Browsing by Author "Adamu, S."
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Item Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension(Journal of the Neurological Sciences, 2019-01) Sarfo, F.S.; Mobula, L.M.; Sarfo-Kantanka, O.; Adamu, S.; Plange-Rhule, J.; Ansong, D.; Gyamfi, R.A.; Duah, J.; Abraham, B.; Ofori-Adjei, D.Background: Sub-Saharan Africa is currently experiencing a high burden of both chronic kidney disease (CKD) and stroke as a result of a rapid rise in shared common vascular risk factors such as hypertension and diabetes mellitus. However, no previous study has prospectively explored independent associations between CKD and incident stroke occurrence among indigenous Africans. This study sought to fill this knowledge gap. Methods: A prospective cohort study involving Ghanaians adults with hypertension or type II diabetes mellitus from 5 public hospitals. Patients were followed every 2 months in clinic for 18 months and assessed clinically for first ever stroke by physicians. Serum creatinine derived estimated glomerular filtration rates (eGFR) were determined at baseline for 2631 (81.7%) out of 3296 participants. We assessed associations between eGFR and incident stroke using a multivariate Cox Proportional Hazards regression model. Results: Stroke incidence rates (95% CI) increased with decreasing eGFR categories of 89, 60–88, 30–59 and <29 ml/min corresponding to incidence rates of 7.58 (3.58–13.51), 14.45 (9.07–21.92), 29.43 (15.95–50.04) and 66.23 (16.85–180.20)/1000 person-years respectively. Adjusted hazard ratios (95%CI) for stroke occurrence according to eGFR were 1.42 (0.63–3.21) for eGFR of 60-89 ml/min, 1.88 (1.17–3.02) for 30-59 ml/min and 1.52 (0.93–2.43) for <30 ml/min compared with eGFR of >89 ml/min. Adjusted HR for stroke occurrence among patients with hypertension with eGFR<60 ml/min was 3.69 (1.49–9.13), p = .0047 and among those with diabetes was 1.50 (0.56–3.98), p = .42. Conclusion: CKD is dose-dependently associated with occurrence of incident strokes among Ghanaians with hypertension and diabetes mellitus. Further studies are warranted to explore interventions that could attenuate the risk of stroke attributable to renal disease among patients with hypertension in SSA. © 2018 The AuthorsItem Highly Prevalent Hyperuricaemia Is Associated With Adverse Clinical Outcomes Among Ghanaian Stroke Patients: an Observational Prospective Study(Ghana Medical Journal, 2015-09) Sarfo, F.S.; Akassi, J.; Antwi, N.K.B.; Obese, V.; Adamu, S.; Akpalu, A.; Bedu-Addo, G.Background: Although a direct causal relationship between hyperuricaemia and stroke continues to be debated, strong associations between serum uric acid (SUA) and cerebrovascular disease exist. Very few studies have been conducted to evaluate the frequency and association between this potentially modifiable biomarker of vascular risk and stroke in sub-Saharan Africa. Therefore the aim of this study was to examine the association between hyperuricaemia and the traditional risk factors and the outcomes of stroke in Ghanaian patients. Methods: In this prospective observational study, 147 patients presenting with stroke at a tertiary referral centre in Ghana were consecutively recruited. Patients were screened for vascular risk factors and SUA concentrations measured after an overnight fast. Associations between hyperuricaemia and stroke outcomes were analysed using Kaplan-Meier and Cox proportional hazards regression analysis. Results: The frequency of hyperuricaemia among Ghanaian stroke patients was 46.3%. Non-significant associations were observed between hyperuricaemia and the traditional risk factors of stroke. SUA concentration was positively correlated with stroke severity and associated with early mortality after an acute stroke with unadjusted hazards ratio of 2.3 (1.4 - 4.2, p=0.001). A potent and independent dose-response association between increasing SUA concentration and hazard of mortality was found on Cox proportional hazards regression, aHR (95% CI) of 1.65 (1.14-2.39), p=0.009 for each 100μmol/l increase in SUA. Conclusions: Hyperuricaemia is highly frequent and associated with adverse functional outcomes among Ghanaian stroke patients. Further studies are warranted to determine whether reducing SUA levels after a stroke would be beneficial within our setting.Item Multilingual validation of the questionnaire for verifying stroke-free status in West Africa(Lippincott Williams and Wilkins, 2016) 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.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. © 2015 American Heart Association, Inc.