Microalbuminuria risks and glomerular filtration in children with sickle cell anaemia in Nigeria

Abstract Introduction Evidence of kidney damage is observed in children with sickle cell anaemia (SCA) and this continues through adulthood with progression to severe functional impairment in some. One of the earliest features of kidney damage associated with SCA is microalbuminuria. Our objective was to determine the risk factors of microalbuminuria in these children and its relationship with estimated glomerular filtration rate. Methods This was a cross-sectional and comparative study involving three hundred and twenty three children with SCA in steady state and equal numbers of apparently healthy age and sex matched haemoglobin AA (HbAA) control, aged 6 months to 18 years. They were consecutively recruited over a 6 month period. Result Microalbuminuria was present in 26% of the study subjects compared with 1.85% of control P = 0.001). Anaemia and high estimated glomerular filtration rate (eGFR) showed strong positive correlation with microalbuminuria (OR = 3.19, CI 0.953–1.116, p = 0.003 and OR = 1.7, CI 1.042–1.066, p = 0.001 respectively). Similarly, eGFR was higher in subjects with SCA than in controls and as well as in those with microalbuminuria compared with those who do not (p = < 0.01). Conclusions The two most important risk factors for microalbuminuria were anaemia and high eGFR. Age category was associated more with microalbuminuria than just age as a variable. Glomerular filtration rate was higher in children with microalbuminuria than those who do not and it was also higher in children with SCA than in control

Accidental sulphuric acid poisoning in a newborn

A six hour old baby girl presented with shortness of breath and haematemesis five hours after accidental ingestion of sulfuric acid. We report the clinical presentation of corrosive ingestion in a neonate a rare and sparsely reported occurrence at such tender age.Key words: Acid ingestion, corrosives injuries, caustic substances, chemical ingestion, newborn

Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: A qualitative study

OBJECTIVES: Although substandard and falsified (SF) blood pressure (BP) lowering medications are a global problem, qualitative research exploring factors driving this in Nigeria has not been reported. This study provides information on factors driving demand for and supply of low-quality BP lowering medications in Nigeria and potential strategies to address these factors. METHODS: This was a cross-sectional qualitative study. Between August 2020 and September 2020, we conducted 11 in-depth interviews and 7 focus group discussions with administrators of health facilities, major manufacturers and distributors of BP lowering medications, pharmacists, drug regulators, patients and primary care physicians purposively sampled from the Federal Capital Territory, Nigeria. Data were analysed using directed content analysis, with the aid of Dedoose. RESULTS: We found that demand for SF BP lowering medications in Nigeria was driven by high out-of-pocket expenditure and stockouts of quality-assured BP lowering medications. Supply of low-quality BP lowering medications was driven by limited in-country manufacturing capacity, non-adherence to good manufacturing and distribution practices, under-resourced drug regulatory systems, ineffective healthcare facility operations, poor distribution practices, limited number of trained pharmacists and the COVID-19 pandemic which led to stockouts. Central medicine store procurement procedures, active pharmaceutical ingredient quality check and availability of trained pharmacists were existing strategies perceived to lower the risk of supply and demand of SF BP lowering medications. CONCLUSION: Our findings suggest that demand for and supply of SF BP lowering medications in Nigeria are driven by multi-level, interrelated factors. Multi-pronged strategies need to target stakeholders and systems involved in drug production, distribution, prescription, consumption, regulation and pricing

Monthly sulphadoxine-pyrimethamine combination versus daily proguanil for malaria chemoprophylaxis in sickle cell disease: a randomized controlled study at the Jos University Teaching Hospital

Background: Malaria carries a high case fatality among patients with sickle cell disease. In Jos University Teaching Hospital, at the time of this study, the use of Proguanil was the acceptable mode of chemoprophylaxis for preventing malaria in these patients. Intermittent Preventive Treatment (IPT) with Sulphadoxine-Pyrimethamine [SP] has shown great potential for reducing the prevalence of malaria and anaemia among pregnant women, infants and travellers. We hypothesised that monthly SP was superior to daily Proguanil in reducing malaria parasitaemia, clinical malaria attacks and sickle cell crises in such patients.Objective: To assess the efficacy and affordability of monthly SP versus daily Proguanil for malaria chemoprophylaxis in patients attending Sickle Cell Clinic at Jos University Teaching Hospital, Plateau State, Nigeria.Methods: One hundred and fifty four patients [114 children and 40 adults] with Sickle Cell Disease in their steady state were randomized to monthly SP or daily Proguanil for malaria chemoprophylaxis. Active detection of malaria parasite in the peripheral blood and packed cell volumes were done at each monthly visit to the clinic over a period of three months. The primary outcome measure was the proportion of patients with malaria parasite in the peripheral blood at the end of 3 months. The secondary outcome measures included episodes of clinical malaria attacks, frequency and type of sickle cell crises and adverse effects of the medication.Results: Ninety four percent [72/77] of patients in the SP group and 91% [70/77] in the Proguanil group respectively completed three months of follow up. SP reduced the prevalence of malaria parasitaemia by 25% [(14%) 10/72] compared to 6.4% [(30%) 21/70] in the proguanil group. [X2 54; p = 0.01]. Seventeen percent [12/72] of the patients receiving monthly SP had malaria attacks compared to 57% [40/70] on prophylaxis with Proguanil. [X2 =25; p&lt; 0.0003]. Thirty three percent [24/72] of the patients receiving SP had at least an episode of bone pain crises compared to 69% [48/70] of the patients receiving Proguanil. [X2 =17.6; p&lt;0.0001]. SP was 8 times cheaper than Proguanil.Conclusion:  Monthly chemoprophylaxis with SP was more efficacious than daily Proguanil in reducing the prevalence of asymptomatic malaria parasitaemia, clinical malaria attack and sickle cell crises in patients with sickle cell disease. SP was 8 times cheaper than Proguanil. No significant side effect was recorded in both groups. The current practice of routinely prescribing daily Proguanil to SCD patients for malaria chemoprophylaxis needs to be reviewed.Keywords: Sickle Cell Disease, Malaria Chemoprophylaxis, sickle cell crisi

Twin Mortality in a Tertiary Hospital in Central Nigeria

Background: The risk of perinatal death in twin pregnancies is increased 2-5 times compared to singletons, and the identification of preventable risk factors becomes increasingly important as the number of multiple pregnancies increases. The objectives of this study were to determine the perinatal mortality rate, the factors that influence perinatal death, andpossible causes of death among twins.Methodology: Twin gestations from 28 weeks or more delivered between 1st January 2000 and 31st December 2007 in Jos University Teaching Hospital (JUTH) were retrospectively studied.Results: Of the 20,612 deliveries within the period, there were 808 sets of twins, giving a twining rate of 30/1,000 deliveries in the institution. The perinatal mortality rate was 80 per 1000 twin deliveries. The major risk factors identified for perinatal mortality in twins were preterm delivery (90.3%), very low birth weight (35.6%) for 1st twin (twin A) and (43.9%) for 2nd twin (twin B), extremely low birth weight (35.6%) for twin Aand 35.1% for twin B. The most probable cause of death was prematurity and its complications, which accounted for 56.1% deaths in twin B and 62.2% deaths in twin A.Conclusion: Perinatal mortality rate among twins in JUTH is high, with preterm delivery as a major risk factor and prematurity as the most probable cause of perinatal mortality

Use Of Leucocyte-Esterase As A Means Of Testing Suitability Of Sputum Specimens For Laboratory Examination

The study has strived to compare the leucocyte-esterase stripe activity on sputum samples with gram-stained direct smear microscopy. This is for the demonstration of white blood cells (WBCs) and so to develop a simple method for selecting suitable sputum samples for cultural examination and laboratory diagnosis. A total of 17(34.0%) out of 50 samples studied were shown to be unsuitable for microbiological examination and for identification of mycobacterial infection. Sputa of patients between the ages of 20-29 years old were found to be more positive by demonstrating more WBCs and squamous epithelial cells (SECs). We believe this technique should offer an alternative to the conventional direct smear microscopy used for examining patient's sputa in our hospital laboratories

Morbidity and mortality pattern of children with sickle cell anaemia in Jos, North Central Nigeria: a single institutional study.

Background: The burden of Non-communicable Diseases (NCDs) in the Tropics is enormous. Sickle Cell Anaemia (SCA) is the most prevalent NCD in Nigerian children. There is a paucity of data on morbidity and mortality pattern of SCA patients in North Central Nigeria. We determined the morbidity and mortality pattern of children with SCA in a teaching hospital.Methods: This was a descriptive study of consecutive admissions of children with SCA between January and December 2015, whose parents gave consent. The patients' biodata, age at diagnosis of SCA, admission diagnosis, course of management and outcome were among data collected in a proforma and analysed using descriptive statistics.Results: Sickle Cell Anaemia accounted for 199 out of 1224 Paediatric admissions (16.8%) during the study period. The mean age at diagnosis of SCA was 23± 8 months, and 70% of the SCA patients were 10 years old or younger. Infections (36.2%), severe anaemia (29.7%) and vaso-occlusive crisis (22.1%) were the commonest indications for admission, while cerebrovascular accidents (30%), severe anaemia (30%) and acute chest syndrome (20%) were the leading causes of mortality.Conclusion: Institution of Early Infant Diagnosis, Public enlightenment, coupled with staff training and improvement in National Blood Transfusion Services are advocated to reduce the high morbidity and mortality from SCA.Key words: Sickle Cell Anaemia, Morbidity, Mortality, Comprehensive care

Determinants of COVID-19 Vaccine Acceptability among Healthcare Workers in Kenya—A Mixed Methods Analysis

Healthcare workers (HCWs) were a priority group for COVID-19 vaccination. Adopting the World Health Organization’s 3C and the expanded 5C vaccine hesitancy models, we assessed the factors associated with COVID-19 vaccine acceptability among HCWs in Kenya. In a mixed methods study, respondents were from eight selected counties across the country. An online survey (n = 746), key informant interviews (n = 18) and focus group discussions (n = 3) were conducted. The data were analyzed concurrently. Quantitative data showed that all the 3C antecedents were strong predictors of vaccine acceptability. The association of vaccine acceptability was strongest with convenience (aOR 20.13, 95% CI 9.01–44.96), then complacency (aOR 10.15, 95% CI 4.63–22.21) and confidence (aOR 6.37, 95% CI 2.90–14.02). Marital status was a significant independent factor associated with vaccine acceptability (aOR 2.70, 95% CI 1.20–6.08). Qualitatively, convenience presented as the no-cost availability of vaccines at the health facilities, whereas non-complacency manifested from the first-hand observed experience of COVID cases, and the need to protect oneself and family members. Confidence was mainly attributed to increased knowledge, resulting from multiple training sessions and trust in regulatory authorities. Other social factors including workplace pressure, religion and misinformation had a role in influencing HCW vaccination decisions. In the background of a pandemic, the 3C model is a strong predictor of vaccine acceptability, and making the vaccines easily available and convenient to HCWs significantly impacts their uptake