Prestroke treatment of stroke risk factors: A cross-sectional survey in central Nigeria

Abstract

Background:Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa.Materials and Methods:We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke.Results:Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant.Conclusions:A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke.

Tackling Rising Cases of Stroke and Hypertension Among Young Adults Through Strategic Communication in Nigeria

“…The prevalence of stroke in sub-Sahara Africa, as Alkali et al, (2016) observe, could be attributable to under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation. Pre-hospital procrastination in accessing medical care for acute stroke usually, as Mellon et al, (2014) observe, attracts the unwanted.…”

Exploring the Epidemiology of Atrial Fibrillation in Nigeria: A Focus on Atrial Fibrillation in Heart Failure Patients and Its Association With Stroke

“…Initially, 27 individuals with suspected cardioembolic stroke exhibited unremarkable findings on ECGs. Subsequent evaluation was conducted through 24-hour Holter monitoring, revealing the presence of AF [40]. The SIREN (Stroke Investigative Research and Educational Network) study, initiated in August 2014 as a multicenter case-control investigation across diverse sites in Nigeria and Ghana, provided valuable insights into the association between AF and stroke.…”

Stroke-related knowledge and attitudes among university students in Northeast Nigeria

“…5,6 The public also lacks adequate knowledge of stroke risk factors such as hypertension, diabetes mellitus, obesity, high cholesterol, physical inactivity and cigarette smoking that are potentially reversible with medical treatment and changes in lifestyle. [7][8][9] In a study from Thailand, a third of stroke survivors didn't know a single stroke risk factor, while a Nigerian study found two- thirds of patients with raised cholesterol only knew of their high risks after they experienced stroke. 7,9 In another study from Nigeria and Ghana, hypertension was the only risk factor identified by a majority of stroke survivors, their family members and healthcare staff, most of whom lacked knowledge of stroke risks due to diabetes, obesity, high cholesterol and cigarette smoking.…”

“…[7][8][9] In a study from Thailand, a third of stroke survivors didn't know a single stroke risk factor, while a Nigerian study found two- thirds of patients with raised cholesterol only knew of their high risks after they experienced stroke. 7,9 In another study from Nigeria and Ghana, hypertension was the only risk factor identified by a majority of stroke survivors, their family members and healthcare staff, most of whom lacked knowledge of stroke risks due to diabetes, obesity, high cholesterol and cigarette smoking. 10 Other studies similarly reported poor knowledge of stroke among Nigerians, although a few studies found good knowledge.…”