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There are very few studies in Africans investigating the association between early life exposure to malnutrition and subsequent hypertension in adulthood. We set out to investigate this potential association within an adult cohort who were born around the time of the Biafran War (1968-1970) and subsequent famine in Nigeria. This was a retrospective analysis of Abia State Non-Communicable Diseases and Cardiovascular Risk Factors (AS-NCD-CRF) Survey, a community-based, cross-sectional study that profiled 386 adults (47.4% men) of Igbo ethnicity born in the decade between January 1965 and December 1974. Based on their date of birth and the timing of the famine, participants were grouped according to their exposure to famine as children (Child-Fam) or in-utero fetus/infant (Fet-Inf-Fam) or no exposure (No-Fam). Binomial logit regression models were fitted to determine the association between famine exposure and hypertension in adulthood. Overall, 130 participants had hypertension (33.7%). Compared to the No-Fam group (24.4%), the prevalence of hypertension was significantly elevated in both the Child-Fam (43% - adjusted OR 2.47, 95% CI 1.14-5.36) and Fet-Inf-Fam (44.6% - adjusted OR 2.54, 95% CI 1.33-4.86) groups. The risk of hypertension in adulthood was highest among females within the Child-Fam group. However, within the Fet-Inf-Fam group males had a equivalently higher risk than females. These data suggest that early life exposure to famine and malnutrition in Africa is associated with a markedly increased risk of hypertension in adulthood; with sex-based differences evident. Thus, the importance of avoiding armed conflicts and food in-security in the region cannot be overstated. The legacy effects of the Biafran War clearly show the wider need for ongoing programs that support the nutritional needs of African mothers, infants and children as well as proactive surveillance programs for the early signs of hypertension in young Africans.

Background. Lupus nephritis (LN) can be complicated with requirement for kidney replacement therapy and death. Efficacy of induction therapies using mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVCYC) has been reported from studies, but there is limited data in Africans comparing both treatments in patients with proliferative LN. Methods. This was a retrospective study of patients with biopsy-proven proliferative LN diagnosed and treated with either MMF or IVCYC in a single centre in Cape Town, South Africa, over a 5-year period. The primary outcome was attaining complete remission after completion of induction therapy. Results. Of the 84 patients included, mean age was 29.6 ± 10.4 years and there was a female preponderance (88.1%). At baseline, there were significant differences in estimated glomerular filtration rate (eGFR) and presence of glomerular crescents between both groups (p≤0.05). After completion of induction therapy, there was no significant difference in remission status (76.0% versus 87.5%;p=0.33) or relapse status (8.1% versus 10.3%;p=0.22) for the IVCYC and MMF groups, respectively. Mortality rate for the IVCYC group was 5.5 per 10,000 person-days of follow-up compared to 1.5 per 10,000 person-days of follow-up for the MMF group (p=0.11), and there was no significant difference in infection-related adverse events between both groups. Estimated GFR at baseline was the only predictor of death (OR: 1.0 [0.9–1.0];p=0.001). Conclusion. This study shows similar outcomes following induction treatment with MMF or IVCYC in patients with biopsy-proven proliferative LN in South Africa. However, a prospective and randomized study is needed to adequately assess these outcomes.

Rhabdomyolysis, though not a common complication of minor blunt trauma, may result in life-threatening acute kidney injury (AKI). Here is illustrated a case of a young male who sustained minor blunt injuries in a road traffic accident, which he overlooked and presented with features of severe AKI. The patient is a 24-year-old male, who presented with progressive weakness, difficulty in walking, and features of uremia, 14 days after he sustained minor blunt injuries and lacerations in a road traffic accident. Evaluation showed elevated serum creatine kinase, serum myoglobin, and severe azotemia. He was commenced on hemodialysis. He was also commenced on antibiotics, analgesic, and 5% dextrose/saline. He had three sessions of hemodialysis on alternate days. His condition improved remarkably after the first session of dialysis. He was discharged after 18 days on admission. Follow-up in the clinic showed a normal renal function. This case report shows rhabdomyolysis from minor blunt injuries sustained in a road traffic accident and complicated by severe AKI. The patient almost recovered full renal function with management.

Background: Population based studies on diabetes mellitus (DM) are scarce in Nigeria. Introduction: This was a population-based house to house survey aimed at determining the prevalence of DM and assessing the risk factors associated with DM in a state in Southeast Nigeria. Methods: This was a cross-sectional observational study in which 1680 adults were recruited using a multistage sampling method to randomly select not more than two suitable participants of both sex in each household from four enumeration areas (EAs) in each local government area (LGA) and the three senatorial zones in the state. A modified World Health Organization (WHO) Stepwise Approach to Surveillance questionnaire was used for data collection and random blood glucose (RBG) was measured after anthropometric assessment. Test statistics used were chi-square, t-test, and logistic regression. Results: The overall prevalence of DM in this study was 3.3%. A positive family history of DM was significantly higher in patients with diabetes: 18.2% vs. 9.6% (p=0.036). The mean (SD) of weight, body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in patients with DM(p=0.001,35years developing DM was 3.89(1.11-13.60). The OR (95% CI) for waist-hip ratio (WHR) was 3.04 (1.02-9.03) and family history of DM had an OR of 2.62(0.88-6.50). The odd of developing DM is positively associated with age>35years, increased WHR, WC, family history of DM, BMI>25Kg/m2, and HC. The odd of developing DM was negatively associated with smoking. Conclusion: The prevalence of DM in this study was 3.3%. A BMI>25 kg/m2, WHR >0.85, family history of DM, HC, and older age were associated with significantly higher prevalence.

Background and Objectives: All over the world, cardiovascular risks constitute a heavy healthcare burden, affecting people with different levels of education, across economies in both the developed and the developing ones. Differences in educational levels in cardiovascular risks have not been completely defined. This study was set out to evaluate the influence of levels of education on the risks of cardiovascular disease in an urban community in Awka, southeast Nigeria. Methodology: In this cross sectional study of 294 subjects conducted in Awka in 2017, biodata, anthropometric and demographic data were obtained. A questionnaire was used to extract information on smoking, alcohol use, tobacco snuff use, diabetes mellitus status, time spent at work > 10 hours daily and night sleep duration 10 hours daily 29.3%, obesity 33.3%, hypertension 58.5%, night sleep 10 hours daily (p 10 hours daily, hypertension and obesity increased in prevalence with increasing levels of education but declined with tertiary education.

Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91–15.45); dyslipidemia, 5.16 (3.78–7.03); diabetes, 3.44 (2.60–4.56); low green vegetable consumption, 1.89 (1.45–2.46); red meat consumption, 1.89 (1.45–2.46); cardiac disease, 1.88 (1.22–2.90); monthly income $100 or more, 1.72 (1.24–2.39); and psychosocial stress, 1.62 (1.18–2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively ( P Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

Background and Objectives. The prevalence of noncommunicable diseases like chronic kidney disease is on the rise in third-world countries. In Nigeria and most sub-Saharan African countries, there is dearth of community-based studies on prevalence and predictors of chronic kidney disease, prompting us to undertake this study. Materials and Methods. This was a cross-sectional study, aimed at ascertaining the prevalence and predictors of chronic kidney disease (CKD) in a semiurban community in Lagos, Southwest Nigeria. The study’s subjects were recruited from Agbowa community in Ikosi-Ejirin Local Council Development Area of Lagos state. The community was randomly selected. Questionnaires were used to obtain relevant information from the subjects. Body mass index, anthropometric measurements, and other relevant data were also collected. Results. CKD was observed in 30 subjects given prevalence of 7.5% in the community. Nine out of the 30 subjects (30%) with CKD were males, while 21 (70%) subjects were females. The prevalence of CKD was significantly higher in the female population. 28 of the subjects with CKD were in stage 3, while 2 of the subjects with CKD were in stage 4. Age, hypertension, and hyperuricemia were significantly associated with CKD. Using multiple logistic regression analysis, 4 variables predicted CKD in the study population. These were age (P =0.01, OR = 0. 274, CI = 0.102 – 0.739), hypertension (p = 0.011, OR = 0. 320, CI = 0.132 – 0.773), hyperuricemia (p=0.001, OR = 0.195, CI =0.083 – 0.461), and female sex (p = 0.009, OR = 3.775, CI = 1.401 – 10.17). Conclusion. The prevalence of CKD in the population is low compared with other studies from other parts of the country, and the predictors included age, hypertension, hyperuricemia, and female gender. This is the first community-based study in Nigeria to identify hyperuricemia as a risk factor for chronic kidney disease in the country.

Background The aim of this study was to identify and discuss published population-based studies carried out in Nigeria that have information on the prevalence of chronic kidney disease (CKD) and have also used the Kidney Disease Outcomes Quality Initiative (KDOQI) practice guidelines in defining CKD, with emphasis on the performance of three estimating equations for glomerular filtration rate (GFR) - Modification of Diet in Renal Disease (MDRD), Cock-croft-Gault, and CKD epidemiology collaboration (CKD-EPI) creatinine equation. Materials and methods A systematic literature search was carried out in Google, MEDLINE, PubMed, and AJOL database, with the aim of identifying relevant population-based studies with information on the prevalence of CKD in a location in Nigeria. Results Seven cross-sectional population-based studies were identified. Two of the studies used the Cockcroft-Gault and observed a prevalence of 24.4% and 26%. Four of the studies used the MDRD and the prevalences observed were 12.3%, 14.2%, 2.5%, and 13.4%. One of the studies used the CKD-EPI equation and the prevalence was 11.4%. The male to female ratios of CKD prevalence in six studies were 1:1.9, 0.8:1, 1:1.6, 1:2, 1:1.8, 1:1.4, and the observed risk factors in the studies were old age, obesity, diabetes mellitus, hypertension, family history of hypertension, family history of renal disease, low-income occupation, use of traditional medication, low hemoglobin, and abdominal obesity. Conclusion The prevalence of CKD was high but variable in Nigeria, influenced by the equation used to estimate the GFR. MDRD and CKD-EPI results are agreeable. There is a need for more population-based studies, with emphasis on repeating the GFR estimation after 3 months in subjects with GFR

Human immunodeficiency virus (HIV) infection is a common cause of chronic kidney disease (CKD) in Sub-Saharan Africa. This study aims at identifying the prevalence and predictors of CKD in newly diagnosed HIV patients in Owerri, South East Nigeria. This was a cross-sectional study consisting of 393 newly diagnosed HIV-seropositive subjects and 136 age- and sex-matched seronegative subjects as controls. CKD was defined as 24-hour urine protein (24-HUP) ≥0.3 g and/or glomerular filtration rate (GFR) < 60 ml/min. Subjects were recruited from the HIV clinic and the Medical Outpatient Department of Federal Medical Centre, Owerri. Clinical and anthropometric data were collected. Relevant investigations were performed, including HIV screening and relevant urine and blood investigations. The mean age of the HIV subjects was 38.84 ± 10.65 years. CKD was present in 86 (22.9%) HIV subjects and 11 (8.l %) controls. Low waist circumference (WC), high serum creatinine, high spot urine protein/creatinine ratio (SUPCR), high 24-HUP/creatinine Ratio (24-HUPCR), high 24-HUP/osmolality Ratio (24-HUPOR) predicted CKD in HIV subjects. CKD prevalence is high (22.9%) among newly diagnosed HIV patients in South East Nigeria. The predictors of CKD included WC, serum creatinine, SUPCR, 24-HUPCR, and 24-HUPOR.

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.

Chronic kidney disease (CKD) is an increasingly prevalent problem worldwide. Treatment of end-stage kidney disease is beyond the reach of an average Nigerian. The prevention and early detection are imperative to reducing its burden.The aim of this study was to determine the prevalence of CKD and some of its risk factors among adults in a representative semi-urban Nigerian population.A cross-sectional study involving 400 randomly selected adults. Participants were assessed using the WHO stepwise approach. Urinary protein-creatinine ratio (PCR) and estimated glomerular filtration rate (GFR) from serum creatinine, among other parameters, were analysed. A PCR ≥200 mg/g was regarded as significant proteinuria while GFR60 ml/min/1.73 m2 was regarded as reduced GFR. Participants with abnormal PCR and/or reduced GFR were re-evaluated after 3 months to document persistence of these abnormalities. CKD was defined as persistent significant proteinuria and/or reduced GFR for more than 3 months.Data were complete for 328 participants. Persistent significant proteinuria was found in 5.8% while persistently reduced GFR was obtained in 4.6% of participants. Overall, the prevalence of CKD was 7.8%. The prevalence of some established CKD risk factors was old age, 36.3%; hypertension, 36.9%; diabetes mellitus, 7.9%; and family history of kidney disease, 6.4%. The predictors of CKD included old age (adjusted odds ratio = 3.2; confidence interval: 1.10-8.92; P= 0.02), hypertension: 3.5 (1.93-11.90; P= 0.001), family history of kidney disease; 4.5 (3.91-10.23; P= 0.01), generalised obesity 1.3 (1.20-6.21; P= 0.001) and central obesity 3.8 (1.13-12.68; P= 0.003).The prevalence of CKD and some of its risk factors were high. Effective control of the modifiable risk factors identified will assist in reducing the burden of CKD.

Introduction: There is data - driven evidence showing that stroke registries improve tracking, documentation and the quality of care for acute stroke patients in centres across all continents except Africa where data is lacking. We report findings from a pilot multi - centre stroke registry in Nigeria. Methods: A World Federation of Neurology/World Stroke Organization (WFN/WSO) supported stroke training programme collaborated with NIH - funded Stroke Investigative Research and Education Network (SIREN) Project to develop a web-based multicenter acute stroke registry in 13 tertiary hospitals across Nigeria. All suspected cases of stroke were recorded in a Stroke Log and CT- confirmed cases were entered into a case report form and a web-based platform (RedCAP). A one hour focus group discussion (FGD) was conducted among 7 site neurologists to evaluate the impact of the pilot programme on stroke care and training. Results: Over a 21 month period (October 2014 - June 2016), 1686 suspected cases of stroke were logged into the stroke log while 1391 brain - CT confirmed cases of stroke were logged onto RedCAP. Across all sites; mean age(SD) was 60.1 (14.2) years, 57.1% male, 78.9% had at least primary education, 67.5%, 31.0% and 1.5% had ischemic, hemorrhagic and ischemic stroke with hemorrhagic transformation respectively, 51.8% were admitted with severe stroke, hypertension was the dominant risk factor (78.7% of cases) and 21.8% died within 7 days. An FGD to evaluate impact showed improved stroke awareness, better CT rate, reduced time to CT, reduced short term mortality, improved training and competence of interns and residents, development of stroke multidisciplinary teams and better job satisfaction among site neurologists. Conclusion: A pilot multicenter national stroke registry is feasible and improves stroke care, training and neurologist job satisfaction in Nigeria.

Background: Autoimmune sensitization by antihypertensive drugs is an emerging cause of morbidity and mortality among hypertensive on antihypertensive therapy and little is known about it in our environment. The aim of this study is to evaluate autoimmune sensitization among hypertensive patients on antihypertensive therapy using DAT (Direct Antiglobulin test or Direct Coomb’s test) and Hemoglobin concentration.Materials and method: This was a 4-month single center prospective study of 60 hypertensive patients on antihypertensive drugs and 40 age and sex matched control who were attending Cardiology Clinic in BMSH Port Harcourt. Hemoglobin concentration, Packed Cell Volume (PCV) and DAT were obtained using Cyanmethemoglobin, Microhematrocrit and Conventional tube methods respectively, while other clinical data were obtained using structured questionnaires. Data analysis was by SPSS version 20.Results: There was no significant change in the mean hemoglobin concentration/PCV of the hypertensive patients on therapy and their control counterparts (13.4 g/dL/40.7% versus 13.4 g/dL/40.7%; p>0.05). The DAT in the hypertensive patients on therapy and their hypertensive control counterparts was negative.Conclusion: Although antihypertensive drugs have the tendency of instigating immune sensitization of red blood cells, this was not demonstrated from this study. However, further studies with a larger sample size can improve validity of the result.

Background : There is limited population based data on the prevalence of cardiovascular risk factors and non-communicable diseases in Nigeria, and Abia state in particular. Aims : The purpose of this survey was to determine the burden of non-communicable diseases as well as associated cardiovascular risk factors in the state using the World Health Organization steps approach. It is believed that information obtained will provide the basis for policies, plans and programs as well as evolve strategies in designing, implementing and evaluation of appropriate interventions that are geared towards controlling them. Methods : The house to house survey was conducted in randomly selected communities in Abia State of Nigeria. Respondents had their biophysical parameters measured: weight, height, waist circumference, hip circumference, pulse rate blood pressure and some biochemical parameters. Results : Women constituted 52.1% of the 2999 participants. The mean age of the participants was 41.7±18.5 years. Three hundred and eighty seven respondents had ever smoked cigarette, 373 men (96.4%) and 14 women (3.6%). Many of the respondents (65.5%) were engaged in work involving sedentary activity. Over eighty percent of the study populations were aware of cancer. Hypertension was present in 31.8% and diabetes mellitus in 3.6%. Obesity was present in 13.8% while low high density lipoprotein-cholesterol was detected in 54.1%. Conclusions : A suggestion is made for the establishment and strengthening of non-communicable diseases surveillance systems in the state. Surveillance of non-communicable diseases and associated risk factors using the World Health Organization stepwise surveillance for non-communicable diseases should be ongoing in the state and should be conducted every two years. Keywords : Cardiovascular risk factors, non-communicable disease, hypertension, cholesterol, Abia, Nigeria

Introduction: Proteinuria is a common marker of kidney damage. This study aimed at determining predictors of proteinuria in subjects without impaired renal filtration function in Owerri, Nigeria. Methods: This was a cross-sectional study involving 136 subjects, consecutively drawn from Federal Medical Centre (FMC), Owerri, Nigeria. Relevant investigations were performed, including 24-hour urine protein (24HUP). Correlation and multivariate linear regression analysis were used to determine the association and strength of variables to predict proteinuria. Proteinuria was defined as 24HUP ≥0.300g and impaired renal filtration function as creatinine clearance (ClCr)

Background Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. Methods This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization's STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. Results In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. Conclusions Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system.

Innocent Ijezie Chukwuonye,1 Kenneth Arinze Ohagwu,2 Enoch Ogbonnaya Uche,3,4 Abali Chuku,5 Rowland Ihezuo Nwanke,2 Christopher Chukwuemeka Ohagwu,6 Ignatius U Ezeani,7 Collins Ogbonna Nwabuko,8 Martin Anazodo Nnoli,9 Efosa Oviasu,4,10 Okechukwu Samuel Ogah4,11 1Division of Nephrology, 2Division of Neurology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria; 3Division of Neurosurgery, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria; 4Federal Medical Centre, Umuahia, Nigeria; 5Department of Ophthalmology, Federal Medical Centre, Umuahia, Nigeria; 6Department of Radiography, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria; 7Division of Endocrinology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria; 8Department of Hematology, Federal Medical Centre, Umuahia, Nigeria; 9Department of Anatomical Pathology, University of Calabar, Calabar, Nigeria; 10Division of Nephrology, Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria; 11Division of Cardiology, University College Hospital Ibadan, Ibadan, Nigeria Abstract: The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P

The prevalence of kidney diseases is on the increase in Nigeria. The cost of its management is far beyond the reach of an average patient. Prevention is thus of paramount importance and awareness of kidney diseases will help in its prevention. The aim of this study is to assess the level of awareness of kidney functions and diseases among adults in a Nigerian population. A semi-structured, researcher - administered questionnaire was the tool for data collection. Four hundred and thirty-five questionnaires were analyzed. There were 160 males (36.8%) and 275 females (63.2%). The mean age was 42.8 ± 14 years with a range of 18-78 years. Among these, 82.1% were aware of the kidneys' involvement in waste removal from the body through urine while 36% and 29% were aware of kidneys' role in blood pressure regulation and blood production, respectively. Only 26.6% correctly identified at least two basic functions of the kidneys. Also, 32.6% of the respondents were aware of at least three common causes of kidney diseases in our environment. Majority of the respondents (70.7%) did not know that kidney diseases could be inherited. Furthermore, belief in alternative therapy for kidney disease was documented in 83.2%, while unawareness of dialysis as a treatment modality was recorded in 68% of the respondents. The awareness of kidney functions and diseases among the population is poor. Measures are needed to improve this to stem the rising prevalence of chronic kidney disease in Nigeria.

Background and Objectives: Urine protein examination is a veritable tool in the management of renal diseases. Proteinuria evaluation from 24-hour urine collection is the gold standard. Prompt urine protein assessment from spot urine sample has become necessary to eliminate inaccuracies inherent in timed urine collection. This study aims at comparing spot urine protein/creatinine ratio (SUPCR) and measured 24-hour urine protein (24 HUP), and also spot urine protein/osmolality ratio (SUPOR) and 24 HUP against measured 24-hour urine protein (24 HUP) for assessment of proteinuria in human immunodeficiency virus (HIV) subjects. Methodology: Three hundred and ninety three HIV subjects from the HIV/AIDS clinic and 136 age- and sexmatched non-HIV subjects as Control. Investigations performed included 24-hour urine protein (24 HUP), spot urine protein (SUP), spot urine creatinine (SUCr), spot urine osmolality (SUOsm), fasting blood sugar (FBS), urinalysis, HIV screening and confirmatory test, electrolyte, urea and creatinine. SUPCR and SUPOR were calculated. Correlation statistics, 2 × 2 contingency table analysis, receiver operator characteristics (ROC) Curve analysis and Bland Altman plots were used to compare SUPCR and 24 HUP, and also SUPOR and 24 HUP in HIV subjects and control. SPSS version 17 and Medcal statistical software were used to analyze the data. P

Background and objectives: Obesity is assuming an epidemic dimension globally. Currently more than 1.9 billion adults are overweight - and at least 600 million of them are obese. There is dearth of community based study on prevalence and predictors of obesity in Nigeria, and none from Abia state in particular, prompting us to undertake the study. Material and Methods: This was a cross-sectional study, aimed at ascertaining the prevalence and predictors of obesity in the state. The study subjects were recruited from the three senatorial zones in the state. In each of the zones, an urban and a rural community were randomly selected. The World Health Organization Stepwise Approach to Surveillance of chronic disease risk factors was used. Body mass index, anthropometric measurements, and other relevant data were also collected. Results: Overweight was present in 716 (28.2%) and obesity was present in 313 (12.3%) of the subjects. Ninety five (30.4%) of the obese subjects were men, while 281(69.7%) were women. One hundred and eighty (57.5%) of the obese subjects were urban dwellers, while 133 (42.4%) were rural dwellers. The women and urban dwellers were significantly more obese than men and rural dwellers respectively (p

Innocent Ijezie Chukwuonye,1 Abali Chuku,2 Ikechi Gareth Okpechi,3 Ugochukwu Uchenna Onyeonoro,4 Okechukwu Ojoemelam Madukwe,5 Godwin Oguejiofor Chukwuebuka Okafor,6 Okechukwu Samuel Ogah5,71Division of Renal Medicine, Department of Internal Medicine, 2Department of Ophthalmology, Federal Medical Centre, Umuahia, Nigeria; 3Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; 4Department of Community Medicine, Federal Medical Centre, 5Ministry of Health, Nnamdi Azikiwe Secretariat, 6Department of Community Medicine, Federal Medical Centre, Umuahia, Nigeria; 7Division of Cardiology, Department of Internal Medicine, University College Hospital, Ibadan, NigeriaBackground and objectives: Obesity is a major risk factor for cardiovascular disease in developed and emerging economies. There is a paucity of data from Nigeria on the association between socioeconomic status and obesity. The aim of this study is to highlight that association in Abia State, South East Nigeria.Material and method: This was a cross-sectional survey in South East Nigeria. Participating subjects were recruited from the three senatorial zones of Abia state. A total of 2,487 adults took part in the study. The subjects were classified based on their monthly income and level of educational attainment (determinants of obesity). Monthly income was classified into three groups: low, middle, and upper income, while educational level was classified into four groups: no formal education, primary, secondary, and tertiary education. Body mass index of subjects was determined and used for defining obesity. Data on blood pressure and other anthropometric measurements were also collected using a questionnaire, modified from the World Health Organization STEPwise Approach to Chronic Disease Risk Factor Surveillance.Results: Overall, the prevalence of obesity in low, middle, and upper income groups was 12.2%, 16%, and 20%, respectively. The overall prevalence of obesity in individuals with no formal education, primary, secondary, and tertiary education was 6.3%, 14.9%, 10.5%, and 17.7%, respectively. Educational status was found to be significantly associated with obesity in women, but not in men, or in the combined group. However, level of income was observed to be significantly associated with obesity in men, women, and in the combined group.Conclusion: Sociodemographic and socioeconomic factors are important determinants of obesity in our study population, and therefore may be indirectly linked to the prevalence and the outcomes of cardiovascular disease in Nigeria.Keywords: obesity, body mass index, BMI, income, education, socioeconomic status, Naira (₦)

Background : Autosomal Dominant Polycystic Kidney Disease (ADPKD) is often characterized clinically by acute/chronic pain, hypertension and variable progression to end-stage renal disease. About 60% of all ADPKD patients are estimated to have chronic pain, and often this is the initially presenting symptom of an ADPKD patient that brings them to medical attention. Aim : This study reports a case of a 65-year old with polycystic kidney disease and chronic loin pain. Findings : Our patient presented with history of chronic loin pain which we believed was due to increased cysts sizes/increase in weight of the kidneys. A good history was taken from him on presentation, and also laboratory investigations were carried out. However, the cause of the pain was believed to be due to increase in cysts sizes/weight of the kidneys. The patient was educated on the possible cause of the pain and various treatment options for the condition. He was placed on intermittent use of paracetamol with good response. Conclusion : A concept that must be employed in patients suffering from chronic loin pain is to educate the patient that the pain may not be relieved permanently by any intervention method adopted, and also to offer them the treatment modalities available to enable them to cope with the pain. Key words : Polycystic kidney disease, chronic loin pain, hypertension, paracetamol

Background Obesity is a major health problem, and there is an increasing trend of overweight and obese individuals in developing countries. Being overweight or obese is known to contribute significantly to morbidity and mortality rates in various countries around the world. We therefore aimed to identify and discuss current epidemiological data on the prevalence of obesity in Nigeria. Method A systematic review of papers published on the prevalence of obesity among adults in the country was carried out. We covered work published in MEDLINE, PubMed, Google, and African Journals Online using the terms “prevalence of overweight and obesity in Nigeria” or “overweight and obesity in Nigeria.” In addition, personal inquiries were made. The search limits were articles published from January 2001 to September 2012. Only studies that used the body mass index to assess for overweight and obesity were included. Results Four studies met the inclusion criteria out of the 75 studies reviewed. In Nigeria, the prevalence of overweight individuals ranged from 20.3%–35.1%, while the prevalence of obesity ranged from 8.1%–22.2%. Conclusion The prevalence of overweight and obese individuals in Nigeria is of epidemic proportions. There is a need to pay closer attention to combating these health disorders.

BACKGROUND: Developing countries of sub-Saharan Africa (SSA) face a double burden of non-communicable diseases (NCDs) and communicable diseases. As high blood pressure (BP) is a common global cardiovascular (CV) disorder associated with high morbidity and mortality, the relationship between gradients of BP and other CV risk factors was assessed in Abia State, Nigeria. METHODS: Using the WHO STEPwise approach to surveillance of chronic disease risk factors, we conducted a population-based cross-sectional survey in Abia state, Nigeria from August 2011 to March 2012. Data collected at various steps included: demographic and behavioral risk factors (Step 1); BP and anthropometric measurements (Step 2), and fasting blood cholesterol and glucose (Step 3). RESULTS: Of the 2983 subjects with complete data for analysis, 52.1% were females and 53.2% were rural dwellers. Overall, the distribution of selected CV disease risk factors was diabetes (3.6%), hypertension (31.4%), cigarette smoking (13.3%), use of smokeless tobacco (4.8%), physical inactivity (64.2%) and being overweight or obese (33.7%). Presence of hypertension, excessive intake of alcohol, smoking (cigarette and smokeless tobacco) and physical inactivity occurred more frequently in males than in females (p

Background: Several studies have reported the burden of smoking and associated risk factors. However, only a few studies have explored the prevalence, pattern of exposure, and risk factors associated with exposure to secondhand smoke (SHS) in Sub-Saharan Africa and particularly Nigeria. Objective: This study was, therefore, aimed at ascertaining the prevalence and risk factors of exposure to SHS in Abia State, Nigeria. Methods: Data of 2787 respondents selected using multi-staged cluster sampling technique were analyzed. Prevalence of exposure to SHS at home and public places was calculated for each sociodemographic and economic group. Results: Exposure to tobacco smoke was more common in respondents who were young, males, unmarried or used alcohol. Females were less frequently and intensely exposed to SHS both at home and public places than males. Predictors of SHS at home were gender, odds ratio (OR) =1.85 (95% confidence interval [CI] 1.20-2.83) and use of alcohol OR = 2.06 (95% CI 1.04-4.09); and in public places were age OR = 1.55 (95% CI 1.10-2.20), gender OR = 2.73 (95% CI 1.96-3.81), and use of alcohol OR = 2.55 (95% CI 1.51-4.28). Conclusions: The findings of study provide basis for designing tobacco control interventions to address exposure to SHS at home and public places.

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.

Background: The goal of the health education is to influence their perception of tobacco use, thereby discouraging smokers and would be-smokers from smoking. Objective: This study is aimed at ascertaining the level of awareness of the warning against smoking, perception of tobacco use and tobacco control measures among residents of Abia State, South-East Nigeria. Materials and Methods: A cross-sectional, population-based survey of respondents (aged 18 years and above) were selected by multi-staged sampling technique. Responses were elicited from them using an interviewer-administered questionnaire on sociodemographic characteristics; awareness of warning against tobacco use, sources of information, perception of harmful effect of tobacco and tobacco control measures. Results: About 88% of the respondents were aware of warning against tobacco use, the most common source of information was media adverts (50.7%). Awareness of warning against tobacco use was found to be associated with sociodemographic characteristics, history of smoking, exposure to smoke at home and public places, and perception of tobacco use. Conclusion: The findings from this study present an opportunity for initiating more robust policies, programs and interventions for tobacco control in the state.

Innocent Ijezie Chukwuonye,1 Abali Chuku,2 Ugochukwu Uchenna Onyeonoro,3 Ikechi Gareth Okpechi,4 Okechukwu Ojoemelam Madukwe,5 Theophilus Ifeanyichukwu Umeizudike,6 Okechukwu Samuel Ogah7,81Department of Internal Medicine, 2Department of Ophthalmology, 3Department of Community Medicine, Federal Medical Centre, Umuahia, Nigeria; 4Division of Hypertension and Nephrology, University of Cape Town, Cape Town, South Africa; 5Ministry of Health, Nnamdi Azikiwe Secretariat, Umuahia, Nigeria; 6Department of Internal Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria; 7Division of Cardiovascular Medicine, University College Hospital, Ibadan, Nigeria; 8Office of the Commissioner for Health, Abia State Ministry of Health, Umuahia, NigeriaBackground and objective: Abdominal obesity is associated with the risk of developing disorders, such as diabetes and hypertension. The objective of this study was to investigate the prevalence of abdominal obesity in Abia State, Nigeria.Materials and methods: We carried out a cross-sectional study aimed at ascertaining the prevalence of abdominal obesity in Abia State, Nigeria. Participants in the study were recruited from communities in the three senatorial zones in the state. Screening for abdominal obesity was carried out in these subjects using waist circumference (the National Cholesterol Education Program Third Adult Treatment Panel criteria were used). The World Health Organization Stepwise Approach to Surveillance of chronic disease risk factors was used. Body mass index, anthropometric measurements, and other relevant data were also collected.Results: Data on waist circumference were obtained from 2,807 subjects. The prevalence of obesity using body mass index in the population was 11.12%. In men and women, it was 7.73%, and 14.37%, respectively. The prevalence of abdominal obesity in the population was 21.75%. In men and women, it was 3.2% and 39.2%, respectively.Conclusion: The prevalence of abdominal obesity is high in Nigeria, and needs to be monitored because it is associated with increased cardiovascular risk.Keywords: waist circumference, body mass index, central obesity

Introduction Stroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA. Purpose In this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education. Methods Stroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman's Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes. Results and discussion The major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana.