Research Articles
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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community
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Item Transforming Parkinson’s Care in Africa (TraPCAf): protocol for a multimethodology National Institute for Health and Care Research Global Health Research Group project(BMC Neurology, 2023) Walker, R.; Fothergill‑Misbah, N.; Akpalu, A.; et al.Background Parkinson’s disease (PD) is the second most common neurodegenerative disorder and, according to the Global Burden of Disease estimates in 2015, was the fastest growing neurological disorder globally with respect to associated prevalence, disability, and deaths. Information regarding the awareness, diagnosis, phenotypic charac‑ teristics, epidemiology, prevalence, risk factors, treatment, economic impact and lived experiences of people with PD from the African perspective is relatively sparse in contrast to the developed world, and much remains to be learned from, and about, the continent. Methods Transforming Parkinson’s Care in Africa (TraPCAf ) is a multi-faceted, mixed-methods, multi-national research grant. The study design includes multiple sub-studies, combining observational (qualitative and quantitative) approaches for the epidemiological, clinical, risk factor and lived experience components, as appropriate, and inter‑ ventional methods (clinical trial component). The aim of TraPCAf is to describe and gain a better understanding of the current situation of PD in Africa. The countries included in this National Institute for Health and Care Research (NIHR) Global Health Research Group (Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Tanzania) represent diverse African geographies and genetic profles, with difering resources, healthcare systems, health and social protection schemes, and policies. The research team is composed of experts in the feld with vast experience in PD, jointly led by a UK-based and Africa-based investigator. Discussion Despite the increasing prevalence of PD globally, robust data on the disease from Africa are lacking. Exist‑ ing data point towards the poor awareness of PD and other neurological disorders on the continent and subsequent challenges with stigma, and limited access to afordable services and medication. This multi-site study will be the frst of its kind in Africa. The data collected across the proposed sub-studies will provide novel and conclusive insights into the situation of PD. The selected country sites will allow for useful comparisons and make results relevant to other low- and middle-income countries. This grant is timely, as global recognition of PD and the public health challenge it poses builds. The work will contribute to broader initiatives, including the World Health Organization’s Intersectoral global action plan on epilepsy and other neurological disordersItem Sociodemographic and behavioural risk factors for obesity among community dwelling older adults in Ghana and Nigeria: A secondary analysis of data from the SIREN study(SAGE, 2021) Akpa, O.M.; Okekunle, A.P.; Sarfo, F.S.; Akinyemi, R.O.; Akpalu, A.; Wahab, K.W.; Komolafe, M.; Obiako, R.; Owolabi, L.; Jenkins, C.; Abiodun, A.; Ogbole, G.; Fawale, B.; Akinyemi, J.; Agunloye, A.; Uvere, E.O.; Fakunle, A.; Ovbiagele, B.; Owolabi, M.O.Objectives: To explore the prevalence and risk factors of obesity among older adults from low and middle-income countries (LMICs). Methods: This is a secondary analysis of data obtained from the SIREN study through in-person interviews and measurements from healthy stroke-free older adults (≥60 years). Overweight/obesity was defined as body mass index ≥25 kg/m2 Abdominal obesity was defined as waist-to-hip ratio (WHR) of >0.90 for males and >0.85/females or waist circumference (WC) of >102 cm for males/>88 cm for females. Adjusted odds ratio (aORs) with 95% confidence interval (CIs) of the relationship between obesity and sociodemographic factors were assessed at P < 0.05. Results: Overall, 47.5% of participants were overweight/obese, 76.6% had a larger than recommended WHR, and 54.4% had a larger than recommended WC. Abdominal obesity (WC; aOR: 9.43, CI: 6.99–12.50), being a Nigerian (aOR: 0.55; CI: 0.42–0.72), living in an urban setting (aOR: 1.92; CI: 1.49–2.46), earning >$100/month (aOR: 1.53; CI: 1.19–1.96), and having formal educa tion (aOR: 1.42; CI: 1.08–1.87) were associated with overweight/obesity. Conclusion: Living in urban settings, earning a higher income, and having a formal education were associated with a higher odds of obesity among older adults from LMICs.Item Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa(Journal of the Neurological Sciences, 2021) Sarfo, F.S.; Akpa, O.; Ovbiagele, B.; Akpalu, A.; Wahab, K.; Komolafe, M.; Obiako, R.; Owolabi, L.; Osaigbovo, G.O.; Jenkins, C.; Adekunle Fakunle, A.; Ogbole, G.; Tiwari, H.K.; Arulogun, O.; Arnett, D.K.; Asowata, O.; Ogah, O.; Akinyemi, R.O.; Owolabi, M.O.Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50–65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82–71.58) and 4.13 (2.64–6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82–96.80) and aOR of 28.93 (15.10–55.44) was highest among the middle-age group. Diabetes with PAR of 32.29% (27.52–37.05) and aOR of 3.49 (2.56–4.75); meat consumption with PAR of 42.34%(32.33–52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02–21.60) and aOR of 2.23 (1.60–3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivityItem Frequency and factors associated with post-stroke seizures in a large multicenter study in West Africa(Journal of the Neurological Sciences, 2021) Sarfo, F.S.; Akinyemi, J.; Akpalu, A.; Wahab, K.; Yaria, J.; Adebayo, O.; Komolafe, M.; Obiako, R.; Owolabi, L.; Osaigbovo, G.O.; Jenkins, C.; Mensah, Y.; Ogbole, G.; Calys-Tagoe, B.; Adebayo, A.; Appiah, L.; Singh, A.; Fakunle, A.; Uvere, E.; Hemant, T.; Balogun, O.; Adeleye, O.; Fawale, F.; Abdulwasiu, A.; Ogunjimi, L.; Akinola, O.; Arulogun, O.; Donna, A.; Ogah, O.; Akinyemi, R.; Ovbiagele, B.; Owolabi, M.O.Background: Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa. Purpose: To assess the frequency and factors associated with PSS by stroke types across 15 hospitals in Nigeria and Ghana. Methods: We analyzed data on all stroke cases recruited into the Stroke Investigative Research and Educational Network (SIREN). We included adults aged ≥18 years with radiologically confirmed ischemic stroke (IS) or intracerebral hemorrhage (ICH). PSS were defined as acute symptomatic seizures occurring at stroke onset and/ or during acute hospitalization up until discharge. We used logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. Results: Among 3344 stroke patients, 499 (14.9%) had PSS (95% CI: 13.7–16.2%). The mean duration of admission in days for those with PSS vs no PSS was 17.4 ± 28.6 vs 15.9 ± 24.7, p = 0.72. There were 294(14.1%) PSS among 2091 ischemic strokes and 159(17.7%) among 897 with ICH, p = 0.01. The factors associated with PSS occurrence were age < 50 years, aOR of 1.59 (1.08–2.33), National Institute of Health Stroke Score (NIHSS), 1.29 (1.16–1.42) for each 5 units rise and white cell count 1.07 (1.01–1.13) for each 10^3 mm3 rise. Factors associated with PSS in ischemic were NIHSS score, aOR of 1.17 (1.04–1.31) and infarct volume of 10–30 cm3 aOR of 2.17(1.37–3.45). Among ICH, associated factors were alcohol use 5.91 (2.11–16.55) and lobar bleeds 2.22 (1.03–4.82). Conclusion: The burden of PSS among this sample of west Africans is substantial and may contribute to poor outcomes of stroke in this region. Further longitudinal studies are required to understand the impact on morbidity and mortality arising from PSS in Africa.Item Research capacity. Enabling the genomic revolution in Africa(Science, 2014-06) Rotimi, C.; Abayomi, A.; Abimiku, A.; Adabayeri, V.M.; Adebamowo, C.; Adebiyi, E.; Ademola, A.D.; Adeyemo, A.; Adu, D.; Affolabi, D.; Akarolo-Anthony, S.; Akpalu, A.; Ameni, G.; Donkor, P.; Ghansah, A.Our understanding of genome biology, genomics, and disease, and even hu-man history, has advanced tremen-dously with the completion of the Human Genome Project. Technologi-cal advances coupled with significant cost reductions in genomic research have yielded novel insights into disease etiol-ogy, diagnosis, and therapy for some of the world's most intractable and devastat-ing diseases—including ma-laria, HIV/AIDS, tuberculosis, cancer, and diabetes. Yet, de-spite the burden of infectious diseases and, more recently, noncommunicable diseases (NCDs) in Africa, Africans have only par-ticipated minimally in genomics research. Of the thousands of genome-wide association studies (GWASs) that have been conducted globally, only seven (for HIV susceptibility, malaria, tuberculosis, and podoconiosis) have been conducted exclusively on Afri-can participants; four others (for prostate cancer, obsessive compulsive disorder, and anthropometry) included some African participants (www.genome.gov/gwastudies/). As discussed in 2011 (www.h3africa.org), if the dearth of genomics research involving Africans persists, the potential health and economic benefits emanating from genomic science may elude an entire continent. The lack of large-scale genomics studies in Africa is the result of many deep-seated issues, including a shortage of African scien-tists with genomic research expertise, lack of biomedical research infrastructure, lim-ited computational expertise and resources, lack of adequate support for biomedical research by African governments, and the participation of many African scientists in collaborative research at no more than the level of sample collection. Overcoming these limitations will, in part, depend on African Enabling the genomic revolution in Africa By The H3Africa Consortium * H3Africa is developing capacity for health-related genomics research in Africa Yet, roughly a decade ago, newly pro-posed DNA-based taxonomy (11) promised to solve the species debate. A Barcode of Life Data Systems (BOLD) (12) quickly emerged, seeking to provide a reliable, cost-effective solution to the problem of species identification (12) and a standard screening threshold of sequence differ-ence (10× average intraspecific difference) to speed the discovery of new animal spe-cies (13). Sometimes considered a "carica-ture of real taxonomy" (14), this approach failed to identify, perhaps not surprisingly, two American crow species and a number of members of the herring gull Larus ar-gentatus species assemblage above the set threshold (13). Furthermore, despite past (3) and present (6) sequencing projects, carrion crows and hooded crows can also not be differentiated from one another by means of DNA-barcode approaches. By contrast, Poelstra et al. show that much more DNA sequencing data are needed, combined with RNA expression data, to reconstruct the evolution of a reproductive barrier that culminated in the speciation of these two crow taxa. Armed with this new very detailed genetic informa-tion, it is clear that none of the currently formulated species concepts fully apply to these two crow taxa (unless one is willing relax some stringency in the various definitions). In-deed, the genomes of German carrion crows are much more similar to those of hooded crows than to Spanish car-rion crows. Put simply, apart from the few carrion crow type "speciation islands," German carrion crows could be con-sidered to represent hooded crows with a black (carrion crow) phenotype. There is a clear need for ad-ditional population genomic studies using a more dense sampling, especially among the fully black carrion crows, before the complexity of repro-ductive isolation and speciation among these two taxa can be fully understood. The specia-tion genomics strategy already proved itself in unraveling the complexities of mimicry among many Heliconius butterfly taxa (7) and, as in the study of Poelstra et al., stresses the im-portance of using RNA-based information in addition to DNA. Only time will tell if, and when, German carrion crows will adopt the "hooded phenotype," a fate that seems un-avoidable. Until then, we can only applaud these crows for defeating Linnaeus's curse.Item Stroke genomics in people of African ancestry: Charting new paths(Cardiovascular Journal of Africa, 2015-03) Akinyemi, R.O.; Ovbiagele, B.; Akpalu, A.; Jenkins, C.; Sagoe, K.; Owolabi, L.; Sarfo, F.; Obiako, R.; Gebreziabher, M.; Melikam, E.; Warth, S.; Arulogun, O.; Lackland, D.; Ogunniyi, A.; Tiwari, H.; Kalaria, R.N.; Arnett, D.; Owolabi, M.O.One in six people worldwide will experience a stroke in his/ her lifetime. While people in Africa carry a disproportionately higher burden of poor stroke outcomes, compared to the rest of the world, the exact contribution of genomic factors to this disparity is unknown. Despite noteworthy research into stroke genomics, studies exploring the genetic contribution to stroke among populations of African ancestry in the United States are few. Furthermore, genomics data in populations living in Africa are lacking. The wide genomic variation of African populations offers a unique opportunity to identify genomic variants with causal relationships to stroke across different ethnic groups. The Stroke Investigative Research and Educational Network (SIREN), a component of the Human Health and Heredity in Africa (H3Africa) Consortium, aims to explore genomic and environmental risk factors for stroke in populations of African ancestry in West Africa and the United States. In this article, we review the literature on the genomics of stroke with particular emphasis on populations of African origin.Item The burden of stroke in Africa: A glance at the present and a glimpse into the future(Cardiovascular Journal of Africa, 2015-03) Owolabi, M.O.; Akarolo-Anthony, S.; Akinyemi, R.; Arnett, D.; Gebregziabher, M.; Jenkins, C.; Tiwari, H.; Arulogun, O.; Akpalu, A.; Sarfo, F.S.; Obiako, R.; Owolabi, L.; Sagoe, K.; Melikam, S.; Adeoye, A.M.; Lackland, D.; Ovbiagele, B.Objective: Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa. Methods: We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures. Results: Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown. Conclusions: While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.Item Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project(Mary Ann Liebert Inc., 2018-05) Akinyemi, R.O.; Akinwande, K.; Diala, S.; Adeleye, O.; Ajose, A.; Issa, K.; Owusu, D.; Boamah, I.; Yahaya, I.S.; Jimoh, A.O.; 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, A.T.; 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, H.K.; Ovbiagele, B.; Owolabi, M.O.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. © Rufus O. Akinyemi et al. 2018.