A cross-sectional single-centre study of anaemia in the elderly

Background: The geriatric population is increasing globally, and anaemia in the elderly is associated with increased morbidity and mortality.  The Anaemia in Elderly study (ANiE study) aimed to assess the prevalence, associations and severity of anaemia in elderly patients attending the outpatient clinics at Rivers State University Teaching Hospital. Methods: This was a prospective cross-sectional study of consenting patients, 60 years and older, attending the outpatient clinics in our hospital. A blood sample was collected for full blood count, blood glucose, serum creatinine and HIV serology. A data collection tool was used to collect data on comorbidities, occupation and income among others. Descriptive analysis and logistic regression were done to determine factors associated with anaemia in elderly patients in the outpatient clinics. Results: A total of 288 patients consented to participate, anaemia was prevalent in 101 (35.1%) of the participants, there was no difference in the prevalence between males and females, the mean PCV was 38.33±1.33%, the majority of the anaemic patients had mild anaemia 46 (45.5%).  Being a patient on follow-up visit to the hospital, the average monthly income and employment status were significantly associated with the occurrence of anaemia. Conclusions: Anaemia according to the WHO definition was prevalent in 35.1% of elderly patients attending the out-patients’ clinics in the hospital. Factors associated with anaemia were employment status and average monthly income. It is important to identify patients at risk and provide appropriate care to prevent further morbidity and mortality.

Sociodemographic determinants of anaemia in pregnant women at antenatal clinic booking

Background: Anaemia is a common complication in pregnancy with adverse outcome. Early identification of women at risk and instituting prophylactic measures will help prevent its development. Objectives were to determine the prevalence and determinants of anaemia in pregnant women at antenatal booking. Methods: A cross-sectional descriptive study was conducted. The participants were 410 pregnant women aged ≥18 years, booking for antenatal care at a gestational age (GA) ≤24 weeks. The recruitment spanned from January to July 2023. Information on maternal age, parity, GA at booking, marital status, religion, education and occupation of the woman and her spouse, and last birth interval, were collected. Data was analysed with statistical package for the social sciences (SPSS) version 25, using descriptive and inferential statistics. Multivariate logistics regression was used to determine adjusted odds ratios with 95% confidence intervals at a p value of <0.05. Results: There were 410 participants, 136 (33.2%) were anaemic. Of these 130 (31.7%) had mild anaemia (Hb 9.0–10.9 g/dl), while 6 (1.5%) had moderate anaemia (Hb 7.0–8.9 g/dl). Factors associated with anaemia after multivariate analysis were Christian religion (aOR=5.49; p=0.028), lower socioeconomic status (aOR=1.77; p=0.009), late booking (aOR=2.76; p=0.003), and birth interval <2 years (aOR=2.12; p=0.003). The risk of anaemia was five-fold likely for a Christian than a Moslem, twice likely for lower socioeconomic status, about three-fold likely when booking late, and twice likely with short inter-pregnancy interval. Conclusions: The prevalence of anaemia at booking was 33.2%. Determinants of anaemia at booking were Christian religion, lower socioeconomic status, late booking, and birth interval less than two years

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Anaemia in Labour: A Prospective Assessment of Women in Rivers State University Teaching Hospital, Nigeria

Background: Anemia in any phase of pregnancy is associated with much morbidity and risk of mortality to the mother and the fetus, it is a global health concern and is quite prevalent in Africa. About 58% of pregnant women in Nigeria are said to be anemic and earlier reports from this study site showed that 69.6% of women initiating antenatal care were anemic, it was commoner in women of teen-age and the hematocrit was lower as the gestational age at booking increased. Methods: We assessed 464 consenting consecutive pregnant women who presented to our labour ward between November 2017 and July 2018 to know their age, booking status, haematocrit at late pregnancy and followed on to know the mode of delivery as well as the occurrence of postpartum bleeding. The data were analysed using IBM Statistical Package for Social Sciences version 23. Results: A total of 462 consenting women were included in the study, majority of study participants were between the age of 26-35 years 299 (64.7%) with a minimum age of 15 years and maximum age of 47 years and mean age was 31.2 ± 5.2 years. The majority had moderate to severe anemia 335 (70.3%) and were booked for antenatal care with trained personnel 402 (87.2%) and 47 (10.2%) of them developed post-partum haemorrhage. A significantly higher proportion of the study participants who were un-booked presented with severe anemia (χ2 =14.3; p=0.001); developed PPH (χ2 =13.9; p&lt;0.001) Table 1. The highest proportion of persons who developed postpartum hemorrhage was found in persons with severe anaemia. This difference was significant. (χ2 =87.1; p&lt;0.001). Hematocrit was found to be the strongest determinant of the occurrence of postpartum hemorrhage among the study participants. The adjusted regression analysis showed that for every one-unit increase in hematocrit of study participants, there was a 16% reduction in the probability of occurrence of PPH and this probability was statistically significant (p&lt;0.001). Booking status was also found to be a predictor of PPH such that un-booked women were 2.3 times more likely to experience PPH than booked women in the study population. This was found to be significant (p=0.04). Table 2 This data supports earlier findings that anaemia worsens the outcome of pregnancy. Unbooked mothers are more at risk of dire outcomes such as postpartum haemorrhage which is the leading cause of maternal mortality. There is a need for guidelines and enforcement of such at all levels of healthcare delivery especially in unorthodox centres where women go for care, as is common in developing countries. The need for health education and active prevention and management of anaemia in the early stages of pregnancy is advocated. Disclosures No relevant conflicts of interest to declare. </jats:sec

Evaluation of blood transfusion practice in obstetrics and gynaecology at a tertiary hospital in Port Harcourt, Nigeria

Background: Blood transfusion is an important part of patient management in obstetrics and gynaecology. There is a need to periodically assess blood transfusion practices in order to identify areas for improvement. Objectives: This study aimed to determine the rate of blood transfusion, indications, local use pattern, and variability of blood type transfused. Patients, Materials and Methods: A prospective observational study over six months was conducted at the Rivers State University Teaching Hospital. Obstetric patients in the peripartum period and gynaecological admissions who underwent blood transfusion were included. The patients' characteristics, blood type, pretransfusion packed cell volume (PCV), indication for transfusion, blood product used, number of pints, and donor group were recorded. Analysis was performed using SPSS version 23, and statistical significance was set at P < 0.05. Results: Overall, 84 out of 1000 patients were transfused, giving a rate of 8.4%, 7.4% in obstetric patients, and 13% in gynaecological patients. Haemorrhage was the main reason for transfusions in obstetrics 40 (65.6%), made up of postpartum haemorrhage 27 (44.3%) and antepartum haemorrhage 13 (21.3%), while antepartum anaemia was 17 (27.9%). In gynaecology, chronic anaemia was the main reason for transfusions 10 (43.5%), while acute haemorrhage was 7 (30.4%). Blood components used were whole blood 66.7% (56/84) and sedimented blood 33.3% (28/84) only. About a quarter of the patients who received blood transfusion, had a pretransfusion PCV of 25% or more (20/84) and received only one pint of blood (21/84). Conclusion: The rate of blood transfusion was relatively high, with gynaecology rates higher than obstetric. The indication for blood transfusion in obstetrics was mainly haemorrhage, while in gynaecology, it was chronic anaemia

Acute Myeloid Leukemia: To Treat or Not to Treat – Experience from a Resource-limited Setting

BACKGROUND: Acute myeloid leukemia (AML) is a group of hematologic malignancies characterized by proliferation of blasts of myeloid lineage in the bone marrow and or peripheral blood or tissues. Treatment outcome remains abysmal in our locality. OBJECTIVE: The aim was to determine the impact of treatment on survival in AML patients in a resource-limited setting. MATERIALS AND METHODS: A 5-year retrospective study was conducted in two tertiary healthcare facilities in Nigeria. Data were retrieved from the case files of patients diagnosed with AML from July 2016 to June 2021. RESULTS: A total of 53 patients; males (n = 28, 52.8%), females (n = 25, 47.2%). Majority (n = 49; 92.5%) had anemia (mean hemoglobin 6.8 ± 2.2 g/dL); 41 (77.4%) leukocytosis (median white blood cell 61 × 109/L); 46 (86.8%) thrombocytopenia; (median platelets 39 × 109/L); while 4 (7.5%) had pancytopenia. The most frequent FAB morphological subtypes of AML were M2 (n = 17, 32.1%; [males, n = 7, 41.2%; females, n = 10, 58.8%]) and M1 (n = 11, 20.8%; [males, n = 7, 63.6%; females, n = 4, 36.4%]). Seven (13.2%) were lost to follow-up. Twenty-six (49.1%) did not receive chemotherapy while 27 (50.9%) received chemotherapy; DA 3 + 7 given as daunorubicin 50 mg/m2 days 1–3 and intravenous cytarabine 100 mg days 1–7 was the most common regimen. The overall mortality rate for all patients was 75.5%. The treated arm had a higher mortality rate of 81.5% compared to the untreated arm (69.2%), however, this was not statistically significant (P = 0.3). Median survival for all patients was 1.0 month, with a 3-year survival rate of 5.92%. There was no difference in the median survival of patients who received versus those who did not receive chemotherapy (1.03 months vs. 0.97 months; P = 0.49). CONCLUSION: AML remains an aggressive malignancy with grave outcome in our resource-limited setting despite receiving chemotherapy

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria

AbstractIdentifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates.</jats:p