Department of Medicine and Therapeutics

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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 Authors
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.