CD4 Changes in HAART-Naive HIV Positive Pregnant Women on HAART: Low Resource Setting Experience

PURPOSE: PMTCT interventions, especially initiation of Highly active antiretroviral therapy (HAART) has modified the natural history of HIV infection by reducing both peripartal and neonatal HIV infections, but the pattern of the immunologic responses of these pregnant women to HAART remains speculative. It is hoped from this study, to describe the pattern of immunologic response of naïve, HIV positive pregnant women on their first initiation on HAART. METHODS: This study described the pattern of CD4 changes observed in freshly diagnosed 126 HIV positive pregnant women, stratified into the trimesters of pregnancy and commenced on HAART (Zidovudine, Lamivudine and Nevirapine) for a period of 2 months in pregnancy. CD4 counts were determined at point of recruitment and monthly thereafter using a Parteccytometer counter (Cyflow(R)). Neonatal outcome was also described. RESULTS: Our findings suggest better immunologic response and fewer neonatal infectionsin group of naïve women initiated on HAART while in the first 26 weeks of pregnancy and lesser response in those commenced in the third trimester of pregnancy.CONCLUSION: Concerted efforts should be directed towards the initiation of HAART prophylaxis before end of 2nd trimester of pregnancy.Keywords: PMTCT, pregnant women, HAART, CD4 change

Presumptive diagnosis of schistosoma haematobium and Schistosoma mansoni using microscopy as gold standard in a Riverrine community of southwestern Nigeria

A cross-sectional study was carried out in Ilie community of Olorunda Local Government Area in Osun state, southwestern Nigeria to comparatively evaluate the presumptive diagnosis of schistosoma infections using microscopy as gold standard. One hundred and thirty seven consented primary school children aged 4 to 15 years were examined for presence of schistosome eggs. The urine samples were analyzed with urinalysis strips for microhaematuria as indicators of presumptive diagnosis for urinary schistosomiasis while fecal samples were analyzed with fecal occult blood test kits for occult blood detection as an indicator of presumptive diagnosis for intestinal schistosomiasis. The indicators of presumptive diagnosis were compared with microscopy examination of urine and stool while sensitivity and specificity of the presumptive diagnostic methods were determined. The results of the prevalence showed that 107(78.1%) had co- infection and overall prevalence of 73.5% and 26.3% recorded for both S. haematobium and S mansoni infection respectively. It was observed that the use of microhaematuria alone had 52% sensitivity and 91.67% specificity while stool occult blood recorded 73.685 and 66.67% for sensitivity and specificity respectively. This study shows that presumptive diagnosis of urinary schistosomiasis is significantly more sensitive  (P<0.05) than intestinal schistosomiasis. Also, various degrees of co- infections were observed across all age groups of study subjects with age group 10- 12 years exhibiting highest co- infection rate 48(13.4); and tendency towards increased transmission and re-infection. Use of these alternatives is recommended in resource limited settings, to be confirmed by gold standard when feasible.Keywords: Presumptive diagnosis, Schistoma haematobium, Schistoma mansoni, Microscopy, Holoendemic Community

Epidemiology of Hepatitis C Virus in the private blood banking sector in Osogbo, Southwest Nigeria

Background: Hepatitis C Virus (HCV) is an agent of Transfusion Transmissible Infection (TTI) which serves as a threat to blood safety and sufficiency of blood and blood products supply.Objectives: This study aimed at determining the distribution patterns of HCV among potential blood donors in a private Blood Bank in Osogbo, Nigeria.Materials and Methods: Over a period of 6 months, 290 consenting prospective blood donors were recruited for this study by convenient sampling technique. Pre-test counseling was done, before blood specimen collection and laboratory serological analysis was carried out, using third generation Enzyme Immunoassay Technique.Results: The mean age of the respondents was 35.99 ±10.94 years. A total of 6 participants (2.07%) tested positive for anti-HCV. In this study, HCV prevalence has no association with age and blood type, but it does with the donor type, where the prevalence is higher among commercial blood donors.Conclusion: The rates were lower than the previous studies in Nigeria perhaps this is due to the positive effect of public awareness on transfusion transmissible infections and the fact that majority of the donors were regular donors. Blood transfusion services should be further strengthened by establishment of blood transfusion committees at State level, to regulate and monitor the practice, especially in the private sector, with a view to ensure that stringent criteria are adhered to in blood donors’ selection.Keywords: Blood Safety, Hepatitis C Virus, Serology and Private sector

Assessment of Ethical and Other Professional Standards in Private Medical Laboratories; Osun State Experience.

Compliance of 21 private medical laboratories in Osun State with ethical and other professional was assessed by the authors' pre and post inspection by the Medical Laboratory Science Council of Nigeria (MLSCN). Laboratory environment, personnel, equipment and adherence to Standard Operating Procedures (SOPs) were used as indicators and the results obtained were compared. Thirteen (62 %) was found to have conformed to environmental specifications before the MLSCN's inspection. This rose to 84% and 89% a month and 6 months post MLSCN inspection respectively. Ten (48%) had the right personnel before the Council's inspection followed by 74% which dropped to 72% six months later. Fifteen (67%) laboratories had prerequisite equipment in use before the Council's inspection and this rose to 84% and 89% a month and 6 months later, respectively. Adherence to SOPs was observed to have risen from 76% baseline to 95% a month after; the value dropped to 89% 6 months after the Council's inspection. Follow-up assessment by volunteer members of the Association of Medical Laboratory Scientists of Nigeria noted a sustained improvement of professional standards in private medical laboratories till 6 months after MLSCN inspection. It is recommended that competent volunteers be engaged by the MLSCN and other stakeholders within and outside the country to continually monitor the sustenance of acceptable standards of practice by medical laboratories.Keywords: Ethics, private medical laboratory, service

Prevalence of filariasis among prospective blood donors at Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria

It has been stated that high prevalence of microfilaria in Africa has compounded the problem of blood shortage in our blood banks as prospective blood donors positive for microfilaria are automatically excluded from donation. This fact, together with changing population demographics, increased travels with respect to rural urban migration and the problems of commercial blood donors has made it necessary to determine the prevalence of filarial infection among blood donors in our institution. A total of 491 subjects aged 18 years and above and voluntarily consenting to donate blood at the blood bank of the Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria between April and June 2005 were screened for microfilaria. Five milliliters of blood was collected from each subject. The modified thick smear technique described by Denham, and Giemsa and Haematoxylin stains were used to detect microfilaria in the blood. Of the 491 prospective blood donors (402 males, 89 females, M:F ratio 4.5:1, age range 18-62 years) screened, the age group 21-30 years and 31-40 years constituted 39.3% and 28.3% respectively. Five (1.01%) were positive for microfilaria; 3 (60%) had Mansonella perstans, 1 (20%) had Onchocerca volvulus while 1 (20%) had Loa loa. All the 5 donors were male aged 23, 25, 31, 50 and 55 years and were asymptomatic. The average parasite density of the donors was 1.4 microfilaria/20 µL of blood. Because of the possibility of allergic reactions from transfused microfilariae, routine screening for microfilariae should be incorporated into transfusion policy in our hospitals. However, in view of the generally low apathy to voluntary blood donation in Nigeria, it may not be justified to exclude potential donor positive for microfilaria. Instituting prompt antifilarial treatment for patients receiving such blood may be a credible alternative Keywords: Prevalence, Filariasis, Blood donors, Osogbo Nigerian Journal of Health and Biomedical Sciences Vol. 5 (2) 2006: 71-7