Role of Sociodemographic and Economic Variables in Predisposition to Vaso-Occlusive Crisis and Mortality in Patients with SCD: Case Study of Sub-Saharan Africa

Sickle cell disease (SCD) is a major public health challenge. It is a common cause of acute and chronic illness and death, which results from a single amino acid substitution (glutamic acid to valine) at position 6 of the beta (β) chain of the hemoglobin molecule. The pathophysiology is based on the polymerization of deoxygenated hemoglobin S (HbS) and production of irreversibly sickled red cells and vaso-occlusive crisis (VOC). The disease is associated with recurrent episodes of acute pain and organ damage. This chapter highlights the role of SES on the predisposition to VOC and mortality among SCD patients. Findings from this review will enable the development and implementation of policies that can facilitate the effective management of SCD in the region. More awareness and education of parents of children and adults living with SCD are needed to identify factors that predispose patients to VOC and common-sense measures to prevent these triggers. SCD patients should be protected against malaria. The need for nutritional intervention, proper hydration, avoidance of dietary intake of sodium, strenuous physical activity, and extreme weather to reduce the incidence of VOC cannot be overemphasized. Protective immunization and access to effective prophylactic and therapeutic agents should be implemented

Epidemiological pattern and outcome of head injuries during festive and non-festive periods in a tertiary hospital, Nnewi, Nigeria

Background: Head injury is trauma to the brain and/or its coverings as a result of an externally applied mechanical force. Study of epidemiological pattern of head injuries is essential in developing necessary preventive strategies and control. To compare the prevalence and pattern of head injuries during the non-festive (February – September) and the festive (October – January) periods in our environment.Methods: Patients’ case files at the Accidents and Emergency unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, were reviewed.Results: Two hundred and sixty-six out of 4,846 met the inclusion criteria for traumatic head injury and were recruited for the study, giving a prevalence of 5.5%. About 77.4% of these presentations were males while 22.6% were females. Both males and females were affected more in the festive period (52.4% and 48.3%) than in the non-festive period (51.7% and 47.6%). The >20 – 30 year group recorded the highest presentation at 30.5%. Traders and Commercial Motorcyclists were the most affected occupations with 25.9% and 24.1% respectively, with the most common causes of head injury during both the festive and non – periods being motorcycle and motor vehicle accidents (68% and 18% respectively). About 63% presented with mild head injury, 14% with moderate and 23% with severe head injuries. About 11.4% were discharged, 83.9% were transferred to the ward for further evaluation and monitoring while 4.7% died at the Accident and Emergency department.Conclusions: Traumatic head injury is one of the major causes of mortality and morbidity in our environment especially in the festive periods. Aggressive and sustained traffic safety education is recommended for all stakeholders in the broad field of accidentology.

Fixed‐dose combination therapy‐based protocol compared with free pill combination protocol: Results of a cluster randomized trial

Abstract Fixed‐dose combination (FDC) therapy is recommended for hypertension management in Nigeria based on randomized trials at the individual level. This cluster‐randomized trial evaluates effectiveness and safety of a treatment protocol that used two‐drug FDC therapy as the second and third steps for hypertension control compared with a protocol that used free pill combinations. From January 2021 to June 2021, 60 primary healthcare centers in the Federal Capital Territory of Nigeria were randomized to a protocol using FDC therapy as second and third steps compared with a protocol that used the same medications in free pill combination therapy for these steps. Eligible patients were adults (≥18 years) with hypertension. The primary outcome was the odds of a patient being controlled at their last visit between baseline to 6‐month follow‐up in the FDC group compared to the free pill group. 4427 patients (mean [SD] age: 49.0 [12.4] years, 70.5% female) were registered with mean (SD) baseline systolic/diastolic blood pressure 155 (20.6)/96 (13.1) mm Hg. Baseline characteristics of groups were similar. After 6‐months, hypertension control rate improved in the two treatment protocols, but there were no differences between the groups after adjustment (FDC = 53.9% versus free pill combination = 47.9%, cluster‐adjusted p = .29). Adverse events were similarly low (<1%) in both groups. Both protocols improved hypertension control rates at 6‐months in comparison to baseline, though no differences were observed between groups. Further work is needed to determine if upfront FDC therapy is more effective and efficient to improve hypertension control rates