Rufus O Akinyemi

• MBBS (Ib), MSc (Ib), PhD (Newcastle), MWACP, FMCP.
• Fellow at University of Ibadan,Ibadan, Nigeria.

Aim: The National Institutes of Health Stroke Scale (NIHSS) score is an established marker of stroke severity. Its use is time-consuming and requires formal training for optimal results. In contrast, the neutrophil-lymphocyte ratio (NLR), known to be independently associated with stroke outcome, can be readily calculated from routine peripheral blo...

Background The relationship between diagnosed high blood pressure (HBP) and proximity to health facilities and noise sources is poorly understood. We investigated the associations between the number of persons diagnosed with HBP at different distance corridors of noise-generating sources (churches, mosques, bus stops, and road networks), and blood...

Diagnosed hypertension stands out as a prominent global cause of mortality, prompting recent efforts to understand not only treatment options but also determinants across diverse age and occupational groups. However, the literature on the impact of environmental factors on diagnosed hypertension is limited, especially in rural areas with restricted...

Background The escalating prevalence of dementia in Africa, propelled by rapidly ageing population, necessitates innovative approaches to raise awareness and address associated challenges. The prevalent misconception of dementia as a result of witchcraft or wizardry is a challenge, and the media acts as a key agent in dispelling such myths. By reac...

Background The recruitment of individuals for Alzheimer’s disease (AD) genetic studies particularly those with low socioeconomic status, and living in rural areas remains a challenge in Sub‐Saharan Africa (SSA), due to stigma‐related cultural beliefs that hinder their participation. The Recruitment and Retention of Alzheimer’s Disease Diversity Gen...

Background Historically, efforts to engage under‐represented communities in health research have encountered limited success, attributable to inadequate community participation, acceptability, and ownership. Globally, an innovative strategy to foster community involvement in research is the establishment of Community Advisory Boards (CABs). These b...

Background Black Americans (BAs), Hispanics/Latinos (H/Ls), and Africans (As) face a disproportionate burden of aging and Alzheimer’s Disease and Related Dementias (AD/ADRD), coupled with underrepresentation in research. Further, researchers also report a lack of compliance on sensitive social determinants of health data for AD/ADRD research. For i...

Background Majority of people living worldwide live in low‐ and middle‐ income countries, including sub‐Saharan Africa (SSA). Most cognitive assessment batteries for Alzheimer’s Disease(AD), are developed in high income countries (HICs), where most international dementia collaborations and data originate. The African Dementia Consortium (AfDC) is a...

Background Understanding the genetic underpinnings of Alzheimer’s disease is crucial for advancing research and developing targeted interventions. Genomic research in dementia in Africa is of utmost importance based on recent reports from studies in African Americans that African ancestral gene is associated with lower risk effect for developing AD...

Background The escalating prevalence of dementia in Africa, propelled by rapidly ageing population, necessitates innovative approaches to raise awareness and address associated challenges. The prevalent misconception of dementia as a result of witchcraft or wizardry is a challenge, and the media acts as a key agent in dispelling such myths. By reac...

Background Hand‐grip strength (HGS) is known to be a surrogate marker of not only fitness and frailty, but of cognitive and cardiometabolic health. It is cheap, readily deployed and can be a valuable tool in resource‐limited settings. Little however is known about the determinants and correlates of HGS in sub‐Saharan Africa, where stroke and vascul...

Background By 2050, the prevalence of dementia is projected to triple with the greatest increases anticipated in Africa and Asia – largely attributable to population growth and cardiometabolic disorder. Hand‐grip strength (HGS) is a known predictor of cardiometabolic and cognitive health. The relationship between HGS and cognitive impairment (CI) a...

Background Stress has emerged as a risk factor in the development and progression of Alzheimer’s Disease (AD). However, there is limited research on the impact cumulative individual and familial stress has on AD. This study aims to investigate the relationship between stress and AD within a global cohort of underrepresented populations including Bl...

Background The burden of Alzheimer’s disease and related dementias is growing fast in Africa. The Recruitment and Retention for Alzheimer’s Disease Diversity Genetic Cohorts in the Alzheimer’s Disease Sequencing Project (READD‐ADSP) has commenced recruitment of 5000 African participants (AD and cognitively unimpaired individuals) to generate genomi...

Background Late‐onset Alzheimer Disease (LOAD) risk and prevalence differ by ancestral group. Furthermore, the frequency of APOE‐4 and its effect size on LOAD risk also differ by ancestry group. If these patterns are a function of evolutionary history, we may find ancestry group‐specific evidence of recent selection at the APOE locus or APOE eQTLs....

Achieving greater diversity and inclusion in global dementia research requires the inclusion of underrepresented geographic, ethnic and regional populations such as indigenous Africans. The ADSP is a collaborative global initiative that includes sample collection across diverse populations, data generation including whole genome sequencing in over...

Background The “Recruitment and Retention for Alzheimer’s Disease Diversity Genetic Cohorts in the ADSP (READD‐ADSP)” is developing a resource to expand ancestral diversity in Alzheimer disease (AD) studies to dissect the genetic architecture of AD across different populations. In addition to US sites, READD‐ADSP includes four US sites and nine cou...

Background: The aim of the study was to examine the association between alcohol consumption and stroke in Nigeria and Ghana. Methods: The study is a multicentre, case-control study. Cases included consenting adults 18 years of age and older with acute stroke. The controls were age- and gender-matched, stroke-free adults. Alcohol consumption was sel...

Acute ischemic stroke (AIS) is a known complication of Takayasu arteritis (TAK); however, it is infrequently the first symptom observed. There have been no reports of concomitant AIS and anterior ischemic optic neuropathy (AION) as an initial manifestation of TAK. We present a case of TAK causing stroke and painless vision loss in a young Nigerian...

BACKGROUND: Africans are affected by ICH at a relatively younger age than Caucasians, raising curiosity on the potential contribution of emerging risk factors such as lipoprotein-a [Lp(a)] to ICH in that population. We hypothesized that low serum Lipoprotein(a) [Lp(a)] could be an independent risk factor for ICH among Nigerian patients. METHODS N...

BACKGROUND: Indigenous Africans with earlier onset ICH and worse outcomes are grossly under-represented in studies exploring the potential contribution of serum lipoprotein(a) (Lp(a) to ICH fatality and outcome. We evaluated the relationship between Lp(a) and ICH outcome (fatality) among Nigerian patients. METHODS: N: 84 cases (first-ever ICH) +8...

BACKGROUND: Indigenous Africans with earlier onset ICH and worse outcomes are grossly under-represented in studies exploring the potential contribution of serum lipoprotein(a) (Lp(a) to ICH fatality and outcome. We evaluated the relationship between Lp(a) and ICH outcome (fatality) among Nigerian patients. METHODS: N: 84 cases (first-ever ICH)...

Neurological disorders are the leading cause of disability and second leading cause of mortality globally, but this burden disproportionately occurs in low- and middle-income countries (LMICs). This combination of a high burden of neurological disorders with a limited specialized neurological workforce and large sections of the population vulnerabl...

Background: The burden of Alzheimer’s disease and related dementias is growing fast in Africa. The Recruitment and Retention for Alzheimer’s Disease Diversity Genetic Cohorts in the Alzheimer’s Disease Sequencing Project (READD-ADSP) has commenced recruitment of 5000 African participants (AD and cognitively unimpaired individuals) to generate genom...

INTRODUCTION Despite a two‐fold risk, individuals of African ancestry have been underrepresented in Alzheimer's disease (AD) genomics efforts. METHODS Genome‐wide association studies (GWAS) of 2,903 AD cases and 6,265 controls of African ancestry. Within‐dataset results were meta‐analyzed, followed by functional genomics analyses. RESULTS A novel...

Introduction The risk of developing neurodegenerative disorders (NDDs) such as Alzheimer’s disease and related dementias (ADRD) and Parkinson’s disease and atypical parkinsonism (PDAP), has been alluded to arise predominantly from the interplay between environmental exposures and genetic variability. The contributions of these factors to NDD in Bla...

Background African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network (SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke i...

This appendix formed part of the original submission. We post it as supplied by the authors. Supplement to: Olowoyo P, Barango P, Moran A, et al. Priorities to reduce the burden of hypertension in Africa through ACHIEVE. Lancet Glob Health 2024; 12: e192-93.

Background Alzheimer’s disease and dementia related disorder incidence and prevalence continue to increase in Africa due to changing ageing demographics. Despite this rise, overall quality and quantity of available evidence to inform best practices in recruitment, retention and inclusion of underrepresented population in ADRD research is very low....

Background Alzheimer’s disease and dementia related disorder incidence and prevalence continue to increase in Africa due to changing ageing demographics. Despite this rise, overall quality and quantity of available evidence to inform best practices in recruitment, retention and inclusion of underrepresented population in ADRD research is very low....

Stroke in Africa

Introduction: The true global burden of vascular cognitive impairment (VCI) is unknown. Reducing risk factors for stroke and cardiovascular disease would inevitably curtail VCI. Areas covered: The authors review current diagnosis, epidemiology, and risk factors for VCI. VCI increases in older age and by inheritance of known genetic traits. They...

Background There is a growing interest in stroke genomics and neurobiobanking research in Africa. These raise several ethical issues, such as consent, re-use, data sharing, storage, and incidental result of biological samples. Despite the availability of ethical guidelines developed for research in Africa, there is paucity of information on how the...

Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends...

The relationship between serum LDL and Hemorrhagic Stroke (HS) severity was explored in a study population of indigenous Africans. Low baseline serum LDL showed an independent association with worse Glasgow Coma score at presentation. Optimal serum LDL levels does not translate to reduced severity of hemorrhagic stroke (HS) in indigenous Africans.

Background: Low vegetable consumption and hypertension are independently associated with stroke, but little is known about the interaction of these two factors. This study evaluated the interaction of low vegetable consumption with hypertension in stroke occurrence among West Africans. Methods: The dataset for this study was from the 3684 stroke ca...

INTRODUCTION: Despite a two-fold increased risk, individuals of African ancestry have been significantly underrepresented in Alzheimers Disease (AD) genomics efforts. METHODS: GWAS of 2,903 AD cases and 6,265 cognitive controls of African ancestry. Within-dataset results were meta-analyzed, followed by gene-based and pathway analyses, and analysis...

Background Heart failure is now a significant contributor to the burden of non-communicable diseases in developing countries like Nigeria which is experiencing epidemiologic and demographic transition. The epidemiology of heart failure in this country is poorly characterized. The aim of the review is to determine the prevalence of heart failure, th...

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disor...

Cerebral small vessel disease (SVD) is common during ageing and can present as stroke, cognitive decline, neurobehavioural symptoms, or functional impairment. SVD frequently coexists with neurodegenerative disease, and can exacerbate cognitive and other symptoms and affect activities of daily living. Standards for Reporting Vascular Changes on Neur...

Background: Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria...

The relationship between APOE polymorphisms and Parkinson’s disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition q...

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regardin...

Background: Secondhand smoking (SHS) is the exposure to smoke arising from a burning cigarette or exhaled by a smoker. It is a significant public health problem worldwide and whether it is associated with hypertension, particularly among Africans, is yet to be clearly understood. This study evaluated the relationship between SHS and hypertension am...

Background: Hypertension is one of the leading risk factors for cerebrovascular and cardiovascular diseases. Early identification of populations at risk of hypertension might be critical in managing hypertension, particularly in Sub-Saharan Africa, where the burden of hypertension is very high. This study aimed to develop a risk-scoring model for p...

Background: The association of vegetable consumption with hypertension remains poorly described in sub-Saharan Africa. This study assessed the relationship between vegetable consumption and hypertension among indigenous Africans. Methods: We harmonized data on the frequency of vegetable consumption (servings/week) and hypertension (defined as systo...

Traumatic brain injury, stroke, and neurodegenerative diseases represent a major cause of morbidity and mortality in Africa, as in the rest of the world. Traumatic brain and spinal cord injuries specifically represent a leading cause of disability in the younger population. Stroke and neurodegenerative disorders predominantly target the elderly and...

The inaugural African Stroke Organization Conference (ASOC) aimed to create a forum to discuss the latest stroke science, highlight opportunities to address the high burden of stroke in Africa, develop a viable pipeline of emerging African stroke researchers, honor leading scientists and policy makers, and provide networking avenues to bolster futu...

Background The relationship between serum LDL level and hemorrhagic stroke is inconclusive. Several epidemiological Studies have noted that low LDL is a risk factor for ICH, however very few studies have defined the link between LDL and hemorrhagic stroke severity. Aim We hypothesized that low serum LDL levels may have association with intracerebr...

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regardin...

Introduction: Second-hand smoking (SHS) is an emerging phenomenon in cardiovascular disease (CVD) epidemiology, but whether SHS is associated with stroke is not clearly understood. We assessed the association between SHS and stroke risk in a cohort of West Africans in the Stroke Investigative Research and Educational Network (SIREN) study. Hypothes...

Introduction: High blood pressure is a prominent risk factor for stroke in Sub-Saharan Africa (SSA) where dietary factors associated with blood pressure are often under-reported. Hypothesis: Dietary patterns (DP) are not associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) among stroke-free Africans from Ghana and Nigeri...

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regardin...

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 in...

Parkinson’s disease (PD) remains a common neurodegenerative movement disorder with significant morbidity, which is expected to increase worldwide in the coming decades. Since its initial description, much has been elucidated about its etiology, pathogenesis, and the role of genetic and environmental risk factors. Effective treatments, including sur...

In tandem with the ever‐increasing aging population in low and middle‐income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person‐years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascula...

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were cons...

Background: Data on non-motor symptoms (NMS) in black Africans with Parkinson's disease (PD) are sparse. Objective: To describe the profile of NMS in the Nigeria PD Registry (NPDR) cohort and explore the relationship between NMS and PD motor phenotype. Methods: We conducted a cross-sectional study of the frequency and burden of NMS, based on t...

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), 50–6...

Background: Brain arteriovenous malformations (BAVM) are a cause of intracerebral haemorrhage (ICH) and seizures especially in young patients. ICH due to BAVMs seem to have relatively better neurologic outcomes compared to other causes of spontaneous ICH as patients often recover fully. In this report we highlight a case of delayed diagnosis of BA...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Health (NIH) OnBehalf SIREN as part of the H3 Africa Consortium Background Hypertension is the principal risk factor for stroke events in Sub-Saharan Africa (SSA). However, international evidence on the significance of physical i...

Background: Age is a non-modifiable risk factor for stroke occurrence due its influence on vascular risk factor acquisition. In sub-Saharan Africa, the effect sizes of vascular risk factors for stroke occurrence by age is unknown. Objective: To quantify the magnitude and direction of the effect sizes of key modifiable risk factors of stroke accordi...

Background: Pre-diabetes and diabetes mellitus (DM) are dysglycemic states associated with stroke occurrence. However, there is limited data from sub-Saharan Africa on the burden and associations between pre-DM and DM and stroke occurrence in a region experiencing an astronomic rise in stroke burden Purpose: To characterize the associations between...

Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hype...

Background Acute infections have been posited as potential precipitants or triggers of the occurrence of stroke among adults with traditional vascular risk factors. We evaluated associations between stroke occurrence and reported febrile illness within 4 weeks (potential antecedent infections) among West Africans. Methods The Stroke Investigative...

The burden of stroke and cardiovascular diseases (CVD) is increasing rapidly, especially in low and middle-income countries (LMIC). Most of the risk factors for these diseases are modifiable and influenced by lifestyle and diet. Although regular consumption of fruits and vegetables are often recommended, the evidence appears burly for green leafy v...

Objectives: Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in A...

The ethical, legal, and social implications (ELSI) of emerging neurobiobanks and data resources are unclear in an African scientific landscape with unique cultural, linguistic, and belief systems. The overarching goal of the African Neurobiobank for Precision Stroke Medicine–—ELSI Project is to identify, examine, and develop novel approaches to add...

Background Clinical disease registries are useful for quality improvement in care, benchmarking standards, and facilitating research. Collaborative networks established thence can enhance national and international studies by generating more robust samples and credible data and promote knowledge sharing and capacity building. This report describes...

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SD...

Introduction Migraine attacks associated with menstruation are generally perceived as more severe than attacks outside this period. Aim and Objective The study aimed at determining the frequency of menstrual-related headaches among a cohort of senior secondary school girls in Abeokuta, Nigeria. We also determined its burden among these school girl...

Objective: To address the variability in prevalence estimates and inconsistencies in potential risk factors for poststroke cognitive impairment (PSCI) using a standardized approach and individual participant data (IPD) from international cohorts in the Stroke and Cognition Consortium (STROKOG) consortium. Methods: We harmonized data from 13 stud...

Background: The number of individuals living with dementia is increasing, negatively affecting families, communities, and healthcare systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortalit...

BACKGROUND: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortali...

Background Lifetime stroke risk has been calculated in a limited number of selected populations. We determined lifetime risk of stroke globally and at the regional and country level. Methods Using Global Burden of Disease Study estimates of stroke incidence and the competing risks of non-stroke mortality, we estimated the cumulative lifetime risk...

Background Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use stan...

Brain Banks are biorepositories of central nervous system (CNS) tissue including fixed and frozen whole brains, brain biopsies and spinal cord, as well as body fluids comprising the cerebrospinal fluid (CSF) and blood stored for research purposes. Though several independent brain banks exist in high income countries, only five low- and middle - inc...

Background: It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. Objective: To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. Methods: A comparative cross-secti...

Background: It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. Objective: To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. Methods: A comparative cross-...

Background: Stroke is the second leading cause of death and adult-onset disability globally. Although its incidence is reducing in developed countries, low- and middle-income countries, especially African countries, are witnessing an increase in cases of stroke, leading to high morbidity and mortality. Evidently, a new paradigm is needed on the con...

A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors...

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...

With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor fo...

Introduction: Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Conse...

Abstract Background: Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk...

Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians spec...