Burden of Adult Neurological Diseases in Odeda Area, Southwest Nigeria
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Open access Original research BMJ Neurol Open: first published as 10.1136/bmjno-2020-000062 on 24 August 2020. Downloaded from Burden of adult neurological diseases in Odeda Area, Southwest Nigeria Folajimi Morenikeji Otubogun ,1,2 Rufus Akinyemi,3,4 Sola Ogunniyi4,5 To cite: Otubogun FM, Akinyemi ABSTRACT burden of neurological disorders globally and R, Ogunniyi S. Burden of Background Few population- based studies have been particularly in the sub- Saharan Africa (SSA) adult neurological diseases conducted to determine the burden of neurological region.4–6 Available neuroepidemiological in Odeda Area, Southwest diseases in sub- Saharan Africa. A better understanding of Nigeria. BMJ Neurology Open data from countries in the SSA region such the magnitude and impact of these disorders is pivotal to 2020;2:e000062. doi:10.1136/ as Nigeria are often derived from hospital- bmjno-2020-000062 effective planning and provision of neurological services. based studies, whereas results from previously Methods A cross- sectional survey of 2392 adults in ► Additional material is Odeda Local Government Area, Ogun State, Southwest conducted population- based surveys may published online only. To view Nigeria was conducted between May and June 2015. require substantial updates due to changes in please visit the journal online Trained non- medical interviewers administered a population structure, lifestyle and epidemio- (http:// dx. doi. org/ 10. 1136/ 7–9 bmjno- 2020- 000062). screening instrument designed to measure the prevalence logical transition. of neurological diseases and disability, while positive responders were subsequently examined by neurologists. Study objective Received 30 March 2020 Diagnoses were made clinically according to well- The objective was to determine the prev- Revised 27 May 2020 established criteria. Accepted 01 June 2020 alence of neurological disorders in adult Results The mean age of respondents was 37.2±16.1 residents of Odeda Local Government Area years. A total of 842 cases of neurological diseases/ (OLGA) of Ogun State in Southwest Nigeria. disability were diagnosed in 815 individuals (26 individuals with more than one disorder). The all- cause neurological copyright. morbidity rate was 352 per 1000, while the crude prevalence rates of common neurological disorders were METHODS 304.3 per 1000 for primary headaches, 16.3 per 1000 for tropical ataxic neuropathy, 7.11 per 1000 for stroke, Study design 5.85 per 1000 for essential tremor and 4.18 per 1000 This was a descriptive, two- phase, cross- for Parkinson’s disease. Neurological years lost due to sectional study conducted between May and disability was 2806.18 per 100 000. June 2015. The first phase involved appli- http://neurologyopen.bmj.com/ Conclusion This study provides evidence of a high cation of a screening tool, while the second neurological disease burden within the communities phase entailed neurological examination surveyed, which may be representative of Southwest of positive responders identified in the Nigeria. In comparison with findings from previous studies © Author(s) (or their first phase. Non- medical interviewers were employer(s)) 2020. Re- use within the same region, this report suggests a persistence recruited and trained to apply the screening of toxiconutritional disorders and postinfectious permitted under CC BY- NC. No instrument, while neurologists performed commercial re- use. See rights neurological sequelae on one hand and increased and permissions. Published by prevalence of non-communicable neurological disorders neurological examinations on identified posi- BMJ. such as stroke and Parkinson’s disease. tive participants. 1Internal Medicine, Olabisi Onabanjo University Teaching Study setting on September 30, 2021 by guest. Protected Hospital, Sagamu, Ogun, Nigeria BACKGROUND This survey was conducted in communities of 2Internal Medicine, University of Medical Sciences, Ondo, Nigeria Neurological disorders are common and OLGA, one of the 10 local government areas 3Institute of Medical Research costly, accounting for 6.3% of the global of Ogun State, Southwest Nigeria, with a popu- and Training, University of burden of diseases and affecting over lation of 109 522. This administrative unit is Ibadan College of Medicine, one billion people.1 Cerebrovascular disease located between 7o13′00″−7o21′66″ north and Ibadan, Oyo, Nigeria is the second leading cause of mortality 3o31′00″−3.5o16′67″ east and has a land mass 4Neurology, University College globally, while migraine is one of the three of 1560 km2. OLGA comprised both urban Hospital Ibadan, Ibadan, Oyo, 2 Nigeria most prevalent conditions in the world. and rural communities, while its residents are 5Medicine, University of Ibadan Despite the huge public health significance predominantly Yoruba (Egba dialect). The College of Medicine, Ibadan, of these diseases, their global impact is often economy is mainly agrarian, with major food Oyo, Nigeria largely underestimated.3 The Global Initia- crops being cassava, yam, cocoyam, plantain, Correspondence to tive on Neurology and Public Health and maize and vegetables, and major cash crop Dr Folajimi Morenikeji Otubogun; international surveys of country resources cocoa. However, other economic activities folabogun@ gmail. com have shown a paucity of information on the include quarrying, trading and artisanship. Otubogun FM, et al. BMJ Neurol Open 2020;2:e000062. doi:10.1136/bmjno-2020-000062 1 Open access BMJ Neurol Open: first published as 10.1136/bmjno-2020-000062 on 24 August 2020. Downloaded from Christianity, Islam and traditional religion are the major Study protocol religions. Permission was obtained from the OLGA health authority The study area’s health service arrangements consist of and community gatekeepers—the heads of various primary health centres, one in each ward and staffed by communities and traditional rulers/village heads. nurses, and community health extension workers. Private Residential houses were visited in each selected cluster clinics also filled the gap for primary healthcare. Secondary and consent was obtained to speak with the head of the level healthcare is obtained from general hospitals, while households, which was usually the oldest individual or tertiary level care is available at the Federal Medical any adult in his/her absence. The number of family units Centre, Abeokuta. At the time of this study, neurolog- living within the house and a listing of individuals 18 years ical manpower was limited to two neurologists and two or older were obtained. This provided the base popula- specialty registrars in neurology. Electroencephalography tion for the study. Only adults that were present at the and CT were available within the study area, whereas MRI single visits were screened for neurological disorders. and neurosurgical support were accessed from neigh- Interviews were conducted in the local language bouring states, which were 66.3–123.7 km away. (Yoruba) and English language. Survey sites were located and boundaries identified with the help of OLGA Inclusion criteria primary health staff and local people. Five non-medical Inclusion criteria included consenting adults aged 18 interviewers were recruited and trained on the use of the years and above at study onset (1 May 2015) and residents screening instrument at the neurology outpatient clinic within OLGA for the preceding 6 months. of Federal Medical Centre, Abeokuta, and an interob- server agreement kappa value of 0.95 was achieved. Sampling technique Phase 1 screening was in three steps. The initial step A two- stage cluster sampling technique was employed. In included allocation of study identification numbers and the first stage, the smaller administrative units of OLGA collection of sociodemographic data such as age (verified were classified into predominantly urban/semiurban and by birth records or historical events), sex, tribe, occupa- rural based on information provided by the local health tion, marital status and highest educational attainment authority. A ballot was done to pick one of two urban/ entered into a pro forma.13 The second step consisted of semiurban wards and two of eight rural wards: Obantoko 22 history questions, while the third step entailed perfor- ward for urban/semiurban and Odeda and Alabata wards mance of 16 simple tasks. An individual was considered copyright. for the rural wards. to ‘screen positive’ if at least one history question and/or Cluster sampling size formula for descriptive survey was one examination task was positive. used and calculated as the following: In phase 2, positive responders were further evaluated n = g z2 p q/d2 by neurologists who took focused histories and performed × × × n: minimum sample size; g: design effect=2; z: standard neurological examinations, after which respondents normal deviate=1.96 at 95% confidence level; p: esti- were classified with or without a neurological disease or http://neurologyopen.bmj.com/ mated prevalence=5.3% (crude point prevalence of least disability. Subjects without prior neurological diagnoses 1 prevalent condition—migraine in a previous survey) ; q: were counselled by the investigators on the nature of 1−p; d: degree of precision=2%. the conditions and importance of accessing further rele- 1.962 0.053 0.947 vant clinical and follow-up care at the neurology clinic n =2 × 2× × 0.02 of the Federal Medical Centre, Abeokuta. However, those n=964.06 with prior neurological diagnoses and care plan were n=964 provided with appropriate health information