Background: Stroke is one of the commonest non-communicable diseases and the commonest cause of death in adult neurology wards. Stroke preva-lence in sub Saharan Africa has dramatically increased over the past decades possibly due to changing life styles, poverty, poor health infrastructures which had led to increased risk factors for stroke. Poor nutrition and lack of access to standard medical care, predispose to high rates of stroke morbidity and mor-tality hence possible low prevalence. Little is known about the prevalence of stroke in people with low socio-economic status in Nigeria. Objectives: The main objective of this study was to determine the prevalence of stroke in two urban slums in south east Nigeria. Materials and Methods: This was a cross sectional descriptive study carried out in two slums in Enugu, South East Nige-ria. Participants were screened using a stroke specific questionnaire and further examined by two independent neurologists for evidence of focal neurological deficits. Analysis was done by SPSS version 22. Results: A total of 1440 par-ticipants were surveyed in the study; 769 (53.4) females and 671 (46.6%) males. About 22.3% (321) screened positive for various neurological diseases out of which 17 (5.3%) had evidence for stroke giving an overall prevalence of 1.2% (males 9 (1.3%) vs females 8 (1%) p = 0.6). The mean age of stroke sur-vivors was 60.1 years, similar in males and females (p = 0.6). The odds ratio for stroke from 40 years showed progress increment doubling between 60 and 70 years and tripled between 40 and 70 years. Age, lower level of education, positive history of hypertension, sickle cell disease, leg swelling and use of snuff positively are correlated with clinical diagnosis of stroke. Conclusion: The prevalence of stroke in two urban slums in Enugu metropolis was 12/1000. Hypertension, diabetes, use of snuff, and low levels of education were signifi-cant risk factors for stroke. Public health educational measures, promoting prevention and early detection of diabetes should be encouraged.
References
[1]
Obiakor, O.R., Opara, S.K. and Oguniyi, A. (2011) Prognosis and Outcome of Acute Stroke in the University College Hospital Ibadan, Nigeria. Nigerian Journal of Clinical Practice, 14, 359-362. https://doi.org/10.4103/1119-3077.86784
[2]
Ezeala-Adikaibe, B.A., Aneke, E., Orjioke, C., Ezeala-Adikaibe, N.P., Mbadiwe, M., Chime, P., et al. (2014) Pattern of Medical Admissions at Enugu State University of Science and Technology Teaching Hospital: A 5-Year Review. Annals of Medical and Health Science Research, 4, 426-431.
[3]
Ekenze, O.S., Onwuekwe, I.O. and Ezeala Adikaibe, B.A. (2010) Profile of Neurological Admissions at the University of Nigeria Teaching Hospital Enugu. Nigerian Journal of Medicine, 19, 419-422. https://doi.org/10.4314/njm.v19i4.61967
[4]
Eze, C.O. and Kalu, U.A. (2014) Pattern of Neurological Admissions in the Tropics: Experience at Abakaliki South-Eastern Nigeria. Journal of Biology, Agriculture and Healthcare, 4, 84-86.
[5]
Osuntokun, B.O. (1971) The Pattern of Neurological Illness in Tropical Africa. Experience at Ibadan, Nigeria. Journal of the Neurological Sciences, 12, 417-442. https://doi.org/10.1016/0022-510X(71)90110-9
[6]
Ojini, F.I. and Danesi, M.A. (2003) The Pattern of Neurological Admissions at the Lagos University Teaching Hospital. Nigerian Journal of Clinical Practice, 6, 38-41.
[7]
Ogun, S.A., Ojini, F.I., Ogungbo, B., Kolapo, K.O. and Danesi, M.A. (2005) Stroke in South West Nigeria: A 10-Year Review. Stroke, 36, 1120-1122. https://doi.org/10.1161/01.STR.0000166182.50840.31
[8]
Owolabi, L.F. and Ibrahim, A. (2012) Stroke in Young Adults: A Prospective Study from Northwestern Nigeria. ISRN Neurology, 2012, Article ID: 468706. https://doi.org/10.5402/2012/468706.
[9]
Moran, A., Forouzanfar, M., Sampson, U., Chugh, S., Feighin, V. and Mensah, G. (2013) The Epidemiology of Cardiovascular Diseases in Sub-Saharan Africa: The Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Progress in Cardiovascular Diseases, 56, 234-239. https://doi.org/10.1016/j.pcad.2013.09.019
[10]
Adeloye, D. (2014) An Estimate of the Incidence and Prevalence of Stroke in Africa; a Systematic Review and Meta-Analysis. PLoS ONE, 9, e100724. https://doi.org/10.1371/journal.pone.0100724
[11]
Owolabi, M., Olowoyo, P., Popoola, F., Lackland, D., Jenkins, C., Arulogun, O., et al. (2018) The Epidemiology of Stroke in Africa: A Systematic Review of Existing Methods and New Approaches. The Journal of Clinical Hypertension, 20, 47-55. https://doi.org/10.1111/jch.13152
[12]
Osuntokun, B., Bademosi, O., Akinkugbe, O., Oyediran, A. and Carlisle, R. (1979) Incidence of Stroke in an African City: Results from the Stroke Registry at Ibadan, Nigeria, 1973-1975. Stroke, 10, 205-207. https://doi.org/10.1161/01.STR.10.2.205
[13]
Osuntokun, B.O., Adeuja, A.O., Schoenberg, B.S., et al. (1987) Neurological Disorders in Nigerian Africans: A Community-Based Study. Acta Neurologica Scandinavica, 75, 13-21. https://doi.org/10.1111/j.1600-0404.1987.tb07883.x
[14]
Danesi, M., Okubadejo, N. and Ojini, F. (2007) Prevalence of Stroke in an Urban, Mixed-Income Community in Lagos, Nigeria. Neuroepidemiology, 28, 216-223. https://doi.org/10.1159/000108114
[15]
Enwereji, K.O., Nwosu, M.C., Ogunniyi, A., Nwani, P.O., Asomugha, A.L., et al. (2014) Epidemiology of Stroke in a Rural Community in Southeastern Nigeria. Vascular Health and Risk Management, 2014, 375-388. https://doi.org/10.2147/VHRM.S57623
[16]
Onwuchekwa, A.C., Tobin-West, C. and Babatunde, S. (2014) Prevalence and Risk Factors for Stroke in an Adult Population in a Rural Community in the Niger Delta, South-South Nigeria. Journal of Stroke and Cerebrovascular Diseases, 23, 505-510. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.010
[17]
Ezejimofor, M.C., Uthman, O.A., Maduka, O., Ezeabasili, A.C., Onwuchekwa, A.C., et al. (2017) Stroke Survivors in Nigeria: A Door-to-Door Prevalence Survey from the Niger Delta Region. Journal of the Neurological Sciences, 372, 262-269. https://doi.org/10.1016/j.jns.2016.11.059
[18]
Sanya, E.O., Desalu, O.O., Adepoju, F., Aderibigbe, S.A., Shittu, A. and Olaosebikan, O. (2015) Prevalence of Stroke in Three Semi-Urban Communities in Middle-Belt Region of Nigeria: A Door to Door Survey. Pan African Medical Journal, 20, 33. https://doi.org/10.11604/pamj.2015.20.33.4594
[19]
Ezeala-Adikaibe, B.A., Aneke, E., Orjioke, C., Okafor, H.U., Ezeala-Adikaibe, N.P. and Mbadiwe, N. (2018) Neurological Admissions at Enugu State University Teaching Hospital: A 5-Year Retrospective Review. Journal of Experimental Research, 6, 1-10.
[20]
Ezeala-Adikaibe, B., Mbadiwe, N., Orjioke, C., Aneke, E., Chime, P. and Okafor, H. (2014) Estimated Probability of Stroke among Medical Outpatients in Enugu South East Nigeria. Annals of Medical and Health Science Research, 4, 879-883.
[21]
Ezeala-Adikaibe, B.A., Orjioke, C., Ekenze, O.S., Ijoma, U., Onodugo, O., Okudo, G., et al. (2015) Population-Based Prevalence of High Blood Pressure among Adults in an Urban Slum in Enugu, South East Nigeria. Journal of Human Hypertension, 30, 285-291. https://doi.org/10.1038/jhh.2015.49
[22]
Ezeala-Adikaibe, B.A., Mbadiwe, N., Okwara, C., Onodugo, O., Onyekonwu, C., Ijoma, U., et al. (2018) Diabetes and Pre-Diabetes among Adults in an Urban Slum in South East Nigeria. Journal of Diabetes Mellitus, 8, 131-144. https://doi.org/10.4236/jdm.2018.84013
[23]
Grimaud, O., Dufouil, C., Alpérovitch, A., Pico, F., Ritchie, K.A., Helmer, C., et al. (2011) Incidence of Ischaemic Stroke According to Income Level among Older People: The 3C Study. Age and Ageing, 40, 116-121. https://doi.org/10.1093/ageing/afq142
[24]
Krishnan, S., Cozier, Y.C., Rosenburg, L. and Palmer, J. (2010) Socioeconomic Status and Incidence of Type 2 Diabetes: Results from the Black Women’s Health Study. American Journal of Epidemiology, 171, 564-570. https://doi.org/10.1093/aje/kwp443
[25]
Forouhi, N.G., Luan, J., Hennings, S. and Wareham, N.J. (2007) Incidence of Type 2 Diabetes in England and Its Association with Baseline Impaired Fasting Glucose: The Ely Study 1990-2000. Diabetic Medicine, 24, 200-207. https://doi.org/10.1111/j.1464-5491.2007.02068.x
[26]
WHO (2005) WHO STEP-wise Approach to Chronic Disease Risk Factor Surveillance (STEPS). WHO, Geneva, Switzerland.
[27]
Osuntokun, B.O., Schoenberg, B.S., Nottidge, V.A., Adeuja, A., Kale, O., Adeyefa, A., et al. (1982) Research Protocol for Measuring the Prevalence of Neuro-logical Disorders in Developing Countries. Results of a Pilot Study in Nigeria. Neuroepidemiology, 1, 143-153. https://doi.org/10.1159/000110696
[28]
Yamane, T. (1967) Statistics, an Introductory Analysis. 2nd Edition, Harper and Row, New York.
[29]
Okafor, C.I. (2012) The Metabolic Syndrome in Africa: Current Trends. IIndian Journal of Endocrinology and Me-tabolism, 16, 56-66. https://doi.org/10.4103/2230-8210.91191
[30]
Integrated Biological and Behavioural Surveillance Survey (IBBSS) (2014) National HIV/AIDS & STIS Control Programme. Federal Ministry of Health, Nigeria.
[31]
Aliyu, S.U., Chiroma, A.S., Jajere, A.M. and Gujba, F.K. (2015) Prevalence of Physical Inactivity, Hypertension, Obesity and Tobacco Smoking: A Case of NCDs Prevention among Adults in Maiduguri, Nigeria. The American Journal of the Medical Sciences, 3, 39-47.
[32]
Lasebikan, V.O. and Ola, B.A. (2016) Prevalence and Correlates of Alcohol Use among a Sample of Nigerian Semirural Community Dwellers in Nigeria. Journal of Addiction Medicine, 2016, Article ID: 2831594. https://doi.org/10.1155/2016/2831594
[33]
Adewuya, A.O., Ola, B.A., Aloba, O.O., Mapayi, B.M., Ibigbami, O.I. and Adewumi, T.A. (2007) Alcohol Use Disorders among Nigerian University Students: Prevalence and Sociodemographic Correlate. Nigerian Journal of Psychiatry, 5, 5-9. https://doi.org/10.4314/njpsyc.v5i1.39893
[34]
Lasebikan, V.O., Ayinde, O., Odunleye, M., Adeyefa, B., Adepoju, S., Fakunle, S., et al. (2018) Prevalence of Alcohol Consumption and Alcohol Use Disorders among Outdoor Drinkers in Public Open Places in Nigeria. BMC Public Health, 18, 400. https://doi.org/10.1186/s12889-018-5344-6
[35]
Venketasubramanian, N., Tan, L.C.S., Sahadevan, S., Chin, J.J., Krishnamoorthy, E.S., Hong, C.Y., et al. (2005) Prevalence of Stroke among Chinese, Malay, and Indian Singaporeans: A Community-Based Tri-Racial Cross-Sectional Survey. Stroke, 36, 551-556. https://doi.org/10.1161/01.STR.0000155687.18818.13
[36]
Feigin, V.L., Lawes, C.M., Bennett, D.A. and Anderson, C.S. (2003) Stroke Epidemiology: A Review of Population-Based Studies of Incidence, Prevalence and Case-Fatality in the Late 20th Century. The Lancet Neurology, 2, 43-53. https://doi.org/10.1016/S1474-4422(03)00266-7
[37]
Agyemang, C., Attah-Adjepong, G., Owusu-Dabo, E., De-Graft Aikins, A., Addo, J., Edusei, A.K., et al. (2012) Stroke in Ashanti Region of Ghana. Ghana Medical Journal, 46, 12-17.
[38]
Engels, T., Baglione, Q., Audibert, M., Viallefont, A., Mouriji, F. and Faris, M.A. (2014) for GRAVCM Study Group. Socioeconomic Status and Stroke Prevalence in Morocco: Results from the Rabat-Casablanca Study. PLoS ONE, 9, e89271. https://doi.org/10.1371/journal.pone.0089271
[39]
Wu, S.H., Woo, J. and Zhang, X.-H. (2013) Worldwide Socioeconomic Status and Stroke Mortality: An Ecological Study. International Journal for Equity in Health, 12, 42. http://www.equityhealthj.com/content/12/1/42 https://doi.org/10.1186/1475-9276-12-42
[40]
Sposato, L.A. and Grimaud, O. (2013) Neighborhood Socioeconomic Status and Stroke Mortality. Neurology, 80, 516-517. https://doi.org/10.1212/WNL.0b013e3182815564
[41]
Addo, J., Ayerbe, L., Mohan, K.M., Crichton, C., Sheldenkar, A., Chen, R., et al. (2012) Socioeconomic Status and Stroke an Updated Review. Stroke, 43, 1186-1191. https://doi.org/10.1161/STROKEAHA.111.639732
[42]
Kapral, M.K., Wang, H., Mamdani, M. and Tu, J.V. (2002) Effect of Socioeconomic Status on Treatment and Mortality after Stroke. Stroke, 33, 268-275. https://doi.org/10.1161/hs0102.101169
[43]
Ajzen, I. (1991) The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50, 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
[44]
Asplund, K. (2001) Snuff: How Dangerous Is It? The Controversy Continues. Journal of Internal Medicine, 250, 457-461. https://doi.org/10.1046/j.1365-2796.2001.00918.x
[45]
Asplund, K., Nasic, S., Janlert, U. and Stegmayr, B. (2003)Smokeless Tobacco as a Possible Risk Factor for stroke in Men A Nested Case—Control Study. Stroke, 34, 1754-1759. https://doi.org/10.1161/01.STR.0000076011.02935.A1
[46]
Boffetta, P. and Straif, K. (2009) Use of Smokeless Tobacco and Risk of Myocardial Infarction and Stroke: Systematic Review with Meta-Analysis. British Medical Journal, 339, b3060. https://doi.org/10.1136/bmj.b3060
[47]
SCENIHR (Scientific Committee on Emerging and Newly-Identified Health Risks) (2008) Scientific Opinion on the Health Effects of Smokeless Tobacco Products. European Commission, Brussels.
[48]
Amarenco, P., Abboud, H., Labreuche, J., Arauz, A., Bryer, A., Lavados, P.M., et al. (2014) Impact of Living and Socioeconomic Characteristics on Cardiovascular Risk in Ischemic Stroke Patients. International Journal of Stroke, 9, 1065-1072. https://doi.org/10.1111/ijs.12290