findings suggest the need for all stakeholders to focus on both patients' education and empowerment in halting the rising burden of stroke across the globe.

Mitra SN, Black RE. Causes of childhood deaths in Bangladesh: an update. Acta Paediatr 2001; 90: 682-690. Stockholm. ISSN 0803-5253Knowledge of the causes of child death is important for health-sector planning since they relate to available interventions. Little is known about causes of child death in Bangladesh from the conventional sources since there is no vital registration system and very few deaths are attended by a quali ed physician. To determine the cause structure of child deaths, verbal autopsy interviews were conducted in the Bangladesh Demographic and Health Survey (BDHS) 1993/94 national sample. Verbal autopsy is a method of nding out the causes of death based on an interview with the next of kin or other caregivers. Between BDHS 1993/94 and BDHS 1996/97, 1-4-y-old child mortality in Bangladesh declined by about 27.0%. This impressive decline prompted a verbal autopsy study using the BDHS 1996/97 national sample to determine whether the cause structure had changed. The same verbal autopsy instrument and methods to collect the data and the same computer algorithm to assign causes of death were used in both surveys. Comparison of BDHS 1993/94 and 1996/97 cause-speci c mortality rates revealed that deaths due to almost all causes had declined, although signi cantly so only for acute respiratory infections (ARI), persistent diarrhoea and drowning. Deaths due to neonatal tetanus, acute watery diarrhoea and undernutrition had not decreased at all. Conclusion:Despite an impressive decline in deaths due to ARI, this condition remains the most important known cause of death in Bangladeshi children. Neonatal tetanus and measles together account for about 10% of deaths in children under 5 y. Further improvements in child survival are possible by improving access to and quality of available child survival interventions.

Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough, while improving the nutritional status of the few who may still be undernourished.

IntroductionOver 80% of stroke deaths occur in low-income and middle-income regions of the world. Identification of predictors of mortality is vital so that prompt therapeutic measures could be instituted to improve outcome. Previous studies have identified factors such as stroke severity, stroke type, older age, impairment of consciousness and hyperglycaemia as predictors of mortality for acute stroke but mortality remain high among patients hospitalized for acute stroke. The study objective was to determine the association between admission serum albumin levels and short-term outcome following acute ischaemic stroke in Nigerians.MethodsConsecutive first-ever acute ischaemic stroke patients were prospectively enrolled between February 2009 and May 2010. Stroke severity at presentation was determined using National Institute of Heath Stroke Score (NIHSS). Admission serum chemistry including albumin, were measured. Patients were then followed up for 30 days and outcome measures applied at the end of the study were 30-day mortality and functional outcome using the Modified Rankin Scale (MRS) and graded as favourable(MRS 0-3) or unfavourable(MRS 4-6). Relationship between serum albumin and stroke outcome was determined.Results75 acute stroke cases were studied. Mean age was 57.68 ± 12.4 years. Outcome was favourable in 48% while 30-day case fatality was 17.3%. The mean age (61.13 years) of those with poor outcome was significantly higher than those with favourable outcome. Mean serum albumin (3.03g/dL) of those with favourable outcome was also significantly higher than (2.08g/dL) of those with unfavourable outcome (p=0.0001). Patients that died had significantly lower serum albumin (1.66g/dl) than survivors (p=0.0001).Receiver operating characteristics curve for optimal cut off point of serum albumin to predict survival or death within 30 days revealed area under the cure (AUC) of 0.870, p-value 0.0001, 95% C/I=0.759-0.982. Serum albumin of 1.55g /dL has sensitivity of 100% and specificity of 61.5%. NIHSS and serum albumin were predictors of poor outcome using multiple regression.ConclusionLow admission serum albumin was an independent determinant of poor outcome.

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IntroductionObesity is a global epidemic. There are rising rates of obesity and its associated disorders, especially in developing countries, including among Health Service Providers (HSPs). Obesity is associated with early retirement, increased morbidity and mortality. Thus, obesity has the potential of reducing long-term retention of HSPs in inadequately staffed health systems of developing countries. This study aimed to determine the magnitude of and factors associated with obesity among HSPs of a tertiary health care facility in Lagos, Nigeria.MethodsA cross sectional study was carried out with a questionnaire, which included the International Physical Activity Questionnaire short form (IPAQ-SF). Obesity was defined as BMI ≥30kg/m2. Statistical significance was set at p < 0.05.Results300 HSPs were recruited, of which 47.7% were medical doctors and dentists, 43.3% were nurses and other categories of HSPs. The mean age and BMI of the HSPs were 39.3(9.0) years and 27.7(4.6) kg/m2 respectively. Eight two (27.3%) HSPs were obese and 134 (44.7%) were overweight, 149(49.7%) had central obesity. After adjusting for confounding variables using multivariate logistic regression, age > 40 years (OR 3.51, p=0.003), female gender (OR 2.84, p=0.007) and earning a monthly salary of ≤ 200,000 naira relative to 201,000-400,000 naira (OR 2.58, p=0.006) were significantly associated with obesity.ConclusionObesity was prevalent among these Nigerian HSPs. This calls for concern, especially with the implication of loosing health workers to obesity related disorders and early retirement.