West Africa Journal of Medicine

EDITORIAL: Toward Holistic Chronic Disease Care: Addressing the Intersecting Burdens on Patients and Caregivers in Low-Resource Health Systems

G. E. Erhabor — Wed, 30 Apr 2025 00:00:00 +0000

It is with great pleasure that we introduce this edition of the journal. The issue encompasses a broad range of scholarly contributions addressing critical areas of clinical practice, medical technology, as well as developments in health systems and policy. Together, these articles provide a comprehensive perspective on the evolving landscape of healthcare in West Africa, highlighting both persistent challenges and emerging opportunities. We acknowledge with gratitude the commitment of our authors, reviewers, and readers, whose continued engagement sustains the journal’s role in advancing medical knowledge and practice in the region.

Chronic diseases are the leading causes of morbidity and mortality worldwide.¹ A number of the articles in this issue illustrate the medical, social, and psychological tolls that various chronic diseases exert on the patients and families alike. Taken together, these insights emphasize that chronic diseases in our setting are not only highly prevalent but also multifaceted in their impact. Recognizing and addressing these interconnected challenges is essential if health systems are to move toward more holistic, patient- and caregiver-inclusive models of care. In a study by Osaigbovo et al., nearly half of stroke survivors were confirmed to have depression, with obesity, recurrent stroke, post-stroke dependency, and diabetes mellitus identified as major predictors. This underscores how chronic illness can compound vulnerabilities—where physical disability feeds into psychological distress, ultimately diminishing quality of life and hindering rehabilitation outcomes.

Similarly, chronic hypertensive heart failure (HHF) presents its own distinctive challenges. The data from a study by Ogah and co-workers in Ibadan, Nigeria, reveal that HHF often affects a relatively younger population compared to high-income countries, with diabetes emerging as the most common comorbidity. Over half of the patients studied had previously experienced heart failure, reflecting the recurrent and debilitating nature of the condition. Notable gender differences were also observed, with males more frequently showing structural and electrical cardiac abnormalities, while females exhibited higher biochemical derangements. These findings highlight the complexity of chronic disease profiles in sub-Saharan Africa and the pressing need for preventive and early intervention strategies, particularly in addressing hypertension as a root cause.

Through their work, Anjorin et al. reveal the dual nature of care, showing that while systems are designed with the patient in mind, the caregiver plays an equally pivotal role. Frequently, a spouse, child, sibling, or close relative, caregivers provide essential day-to-day support, ranging from physical assistance and financial contributions to emotional and psychological care. Yet, this indispensable role comes with profound costs, encapsulated in the concept of caregiver burden. Caregiver burden refers to the physical, emotional, social, and financial strain experienced by those who care for individuals with chronic illness. It is multidimensional—manifesting as fatigue, anxiety, depression, financial hardship, social isolation, and reduced quality of life. Unlike acute episodes of illness, chronic diseases extend over months or years, placing caregivers under sustained stress that can erode their own health and well-being.^2,3

In the cross-sectional study of 248 caregivers of patients with chronic diseases admitted to the Emergency Department of a University Teaching Hospital, Anjorin and colleagues found that over three-quarters experienced significant caregiver burden. Nearly one in five reported dissatisfaction with life. The majority were close family members-sons and daughters who had set aside personal and professional commitments to provide care. Importantly, rural caregivers bore disproportionate strain, with a higher burden and lower life satisfaction compared to their urban counterparts. Longer duration of caregiving also correlated with increased stress. These findings are not unique to Nigeria; they reflect a global challenge. The implications of caregiver burden go beyond the caregiver. A strained caregiver may struggle to provide consistent and effective care, ultimately compromising the patient’s health outcomes. Studies have demonstrated links between high caregiver burden and poorer adherence to treatment, delayed recovery, increased hospital readmissions, and in some cases, higher patient mortality.^2-5 Thus, attending to caregiver needs is not simply a humanitarian gesture—it is a matter of clinical and public health importance.

In many health systems, particularly in low- and middle-income countries, caregivers are the silent backbone of chronic disease management. They fill the gaps left by limited health workforce capacity and inadequate social support structures. Despite this, caregiver well-being is rarely integrated into patient care plans. The result is a paradox: those who sustain the health of others often experience declining health themselves, leading to a cycle of suffering that perpetuates household vulnerability.^4,5

The implications for policy and practice are clear. Caregiver well-being must be systematically integrated into chronic disease management. Healthcare systems must expand their scope of concern to explicitly include caregivers. This requires a multifaceted approach that addresses the diverse dimensions of caregiver burden. First, caregiver well-being should be routinely assessed during patient encounters, using validated tools that help clinicians identify those at risk of significant strain. Beyond assessment, there is a need for accessible psychosocial support, including counseling services and peer support groups, which provide caregivers with much-needed emotional outlets and a sense of community. In addition, respite care services are essential to give caregivers opportunities to rest and recover, thereby preventing burnout and sustaining their capacity to provide quality care. Educational initiatives also play a vital role, equipping caregivers with the knowledge and skills necessary to manage chronic illness more effectively and confidently. Finally, health policy must acknowledge the economic impact of caregiving by introducing financial support mechanisms-such as subsidies, tax relief, or other forms of assistance-to reduce the financial strain that often accompanies long-term caregiving responsibilities. Ultimately, caregiver burden cannot remain an unseen or unspoken reality. The health of caregivers is intertwined with the health of those they serve. As chronic diseases continue to rise in prevalence across West Africa, our health systems must undergo a paradigm shift to a family- and caregiver-inclusive model.

The evolving and multifaceted health challenges within our region demand sustained scholarly engagement and rigorous dissemination of evidence. In this regard, the West African Journal of Medicine remains committed to serving as a platform for the publication of high-quality scientific work subjected to robust peer review. Preparations are in progress for a forthcoming special issue that will feature significant contributions reflecting advances in biomedical research and clinical practice. We invite the submission of original articles, systematic reviews, and critical analyses for possible inclusion. To facilitate participation, all accepted manuscripts will undergo accelerated review processes and benefit from waivers of article processing charges. Through sustained academic inquiry and collaboration, it is anticipated that these contributions will inform practice, guide policy, and strengthen the broader discourse on health in West Africa and beyond.

Prof G.E Erhabor

Editor-in-chief

References

Hacker K. The burden of chronic disease. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2024;8(1):112-9.
Choi JY, Lee SH, Yu S. Exploring factors influencing caregiver burden: a systematic review of family caregivers of older adults with chronic illness in local communities. InHealthcare 2024;12(10):1002
Liu Z, Heffernan C, Tan J. Caregiver burden: A concept analysis. International journal of nursing sciences. 2020;7(4):438-45.
Mohamed ER, Abou-Hashim RM, Shaltoot H. Assessment of stress in caregivers of acutely hospitalized elderly and its relation to hospital outcomes. Middle East Current Psychiatry. 2023;30(1):113.
Chavan PP, Weitlauf JC, LaMonte MJ, Sisto SA, Tomita M, Gallagher‐Thompson D, et al. Caregiving and all‐cause mortality in postmenopausal women: Findings from the Women's Health Initiative. Journal of the American Geriatrics Society. 2024;72(1):24-36.

CASE REPORT: Transcatheter Aortic Valve Implantation in West Africa: A Severe Aortic Stenosis Case Report

T. Majekodunmi, O. K. Oguntuga — Tue, 30 Apr 2024 00:00:00 +0000

Background and objectives: Aortic valve stenosis (AoS) is the most common valvular pathology in the elderly, many of whom are ineligible or high-risk for surgery due to comorbidities. Transcatheter Aortic Valve Implantation (TAVI) was developed as a less invasive alternative to Surgical Aortic Valve Replacement (SAVR) for patients with severe AoS. Its efficacy was first demonstrated in the landmark PARTNER trial, which compared TAVI to medical therapy in ineligible SAVR patients. Subsequent studies have validated its use in intermediate and low-risk groups. Despite its growing adoption, there has yet to be a report of a successful TAVI procedure in West Africa.

Methods: The procedure involved transcatheter aortic valve implantation using radial and femoral arterial access. A 14Fr Python sheath was introduced after vessel dilation, and the valve was crimped and positioned in the aortic annulus under fluoroscopic guidance. Serial aortograms confirmed accurate placement, and haemostasis was achieved using a Proglide suture, protamine administration, and manual pressure. The patient was transferred to the ICU post-procedure for monitoring.

Results: The patient's post-procedure imaging showed a well-seated valve with trivial central aortic regurgitation, no paravalvular leak, and an insignificant gradient of 12.25 mmHg. The patient remained stable, resumed anticoagulation, and was discharged with a follow-up scheduled in one week.

Conclusions: This case report details the successful prosthetic aortic valve implantation in an 83-year-old high-risk surgical candidate with hypertension and bilateral knee replacements. It marks a significant step toward adopting less invasive valvular heart disease management approaches in the region.

ORIGINAL: The Burden on Caregivers and Life Satisfaction Among Caregivers of Patients with Chronic Diseases Admitted to the Emergency Department of a Tertiary Health Institution in Southwest Nigeria

Tue, 30 Apr 2024 00:00:00 +0000

Introduction: Caregivers of patients in hospital experience enormous strain and discomfort while caring for their loved ones. The burden on caregivers while caring for a hospitalised patient is also varied and requires proper identification due to the significant role these caregivers play in the patient's outcome. Caregiver burden is related to the well-being of both the patient and caregiver; therefore, understanding the attributes associated with caregiver burden is important.

Aim: To assess the relationship between the social, emotional, financial, and family burden with life satisfaction of caregivers of patients.

Method: This was a cross-sectional study that recruited 248 adult caregivers (18 years and above) of patients with chronic diseases admitted into the Emergency Department of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). All caregivers who consented to participate in the study had an interviewer-administered questionnaire.

Results: The mean age of caregivers was 41.27 ±15.28 years with a range of 16-89 years. More were within the age groups 21-30 years, and were mostly family members (94%). Sons/daughters were the most prevalent (39.1%), with daughters constituting 24.5% and sons were 14.6%. Majority (77.0%) of the caregivers experienced caregiver burden. The mean burden score based on the Zarit Burden Interview was 17.85±7.67 and 21.8% of the caregivers were dissatisfied with life. The rural dwellers experienced high burden and were less satisfied with life compared to the urban dwellers (p =0.029). Also, caregivers who had cared for their sick patient for three months to one year experienced higher burden compared to those who had cared for shorter duration (p=0.020).

Conclusion: Caregiver burden was present among caregivers and the level of satisfaction with life can influence burden of care.

ORIGINAL: Frequency of Depression and its Associated Factors Among Stroke Survivors in a Tertiary Hospital in Nigeria

G. O. Osaigbovo, G. A. Amusa, N. H. Alkali, A. I. Zoakah — Wed, 30 Apr 2025 00:00:00 +0000

Background: Stroke is a leading cause of disability and mortality worldwide, and post-stroke depression is a common neuropsychiatric complication. Post-stroke depression is associated with increased disability, diminished quality of life, and elevated mortality rates among stroke survivors. Recognizing how common depression is among stroke survivors and the factors associated with it are crucial for timely intervention and improved rehabilitation outcomes.

Methods: A hospital-based cross-sectional study conducted at Jos University Teaching Hospital, with 396 adult stroke survivors. Participants were screened for depression using the Patient Health Questionnaire-9 (PHQ-9) and the Beck Depression Inventory (BDI). Confirmatory diagnoses were established using the Structured Clinical Interview for DSM-4 (SCID-IV). Data were analysed using SPSS version 25.

Results: Among the 396 stroke survivors, 81.8% screened positive for depression on the PHQ-9, while 87.9% were classified as depressed using the BDI. The SCID-IV confirmed depression in 42.4% of participants. Factors associated with post-stroke depression included elevated waist-hip ratio (AOR = 8.226; 95% CI: 2.628-25.760; p < 0.001), repeat stroke (AOR = 5.034; 95% CI: 2.767-9.160; p < 0.001), elevated body mass index (AOR = 3.007; 95% CI: 1.872-4.828; p < 0.001), post-stroke dependency (AOR = 2.798; 95% CI: 1.738-4.508; p < 0.001), and diabetes mellitus (AOR = 2.145; 95% CI: 1.309-3.513; p = 0.003).

Conclusion: The frequency of depression among stroke survivors in Jos was high. The determinants of depression were obesity, previous history of stroke, diabetes mellitus and post-stroke disability. Early detection and targeted interventions are recommended to enhance better outcomes.

ORIGINAL: Contemporary Baseline Clinical Profile of Chronic Hypertensive Heart Failure in Ibadan, Nigeria

Wed, 30 Apr 2025 00:00:00 +0000

Introduction: Cardiovascular disease (CVD) has become the major cause of morbidity and mortality in Sub-Saharan Africa (SSA). Despite this, there is still very little data on the pattern of hypertensive heart disease in SSA.

Objective: This study described the characteristics of heart failure caused by hypertensive heart disease in Ibadan, Nigeria.

Methods: This was a hospital-based cross-sectional study conducted in the cardiology unit of the Department of Medicine, University College Hospital, Ibadan, Nigeria. Eligible patients were those presenting with chronic hypertensive heart failure to the cardiology unit or referred to the unit for the same purpose. Data collection started from August 1, 2016, to July 31, 2021. Analysis was done with the SPSS statistical package. A 2-tailed p-value of <0.05 was assumed to be statistically significant.

Results: A total of 753 subjects met the inclusion criteria for the study. The mean age of the population was 60.3 (range, 18-98 years). The most common co-morbidity was diabetes mellitus (13.9%). About 54% of the subjects had a previous history of heart failure. Serum sodium (p = 0.022), creatinine (p = 0.001), and total cholesterol (p = 0.004) were significantly higher in females. Men are more likely to have left-axis deviation (p=0.016) and left atrial abnormality (p=0.016). Heart failure with reduced ejection fraction was common in males.

Conclusion: HHF in Ibadan, Nigeria, affects a relatively younger population compared to their counterparts in high-income countries. Our findings are similar to data from other parts of sub-Saharan Africa. Preventive programmes should be utilised at all levels to stem the menace of hypertension.

ORIGINAL: Comparative Ultrasound Evaluation of Carotid Intima-Media Thickness in Preeclamptic and Healthy Normotensive Pregnant Women at a Nigerian Tertiary Hospital

O. E. Ojeyemi, K. Ojeyemi, O. Ogunsuji, J. Akinmoladun, G. Obajimi, G. Ogbole — Wed, 30 Apr 2025 00:00:00 +0000

Introduction: Preeclampsia is defined as hypertension occurring after 20 weeks of gestation with associated proteinuria. It remains one of the leading causes of maternal and perinatal morbidity and mortality in developing countries. The increased risk of atherosclerosis makes affected women more prone to cardiovascular and cerebrovascular complications. Carotid intima-media thickness (CIMT), measured non-invasively by high-resolution B-mode ultrasound, offers an opportunity for early identification of women with atherosclerosis, thereby allowing preventive measures and early intervention.

Methods: A prospective comparative study conducted at the Radiology Department of the University College Hospital, Ibadan. Seventy women with preeclampsia were consecutively recruited into the study, and an equal number of normotensive pregnant women, matched by maternal and gestational age were selected between August 2022 and January 2023. Carotid Intima-Media Thickness (CIMT) was assessed by ultrasound using the technique of 'multiple carotid sites measurement'. Data analysis was performed using IBM SPSS version 23, employing descriptive statistics, Chi-square test, and Student's t-test to evaluate associations and compare CIMT values. A p-value < 0.05 was considered statistically significant.

Results: Mean CIMT values were 0.639 ± 0.152 mm and 0.663 ± 0.156 mm for women with preeclampsia, and 0.610 ± 0.131 mm and 0.618 ± 0.126 mm for normotensive pregnant women on the right and left respectively (95% CI, -0.002-0.092; p= 0.061). In preeclamptic and control groups, mean CIMT values were lower in nulliparous women compared with multiparous women. There was a positive correlation between the age of the participants and CIMT on the right (r = 0.067) and left (r = 0.150). A positive correlation was also demonstrated between blood pressure and CIMT on both sides.

Conclusion: Mean CIMT values were higher on both sides in women with preeclampsia compared with normotensive pregnant women.

ORIGINAL: Incidence and Short-Term Outcome of Acute Kidney Injury in Critically Ill Patients in Southern Nigeria: A Multi-Centre Retrospective Study

Wed, 30 Apr 2025 00:00:00 +0000

Background and objectives: Despite the burden and severity of AKI in ICU patients, there is limited epidemiologic information in Sub-Saharan Africa. Epidemiologic data on AKI in critically ill patients are required to advocate for government health policies that will reduce the burden of AKI. This study determined the incidence, aetiologies, and short-term outcomes of AKI in ICU patients in Southern Nigeria.

Methods: A multi-centre retrospective descriptive study of all patients with medical conditions, who developed AKI in the ICU of the participating hospitals during the study period. Data collected include socio-demographics, hospital-related data such as duration of stay in ICU, past and current medical history, and outcome of illness.

Results: Out of 473 cases, AKI was diagnosed in 203 (42.9%). Seventy-three (36.0%) were oliguric, 50.2% had non-oliguric AKI, while it was not specified in 13.8% patients. The most common causes of AKI were hypovolaemia (34.0%) and sepsis (27.6%). Factors associated with the development of AKI were sepsis [AOR:6.17; CI:2.33-16.32; p = <0.001] and need for inotropes [AOR:2.03; CI:1.34-3.94; P = 0.003]. Although dialysis was indicated in 34 (16.7%) of the AKI patients, 58.8% of them received it. One hundred and sixteen (57.1%) of the AKI patients were discharged with full renal recovery, while 40.9% died.

Conclusion: Four out of every 10 patients admitted into the ICU developed AKI, and the common aetiologies were hypovolaemia and sepsis. Regular critical care training is required to effectively identify at-risk patients and to take prompt measures towards mitigating these risks.

ORIGINAL: Evaluating Serum Cystatin C as A Marker of Reduced Glomerular Filtration Rate in Pregnant Women: A Better Alternative to Creatinine?

Wed, 30 Apr 2025 00:00:00 +0000

Background: Monitoring kidney function during pregnancy is vital, especially in women with hypertensive disorders like preeclampsia. Serum creatinine, although widely used, is limited in sensitivity due to physiological changes in pregnancy. Cystatin C, a novel biomarker, has emerged as a potentially superior and early indicator of glomerular filtration rate (GFR). The aim of this study was to evaluate the diagnostic performance of cystatin C compared to creatinine in pregnant women.

Methods: A cross-sectional comparative study was conducted among 180 pregnant women at a tertiary centre in Nigeria. Participants included 90 women with preeclampsia and 90 normotensive controls. The respondents were interviewed using a pre-tested, interviewer -administered, semi-structured questionnaire. Serum creatinine and cystatin C levels were measured, and estimated GFR was calculated using the CKD-EPI equation. Group comparisons and correlation analyses were performed.

Results: Mean serum cystatin C levels were significantly higher in preeclamptic women (1.09 ± 0.62 mg/L) compared to controls (0.80 ± 0.22 mg/L, p < 0.001). Although mean serum creatinine levels were slightly higher in the preeclamptic group (89.4 ± 52.5 µmol/L) than in the control group (86.9 ± 47.5 µmol/L), the difference was not statistically significant (p = 0.168). Cystatin C demonstrated a stronger inverse correlation with eGFR (r = -0.68) than creatinine (r = -0.49). Kidney dysfunction (eGFR < 60 mL/min) was detected in 11.1% of preeclamptic women using cystatin C-based threshold and absent in normotensive controls (p < 0.001).

Conclusion: Cystatin C outperforms serum creatinine in detecting early kidney dysfunction in pregnancy and may be a more reliable tool for antenatal screening, especially in high-risk populations. Its adoption could improve early diagnosis and clinical outcomes in resource-limited settings.

ORIGINAL: A Two-Year Prospective Study of the Mechanisms and Patterns of Limb Injury in Multiply Injured Patients at UNIOSUN Teaching Hospital, Osogbo, Nigeria

Wed, 30 Apr 2025 00:00:00 +0000

Background: Multiple injured patients are patients who sustained injury to more than one system in the body, while a polytraumatized patient is the one who sustained injury to two or more regions of a system in the body. Better patient outcomes and effective management depend on an understanding of the patterns and characteristics of limb injuries in the multiply injured individuals. This is especially important in places with little resources, like Southwestern Nigeria, where trauma is common and it's important to make the best use of the few available medical resources. Therefore, the aim of this research is to determine the common aetiology that led to various limb injuries in the multiple injured patients at UNIOSUN Teaching Hospital, Osogbo, Osun state.

Methodology: A prospective observational design was employed, involving multiple injured patients admitted to UNIOSUN Teaching Hospital from May 1st, 2022 to April 30th, 2024. Data collection includes demographic information, aetiology of the injury and type of injury sustained. SPSS Version 20 was employed to determine the frequency and distribution of data. Descriptive analysis revealed demographic characteristics, patterns of limb injury, highlighting the common causes, prevalence of different types of limb injuries, distribution of affected limbs and sides in the multiply injured patients.

Result: The study found a higher representation of males in road traffic accidents, with a diverse age group. Most participants were passengers or pedestrians, with 71.4% of injuries being closed. Most participants did not use seat belts and were not seated.

Conclusion: This study demonstrated that limb injuries from road traffic accidents predominantly affected young adult males, with motorcycle crashes being the leading cause. Fractures, especially of the lower limbs, were the most common injury types, and surgical intervention was frequently required. These findings show the significant burden of limb trauma managed at UNIOSUN Teaching Hospital and emphasize the demographic and clinical patterns associated with such injuries.

REVIEW ARTICLE: Barriers and Facilitators to Utilization of Cervical Cancer Screening Services in Eswatini: A Scoping Review

T. N. Maseko, J. M. Tsoka-Gwegweni, X. Dlamini, R. Nkambule, V. Okello — Wed, 30 Apr 2025 00:00:00 +0000

Background: The implementation of cervical cancer screening programmes in Eswatini has been shown to be helpful in lowering both the occurrence and fatality rates associated with cervical cancer. However, there is a low level of screening participation among women.

Aim: To provide a comprehensive synthesis of the barriers and facilitators to the uptake of cervical screening services from the perspectives of the healthcare providers (supply side) and the individuals receiving the screening (demand side) in Eswatini.

Methods: The review followed the guidelines set out by the PRISMA scoping review criteria of peer-reviewed research publications that were published during the last five years. The publications included in the study were primarily centred on the documentation of Eswatini's nationwide endeavours in cervical cancer screening. A total of four databases were used, namely Medline, PubMed, CINAHL, and Google Scholar.

Results: A total of 16 records fulfilled the established criteria for inclusion. The research primarily examined many aspects related to the supply side of cervical cancer (CC) screening. These aspects included the training and skills of health workers, the extent of CC screening service coverage, the capacity of health services, and the resource limitations that contribute to inadequate implementation and delivery of CC screening services.

Conclusions: The outcomes of the review revealed the need for implementers to take into account the interplay between demand-side and supply-side elements that support the provision and acceptance of cervical cancer screening services.

Contribution: The review presents evidence on barriers, enablers and practice in cervical cancer screening in Africa.

REVIEW ARTICLE: Health-Related Social Media Misinformation: Implications for the Burden of Noncommunicable Diseases in Sub-Saharan Africa

N. C. Menakaya, E. I. Unuigbe — Wed, 30 Apr 2025 00:00:00 +0000

Background/purpose: The use of social media platforms for social and educational interactions has transformed the way information sharing takes place. However, this has also exposed the public to health-related misinformation, posing significant challenges for global health. This is particularly challenging in sub-Saharan Africa (SSA), where the burden of noncommunicable diseases (NCDs) now compounds existing challenges from communicable diseases. This review aimed to examine the growing challenge of health-related social media misinformation and the potential implications for NCD burden in SSA, and explore possible strategies for combating social media misinformation in the context of NCDs.

Data source: Useful data for this review were obtained by consultation of online sources of information using search engines and online databases.

Findings: Social media platforms serve various health-related purposes, including health interventions, health campaigns, medical education, disease outbreak surveillance, and behavior change. WhatsApp, Facebook, X (formerly Twitter), and YouTube are the leading platforms associated with health-related misinformation in SSA. Potential implications of health-related social media misinformation are misconceived clinical diagnosis, inappropriate self-medication and failure to adhere to evidence-based treatment modalities.

Conclusions: Social media misinformation in the area of NCDs can potentially influence people's health-related attitudes, behaviour and undermine appropriate implementation of evidence-based interventions. Collaboration among stake holders such as healthcare professionals, religious organizations and social media influencers, as well as public awareness campaigns and regulatory policies are plausible strategies for combating the issue. There is limited research on the implications of health-related social media misinformation on NCDs in SSA highlighting the need for further studies.