Safety in the workplace: The burden and pattern of markers of Hepatitis B virus infection in routine blood samples in haematology laboratory at Irrua, Edo, Nigeria

Hepatitis B virus [HBV] infection is a worldwide problem resulting in many deaths yearly from cirrhosis and liver cancer. Regrettably also, healthcare workers get exposed to blood-borne pathogens, including hepatitis B virus at work. HBV infection in immuno-competent hosts results in acute fulminant illness which may be fatal, partially resolved to become chronic, or completely resolved. HBV immunization in the country cover neonates and health workers leaving many people uncovered. Lack of monitoring and confirmation of successful HBV immunization in heath workers reduces coverage in this group leaving many susceptible to HBV infection at work. We aimed to determine the magnitude of this risk for occupational exposure to HBV infection. We therefore analyzed sixty nine routine blood samples coming to our Haematology laboratory at Irrua, Edo, Nigeria, using the five parameter hepatitis B virus kit manufactured by Micropoint Diagnostics USA. Results showed that HBsAg, Ant-HBs, HBeAg, Anti-HBe and Anti-HBc were reactive in 11.6%, 23%, 1.4%, 7% and 7% of our study samples indicating that the burden of HBV infectivity is high. We recommend active monitoring and routine confirmation of successful HBV immunization in health workers with expansion of the program to cover more of our population.Keywords: Chronic HBV Infection, Occupational exposure, Immunization, Management of Chronic HBV infectio

Quality of care: Ensuring patient safety in blood transfusion in Irrua, Edo State Nigeria

Blood transfusion can be very beneficial and life saving to patients; though it carries with it the risk of Transfusion Transmissible Infections [TTIs] likes the Human Immuno deficiency Virus [HIV], Hepatitis B Virus [HBV], Hepatitis C Virus [HCV] and Syphilis. Unfortunately, many hospitals in Nigeria are unable to undertake adequate donor-blood screening for TTIs using the ELISA Technique, owing to lack of facilities, manpower and/or funding. As our center partners with the National Blood Transfusion Service [NBTS] for screening with ELISA, we set out to determine the prevalence of the TTIs among blood donors in order to underscore the desirability of optimal screening of blood and partnering with the NBTS to improve blood safety. Donor blood units were sent to the NBTS for rescreening with ELISA technique, after we had screened for the TTIs using rapid kits. We then reviewed the results of 613 donors over two years to determine the prevalence of TTIs among donors. Overall results showed that 86 (13.6%) was reactive for one or two of the TTIs: HIV 23(3.6%); HBV 41 (6.5%); HCV 17 (2.7%) and Syphilis 5(0.8%). Our findings suggest that screening donor blood with rapid kits only is froth with dangers to the patient; hence hospitals lacking the capacity to screen with ELISA should partner with the NBTS.Keywords: Blood Safety, ELISA Screening, Rapid Kit Screening, TTIs, NBT

Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18: a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676·5 (513·6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100 000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81·1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas. </p