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Yorke E, Akpalu J, de-Graft Johnson G, Atiase Y, Reynolds M, Laryea R, Tetteh J, Yawson AE, Amoah AGB. A national audit of facilities, human and material resources for the comprehensive management of diabetes in Ghana-A 2023 update. PLoS One 2024; 19:e0303624. [PMID: 38768080 DOI: 10.1371/journal.pone.0303624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION The human and material resources as well as the systems for managing diabetes in Africa are inadequate. This study or needs assessment, aimed at updating the human and material resources, identifying the gaps and unmet needs for comprehensive diabetes care in Ghana. METHODS We conducted a national audit of 122 facilities in all 16 administrative regions of Ghana. Information obtained covered areas on personnel and multidisciplinary teams, access to medications, access to laboratory services, financing, screening services, management of diabetes complications, and availability/use of diabetes guidelines or protocols. Data was analysed using STATA version 16.1. P-values <0.05 were set as significant. RESULTS Only 85(69.7%) out of the 122 surveyed facilities had a dedicated centre or service for diabetes care. Twenty-eight (23%) had trained diabetes doctors/specialists; and whilst most centres had ophthalmic nurses and dieticians, majority of them did not have trained diabetes educators (nurses), psychologists, ophthalmologists, podiatrists, and foot/vascular surgeons. Also, 13.9% had monofilaments, none could perform urine dipstick for microalbumin; 5 (4.1%) and just over 50% could perform laboratory microalbumin estimation and glycated haemoglobin, respectively. Access to and supply of human insulins was better than analogue insulin in most centres. Nearly 100% of the institutions surveyed had access to metformin and sulphonylurea with good to excellent supply in most cases, whilst access to Sodium Glucose Transporter-2 inhibitors and Glucagon-like peptide-1 analogues were low, and moderate for Dipeptidyl peptidase-4 inhibitors and thiazolidinediones. Majority of the health facilities (95.1%) offered NHIS as payment mechanism for clients, whilst 68.0% and 30.3% of the patients paid for services using out-of-pocket and private insurance respectively. Fifteen facilities (12.3%) had Diabetes Support Groups in their locality and catchment areas. CONCLUSION An urgent multisectoral collaboration, including prioritisation of resources at the facility level, to promote and achieve acceptable comprehensive diabetes care is required.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Gwendolyn de-Graft Johnson
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Yacoba Atiase
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Margaret Reynolds
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Ruth Laryea
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Albert G B Amoah
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
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Sarfo FS, Asowata OJ, Akpa OM, Akinyemi J, Wahab K, Singh A, Akpalu A, Opare-Addo PA, Okekunle AP, Ogbole G, Fakunle A, Adebayo O, Obiako R, Akisanya C, Komolafe M, Olunuga T, Chukwuonye II, Osaigbovo G, Olowoyo P, Adebayo PB, Jenkins C, Bello A, Laryea R, Ibinaye P, Olalusi O, Adeniyi S, Arulogun O, Ogah O, Adeoye A, Samuel D, Calys-Tagoe B, Tiwari H, Obiageli O, Mensah Y, Appiah L, Akinyemi R, Ovbiagele B, Owolabi M. Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study. J Neurol Sci 2024; 459:122968. [PMID: 38518449 PMCID: PMC11073807 DOI: 10.1016/j.jns.2024.122968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/07/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Hypertension is preeminent among the vascular risk factors for stroke occurrence. The wide gaps in awareness, detection, treatment, and control rates of hypertension are fueling an epidemic of stroke in sub-Saharan Africa. PURPOSE To quantify the contribution of untreated, treated but uncontrolled, and controlled hypertension to stroke occurrence in Ghana and Nigeria. METHODS The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n = 3684) with age- and sex-matched stroke-free controls (n = 3684). We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with risk of stroke occurrence. We assessed the adjusted odds ratio and population-attributable risk of hypertension treatment control status associated with stroke occurrence. RESULTS The frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension and controlled hypertension among stroke cases were 4.0%, 47.7%, 37.1%, and 9.2% vs 40.7%, 34.9%, 15.9%, and 7.7% respectively among stroke-free controls, p < 0.0001. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15-8.41) and 35.4% (33.4-37.4); treated but uncontrolled hypertension was 9.95 (7.60-13.02) and 35.9% (34.2-37.5); and controlled hypertension 5.37 (3.90-7.41) and 8.5% (7.6-9.5) respectively. Untreated hypertension contributed a PAR of 47.5% to the occurrence of intracerebral hemorrhage vs 29.5% for ischemic stroke. The aOR of untreated hypertension for stroke occurrence was 13.31 (7.64-23.19) for <50 years; 7.14 (4.51-11.31) for 50-64 years; and 3.48 (2.28-5.30) for 65 years or more. CONCLUSION The contribution of untreated hypertension and treated but uncontrolled hypertension to stroke occurrence among indigenous Africans is substantial. Implementing targeted interventions that address gaps in hypertension prevention and treatment, involving the local population, healthcare providers, and policymakers, can potentially substantially reduce the escalating burden of strokes in Africa.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Osahon Jeffery Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria; Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Joshua Akinyemi
- Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Public Health, Osun State University, Osogbo, Nigeria
| | | | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Morenkeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | | | - Paul Olowoyo
- Federal Teaching Hospital, Ido-Ekiti Ado-Ekiti, Nigeria
| | | | | | - Abiodun Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | - Dialla Samuel
- Department of Medicine, University of Ibadan, Nigeria
| | | | - Hemant Tiwari
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Yaw Mensah
- Korle Bu Teaching Hospital, Accra, Ghana
| | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rufus Akinyemi
- Department of Medicine, University of Ibadan, Nigeria; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | - Mayowa Owolabi
- Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria; Lebanese American University, Beirut, Lebanon.
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Akinyemi RO, Tiwari HK, Srinivasasainagendra V, Akpa O, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Mamaeva OA, Halloran BA, Akinyemi J, Lackland D, Obiabo OY, Sunmonu T, Chukwuonye II, Arulogun O, Jenkins C, Adeoye A, Agunloye A, Ogah OS, Ogbole G, Fakunle A, Uvere E, Coker MM, Okekunle A, Asowata O, Diala S, Ogunronbi M, Adeleye O, Laryea R, Tagge R, Adeniyi S, Adusei N, Oguike W, Olowoyo P, Adebajo O, Olalere A, Oladele O, Yaria J, Fawale B, Ibinaye P, Oyinloye O, Mensah Y, Oladimeji O, Akpalu J, Calys-Tagoe B, Dambatta HA, Ogunniyi A, Kalaria R, Arnett D, Rotimi C, Ovbiagele B, Owolabi MO. Novel functional insights into ischemic stroke biology provided by the first genome-wide association study of stroke in indigenous Africans. Genome Med 2024; 16:25. [PMID: 38317187 PMCID: PMC10840175 DOI: 10.1186/s13073-023-01273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/12/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network (SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke in indigenous Africans. METHODS Cases were consecutively recruited consenting adults (aged > 18 years) with neuroimaging-confirmed ischemic stroke. Stroke-free controls were ascertained using a locally validated Questionnaire for Verifying Stroke-Free Status. DNA genotyping with the H3Africa array was performed, and following initial quality control, GWAS datasets were imputed into the NIH Trans-Omics for Precision Medicine (TOPMed) release2 from BioData Catalyst. Furthermore, we performed fine-mapping, trans-ethnic meta-analysis, and in silico functional characterization to identify likely causal variants with a functional interpretation. RESULTS We observed genome-wide significant (P-value < 5.0E-8) SNPs associations near AADACL2 and miRNA (MIR5186) genes in chromosome 3 after adjusting for hypertension, diabetes, dyslipidemia, and cardiac status in the base model as covariates. SNPs near the miRNA (MIR4458) gene in chromosome 5 were also associated with stroke (P-value < 1.0E-6). The putative genes near AADACL2, MIR5186, and MIR4458 genes were protective and novel. SNPs associations with stroke in chromosome 2 were more than 77 kb from the closest gene LINC01854 and SNPs in chromosome 7 were more than 116 kb to the closest gene LINC01446 (P-value < 1.0E-6). In addition, we observed SNPs in genes STXBP5-AS1 (chromosome 6), GALTN9 (chromosome 12), FANCA (chromosome 16), and DLGAP1 (chromosome 18) (P-value < 1.0E-6). Both genomic regions near genes AADACL2 and MIR4458 remained significant following fine mapping. CONCLUSIONS Our findings identify potential roles of regulatory miRNA, intergenic non-coding DNA, and intronic non-coding RNA in the biology of ischemic stroke. These findings reveal new molecular targets that promise to help close the current gaps in accurate African ancestry-based genetic stroke's risk prediction and development of new targeted interventions to prevent or treat stroke.
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Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Onoja Akpa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Olga A Mamaeva
- Department of Epidemiology, School of Public Health University of Alabama at Birmingham, Birmingham, USA
| | - Brian A Halloran
- Department of Pediatrics, Volker Hall University of Alabama at Birmingham, Birmingham, USA
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Olugbo Y Obiabo
- Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria
| | - Taofik Sunmonu
- Department of Medicine, Federal Medical Centre, Ondo State, Owo, Nigeria
| | - Innocent I Chukwuonye
- Department of Medicine, Federal Medical Centre Umuahia, Abia State, Umuahia, Nigeria
| | - Oyedunni Arulogun
- Department of Health Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | - Abiodun Adeoye
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Atinuke Agunloye
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Okechukwu S Ogah
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Public Health, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo M Coker
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Genetics and Cell Biology Unit, Department of Zoology, Faculty of Science, University of Ibadan, Ibadan, Nigeria
| | - Akinkunmi Okekunle
- Department of Food and Nutrition, Seoul National University, Seoul, South Korea
| | - Osahon Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Samuel Diala
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ogunronbi
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Osi Adeleye
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Ruth Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Raelle Tagge
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, San Francisco, USA
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Nathaniel Adusei
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Paul Olowoyo
- Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Olayinka Adebajo
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abimbola Olalere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Oladele
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph Yaria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Ibinaye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olalekan Oyinloye
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Yaw Mensah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Omotola Oladimeji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Benedict Calys-Tagoe
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rajesh Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Donna Arnett
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Charles Rotimi
- Center for Genomics and Global Health, National Human Genome Research Institute, NIH, Bethesda, USA
| | - Bruce Ovbiagele
- Genetics and Cell Biology Unit, Department of Zoology, Faculty of Science, University of Ibadan, Ibadan, Nigeria
| | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- University College Hospital, Ibadan, Nigeria.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
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Asowata O, Okekunle A, Akpa O, Fakunle A, Akinyemi J, Komolafe M, Sarfo F, Akpalu A, Obiako R, Wahab K, Osaigbovo G, Owolabi L, Jenkins C, Calys-Tagoe B, Arulogun O, Ogbole G, Ogah OS, Appiah L, Ibinaiye P, Adebayo P, Singh A, Adeniyi S, Mensah Y, Laryea R, Balogun O, Chukwuonye I, Akinyemi R, Ovbiagele B, Owolabi M. Risk Assessment Score and Chi-Square Automatic Interaction Detection Algorithm for Hypertension Among Africans: Models From the SIREN Study. Hypertension 2023; 80:2581-2590. [PMID: 37830199 PMCID: PMC10715722 DOI: 10.1161/hypertensionaha.122.20572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND This study aimed to develop a risk-scoring model for hypertension among Africans. METHODS In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 risk factors. We randomly split the dataset into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0 to 1 using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating hypertensives. RESULTS Mean age was 59.9±13.3 years, 56.0% were hypertensives, and 8 factors, including diabetes, age ≥65 years, higher waist circumference, (BMI) ≥30 kg/m2, lack of formal education, living in urban residence, family history of cardiovascular diseases, and dyslipidemia use were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both datasets. The probability risk score presented a good performance-receiver operating characteristic: 64% (95% CI, 61.0-68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test dataset. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1-69.3) for the training set and 64.6% (95% CI, 61.0-68.0) for the testing dataset. CONCLUSIONS The novel risk-scoring model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention.
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Affiliation(s)
| | - Akinkunmi Okekunle
- University of Ibadan, Ibadan, Nigeria
- Seoul National University, Seoul, Korea
| | | | - Adekunle Fakunle
- University of Ibadan, Ibadan, Nigeria
- College of Health Sciences, Osun State University, Osogbo, Nigeria
| | | | | | - Fred Sarfo
- Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | | | | | | | | | | | | | | | | | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Yaw Mensah
- University of Ghana Medical School, Accra, Ghana
| | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | | | | | - Rufus Akinyemi
- University of Ibadan, Ibadan, Nigeria
- Federal Medical Centre, Abeokuta, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San Francisco, USA
| | - Mayowa Owolabi
- University of Ibadan, Ibadan, Nigeria
- Lebanese American University, 1102 2801 Beirut, Lebanon
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Center, Ibadan, Nigeria
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Jegede A, Balogun O, Olorunsogbon OF, Nichols M, Akinyemi J, Jenkins C, Ogunronbi M, Singh A, Obiako R, Wahab K, Bello A, Akpalu A, Sarfo FS, Owolabi LF, Ojebuyi B, Adigun M, Olujobi D, Musbahu R, Titiloye M, Afolami I, Calys-Tagoe B, Uvere E, Laryea R, Fakunle A, Adeleye O, Adesina D, Mensah N, Oguike W, Coleman N, Adeniyi S, Omotoso L, Asibey S, Melikam L, Yusuf J, Gbenga A, Mande A, Uthman M, Kalaria RN, Owolabi M, Ovbiagele B, Arulogun O, Akinyemi RO. Research participants' perception of ethical issues in stroke genomics and neurobiobanking research in Africa. medRxiv 2023:2023.10.03.23296473. [PMID: 37873327 PMCID: PMC10593020 DOI: 10.1101/2023.10.03.23296473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background There is a growing interest in stroke genomics and neurobiobanking research in Africa. These raise several ethical issues, such as consent, re-use, data sharing, storage, and incidental result of biological samples. Despite the availability of ethical guidelines developed for research in Africa, there is paucity of information on how the research participants' perspectives could guide the research community on ethical issues in stroke genomics and neurobiobanking research. To explore African research participants' perspectives on these issues, a study was conducted at existing Stroke Investigation Research and Education Network (SIREN) sites in Nigeria and Ghana. Method Using an exploratory design, twenty-eight Focus Group Discussions (FGDs) sessions were conducted with stroke survivors (n=7), caregivers(n=7), stroke - free controls(n=7), and Community Advisory Board members(n=7). Data were collected using an interview guide. Interviews were conducted in English and indigenous languages of the community, audio recorded, and transcribed verbatim. Data were analyzed using NVivo (March, 2020) Software. Result Results revealed that stroke genomics and neurobiobanking research in Africa require researchers' direct attention to ethical issues. Concerns were raised about understanding, disclosure and absence of coercion as components of true autonomous decision making in research participation. Participants argued that the risk and benefits attached to participation should be disclosed at the time of recruitment. Fears around data sharing were voiced as adherence to the principle of privacy and confidentiality were of paramount importance to participants. The preference was to receive the results of incidental findings with no stigma attached from society. Conclusion Research participants' perspectives are a vital aspect of community engagement in stroke genomics and neurobiobanking research. Findings from this study suggest that research participants are interested in these fields of research in Africa if their concerns about ethical issues are appropriately addressed within the research framework.
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Affiliation(s)
- Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Olubukola Balogun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Olorunyomi Felix Olorunsogbon
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Mayowa Ogunronbi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Arti Singh
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Abiodun Bello
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Albert Akpalu
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Fred S. Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Babatunde Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Nigeria
| | - Muyiwa Adigun
- Department of Public Law, Faculty of Law, University of Ibadan, Ibadan, Nigeria
| | - Dorcas Olujobi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Rabiu Musbahu
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Musibau Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
| | - Ibukun Afolami
- Department of Human Nutrition and Dietetics, College of Medicine, University of Ibadan, Nigeria
| | | | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Deborah Adesina
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Nathaniel Mensah
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Nathaniel Coleman
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Sunday Adeniyi
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Lanre Omotoso
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Shadrack Asibey
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lois Melikam
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Jibril Yusuf
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abdullateef Gbenga
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Aliyu Mande
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muhammed Uthman
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- School of Medicine, University of California, San Francisco, CA, USA
| | - Oyedunni Arulogun
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Rufus O. Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
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6
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Opoku NO, Doe F, Dubben B, Fetcho N, Fischer K, Fischer PU, Gordor S, Goss CW, Gyasi ME, Hoerauf A, Hong AR, Kanza E, King CL, Laryea R, Lew D, Seidu MA, Weil GJ. A randomized, open-label study of the tolerability and efficacy of one or three daily doses of ivermectin plus diethylcarbamazine and albendazole (IDA) versus one dose of ivermectin plus albendazole (IA) for treatment of onchocerciasis. PLoS Negl Trop Dis 2023; 17:e0011365. [PMID: 37205721 DOI: 10.1371/journal.pntd.0011365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/08/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Onchocerciasis ("river blindness") has been targeted for elimination. New treatments that kill or permanently sterilize female worms could accelerate this process. Prior studies have shown that triple drug treatment with ivermectin plus diethylcarbamazine and albendazole (IDA) leads to prolonged clearance of microfilaremia in persons with lymphatic filariasis. We now report results from a randomized clinical trial that compared the tolerability and efficacy of IDA vs. a comparator treatment (ivermectin plus albendazole, IA) in persons with onchocerciasis. METHODS AND FINDINGS The study was performed in the Volta region of Ghana. Persons with microfiladermia and palpable subcutaneous nodules were pre-treated with two oral doses of ivermectin (150 μg/kg) separated by at least 6 months prior to treatment with either a single oral dose of ivermectin 150 μg/kg plus albendazole 400 mg (IA), a single oral dose of IDA (IDA1, IA plus diethylcarbamazine (DEC. 6 mg/kg) or three consecutive daily doses of IDA (IDA3). These treatments were tolerated equally well. While adverse events were common (approximately 30% overall), no severe or serious treatment-emergent adverse events were observed. Skin microfilariae were absent or present with very low densities after all three treatments through 18 months, at which time nodules were excised for histological assessment. Nodule histology was evaluated by two independent assessors who were masked regarding participant infection status or treatment assignment. Significantly lower percentages of female worms were alive and fertile in nodules recovered from study participants after IDA1 (40/261, 15.3%) and IDA3 (34/281, 12.1%) than after IA (41/180, 22.8%). This corresponds to a 40% reduction in the percentage of female worms that were alive and fertile after IDA treatments relative to results observed after the IA comparator treatment (P = 0.004). Percentages of female worms that were alive (a secondary outcome of the study) were also lower after IDA treatments (301/574, 52.4%) than after IA (127/198, 64.1%) (P = 0.004). Importantly, some comparisons (including the reduced % of fertile female worms after IDA1 vs IA treatment, which was the primary endpoint for the study) were not statistically significant when results were adjusted for intraclass correlation of worm fertility and viability for worms recovered from individual study participants. CONCLUSIONS Results from this pilot study suggest that IDA was well tolerated after ivermectin pretreatment. They also suggest that IDA was more effective than the comparator treatment IA for killing or sterilizing female O. volvulus worms. No other short-course oral treatment for onchocerciasis has been demonstrated to have macrofilaricidal activity. However, this first study was too small to provide conclusive results. Therefore, additional studies will be needed to confirm these promising findings. TRIAL REGISTRATION The study is registered at Cinicaltrials.gov under the number NCT04188301.
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Affiliation(s)
- Nicholas O Opoku
- Fred Newton Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Felix Doe
- Hohoe Municipal Hospital, Hohoe, Ghana
| | - Bettina Dubben
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Nicole Fetcho
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Kerstin Fischer
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Peter U Fischer
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Shelter Gordor
- Fred Newton Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Charles W Goss
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Augustine R Hong
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eric Kanza
- Fred Newton Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Democratic Republic of the Congo (DRC)
| | - Christopher L King
- Center for Global Health and Diseases, Case-Western Reserve University, Cleveland, Ohio, United States of America
| | - Ruth Laryea
- Fred Newton Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Mahmood A Seidu
- Department of Medical Laboratory Science, School of Biomedical and Allied Sciences, University of Ghana, Accra, Ghana
| | - Gary J Weil
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
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7
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Uvere EO, Nichols M, Ojebuyi BR, Isah SY, Calys-Tagoe B, Jenkins C, Obiako R, Owolabi L, Akpalu A, Sarfo FS, Ogunronbi O, Adigun M, Fakunle GA, Hamzat B, Laryea R, Uthman B, Akinyemi JO, Adeleye O, Melikam L, Balogun O, Sule A, Adeniyi S, Asibey SO, Oguike W, Olorunsogbon O, Singh A, Titiloye MA, Musbahu R, Wahab KW, Kalaria RN, Jegede AS, Owolabi MO, Ovbiagele B, Arulogun OS, Akinyemi RO. Capacity-Building for Stroke Genomic Research Data Collection: The African Neurobiobank Ethical, Legal, and Social Implications Project Experience. Biopreserv Biobank 2023; 21:158-165. [PMID: 35759418 PMCID: PMC10125390 DOI: 10.1089/bio.2021.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The fields of stroke genomics, biobanking, and precision medicine are rapidly expanding in sub-Saharan Africa. However, the ethical, legal, and social implications (ELSI) of emerging neurobiobanking and genomic data resources are unclear in an emerging African scientific landscape with unique cultural, linguistic, and belief systems. Objective: This article documents capacity-building experiences of researchers during the development, pretesting, and validation of data collection instruments of the African Neurobiobank for Precision Stroke Medicine-(ELSI) Project. Methods: The African Neurobiobank for Precision Stroke Medicine-ELSI project is a transnational, multicenter project implemented across seven sites in Ghana and Nigeria. Guided by the Community-Based Participatory Research framework, we conducted three workshops with key stakeholders to review the study protocol, ensure uniformity in implementation; pretest, harmonize, and integrate context-specific feedback to ensure validity and adaptability of data collection instruments. Workshop impact was assessed using an open-ended questionnaire, which included questions on experience with participation in any of the workshops, building capacity in Genetic and Genomic Research (GGR), level of preparedness toward GGR, the genomic mini-dictionary developed by the team, and its impact in enhancing understanding in GGR. Data were analyzed qualitatively using a thematic framework approach. Results: Findings revealed the usefulness of the workshop in improving participants' knowledge and capacity toward GGR implementation. It further identified local, context-specific concerns regarding quality data collection, the need to develop culturally acceptable, genomic/biobanking data collection tools, and a mini-dictionary. Participants-reported perceptions were that the mini-dictionary enhanced understanding, participation, and data collection in GGR. Overall, participants reported increased preparedness and interest in participating in GGR. Conclusion: Capacity-building is a necessary step toward ELSI-related genomic research implementation in African countries where scholarship of ELSI of genomics research is emerging. Our findings may be useful to the design and implementation of ELSI-GGR projects in other African countries.
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Affiliation(s)
- Ezinne O. Uvere
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michelle Nichols
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Babatunde R. Ojebuyi
- Department of Communication and Language Arts, University of Ibadan, Ibadan, Nigeria
| | | | | | - Carolyn Jenkins
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Olumayowa Ogunronbi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Muyiwa Adigun
- Department of Law, University of Ibadan, Ibadan, Nigeria
| | | | - Bello Hamzat
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | - Babatunde Uthman
- Department of Epidemiology & Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Joshua O. Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Osi Adeleye
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lois Melikam
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olubukola Balogun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Abdullateef Sule
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Shadrack O. Asibey
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olorunyomi Olorunsogbon
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Musibau A. Titiloye
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rabiu Musbahu
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kolawole W. Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayodele S. Jegede
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa O. Owolabi
- Department of Medicine, University of Ibadan, Ibadan. Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, San Francisco, California, USA
| | - Oyedunni S. Arulogun
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus O. Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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8
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Ojebuyi BR, Afolami I, Adigun M, Singh A, Jenkins C, Nichols M, Wahab K, Bello A, Sarfo FS, Owolabi LF, Musbahu R, Obiako R, Akpalu A, Ogunronbi M, Olorunsogbon O, Calys-Tagoe B, Adesina D, Coleman N, Sule AG, Mande A, Uthman M, Titiloye M, Uvere E, Bukola O, Melikam S, Laryea R, Fakunle A, Adeleye O, Mensah N, Yusuf J, Adeniyi S, Asibey S, Omotoso L, Melikam L, Olujobi D, Oguike W, Akinyemi J, Jegede A, Kalaria R, Ovbiagele B, Owolabi M, Arulogun O, Akinyemi R. COMMUNICATING ELSI ISSUES IN NEUROBIOBANKING AND STROKE GENOMIC RESEARCH IN AFRICA: PROJECT INTERVENTION TOOLS DEVELOPMENT AND EVALUATION PROCEDURES. J Stroke Cerebrovasc Dis 2023. [DOI: 10.1016/j.jstrokecerebrovasdis.2023.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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9
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Sarfo FS, Ovbiagele B, Akinyemi J, Akpa O, Akpalu A, Wahab K, Ogbole G, Obiako R, Komolafe M, Owolabi L, Osaigbovo G, Jenkins C, Fakunle A, Adeoye A, Lackland D, Arnett D, Tiwari HK, Olunuga T, Uvere E, Fawale B, Ogah O, Agunloye A, Faniyan M, Diala S, Yinka O, Laryea R, Osimhiarherhuo A, Akinsanya C, Abdulwasiu A, Akpalu J, Arulogun O, Appiah L, Dambatta H, Olayemi B, Onasanya A, Isah S, Akinyemi R, Owolabi M. Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans. J Stroke Cerebrovasc Dis 2022; 31:106805. [PMID: 36194925 PMCID: PMC9840812 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND 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. PURPOSE To characterize the associations between stroke and dysglycemic status among West Africans. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | | | | | - Onoja Akpa
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Godwin Ogbole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | | | | | - Abiodun Adeoye
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Ezinne Uvere
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bimbo Fawale
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Okechukwu Ogah
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Samuel Diala
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladele Yinka
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | | | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | - Mayowa Owolabi
- College of Medicine, University of Ibadan, Ibadan, Nigeria.
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10
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Singh A, Arulogun O, Akinyemi J, Nichols M, Calys-Tagoe B, Ojebuyi B, Jenkins C, Obiako R, Akpalu A, Sarfo F, Wahab K, Sunday A, Owolabi LF, Adigun M, Afolami I, Olorunsogbon O, Ogunronbi M, Melikam ES, Laryea R, Asibey S, Oguike W, Melikam L, Sule A, Titiloye MA, Yahaya IS, Bello A, Kalaria RN, Jegede A, Owolabi M, Ovbiagele B, Akinyemi R. Biological sample donation and informed consent for neurobiobanking: Evidence from a community survey in Ghana and Nigeria. PLoS One 2022; 17:e0267705. [PMID: 35951660 PMCID: PMC9371301 DOI: 10.1371/journal.pone.0267705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Genomic research and neurobiobanking are expanding globally. Empirical evidence on the level of awareness and willingness to donate/share biological samples towards the expansion of neurobiobanking in sub-Saharan Africa is lacking. Aims To ascertain the awareness, perspectives and predictors regarding biological sample donation, sharing and informed consent preferences among community members in Ghana and Nigeria. Methods A questionnaire cross-sectional survey was conducted among randomly selected community members from seven communities in Ghana and Nigeria. Results Of the 1015 respondents with mean age 39.3 years (SD 19.5), about a third had heard of blood donation (37.2%, M: 42.4%, F: 32.0%, p = 0.001) and a quarter were aware of blood sample storage for research (24.5%; M: 29.7%, F: 19.4%, p = 0.151). Two out of ten were willing to donate brain after death (18.8%, M: 22.6%, F: 15.0%, p<0.001). Main reasons for unwillingness to donate brain were; to go back to God complete (46.6%) and lack of knowledge related to brain donation (32.7%). Only a third of the participants were aware of informed consent (31.7%; M: 35.9%, F: 27.5%, p<0.001). Predictors of positive attitude towards biobanking and informed consent were being married, tertiary level education, student status, and belonging to select ethnic groups. Conclusion There is a greater need for research attention in the area of brain banking and informed consent. Improved context-sensitive public education on neurobiobanking and informed consent, in line with the sociocultural diversities, is recommended within the African sub region.
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Affiliation(s)
- Arti Singh
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Carolina, Charleston, United Sates of America
| | | | - Babatunde Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Nigeria
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Carolina, Charleston, United Sates of America
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Albert Akpalu
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Fred Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Nigeria
| | - Adeniyi Sunday
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Nigeria
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Muyiwa Adigun
- Faculty of Law, University of Ibadan, Ibadan, Nigeria
| | - Ibukun Afolami
- Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olorunyomi Olorunsogbon
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ogunronbi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ruth Laryea
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Shadrack Asibey
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Lois Melikam
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Abdullateef Sule
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Musibau A. Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Isah Suleiman Yahaya
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Abiodun Bello
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- * E-mail:
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11
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Sarfo FS, Akpalu A, Bockarie A, Appiah L, Nguah SB, Ayisi-Boateng NK, Adamu S, Neizer C, Arthur A, Nyamekye R, Agyenim-Boateng K, Tagge R, Adusei-Mensah N, Ampofo M, Laryea R, Singh A, Amuasi JH, Ovbiagele B. Phone-Based Intervention under Nurse Guidance after Stroke (PINGS II) Study: Protocol for a Phase III Randomized Clinical Trial. J Stroke Cerebrovasc Dis 2021; 30:105888. [PMID: 34102553 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105888] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/24/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The Sub-Saharan African (SSA) region now has the highest estimated effect size of hypertension for stroke causation worldwide. An urgent priority for countries in SSA is to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. Thus the overall objective of the Phone-based Intervention under Nurse Guidance after Stroke II study (PINGS-2) is to deploy a hybrid study design to assess the efficacy of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to improve longer term blood pressure (BP) control among stroke survivors. MATERIALS AND METHODS A phase III randomized controlled trial involving 500 recent stroke survivors to be enrolled across 10 Ghanaian hospitals. Using a computer-generated sequence, patients will be randomly assigned 1:1 into the intervention or usual care arms. The intervention comprises of (i) home BP monitoring at least once weekly with nurse navigation for high domiciliary BP readings; (2) medication reminders using mobile phone alerts and (3) education on hypertension and stroke delivered once weekly via audio messages in preferred local dialects. The intervention will last for 12 months. The control group will receive usual care as determined by local guidelines. The primary outcome is the proportion of patients with systolic BP <140 mm Hg at 12 months. Secondary outcomes will include medication adherence, self-management of hypertension, major adverse cardiovascular events, health related quality of life and implementation outcomes. CONCLUSION An effective PINGS intervention can potentially be scaled up and disseminated across healthcare systems in low-and-middle income countries challenged with resource constraints to reduce poor outcomes among stroke survivors.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel Blay Nguah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - Agnes Arthur
- Ankaase Methodist Faith Hospital, Ankaase, Ghana
| | | | | | - Raelle Tagge
- Northern California Institute of Research and Education, USA
| | | | | | | | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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12
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Cilia R, Cereda E, Akpalu A, Sarfo FS, Cham M, Laryea R, Obese V, Oppon K, Del Sorbo F, Bonvegna S, Zecchinelli AL, Pezzoli G. Natural history of motor symptoms in Parkinson's disease and the long-duration response to levodopa. Brain 2020; 143:2490-2501. [PMID: 32844196 PMCID: PMC7566883 DOI: 10.1093/brain/awaa181] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/01/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023] Open
Abstract
The natural pattern of progression of Parkinson’s disease is largely unknown because
patients are conventionally followed on treatment. As Parkinson’s disease progresses, the
true magnitude of the long-duration response to levodopa remains unknown, because it can
only be estimated indirectly in treated patients. We aimed to describe the natural course
of motor symptoms by assessing the natural OFF in consecutive Parkinson’s disease patients
never exposed to treatment (drug-naïve), and to investigate the effects of daily levodopa
on the progression of motor disability in the OFF medication state over a 2-year period.
In this prospective naturalistic study in sub-Saharan Africa, 30 Parkinson’s disease
patients (age at onset 58 ± 14 years, disease duration 7 ± 4 years) began levodopa
monotherapy and were prospectively assessed using the Unified Parkinson’s disease Rating
Scale (UPDRS). Data were collected at baseline, at 1-year and 2-years follow-up.
First-ever levodopa intake induced a significant improvement in motor symptoms (natural
OFF versus ON state UPDRS-III 41.9 ± 15.9 versus 26.8 ± 15.1, respectively;
P < 0.001). At 1-year follow-up, OFF state
UPDRS-III score after overnight withdrawal of levodopa was considerably lower than natural
OFF (26.5 ± 14.9; P < 0 .001). This effect was not
modified by disease duration. At the 2-year follow-up, motor signs after overnight OFF
(30.2 ± 14.2) were still 30% milder than natural OFF
(P = 0.001). The ON state UPDRS-III at the first-ever
levodopa challenge was similar to the overnight OFF score at 1-year follow-up and the two
conditions were correlated (r = 0.72,
P < 0.001). Compared to the natural progression of
motor disability, levodopa treatment resulted in a 31% lower annual decline in UPDRS-III
scores in the OFF state (3.33 versus 2.30 points/year) with a lower model’s variance
explained by disease duration (67% versus 36%). Using the equation regressed on
pretreatment data, we predicted the natural OFF at 1-year and 2-year follow-up visits and
estimated that the magnitude of the long-duration response to levodopa ranged between 60%
and 65% of total motor benefit provided by levodopa, independently of disease duration
(P = 0.13). Although levodopa therapy was associated
with motor fluctuations, overnight OFF disability during levodopa was invariably less
severe than the natural course of the disease, independently of disease duration. The same
applies to the yearly decline in UPDRS-III scores in the OFF state. Further research is
needed to clarify the mechanisms underlying the long-duration response to levodopa in
Parkinson’s disease. Understanding the natural course of Parkinson’s disease and the
long-duration response to levodopa may help to develop therapeutic strategies increasing
its magnitude to improve patient quality of life and to better interpret the outcome of
randomized clinical trials on disease-modifying therapies that still rely on the overnight
OFF to define Parkinson’s disease progression.
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Affiliation(s)
- Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy.,Previous address: Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Albert Akpalu
- Korle Bu Teaching Hospital, Accra, Greater Accra region, Ghana
| | | | - Momodou Cham
- Father Novati Catholic Hospital, Sogakope, Volta region, Ghana
| | - Ruth Laryea
- Korle Bu Teaching Hospital, Accra, Greater Accra region, Ghana
| | - Vida Obese
- Komfo Anokye Teaching Hospital, Kumasi, Ashanti region, Ghana
| | - Kenneth Oppon
- Father Novati Catholic Hospital, Sogakope, Volta region, Ghana
| | | | - Salvatore Bonvegna
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy.,Previous address: Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | | | - Gianni Pezzoli
- Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy.,Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
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13
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Sarfo FS, Ovbiagele B, Gebregziabher M, Akpa O, Akpalu A, Wahab K, Ogbole G, Akinyemi R, Obiako R, Komolafe M, Owolabi L, Lackland D, Arnett D, Tiwari H, Markus HS, Akinyemi J, Oguntade A, Fawale B, Adeoye A, Olugbo O, Ogunjimi L, Osaigbovo G, Jenkins C, Chukwuonye I, Ajose O, Oyinloye L, Mutiso F, Laryea R, Calys-Tagoe B, Salaam A, Amusa G, Olowookere S, Imoh C, Mande A, Arulogun O, Adekunle F, Appiah L, Balogun O, Singh A, Adeleye O, Ogah O, Makanjuola A, Owusu D, Kolo P, Adebayo O, Agunloye A, Shidali V, Faniyan M, Lakoh S, Diala S, Iheonye H, Efidi C, Sanya E, Sunmonu T, Akintunde A, Owolabi M. Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans. Neurology 2020; 94:e998-e1012. [PMID: 32075893 PMCID: PMC7238923 DOI: 10.1212/wnl.0000000000009056] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 09/26/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans. METHODS The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors. RESULTS Of 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78-213.72); dyslipidemia, 2.95 (1.84-4.74); meat consumption, 1.55 (1.01-2.38); family history of CVD, 2.22 (1.41-3.50); nonconsumption of green vegetables, 3.61 (2.07-6.31); diabetes mellitus, 2.11 (1.29-3.46); stress, 1.68 (1.03-2.77); and current tobacco use, 14.27 (2.09-97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43-2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00-1.01); presence of midline shift, 1.54 (1.11-2.13); lobar ICH, 1.72 (1.16-2.55); and supratentorial bleeds, 2.17 (1.06-4.46). CONCLUSIONS Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.
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Affiliation(s)
- Fred S Sarfo
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Bruce Ovbiagele
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Mulugeta Gebregziabher
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Onoja Akpa
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Albert Akpalu
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Kolawole Wahab
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Godwin Ogbole
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Rufus Akinyemi
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Reginald Obiako
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Morenikeji Komolafe
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Lukman Owolabi
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria.
| | - Daniel Lackland
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Donna Arnett
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Hemant Tiwari
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Hugh S Markus
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Joshua Akinyemi
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Ayodipupo Oguntade
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Bimbo Fawale
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Abiodun Adeoye
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Obiabo Olugbo
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Luqman Ogunjimi
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Godwin Osaigbovo
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Carolyn Jenkins
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Ijezie Chukwuonye
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Olabamiji Ajose
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Lekan Oyinloye
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Fedelis Mutiso
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Ruth Laryea
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Benedict Calys-Tagoe
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Abdul Salaam
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Ganiyu Amusa
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Samuel Olowookere
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Chidiebere Imoh
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Aliyu Mande
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Oyedunni Arulogun
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Fakunle Adekunle
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Lambert Appiah
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Olayemi Balogun
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Arti Singh
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Osi Adeleye
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Okechukwu Ogah
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Akintomiwa Makanjuola
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Dorcas Owusu
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Philip Kolo
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Oladimeji Adebayo
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Atinuke Agunloye
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Vincent Shidali
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Moyinoluwalogo Faniyan
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Sulaiman Lakoh
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Samuel Diala
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Henry Iheonye
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Chika Efidi
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Emmanuel Sanya
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Taofiki Sunmonu
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Adeseye Akintunde
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria
| | - Mayowa Owolabi
- From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria.
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Akinyemi RO, Jenkins C, Nichols M, Singh A, Wahab K, Akpalu A, Sarfo FS, Owolabi LF, Obiako R, Akinyemi J, Ojebuyi B, Adigun M, Musbahu R, Bello A, Titiloye M, Calys-Tagoe B, Ogunronbi M, Uvere E, Laryea R, Fakunle A, Adeleye O, Olorunsogbon O, Ojo A, Adesina D, Mensah N, Oguike W, Coleman N, Mande A, Uthman M, Kalaria RN, Jegede A, Owolabi M, Ovbiagele B, Arulogun O. 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. Int J Qual Methods 2020; 19:10.1177/1609406920923194. [PMID: 34276269 PMCID: PMC8284747 DOI: 10.1177/1609406920923194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The ethical, legal, and social implications (ELSI) of emerging neurobiobanks and data resources are unclear in an African scientific landscape with unique cultural, linguistic, and belief systems. The overarching goal of the African Neurobiobank for Precision Stroke Medicine-ELSI Project is to identify, examine, and develop novel approaches to address ELSI issues of biobanking and stroke genomic research in sub-Saharan Africa (SSA). To accomplish the goal we will (1) explore knowledge, attitude, perceptions, barriers, and facilitators influencing ELSI issues related to biobanking and stroke genomic research; (2) use information obtained to craft a community intervention program focused on ELSI issues; and (3) build capacity and careers related to genomics and biobanking for effective client/community engagement while enhancing regulatory, governance, and implementation competences in biobanking science in SSA. A community-based participatory research and mixed-methodological approach, focused on various levels of the social ecological model, will be used to identify and examine relevant ELSI issues. Contextual intervention tools, platforms, and practices will be developed to enhance community understanding and participation in stroke biobanking and genomics research activities while facilitating enduring trust, and equitable and fair utilization of biobanking resources for genetic and trans-omics research. A concurrent capacity building program related to genetic counseling and biobanking will be implemented for early career researchers. The huge potential for neurobiobanking and genomics research in Africa to advance precision medicine applicable to stroke and other neurological disorders requires addressing ELSI challenges while building sustainable research, career, and regulatory capacities in trans-omics and biobanking science.
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Affiliation(s)
- Rufus O. Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arti Singh
- KNUST Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Albert Akpalu
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Fred S. Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Babatunde Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Nigeria
| | | | - Rabiu Musbahu
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
- Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Abiodun Bello
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Musibau Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
| | | | - Mayowa Ogunronbi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Olorunyomi Olorunsogbon
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Adebayo Ojo
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Deborah Adesina
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Nathaniel Mensah
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Nathaniel Coleman
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Aliyu Mande
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
| | - Muhammed Uthman
- Department of Epidemiology and Community Health, Faculty of Clinical Sciences, University of Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- School of Medicine, University of California, San Francisco, CA, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
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Akinyemi RO, Sarfo FS, Akinyemi J, Singh A, Onoja Akpa M, Akpalu A, Owolabi L, Adeoye AM, Obiako R, Wahab K, Sanya E, Komolafe M, Ogbole G, Fawale M, Adebayo P, Osaigbovo G, Sunmonu T, Olowoyo P, Chukwuonye I, Obiabo Y, Adeniji O, Fakunle G, Melikam E, Saulson R, Yaria J, Uwanruochi K, Ibinaiye P, Adeniyi Amusa G, Suleiman Yahaya I, Hamisu Dambatta A, Faniyan M, Olowoniyi P, Bock-Oruma A, Chidi Joseph O, Oguntade A, Kolo P, Laryea R, Lakoh S, Uvere E, Farombi T, Akpalu J, Oyinloye O, Appiah L, Calys-Tagoe B, Shidali V, Abdulkadir Tabari N, Adebayo O, Efidi R, Adeleye O, Owusu D, Ogunjimi L, Aridegbe O, Lucius Imoh C, Sanni T, Gebreziabher M, Hemant T, Arulogun O, Ogunniyi A, Jenkins C, Owolabi M, Ovbiagele B. Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study. Int J Stroke 2019; 14:69-79. [PMID: 30040054 PMCID: PMC8325169 DOI: 10.1177/1747493018790059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. OBJECTIVE To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. METHODS A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants' knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed. RESULTS Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25-1.81) and a family history of stroke (OR 1.20, 1.03-1.39) while Islamic religion (OR=0.82, CI: 0.72-0.94), being currently unmarried (OR = 0.81, CI: 0.70-0.92), and alcohol use (OR = 0.78, CI: 0.67-0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03-1.74) but inversely associated with a medical history of high blood pressure (OR = 0.79, 0.65-0.96). CONCLUSION To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventions.
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Affiliation(s)
- Rufus O Akinyemi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria,Federal Medical Centre, Abeokuta, Nigeria
| | - Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Arti Singh
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Matthew Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana, Accra, Ghana
| | - Lukman Owolabi
- Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Abiodun M. Adeoye
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel Sanya
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Department of Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | - Godwin Osaigbovo
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Taofiki Sunmonu
- Department of Medicine, Federal Medical Centre, Owo, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Yahaya Obiabo
- Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | | | - Gregory Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Melikam
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Raelle Saulson
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Joseph Yaria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Phillip Ibinaiye
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | | | | | - Mercy Faniyan
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Peter Olowoniyi
- Department of Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Andrew Bock-Oruma
- Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Odo Chidi Joseph
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Philip Kolo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- Department of Medicine, University of Ghana, Accra, Ghana
| | - Sulaiman Lakoh
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitope Farombi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Olalekan Oyinloye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lambert Appiah
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Vincent Shidali
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Oladimeji Adebayo
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Richard Efidi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Dorcas Owusu
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Luqman Ogunjimi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Taofeeq Sanni
- Department of Medicine, Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Tiwari Hemant
- Department of Epidemiology, University of Alabama at Birmingham, Alabama, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Carolyn Jenkins
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Mayowa Owolabi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
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16
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Adjei P, Nkromah K, Akpalu A, Laryea R, Osei Poku F, Ohene S, Puplampu P, Twumasi Aboagye E. A cross-sectional comparative study of perceived stigma between patients with epilepsy and patients living with HIV/AIDS in Accra, Ghana. Epilepsy Behav 2018; 89:1-7. [PMID: 30384093 DOI: 10.1016/j.yebeh.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Health-related stigma is a great challenge to the treatment of diseases. In epilepsy like other conditions, it causes affected individuals to conceal their illness. In this study, we described stigma perceived by patients with epilepsy at the Korle Bu Teaching Hospital (KBTH), a tertiary referral facility, and the Accra Psychiatry Hospital in Ghana (APH). We then compared the perception of stigma in patients with epilepsy to stigma perceived by persons living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (PLWHA), a chronic communicable disease stigmatized in Ghana. METHODS A total of 351 patients with epilepsy were recruited from both sites by systematic random sampling and interviewed. The Kilifi Stigma Scale for Epilepsy was used to determine individual patient's stigma score. Statistical analysis was done using multiple logistic regression analysis to control for the effect of measured independent variables that were significant on univariate analysis: age, gender, marital status, income, type of epilepsy, and the frequency of seizures, on the outcome variable. Comparative analysis of the mean stigma score in patients with epilepsy and persons living with HIV/AIDS was done using the Student's t-test and Mann-Whitney U test (Wilcoxon rank sum test). RESULTS The presence of perceived stigma using the Kilifi Stigma Score Estimation was 32.02% (62), 33.33% (49), and 28.88% (54) among respondents from KBTH, APH, and PLWHA respectively. Results from Wilcoxon rank sum test showed that the median stigma score between the three groups was significant; KBTH and APH (p-value; 0.0258), KBTH and PLWHA (p-value; 0.00001), and APH and PLWHA (p-value; 0.0000). Age (<40 years), seizure frequency, ethnic group (Ewe and Guan), and being divorced showed high odds for perceived stigma among KBTH patients with epilepsy. Having tertiary education led to lower odds for perceived stigma in epilepsy for APH patients with epilepsy. CONCLUSION This study showed that epilepsy is associated with a high stigma perception. The perceived stigma was greater than stigma in PLWHAs in Accra. Stigma was affected by unemployment, ethnicity (Ewe and Guan), and uncontrolled seizures. Increasing age reduced perceived stigma and the management of patients with epilepsy in a psychiatric facility might have impacted negatively on the perceived stigma.
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Affiliation(s)
- Patrick Adjei
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana.
| | | | - Albert Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana
| | - Ruth Laryea
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Sammy Ohene
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana
| | - Peter Puplampu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana
| | - Elvis Twumasi Aboagye
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
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17
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Jenkins C, Ovbiagele B, Arulogun O, Singh A, Calys-Tagoe B, Akinyemi R, Mande A, Melikam ES, Akpalu A, Wahab K, Sarfo FS, Sanni T, Osaigbovo G, Tiwari HK, Obiako R, Shidali V, Ibinaiye P, Akpalu J, Ogbole G, Owolabi L, Uvere E, Taggae R, Adeoye AM, Gebregziabher M, Akintunde A, Adebayo O, Oguntade A, Bisi A, Ohagwu K, Laryea R, Olowoniyi P, Yahaya IS, Olowookere S, Adeyemi F, Komolafe M, Fawale MB, Sunmonu T, Onyeonoro U, Imoh LC, Oguike W, Olunuga T, Kolo P, Ogah OS, Efidi R, Chukwuonye I, Bock-Oruma A, Owusu D, Odo CJ, Faniyan M, Ohnifeman OA, Ajose O, Ogunjimi L, Johnson S, Ganiyu A, Olowoyo P, Fakunle AG, Tolulope A, Farombi T, Obiabo MO, Owolabi M. Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action. PLoS One 2018; 13:e0206548. [PMID: 30444884 PMCID: PMC6239297 DOI: 10.1371/journal.pone.0206548] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/15/2018] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Bruce Ovbiagele
- Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Oyedunni Arulogun
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Rufus Akinyemi
- Federal Medical Center, University of Ibadan, Abeokuta, Nigeria
| | | | | | | | | | | | - Taofeeq Sanni
- Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Hemant K. Tiwari
- Biostatistics, University of Alabama, Birmingham, Alabama, United States of America
| | | | | | | | | | - Godwin Ogbole
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | | | - Ezinne Uvere
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | - Raelle Taggae
- Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | | | - Mulugeta Gebregziabher
- Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Adeseye Akintunde
- Ladoke Akintola University of Technology & Teaching Hospital, Ogbomoso, Nigeria
| | - Oladimeji Adebayo
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | | | - Ayotunde Bisi
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | | | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | | | | | | | | | | | - Wisdom Oguike
- Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Taiye Olunuga
- Federal Medical Center, University of Ibadan, Abeokuta, Nigeria
| | - Phillip Kolo
- Medicine, University of Ilorin, University of Ilorin Teaching Hospital Ilorin, Nigeria
| | - Okechukwu S. Ogah
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | - Richard Efidi
- Radiology, College of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | | | - Chidi Joseph Odo
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | | | | | - Olabanji Ajose
- Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria
| | - Luqman Ogunjimi
- University College Hospital and University of Ibadan, Ibadan, Nigeria
| | - Shelia Johnson
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Amusa Ganiyu
- Cardiology, Jos University Teaching Hospital, Jos, Nigeria
| | - Paul Olowoyo
- Neurology, Medicine, Federal Teaching Hospital, Ido-Ekiti College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | | | - Afolaranmi Tolulope
- Community Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Temitope Farombi
- Neurology Unit, Chief Tony Anenih Geriatric Center, University College Hospital, Ibadan, Nigeria
| | | | - Mayowa Owolabi
- University College Hospital and University of Ibadan, Ibadan, Nigeria
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18
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Akinyemi RO, Akinwande K, Diala S, Adeleye O, Ajose A, Issa K, Owusu D, Boamah I, Yahaya IS, Jimoh AO, Imoh L, Fakunle G, Akpalu A, Sarfo F, Wahab K, Sanya E, Owolabi L, Obiako R, Osaigbovo G, Komolafe M, Fawale M, Adebayo P, Olowoyo P, Obiabo Y, Sunmonu T, Chukwuonye I, Balogun O, Adeoye B, Oladele F, Olowoniyi P, Adeyemi F, Lezzi A, Falayi AT, Fasanya M, Ogunwale K, Adeola O, Olomu O, Aridegbe O, Laryea R, Uvere E, Faniyan M, Melikam E, Tagge R, Akpa O, Akinyemi J, Arulogun O, Tiwari HK, Ovbiagele B, Owolabi MO. Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project. Biopreserv Biobank 2018; 16:217-232. [PMID: 29733683 PMCID: PMC5995267 DOI: 10.1089/bio.2017.0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Rufus O. Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | | | - Samuel Diala
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Abiodun Ajose
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Kehinde Issa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Dorcas Owusu
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Isaac Boamah
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | | | - Lucius Imoh
- Neurology Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Gregory Fakunle
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Albert Akpalu
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Fred Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel Sanya
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lukman Owolabi
- Neurology Unit, Department of Medicine, Bayero University, Kano, Nigeria
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Godwin Osaigbovo
- Neurology Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Morenikeji Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Michael Fawale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Neurology Unit, Department of Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | - Paul Olowoyo
- Neurology Unit, Department of Medicine, Federal University Teaching Hospital, Ido Ekiti, Nigeria
| | - Yahaya Obiabo
- Neurology Unit, Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Taofiki Sunmonu
- Neurology Unit, Department of Medicine, Federal Medical Center, Owo, Nigeria
| | - Ijezie Chukwuonye
- Neurology Unit, Department of Medicine, Federal Medical Center, Umuahia, Nigeria
| | - Olayemi Balogun
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Basirat Adeoye
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Florence Oladele
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Peter Olowoniyi
- Neurology Unit, Department of Medicine, Federal Medical Center, Umuahia, Nigeria
| | - Frederick Adeyemi
- Neurology Unit, Department of Medicine, Federal Medical Center, Owo, Nigeria
| | - Arthur Lezzi
- Neurology Unit, Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Ajibola Tunde Falayi
- Neurology Unit, Department of Medicine, Federal University Teaching Hospital, Ido Ekiti, Nigeria
| | - Michael Fasanya
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Kolawole Ogunwale
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olabisi Adeola
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Omolara Olomu
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | | | - Ruth Laryea
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ezinne Uvere
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Moyinoluwalogo Faniyan
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ezinne Melikam
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Raelle Tagge
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Onoja Akpa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oyedunni Arulogun
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K. Tiwari
- School of Public Health, University of Alabama, Birmingham, Alabama
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mayowa O. Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
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19
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Owolabi M, Sarfo F, Howard VJ, Irvin MR, Gebregziabher M, Akinyemi R, Bennett A, Armstrong K, Tiwari HK, Akpalu A, Wahab KW, Owolabi L, Fawale B, Komolafe M, Obiako R, Adebayo P, Manly JM, Ogbole G, Melikam E, Laryea R, Saulson R, Jenkins C, Arnett DK, Lackland DT, Ovbiagele B, Howard G. Stroke in Indigenous Africans, African Americans, and European Americans: Interplay of Racial and Geographic Factors. Stroke 2017; 48:1169-1175. [PMID: 28389611 DOI: 10.1161/strokeaha.116.015937] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA). METHODS SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa-the ancestral home of 71% AA-whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies. RESULTS There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively (P<0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; P<0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; P<0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%; P<0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%; P<0.0001). Premorbid sedentary lifestyle was similar in AA (37.7%) and EA (34.0%) but lower frequency in IA (8.0%). CONCLUSIONS Environmental risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry.
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Affiliation(s)
- Mayowa Owolabi
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Fred Sarfo
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Virginia J Howard
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Marguerite R Irvin
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Mulugeta Gebregziabher
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Rufus Akinyemi
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Aleena Bennett
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Kevin Armstrong
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Hemant K Tiwari
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Albert Akpalu
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Kolawole W Wahab
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Lukman Owolabi
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Bimbo Fawale
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Morenikeji Komolafe
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Reginald Obiako
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Philip Adebayo
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Jennifer M Manly
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Godwin Ogbole
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Ezinne Melikam
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Ruth Laryea
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Raelle Saulson
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Carolyn Jenkins
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Donna K Arnett
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Daniel T Lackland
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
| | - Bruce Ovbiagele
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
| | - George Howard
- From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.)
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Adeoye AM, Ovbiagele B, Kolo P, Appiah L, Aje A, Adebayo O, Sarfo F, Akinyemi J, Adekunle G, Agyekum F, Shidali V, Ogah O, Lackland D, Gebregziabher M, Arnett D, Tiwari HK, Akinyemi R, Olagoke OO, Oguntade AS, Olunuga T, Uwanruochi K, Jenkins C, Adadey P, Iheonye H, Owolabi L, Obiako R, Akinjopo S, Armstrong K, Akpalu A, Fakunle A, Saulson R, Aridegbe M, Olowoyo P, Osaigbovo G, Akpalu J, Fawale B, Adebayo P, Arulogun O, Ibinaiye P, Agunloye A, Ishaq N, Wahab K, Akpa O, Adeleye O, Bock-Oruma A, Ogbole G, Melikam S, Yaria J, Ogunjimi L, Salaam A, Sunmonu T, Makanjuola A, Farombi T, Laryea R, Uvere E, Kehinde S, Chukwuonye I, Azuh P, Komolafe M, Akintunde A, Obiabo O, Areo O, Kehinde I, Amusa AG, Owolabi M. Exploring Overlaps Between the Genomic and Environmental Determinants of LVH and Stroke: A Multicenter Study in West Africa. Glob Heart 2017; 12:107-113.e5. [PMID: 28302552 DOI: 10.1016/j.gheart.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown. OBJECTIVES We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study. METHODS SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques. RESULTS This preliminary analysis included only 725 stroke patients (mean age 59.1 ± 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p < 0.001). Those with LVH were younger (57.9 ± 12.8 vs. 60.6 ± 13.4; p = 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p < 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p < 0.001). Significant independent predictors of LVH were age <45 years (adjusted odds ratio [AOR]: 1.91; 95% confidence interval [CI]: 1.14 to 3.19), female sex (AOR: 2.01; 95% CI: 1.44 to 2.81), and diastolic blood pressure > 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p < 0.001). CONCLUSIONS The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry.
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Affiliation(s)
| | | | - Philip Kolo
- University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | - Fred Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | | | | | - Dan Lackland
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raelle Saulson
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Paul Olowoyo
- Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | | | - Bimbo Fawale
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | | | | | | | | | | | | | - Omisore Adeleye
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | | | | | | | | | | | | | | | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | | | | | - Olugbo Obiabo
- Delta State University Teaching Hospital, Ogara, Nigeria
| | - Olusegun Areo
- Federal University Teaching Hospital, Ido-Ekiti, Nigeria
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Jenkins C, Arulogun OS, Singh A, Mande AT, Ajayi E, Calys-Tagoe B, Ovbiagele B, Lackland DT, Sarfo FS, Akinyemi R, Akpalu A, Obiako R, Melikam ES, Laryea R, Shidali V, Sagoe K, Ibinaiye P, Fakunle AG, Owolabi LF, Owolabi MO. Stroke Investigative Research and Education Network: Community Engagement and Outreach Within Phenomics Core. Health Educ Behav 2017; 43:82S-92S. [PMID: 27037152 DOI: 10.1177/1090198116634082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stroke is the leading cause of neurological hospital admissions in sub-Saharan Africa (SSA) and the second leading cause of death globally. The Stroke Investigative Research and Education Network seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other noncommunicable diseases in SSA. One of the first steps to address this goal is to effectively engage the communities that suffer the high burden of disease. The purpose of this article is to describe plans to elucidate information about knowledge, attitudes, beliefs, and practices about stroke and genomics from patients, caregivers, and local leaders, to recruit participation in research activities and dissemination of ongoing results, as well as to facilitate research uptake and impact within the broader communities of scientists, health professionals, policy makers, and others. We describe the (a) study sites and their communities; (b) plans for community advisory boards, focus groups, and surveys; (c) methods for data management in REDCap database; (d) analyses of qualitative data; (e) evaluation of community and public engagement across multiple sites and research teams in SSA and the United States; (f) use of RE-AIM for presentation of evaluation data; and (g) community indicators of success. This is the first of its kind public outreach engagement initiative to evaluate stroke and genomics in SSA, and has implications as a model for assessment in other high-stroke risk populations.
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22
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Sarfo F, Gebregziabher M, Ovbiagele B, Akinyemi R, Owolabi L, Obiako R, Akpa O, Armstrong K, Akpalu A, Adamu S, Obese V, Boa-Antwi N, Appiah L, Arulogun O, Mensah Y, Adeoye A, Tosin A, Adeleye O, Tabi-Ajayi E, Phillip I, Sani A, Isah S, Tabari N, Mande A, Agunloye A, Ogbole G, Akinyemi J, Laryea R, Melikam S, Uvere E, Adekunle G, Kehinde S, Azuh P, Dambatta A, Ishaq N, Saulson R, Arnett D, Tiwari H, Jenkins C, Lackland D, Owolabi M. Multilingual Validation of the Questionnaire for Verifying Stroke-Free Status in West Africa. Stroke 2015; 47:167-72. [PMID: 26578660 DOI: 10.1161/strokeaha.115.010374] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Questionnaire for Verifying Stroke-Free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological, and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages, Yoruba, Hausa and Akan, for ascertainment of stroke-free status of control subjects enrolled in an on-going stroke epidemiological study in West Africa. METHODS Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records, and neuroimaging (gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by gold standard, 98% were determined to have had stroke, whereas of 219 without stroke 87% were determined to be stroke-free by QVSFS. Negative predictive value of the QVSFS across the 3 languages was 0.97 (range, 0.93-1.00), sensitivity, specificity, and positive predictive value were 0.98, 0.82, and 0.80, respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen k=0.92. CONCLUSIONS QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa.
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Affiliation(s)
- Fred Sarfo
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.).
| | - Mulugeta Gebregziabher
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Bruce Ovbiagele
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Rufus Akinyemi
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Lukman Owolabi
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Reginald Obiako
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Onoja Akpa
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Kevin Armstrong
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Albert Akpalu
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Sheila Adamu
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Vida Obese
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Nana Boa-Antwi
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Lambert Appiah
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Oyedunni Arulogun
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Yaw Mensah
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Abiodun Adeoye
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Aridegbe Tosin
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Osimhiarherhuo Adeleye
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Eric Tabi-Ajayi
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Ibinaiye Phillip
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Abubakar Sani
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Suleiman Isah
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Nasir Tabari
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Aliyu Mande
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Atinuke Agunloye
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Godwin Ogbole
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Joshua Akinyemi
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Ruth Laryea
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Sylvia Melikam
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Ezinne Uvere
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Gregory Adekunle
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Salaam Kehinde
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Paschal Azuh
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Abdul Dambatta
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Naser Ishaq
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Raelle Saulson
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Donna Arnett
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Hemnant Tiwari
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Carolyn Jenkins
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Dan Lackland
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
| | - Mayowa Owolabi
- From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., V.O., N.B.-A., L.A.); Department of Neurology, Medical University of South Carolina, (M.G., B.O., K.A., R.S., C.J., D.L.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., S.I., N.T., A.M., A.D., N.I.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., E.T.-A., I.P., A.S., P.A.); Department of Medicine, University of Ibadan, Ibadan, Nigeria (O. Akpa, O. Arulogun, A. Adeoye, A.T., O. Adeleye, A. Agunloye, G.O., J.A., S.M., E.U., G.A., S.K., M.O.); Department of Medicine, University of Ghana Medical School, Accra, Ghana (A. Akpalu, Y.M., R.L.); and Department of Biostatistics, University of Alabama at Birmingham (D.A., H.T.)
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Akpalu A, Sarfo FS, Ovbiagele B, Akinyemi R, Gebregziabher M, Obiako R, Owolabi L, Sagoe K, Jenkins C, Arulogun O, Adamu S, Appiah LT, Adadey MA, Agyekum F, Quansah JA, Mensah YB, Adeoye AM, Singh A, Tosin AO, Ohifemen O, Sani AA, Tabi-Ajayi E, Phillip IO, Isah SY, Tabari NA, Mande A, Agunloye AM, Ogbole GI, Akinyemi JO, Akpa OM, Laryea R, Melikam SE, Adinku D, Uvere E, Burkett NS, Adekunle GF, Kehinde SI, Azuh PC, Dambatta AH, Ishaq NA, Arnett D, Tiwari HK, Lackland D, Owolabi M. Phenotyping Stroke in Sub-Saharan Africa: Stroke Investigative Research and Education Network (SIREN) Phenomics Protocol. Neuroepidemiology 2015; 45:73-82. [PMID: 26304844 DOI: 10.1159/000437372] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/28/2015] [Indexed: 01/01/2023] Open
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.
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Adjei P, Akpalu A, Laryea R, Nkromah K, Sottie C, Ohene S, Osei A. Beliefs on epilepsy in Northern Ghana. Epilepsy Behav 2013; 29:316-21. [PMID: 24025488 DOI: 10.1016/j.yebeh.2013.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/23/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
Stigma associated with any chronic disease is one of the greatest challenges to the treatment of the disease. Stigma in health is a complex concept, and it causes people with a stigmatizing disease to conceal their disorder. Epilepsy is one such condition with numerous outdated, sometimes inhumane, and sometimes absurd perceptions that tend to fuel its stigma. Health-care workers who participated in an epilepsy training program as part of a World Health Organization/Ghana Health Service collaboration were asked to compile the perceptions associated with epilepsy in their communities. The comments they gathered are presented here.
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Affiliation(s)
- Patrick Adjei
- Department of Medicine and Therapeutics, University of Ghana Medical School, Korle Bu, Accra, Ghana; Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana.
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