Abstract P616: Characterization of the Associations Between Pre-Diabetes and Diabetes With Occurrence of Stroke by Its Types, Subtypes and Outcomes Among West Africans

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mayowa Owolabi ◽  
FRED S SARFO ◽  
Joshua Akinyemi ◽  
Kolawole Wahab ◽  
Edward Komolafe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Effect Size ◽  
Conditional Logistic Regression ◽  
Sub Saharan Africa ◽  
Stroke Severity ◽  
Glycemic Status ◽  
Outcome Indicators ◽  
West Africans ◽  
Sub Saharan ◽  
And Gender

Background: Pre-diabetes and diabetes mellitus (DM) are dysglycemic states associated with stroke occurrence. However, there is limited data from sub-Saharan Africa on the burden and associations between pre-DM and DM and stroke occurrence in a region experiencing an astronomic rise in stroke burden Purpose: To characterize the associations between stroke occurrence, types, subtypes, severity and outcome indicators according to glycemic 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 evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular, lifestyle, psychosocial factors, stroke severity and outcomes were performed. 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. The frequencies of euglycemia, pre-DM and DM among age- and sex-matched stroke-free controls were 69.2%, 13.3% and 17.5% respectively. Pre-diabetes was independently associated with stroke, adjusted odds ratio (95% CI) of 3.68 (2.61 - 5.21) as was having DM, aOR of 4.29 (3.19 - 5.74). The effect size of Pre-DM for ischemic stroke of 3.06 (95% CI: 2.01 - 4.64) was lower than that for DM of 4.82 (3.37-6.89). However, the effect size of Pre-DM for hemorrhagic stroke of 6.81 (95% CI: 3.29 - 14.08) is higher than 3.36 (1.94 - 5.86) for DM. Furthermore, the effect sizes of pre-DM for ischemic stroke subtypes were 9.64 (95% CI: 1.30-71.57) for cardio-embolic stroke, 3.64 (95% CI: 1.80-7.34) for small-vessel occlusive disease and 4.63 (95% CI: 0.80-26.65) for large-vessel disease. Conclusion: Every 2 out of 3 stroke cases admitted had a blood glucose abnormality. In addition to confirming the known associations between DM and stroke occurrence, we demonstrate that pre-DM is independently and more potently associated with hemorrhagic than ischemic strokes among West Africans.

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

Stroke ◽  
2021 ◽  
Author(s):  
Fred S. Sarfo ◽  
Bruce Ovbiagele ◽  
Onoja Akpa ◽  
Albert Akpalu ◽  
Kolawole Wahab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Vegetable Consumption ◽  
Conditional Logistic Regression ◽  
Small Vessel ◽  
Large Artery ◽  
Vessel Occlusion ◽  
West Africans ◽  
And Gender

Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91–15.45); dyslipidemia, 5.16 (3.78–7.03); diabetes, 3.44 (2.60–4.56); low green vegetable consumption, 1.89 (1.45–2.46); red meat consumption, 1.89 (1.45–2.46); cardiac disease, 1.88 (1.22–2.90); monthly income $100 or more, 1.72 (1.24–2.39); and psychosocial stress, 1.62 (1.18–2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively ( P <0.0001). Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

scholarly journals Information Technology and Gender Economic Inclusion in Sub-Saharan Africa

2021 ◽  
pp. 1-14
Author(s):  
Simplice A. Asongu ◽  
Joseph Amankwah‐Amoah ◽  
Rexon T. Nting ◽  
Godfred Adjapong Afrifa
Keyword(s):  
Information Technology ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
And Gender

scholarly journals Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 496
Author(s):  
Caroline Deignan ◽  
Alison Swartz ◽  
Sara Cooper ◽  
Christopher J. Colvin
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Hpv Vaccine ◽  
Hpv Vaccination ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Qualitative Systematic Review ◽  
Sub Saharan ◽  
And Gender

Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest worldwide. All three of the Human Papillomavirus (HPV) vaccines (9-valent, quadrivalent and bivalent HPV vaccine) provide primary protection against the most common cancer-causing strains of HPV (types 16 and 18) that are known to cause 70% of cervical cancers. Over the last five years, there has been an increase in Sub-Saharan African countries that have introduced the HPV vaccine. The majority of research has been conducted on supply-side barriers and facilitators to HPV vaccination uptake in SSA, yet little research has been conducted on demand-side or end-user perspectives of, and decisions around, HPV vaccination. In order to complement existing research, and inform current and future HPV vaccination implementation approaches, this qualitative systematic review explored Stakeholders’ understandings of HPV vaccination in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Thirty-one studies were found eligible for inclusion and were analyzed thematically using Braun and Clarke’s methods for conducting a thematic analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from this analysis; knowledge of HPV vaccination and cervical cancer is intertwined with misinformation; fear has shaped contradictory perceptions about HPV vaccination and gender dynamics are relevant in how stakeholders understand HPV vaccination in SSA.

Abstract WP227: Risk Factors for Pathophysiologic Subtypes of Ischemic Stroke Among West Africans: Findings From the SIREN Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Fred S Sarfo ◽  
Bruce Ovbiagele ◽  
Onoja M Akpa ◽  
Rufus Akinyemi ◽  
Albert Akpalu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Vegetable Consumption ◽  
Conditional Logistic Regression ◽  
Meat Consumption ◽  
Small Vessel ◽  
Large Artery ◽  
Green Vegetable ◽  
Catchment Areas ◽  
West Africans

Background: The risk factors associated with the occurrence of the distinct pathophysiologic subtypes of ischemic stroke are unknown among indigenous Africans. Objective: To identify and quantify the contributions of risk factors for occurrence of ischemic stroke and its etiologic subtypes among West Africans. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Nigeria and Ghana. Cases included adults aged >18 years with CT/MRI confirmed stroke and ischemic strokes were etiologically subtyped using the TOAST protocol. Controls were age-and-gender matched stroke-free adults recruited from the communities in catchment areas of cases. Comprehensive evaluation for vascular, lifestyle and psychosocial factors was performed using standard instruments. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: There were 1,721 ischemic stroke cases with a mean age of 62.19 ± 14.03 vs 60.86 ± 13.71 for controls. Using the TOAST etiologic scheme, 867 (50.3%) were small vessel occlusions, 425(24.7%) were large-artery atherosclerotic, 181(10.5%) were cardio-embolic, 204(11.9%) were undetermined and 44(2.6%) were of other determined etiology. The 7 dominant risk factors for ischemic strokes aOR (95%CI) were hypertension 10.76(7.15-16.20), dyslipidemia 5.30(3.86-7.29), diabetes 3.61(2.72-4.80), psychosocial stress 1.68(1.20-2.35), cardiac disease 1.94 (1.25-3.02), meat consumption 2.02(1.54-2.65), green vegetable consumption 0.44(0.33-0.59). Hypertension, dyslipidemia, diabetes, meat consumption and green vegetable intake were confluent factors shared by small-vessel, large-vessel and cardio-embolic ischemic stroke subtypes. Conclusion: We provide empiric evidence of risk factors to be targeted for stroke prevention. Our findings open a vista into future studies aimed at elucidating the genetic factors linked with pathophysiologic subtypes of stroke among Africans.

Abstract WP286: Race and Gender Differences Among Patients With First or Recurrent Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Mary G George ◽  
Xin Tong
Keyword(s):  
Gender Differences ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Hospital Death ◽  
Stroke Severity ◽  
Race And Gender ◽  
Black Females ◽  
White Males ◽  
Black Patients ◽  
And Gender

Introduction: Little information is known about the race and gender differences in stroke severity of acute ischemic stroke (AIS) among those presenting with and without a recurrent stroke (RS). Methods: The study is limited to white and black patients who were admitted with an AIS in the Paul Coverdell National Acute Stroke Program from 2012-2014. There were 157 967 admissions from 453 hospitals identified. After excluding those with missing NIHSS (33 017), the analysis focused on 124 950 patients. Results: The median age of blacks and females was greater than for whites and males, 74 vs 63 and 75 vs 68, respectively. RS accounted for 21.8% of AIS in white males, 21.2% in white females, 28.3% in black males, and 30.0% in black females. The median NIHSS was higher among females with initial stroke or RS stroke (4.0 vs 3.0 and 5.0 vs 4.0, respectively, p<0.0001) and higher among blacks with initial stroke or RS (4.0 vs 3.0 and 5.0 vs 4.0, respectively, p<0.0001). Overall in-hospital death was greater among whites and females compared to blacks and males (4.1% vs 2.9%, p<0.0001; 4.2% vs 3.5%, p<0.0001, respectively), and this pattern was consistent for initial AIS and RS. Use of tPA was greater among whites and males compared to blacks and females (11.6% vs 10.3%, p<0.0001; 11.5 vs 11.1%, p=0.02, respectively). This pattern was consistent for initial AIS and RS by race and for initial AIS by gender, but not for tPA for RS by gender. Females and blacks were less likely to have a mild stroke (NIHSS score 0-4) than males and whites for both initial and RS (p<0.0001). After adjusting for age, state, hospital, and year, the odds of having an NIHSS ≥5 was 16% lower among males, 36% greater among blacks, and 38% greater for those with a RS (data not shown). Conclusion: Race and gender differences on age, stroke severity, receipt of tPA, and in-hospital death among initial AIS patients persist for RS. Blacks, females, and those with a RS have more severe AIS.

ICT Is Not Gender Blind

2016 ◽  
pp. 174-193 ◽  
Author(s):  
Adamkolo Mohammed Ibrahim ◽  
Mohammed Alhaji Adamu
Keyword(s):  
Gender Gap ◽  
Gender Disparity ◽  
Sub Saharan Africa ◽  
Research Findings ◽  
Software And Hardware ◽  
Sub Saharan ◽  
Gender Based ◽  
And Gender ◽  
Online Library ◽  
Developed World

This chapter critically reviewed literature on gender disparity associated with access and usage of ICT, focusing on the less developed world, especially Sub-Saharan Africa. The authors used relevant online literature sourced from research databases such as Google Scholar, Elsevier and Wiley Online Library. With the aid of graphical illustrations, the chapter aligned its argument with some critical global research findings regarding gender-based mobile phone and Internet usage and the concept of ICT and gender. The chapter concluded that ICT gender gap negatively affects the socio-economic development of women, and recommended that ICTs manufacturers should integrate gender-balanced software and hardware right at the time of production of the technologies.

scholarly journals Serum levels of Trimethylamine-N-oxide in patients with ischemic stroke

2019 ◽  
Vol 39 (6) ◽  
Author(s):  
Maimaiti Rexidamu ◽  
Hongmei Li ◽  
Haiyan Jin ◽  
Jiankang Huang
Keyword(s):  
Ischemic Stroke ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Clinical Severity ◽  
Chinese Patients ◽  
Stroke Severity ◽  
Increased Risk ◽  
Median Level ◽  
And Gender

Abstract Objective: Accumulating evidence suggests that Trimethylamine-N-oxide (TMAO), a gut microbial metabolite, is implicated in the pathogenesis of many cardiovascular diseases. The aim of the present study was to investigate the serum levels of TMAO in Chinese patients with ischemic stroke. Method: In the present study, 255 consecutive patients with first-ever acute ischemic stroke and 255 age and gender-matched healthy volunteers were included for testing serum TMAO. Stroke severity was determined by the NIH Stroke Scale (NIHSS). The stroke severity was dichotomized as minor (NIHSS ≤ 5) and moderate-to-high clinical severity (NIHSS > 6). Results: The serum levels of TMAO in stroke ranged from 0.5 to 18.3 μM, with a median value of 5.8 (interquartile range (IQR), 3.3–10.0) μM, which was higher than in those controls (3.9; IQR, 2.6–6.1 μM). The median level of TMAO in those patients was significantly lower than in those moderate-to-high stroke patients (4.1 μM [IQR, 2.8–6.2] vs. 9.1 μM [5.1–11.0]; P<0.001). In univariate and multivariable models, the unadjusted risk of moderate-to-high stroke was increased by 31% (odds ratio (OR) = 1.31 [95% confidence interval (CI): 1.21–1.42], P<0.001) and 22% (OR = 1.22; 95% CI = 1.08–1.32; P<0.001), when TMAO was increased each by 1 μM. Based on the receiver operating characteristic (ROC) curve, the optimal cut-off value of serum level of TMAO as an indicator for screening of moderate-to-high stroke was estimated to be 6.6 μM, which yielded a sensitivity of 69.3 % and a specificity of 79.0%, with the area under the curve at 0.750 (95% CI, 0.687–0.812). Conclusions: Higher TMAO levels were associated with increased risk of first ischemic stroke and worse neurological deficit in Chinese patients.

scholarly journals Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda

2019 ◽  
Vol 30 (5) ◽  
pp. 479-485
Author(s):  
James Muchira ◽  
Eileen Stuart-Shor ◽  
Jen Manne-Goehler ◽  
Janet Lo ◽  
Alexander C Tsai ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Fasting Blood Glucose ◽  
High Specificity ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
And Gender ◽  
Living With Hiv ◽  
Cd4 Cell

Sub-Saharan Africa (SSA) is facing a growing co-epidemic of chronic HIV infection and diabetes. Hemoglobin A1c (A1c) may underestimate glycemia among people living with HIV (PLWH). We estimated the validity of A1c to diagnose diabetes among PLWH and HIV-uninfected persons in rural Uganda. Data were derived from a cohort of PLWH and age- and gender-matched HIV-uninfected comparators. We compared A1c to fasting blood glucose (FBG) using Pearson correlations, regression models, and estimated the sensitivity and specificity of A1c for detecting diabetes with FBG ≥126 mg/dL as reference standard. Approximately half (48%) of the 212 participants were female, mean age of 51.7 years (SD = 7.0) at enrollment. All PLWH (n = 118) were on antiretroviral therapy for a median of 7.5 years with mean CD4 cell count of 442 cells/µL. Mean FBG (89.7 mg/dL) and A1c (5.6%) were not different between PLWH and HIV-uninfected ( P > 0.50) groups, but the HIV-uninfected group had a higher prevalence of A1c >5.7% (33% vs. 20%, P = 0.024). We found a relatively strong correlation between A1c and FBG (r = 0.67). An A1c ≥6.5% had a poor sensitivity (46%, 95% CI 26–67%) but high specificity (98%, 95% CI 96–99%) for detecting diabetes. More work is needed to define an optimal A1c for screening diabetes in SSA.

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