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ORIGINAL ARTICLE
Year : 2019  |  Volume : 18  |  Issue : 2  |  Page : 55-59  

Relative frequencies of neurological disorders in Northwestern Nigeria: A retrospective study


Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication8-May-2019

Correspondence Address:
Dr. Salisu Abdullahi Balarabe
Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, PMB 2370, Sokoto
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_13_18

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   Abstract 


Background: Early diagnosis and management of diseases takes a center stage in the control and prevention of chronic debilitating disorders. It also plays a prominent role in ensuring that patients are better equipped on how to deal with the disease burden. One reliable means of achieving this objective is to retrospectively study the frequency of common diseases. Materials and Methods: This was a retrospective study conducted between January 2010 and December 2014. Relevant data were extracted from patients' case folders. Adjustment to correct for potential biases such as multiple admissions and secondary diagnosis using a covariate on admission data was made to correct for systematic error. Information obtained was analyzed for frequency and distribution.Results: The mean age of the patients was 44.9 years (standard deviation ± 16.7), with an age range of 15–99 years. The most common neurological disorder was stroke which accounted for 21.3%, followed by spinal cord compression syndromes (20.8%), epilepsy (17.3%), parkinsonian syndromes (8.9%), headaches (7.1%), and bacterial meningitis (5.2%). The highest number of cases of neurological disorder occurred within the age group of 45–54 years. Conclusion: The outcome of this study revealed that stroke and spinal cord compression syndromes were the most common neurological disorders in our center. It also showed that individuals within their productive age (50–54 years) were more affected. Given the present state of constrained resources, coordinated efforts at the institutional, state, and federal government levels are essential to encourage prioritization, funding, and implementation of effective health-care delivery system.

   Abstract in French 

Résumé
Les populations vieillissantes et le nombre de personnes âgées individus augmente exponentiellement, il y a une croissance nombre de personnes nécessitant des soins de longue durée. Par conséquent, le besoin d'évaluation, d'évaluation et de mise à jour des connaissances la fréquence et le contrôle des maladies invalidantes chroniques devient plus important. En outre, à mesure que les pays en développement les sociétés à affronter les effets du changement dans le fardeau. Antécédents: le diagnostic précoce et la gestion des maladies prend une étape centrale dans le contrôle et la prévention des troubles chroniques débilitants. Il joue également un rôle prépondérant en veillant à ce que les patients soient mieux outillés sur la façon de traiter le fardeau de la maladie. Un moyen fiable d'atteindre cet objectif est de réviser rétrospectivement la fréquence des maladies courantes. Matériaux et méthodes: il s'agissait d'une étude rétrospective menée entre janvier 2010 et décembre 2014. Les données pertinentes ont été extraites des dossiers de cas des patients. Ajustement pour corriger les biais potentiels comme les admissions multiples et le diagnostic secondaire à l'aide d'une covariable sur les données d'admission a été faite pour corriger l'erreur systématique. Informations obtenues a été analysée pour la fréquence et la distribution. Résultats: l'âge moyen des patients était de 44,9 ans (écart-type ± 16,7), d'une tranche d'âge de 15 à 99 ans. Le trouble neurologique le plus fréquent était un AVC qui représentait 21,3%, suivi de la moelle épinière syndromes de compression (20,8%), épilepsie (17,3%), syndromes parkinsoniens (8,9%), maux de tête (7,1%) et méningite bactérienne (5,2%). Le plus grand nombre de cas de trouble neurologique s'est produit dans le groupe d'âge de 45 à 54 ans. Conclusion: le résultat de cette étude a révélé que les syndromes de compression des AVC et de la moelle épinière étaient les troubles neurologiques les plus fréquents dans notre centre. Il a également montré que les individus de leur âge productif (50 – 54 ans) ont été plus touchés. Compte tenu de l'état actuel des ressources limitées, les efforts coordonnés aux niveaux institutionnel, étatique et fédéral sont essentiels pour encourager la priorisation, le financement et la mise en œuvre de système de prestation de soins de santé.

Keywords: Burden, neurological disorders, northwestern Nigeria, relative frequency, retrospective study


How to cite this article:
Balarabe SA, Kamfani JM. Relative frequencies of neurological disorders in Northwestern Nigeria: A retrospective study. Ann Afr Med 2019;18:55-9

How to cite this URL:
Balarabe SA, Kamfani JM. Relative frequencies of neurological disorders in Northwestern Nigeria: A retrospective study. Ann Afr Med [serial online] 2019 [cited 2019 Jul 15];18:55-9. Available from: http://www.annalsafrmed.org/text.asp?2019/18/2/55/257826




   Introduction Top


As populations are aging and the number of elderly individuals is exponentially increasing, there are a growing number of people in need of long-term care. Therefore, the need for evaluation, assessment, and updating knowledge on frequency and control of chronic disabling diseases becomes more important. In addition, as countries in developing societies confront the effects of change in the burden and epidemiological transition of chronic noncommunicable diseases, there will be an increased need for up-to-date assessment of nonfatal health outcomes and exploration of the implications of growing number of individuals with chronic diseases.[1] Moreover, as the expense of health-care delivery in Nigeria rises toward unsustainable levels, there is a need for cost justification in which the prevalence, morbidity, and disability of the diseases we manage are becoming critical to the continued allocation of available meager resources toward neurological care. This is so because the outcome of huge financial investments in cardiovascular diseases in developed societies in the past has yielded significant benefits for such diseases, dramatically increasing overall health and survival.[1]

Although mortality is the usual primary outcome measure in many research studies, the cost and societal impact of diseases are largely determined by the disability they cause; this is particularly true of neurological disorders since the years lost to disability from neurological and musculoskeletal disorders are greater than that of all other categories of diseases.[2],[3] After comprehensive review of the nationwide and world literature, we chose for discussion the most prevalent and commonly managed neurological diseases in the region, focusing on those prevalence and incidence estimates we considered the most reliable. Using this method, stroke, compressive myelopathies, epilepsy, movement disorders, and headache emerged as the most common disorders and are highlighted below. We excluded many other disorders that are not as common and disorders with mixed etiologies to be as conservative as possible, despite the fact that these diseases were managed in our neurology unit.


   Materials and Methods Top


This was a retrospective study conducted in the neurology unit of Usmanu Danfodiyo University Teaching Hospital Sokoto (UDUTHS) over the period of 5 years (between January 2010 and December 2014). Relevant data were extracted from patients' case folders; data were validated using Microsoft Excel. Relevant data were analyzed. Adjustment to correct for potential biases such as multiple admissions and secondary diagnosis using a covariate on admission data was made to correct for systematic error. Information obtained was analyzed for frequency and distribution. Analysis of data was carried out using the “Statistical Package for the Social Sciences” (SPSS) program for Windows version 23.0 (SPSS Inc., Chicago, IL, USA). Mean and standard deviation (SD) were used to describe quantitative variables. Bivariate analysis was carried out using Pearson's Chi-square or Fisher's exact test for categorical variables. Student's t-test was used to compare the means of continuous variables.


   Results Top


There were a total of 2537 cases of neurological disorders managed in the unit during the study period. Females accounted for 52.7% and males were 47.3%, with a female-to-male ratio of 1.1:1 [Figure 1]. The mean age was 44.9 years (SD ± 16.7), with an age range of 15–99 years. The common neurological disorders were stroke (21.3%), spinal cord compression syndromes (20.9%), and epilepsy (17.3%) [Table 1]. The highest number of cases of neurological disorder occurred within the age group of 45–54 years [Table 2]. Correlation of Age and sex showed predominance of neurological diseases among young females [Figure 2]. Distribution of neurological disorders by sex, showed predominance of neurological diseases among females [Table 3], the role of sex was further evaluated by sex and age correlation [Table 4].
Figure 1: Sex distribution of neurological diseases among patients

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Table 1: Frequency of neurological disorders

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Table 2: Age distribution of neurological disorder

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Figure 2: Age and sex distribution of neurological diseases among patients

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Table 3: Distribution of neurological disorder by sex

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Table 4: Cross tabulation by age and sex among neurological patients

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   Discussion Top


The highest frequency of neurological disorders observed in the 45–54 years' age group was lower than the frequency found in the 50–60 years' age group reported in a study in Ghana,[4] but the mean age of 44.9 years in this study correlated well with the study in Cameroon.[5]

Stroke

In this study, stroke is rated as the most common neurological disorder which corroborated findings of a study from the southern part of the country[6] and earlier study in this region by Owolabi et al.[7] The mean age of 56.85 years, SD ± 14.40, is similar to the mean age of 58 years reported by Divyant and Amit[8] in a study on clinical profile and risk factors among 140 stroke patients in a tertiary care hospital in Bareilly; it also corresponded well with the mean age of 57 years reported by Manorenj et al.[9] and findings in other studies in developed[10] and developing countries.[11],[12] Therefore, this study supported previous hospital- and community-based studies that reported the incidence and prevalence of stroke among both blacks and nonblacks. More importantly, this study found trends toward increasing stroke incidence among relatively young individuals, a finding that is of great public health significance.

Epilepsy

The female preponderance was observed in an earlier study from southeast Nigeria.[10] The average age of patients was 35.8 years with SD ± 9.6 and an age range of 24–72 years. This figure did not correlate well with findings by Kora et al. among patients with posterior circulation stroke in a tertiary care center in southern India.[11] The study also revealed that the peak age prevalence occurred within the age group of 30–39 years which constituted 58.2%, followed by the age group of 20–29 years which constituted 22.6% of all cases. Finding in this study supported report of International League Against Epilepsy Commission on epidemiology, that epilepsy is a common neurological disorder affecting about 65 million people in the world,[13] and approximately 80% of cases occur in developing countries with little or no access to medical facilities or treatment.[14] The burden of and the global socioeconomic costs afforded by epilepsy are enormous, and its deleterious effect on psychological, cognitive, and social functioning on those who are affected is often substantial and devastating.[15]

Compressive myelopathies

The male preponderance of tuberculosis of the spin in this study substantiated differential sex hospital attendance pattern in the region of the study, as women often require permission of their husbands to access health care in a hospital environment, as alluded to in some other previous studies.[16],[17],[18],[19],[20] Pott's disease is one of the major causes of compressive myelopathies in developing countries; the disease is chronic, debilitating, and associated with long-term sequelae, such as pressure sore, deep venous thrombosis, and risk of pulmonary embolism.[21] The second common compressive myelopathy in this study is cervical spondylosis. The mean age of affected people in this study was 52 years, which correlated well with earlier studies by Pallis et al. who found that cervical spondylosis was a disease of the elderly affecting mostly those over 50 years.[22] In a related development, Ahmed et al. found that the maximum number of cases (60%) of cervical spondylosis among patients in Bangladesh was in the age group of above 50 years.[23]

Movement disorders

The mean age of 51.5 years among patients with secondary parkinsonism in our study was similar to 51.4 years of secondary parkinsonism reported by Femi et al.[24] in an earlier study in this region. It is also similar to what was reported in southwestern Nigeria by Osuntokun and Bademosi.[25] In addition, the mean age of our patients corroborated what was reported in other nations.[26],[27],[28] Male preponderance in our study was reported in other studies though the gender proportion in our study is much higher than earlier studies in the country. This may be accounted for by methodological differences between the studies; our study population was all patients with movement disorders.

Headaches

The female preponderance of headache found in our study is similar to earlier studies that cut across cultures and geographical locations,[29],[30],[31],[32],[33] including a cohort study in our center.[34] Possible mechanisms mentioned include hormonal influence and factors related to health-seeking behavior of female gender, particularly for headache disorders.[35]


   Conclusion Top


This study revealed that stroke and spinal cord compression syndrome are the most common neurological disorders in our center. It also showed that individuals within their productive age (50–54 years) are more commonly affected. Therefore, given the present state of constrained resources and competing priorities, coordinated efforts at the individual, institutional, organizational, local, state, and federal government levels are essential to encourage prioritization, funding, and implementation for the above initiatives. Subspecialty organizations and individual neurologists and neuroscientists must work together to coordinate their advocacy efforts. It is important to note that the very future of the neurological sciences and the patients we manage is now at stake, and the welfare of generations yet to come hangs upon the success of our efforts. This study serves as a key component to the policy-makers and planners to plan well in establishing policies and resource allocation, as well as supplying of adequate diagnostic facilities.

Recommendations

  1. Given the resource-limited setting in developing countries and the cost of brain disorders, which are frequently chronic and sometimes relapsing, greater emphasis needs to be placed on early detection, effective treatment, and early prevention
  2. In view of the relevance of determining the prevalence of disorders of the brain, there is need for concerted effort by all stakeholders toward advocacy, through the provision of education, publications, consultation, and evaluation services. This is particularly critical as some of these vulnerable patients are unable to advocate for themselves
  3. Private–public partnerships should be encouraged to promote novel drug development and to rapidly bring treatments to patients with brain disorders
  4. Efforts to remove hurdles to research must be supported at governmental level, such as removing inappropriate regulations and bottlenecks within the system that would facilitate implementing faster and simpler processes for approval and governance of translational research.


Acknowledgments

We would like to thank the Record Department of UDUTHS for supplying the clinic-specific data. We would also like to thank the Ethical Committee Members of UDUTHS for ethical approval to conduct this research. We thank members of the Department of Medicine, UDUTHS, for providing constructive criticism on earlier presentations of various segments of the manuscript and support in raising awareness of the issue.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Vos T, Abajobir AA, Abbafati C, Abbas KM, Abate KH. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211-59.  Back to cited text no. 1
    
2.
Dua T, Janca A, Muscetta A. Global burden of neurological disorders: Estimates and projections. In: Neurological Disorders: Public Health Challenges. Geneva, Switzerland: WHO Press; 2006. p. 26-39.  Back to cited text no. 2
    
3.
Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, et al. The state of US health, 1990-2010: Burden of diseases, injuries, and risk factors. JAMA 2013;310:591-608.  Back to cited text no. 3
    
4.
Sarfo FS, Akassi J, Badu E, Okorozo A, Ovbiagele B, Akpalu A, et al. Profile of neurological disorders in an adult neurology clinic in Kumasi, Ghana. eNeurologicalSci 2016;3:69-74.  Back to cited text no. 4
    
5.
Tegueu CK, Nguefack S, Doumbe J, Fogang YF, Mbonda PC, Mbonda E, et al. The spectrum of neurological disorders presenting at a neurology clinic in Yaoundé, Cameroon. Pan Afr Med J 2013;14:148.  Back to cited text no. 5
    
6.
Ojini FI, Danesi MA. Pattern of neurological admission at the Lagost University teaching hospital. Niger J Clin Pract 2003;3:38.  Back to cited text no. 6
    
7.
Owolabi LF, Shehu MY, Shehu MN, Fadare J. Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Ann Indian Acad Neurol 2010;13:167-70.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Divyant R, Varshney Amit V. Stroke: The study of clinical profile and risk factor in tertiary care hospital. IJSR 2016;5:187-8.  Back to cited text no. 8
    
9.
Manorenj S, Inturi S, Jyotsna B, Savya VS, Areli D, Reddy B, et al. Prevalence, pattern, risk factors and outcome of stroke in women: A clinical study of 100 cases from a tertiary care center in South India. Int J Res Med Sci 2016;4:2388-93.  Back to cited text no. 9
    
10.
Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T, et al. Cerebrovascular disease in the community: Results of a WHO collaborative study. Bull World Health Organ 1980;58:113-30.  Back to cited text no. 10
    
11.
Kora SA, Doddamani GB, Pramila D, Goorannavar SM, Satish B. Clinical profile of posterior circulation stroke in a tertiary care center in Southern India. J Clin Diagn Res 2011;5:217-21.  Back to cited text no. 11
    
12.
Owolabi LF, Nagoda M. Stroke in developing countries: Experience at Kano, Northwestern Nigeria. Sudan J Med Sci 2012;7:9-14.  Back to cited text no. 12
    
13.
Thurman DJ, Beghi E, Begley CE, Berg AT, Buchhalter JR, Ding D, et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia 2011;52 Suppl 7:2-6.  Back to cited text no. 13
    
14.
Neligan A, Bell GS, Johnson AL, Goodridge DM, Shorvon SD, Sander JW, et al. The long-term risk of premature mortality in people with epilepsy. Brain 2011;134:388-95.  Back to cited text no. 14
    
15.
Panayiotopoulos CP, Tahan R, Obeid T. Juvenile myoclonic epilepsy: Factors of error involved in the diagnosis and treatment. Epilepsia 1991;32:672-6.  Back to cited text no. 15
    
16.
Solagberu BA, Ayorinde RO. Tuberculosis of the spine in ilorin, nigeria. East Afr Med J 2001;78:197-9.  Back to cited text no. 16
    
17.
Ikem IC, Bamgboye EA, Olasinde AA. A 15 year review at OAU THC Ile-Ife. Niger Postgrad Med J 2001;8:22-5.  Back to cited text no. 17
  [Full text]  
18.
Sayi EN, Mlay SM. Tuberculosis of the spine in children at Muhimbili medical centre, Dar es Salaam. East Afr Med J 1995;72:46-8.  Back to cited text no. 18
    
19.
Rezai AR, Lee M, Cooper PR, Errico TJ, Koslow M. Modern management of spinal tuberculosis. Neurosurgery 1995;36:87-97.  Back to cited text no. 19
    
20.
Ogunseyinde AO, Obajimi MO, Ige OM, Alonge T, Fatunde OJ. Computed tomographic evaluation of TB spine in Ibadan. West Afr J Med 2004;23:228-31.  Back to cited text no. 20
    
21.
Ekinci S, Tatar O, Akpancar S, Bilgic S, Ersen O. Spinal tuberculosis. J Exp Neurosci 2015;9:89-90.  Back to cited text no. 21
    
22.
Pallis C, Jones AM, Spillane JD. Cervical spondylosis; incidence and implications. Brain 1954;77:274-89.  Back to cited text no. 22
    
23.
Ahmed Z, Khan M, Islam N. Cervical spondylosis. Asian Med J 1992;25:271-7.  Back to cited text no. 23
    
24.
Femi OL, Ibrahim A, Aliyu S. Clinical profile of parkinsonian disorders in the tropics: Experience at Kano, Northwestern Nigeria. J Neurosci Rural Pract 2012;3:237-41.  Back to cited text no. 24
[PUBMED]  [Full text]  
25.
Osuntokun BO, Bademosi O. Parkinsonism in the Nigerian African: A prospective study of 217 patients. East Afr Med J 1979;56:597-607.  Back to cited text no. 25
    
26.
Khealani BA, Baig SM. Clinical spectrum of Parkinson's disease from Pakistan. Singapore Med J 2006;47:1075-9.  Back to cited text no. 26
    
27.
Behari M, Bhatnagar SP, Muthane U, Deo D. Experiences of Parkinson's disease in India. Lancet Neurol 2002;1:258-62.  Back to cited text no. 27
    
28.
Tanner CM, Goldman SM. Epidemiology of Parkinson's disease. Neurol Clin 1996;14:317-35.  Back to cited text no. 28
    
29.
Onwuekwe I, Ezeala-Adikaibe B. Prevalence and distribution of neurological disease in a neurology clinic in Enugu, Nigeria. Ann Med Health Sci Res 2011;1:63-7.  Back to cited text no. 29
[PUBMED]  [Full text]  
30.
Takele GM, Tekle Haimanot R, Martelletti P. Prevalence and burden of primary headache in Akaki textile mill workers, ethiopia. J Headache Pain 2008;9:119-28.  Back to cited text no. 30
    
31.
Hughes MD, Wu J, Williams TC, Loberger JM, Hudson MF, Burdine JR, et al. The experience of headaches in health care workers: Opportunity for care improvement. Headache 2013;53:962-9.  Back to cited text no. 31
    
32.
Sokolovic E, Riederer F, Szucs T, Agosti R, Sándor PS. Self-reported headache among the employees of a Swiss university hospital: Prevalence, disability, current treatment, and economic impact. J Headache Pain 2013;14:29.  Back to cited text no. 32
    
33.
Dikici S, Baltaci D, Arslan G, Atar G, Ercan N, Yilmaz A, et al. Headache frequency among the health care workers and the relationship working conditions. Abant Med J 2013;2:106-13.  Back to cited text no. 33
    
34.
Balarabe SA, Yunusa MA. Prevalence of migraine among medical students in Sokoto, North-Western Nigeria. EJPMR 2016;3:604-8.  Back to cited text no. 34
    
35.
Martin BC, Dorfman JH, McMillan JA, McMillan CA. Prevalence of migraine headache and association with sex, age, race, and rural/urban residence: A population-based study of Georgia Medicaid recipients. Clin Ther 1994;16:855-72.  Back to cited text no. 35
    


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