title: Prestroke treatment of stroke risk factors: A cross-sectional survey in central Nigeria.
abstract: BACKGROUND
  Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa.
  
  
  METHODS
  We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke.
  
  
  RESULTS
  Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant.
  
  
  CONCLUSIONS
  A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke.
authors.affiliation: Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.
authors.forename: Nura H
authors.initials: NH
authors.lastname: Alkali
authors.affiliation: Department of Medicine, National Hospital Abuja, Abuja, Nigeria.
authors.forename: Sunday A
authors.initials: SA
authors.lastname: Bwala
authors.affiliation: Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Dunga
authors.affiliation: Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.
authors.forename: Musa M
authors.initials: MM
authors.lastname: Watila
authors.affiliation: Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.
authors.forename: Yusuf B
authors.initials: YB
authors.lastname: Jibrin
authors.affiliation: Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Tahir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D001364:Awareness; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents