Effect of treatment of anaemia in pregnancy with oral haematinics on pregnancy outcomes at Kenyatta National Hospital

Objective: To assess the effect of treatment of anaemia in pregnancy with oral haematinics on pregnancy outcome.Design: Prospective cohort study.Setting: Kenyatta National Hospital.Participants: The exposed were pregnant women with haemoglobin (Hb) concentration of 6-10g/dl at 28-34 weeks of gestation recruited sequentially and the unexposed were pregnant women with Hb ≥11g/dl individually matched by age, parity and gestational age to the exposed.Interventions: The exposed received Ranferon one capsule twice daily and the unexposed received one capsule once daily.Main outcome measures: Haematological response, weight gain and body mass index (BMI) over the pregnancy period, estimated blood loss at delivery, participants’ temperature 24 hours post-delivery and foetal outcome (birth weight and Apgar score).Results: There were 69 exposed and 69 unexposed women available for analysis. After four weeks of treatment, 78.3% of the exposed had Hb ≥11g/dl. In addition, statistically significant differences in the mean increase in Hb concentration, mean corpuscular volume and mean corpuscular haemoglobin between the exposed and unexposed were observed (P <0.001, P = 0.005 and P = 0.005, respectively). Differences in weight gain, change in BMI, estimated blood loss at delivery, temperature 24 hours post-delivery and infants birth weight between the exposed and unexposed were not statistically significant. There was no difference in the Apgar score between the two arms.Conclusion: Treatment of mild to moderate anaemia in the third trimester of pregnancy with oral haematinics results in outcomes similar to those in women without anaemia but on routine supplementation

Haematological parameters in systemic lupus erythematosus patients at Kenyatta National Hospital, Nairobi

Background: Haematological abnormalities are the most common manifestations of Systemic Lupus Erythematosus (SLE). Anaemia of Chronic Disease (ACD) has been associated with significantly higher disease activity. Thrombocytopenia early in the course of disease is indicative of more severe active disease and if severe it is an independent predictor of damage accrual and mortality. Leucopenia usually reflects disease activity.Objectives: To determine the prevalence of haematological abnormalities, among SLE patients on follow up at Rheumatology and Renal Outpatient clinics at Kenyatta National Hospital. Specifically, the study aimed to describe the prevalence of anaemia, leucopenia, and thrombocytopenia and identify patient factors associated with these abnormalities.Design: Cross-sectional hospital based descriptive study.Setting: Rheumatology out-patient clinic and Renal out-patient clinic at KNH.Subjects: Sixty five patients who fulfilled the 1997 American College of Rheumatology Classification Criteria for SLE.Results: Sixty five eligible SLE patients were recruited into the study. The mean (SD) age was 36.5 (± 12) years. There were 3 (5%) males and 62 (95%) females. Forty nine (75%) patients had at least one abnormality. The abnormalities involved all the three cell lines. The prevalence of abnormalities were; anaemia 43%, leucopenia 26% and thrombocytopenia 20%.Conclusion: Haematological abnormalities were the second most common manifestation of the disease after arthritis and arthralgia among SLE patients on follow up at Kenyatta National Hospital Rheumatology and Renal clinic. Though majority of these abnormalities were mild to moderate and clinically asymptomatic, the proportions of anaemia, leucopenia and thrombocytopenia were substantially high.Keywords: Haematological parameters, Systemic Lupus Erythematosus, Kenyatta National Hospita

PREVALENCE OF CYTOMEGALOVIRUS ANTIBODIES IN BLOOD DONORS AT THE NATIONAL BLOOD TRANSFUSION CENTRE, NAIROBI

Background: Cytomegalovirus (CMV) infection in susceptible patients is associatedwith serious morbidity and a high mortality. Transmission of cytomegalovirus infectionthrough blood transfusion is markedly reduced by transfusion of CMV seronegativeblood products, or by transfusion of leucodepleted blood products.Objective: To determine the prevalence CMV IgG and IgM antibodies among blooddonors at the National Blood Transfusion Services (NBTS), Nairobi.Design: Cross-sectional descriptive study.Setting: Four hundred participants were recruited from blood donors at the NBTS andtesting was done at the Kenyatta National Hospital (KNH) immunology laboratoriesand the NBTC.Main outcome measures: Social demographic data and the CMV serologic status forthe participants was determined and documented as being positive or negative forimmunoglobulin G (IgG) and immunoglobulin M (IgM). The age, gender, maritalstatus, education level and geographical area of residence of the participants weredocumented. Corresponding results of HIV, hepatitis B antigen, hepatitis C antibodyfrom the patients were obtained from the NBTS.Results: Majority of the blood donors recruited were male at 57.9%. Most blood donorswere aged 16-20 years (42.5%) and only 17.2% were above 30 years of age. Unmarriedblood donors, those with secondary school education and an income between Kshs5,000 (US$67)and KShs 50,000 (US$ 667) monthly were the majority at 78.5%, 54.8%and 66.1% respectively. Sexually active blood donors constituted 60.5% of the donorsrecruited. Positivity for transfusion transmissible infections (TTI) tested was 1.3%,0.3%, 2.3% and 1.0% for human immunodeficiency virus (HIV), syphilis, hepatitisB and hepatitis C respectively. Anti- CMV IgG and IgM positivity was 97.0%,( 95%CI 96.45-97.53%), and 3.6% (95% CI 1.7-5.2%), respectively. There was no statisticaldifference between different ages, marital status, salary, individual’s sexuality in theprevalence of CMV antibodies. However females had a higher prevalence of CMVantibodies.Conclusion: There is a very high prevalence of cytomegalovirus antibodies amongblood donors at the NBTS, with virtually all blood donors having been exposed to thevirus. Since the CMV remains latent within leucocytes after infection inspite of theprescence of antibodies in seropositive individuals, leucoreduction of blood productsis recommended before transfusion to seronegative susceptible patients. In Kenya,susceptible groups of patients include very low birthweight babies, patients withacquired immune deficiency syndrome (AIDS) due to human immunodeficiency virusinfections (HIV) patients, patients on myelosuppressive cancer therapy and recipientsof kidney transplants. Further studies are recomended to determine the prevalence ofCMV antibodies in these patients in order to establish the magnitude of the demandfor CMV safe blood

Evidence review of hydroxyurea for the prevention of sickle cell complications in low-income countries.

Hydroxyurea is widely used in high-income countries for the management of sickle cell disease (SCD) in children. In Kenyan clinical guidelines, hydroxyurea is only recommended for adults with SCD. Yet many deaths from SCD occur in early childhood, deaths that might be prevented by an effective, disease modifying intervention. The aim of this review was to summarise the available evidence on the efficacy, effectiveness and safety of hydroxyurea in the management of SCD in children below 5 years of age to support guideline development in Kenya. We undertook a systematic review and used the Grading of Recommendations Assessment, Development and Evaluation system to appraise the quality of identified evidence. Overall, available evidence from 1 systematic review (n=26 studies), 2 randomised controlled trials (n=354 children), 14 observational studies and 2 National Institute of Health reports suggest that hydroxyurea may be associated with improved fetal haemoglobin levels, reduced rates of hospitalisation, reduced episodes of acute chest syndrome and decreased frequency of pain events in children with SCD. However, it is associated with adverse events (eg, neutropenia) when high to maximum tolerated doses are used. Evidence is lacking on whether hydroxyurea improves survival if given to young children. Majority of the included studies were of low quality and mainly from high-income countries. Overall, available limited evidence suggests that hydroxyurea may improve morbidity and haematological outcomes in SCD in children aged below 5 years and appears safe in settings able to provide consistent haematological monitoring

Evidence review of hydroxyurea for the prevention of sickle cell complications in low-income countries

Hydroxyurea is widely used in high-income countries for the management of sickle cell disease (SCD) in children. In Kenyan clinical guidelines, hydroxyurea is only recommended for adults with SCD. Yet many deaths from SCD occur in early childhood, deaths that might be prevented by an effective, disease modifying intervention. The aim of this review was to summarise the available evidence on the efficacy, effectiveness and safety of hydroxyurea in the management of SCD in children below 5 years of age to support guideline development in Kenya. We undertook a systematic review and used the Grading of Recommendations Assessment, Development and Evaluation system to appraise the quality of identified evidence. Overall, available evidence from 1 systematic review (n=26 studies), 2 randomised controlled trials (n=354 children), 14 observational studies and 2 National Institute of Health reports suggest that hydroxyurea may be associated with improved fetal haemoglobin levels, reduced rates of hospitalisation, reduced episodes of acute chest syndrome and decreased frequency of pain events in children with SCD. However, it is associated with adverse events (eg, neutropenia) when high to maximum tolerated doses are used. Evidence is lacking on whether hydroxyurea improves survival if given to young children. Majority of the included studies were of low quality and mainly from high-income countries. Overall, available limited evidence suggests that hydroxyurea may improve morbidity and haematological outcomes in SCD in children aged below 5 years and appears safe in settings able to provide consistent haematological monitoring

A pilot external quality assurance study of transfusion screening for HIV, HCV and HBsAG in 12 African countries

Background and Objectives: Serologic screening for the major transfusion transmissible viruses (TTV) is critical to blood safety and has been widely implemented. However, actual performance as measured by proficiency testing has not been well studied in sub-Saharan Africa. Therefore, we conducted an external quality assessment of laboratories engaged in transfusion screening in the region. Materials and Methods: Blinded test panels, each comprising 25 serum samples that were pedigreed for HIV, HBsAg, HCV and negative status, were sent to participating laboratories. The panels were tested using the laboratories' routine donor screening methods and conditions. Sensitivity and specificity were calculated, and multivariable analysis was used to compare performance against mode of testing, country and infrastructure. Results: A total of 12 African countries and 44 laboratories participated in the study. The mean (range) sensitivities for HIV, HBsAg and HCV were 91·9% (14·3-100), 86·7% (42·9-100) and 90·1% (50-100), respectively. Mean specificities for HIV, HBsAg and HCV were 97·7%, 97% and 99·5%, respectively. After adjusting for country and infrastructure, rapid tests had significantly lower sensitivity than enzyme immunoassays for both HBsAg (P < 0·0001) and HCV (P < 0·05). Sensitivity also varied by country and selected infrastructure variables. Conclusion: While specificity was high, sensitivity was more variable and deficient in a substantial number of testing laboratories. These findings underscore the importance of proficiency testing and quality control, particularly in Africa where TTV prevalence is high