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Onyamboko MA, Olupot-Olupot P, Were W, Namayanja C, Onyas P, Titin H, Baseke J, Muhindo R, Kayembe DK, Ndjowo PO, Basara BB, Okalebo CB, Williams TN, Uyoga S, Taya C, Bamisaiye A, Fanello C, Maitland K, Day NPJ, Taylor WRJ, Mukaka M. Factors affecting haemoglobin dynamics in African children with acute uncomplicated Plasmodium falciparum malaria treated with single low-dose primaquine or placebo. BMC Med 2023; 21:397. [PMID: 37858129 PMCID: PMC10588240 DOI: 10.1186/s12916-023-03105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Single low-dose primaquine (SLDPQ) effectively blocks the transmission of Plasmodium falciparum malaria, but anxiety remains regarding its haemolytic potential in patients with glucose-6-phopshate dehydrogenase (G6PD) deficiency. We, therefore, examined the independent effects of several factors on haemoglobin (Hb) dynamics in falciparum-infected children with a particular interest in SLDPQ and G6PD status. METHODS This randomised, double-blind, placebo-controlled, safety trial was conducted in Congolese and Ugandan children aged 6 months-11 years with acute uncomplicated P. falciparum and day (D) 0 Hbs ≥ 6 g/dL who were treated with age-dosed SLDPQ/placebo and weight-dosed artemether lumefantrine (AL) or dihydroartemisinin piperaquine (DHAPP). Genotyping defined G6PD (G6PD c.202T allele), haemoglobin S (HbS), and α-thalassaemia status. Multivariable linear and logistic regression assessed factor independence for continuous Hb parameters and Hb recovery (D42 Hb > D0 Hb), respectively. RESULTS One thousand one hundred thirty-seven children, whose median age was 5 years, were randomised to receive: AL + SLDPQ (n = 286), AL + placebo (286), DHAPP + SLDPQ (283), and DHAPP + placebo (282). By G6PD status, 284 were G6PD deficient (239 hemizygous males, 45 homozygous females), 119 were heterozygous females, 418 and 299 were normal males and females, respectively, and 17 were of unknown status. The mean D0 Hb was 10.6 (SD 1.6) g/dL and was lower in younger children with longer illnesses, lower mid-upper arm circumferences, splenomegaly, and α-thalassaemia trait, who were either G6PDd or heterozygous females. The initial fractional fall in Hb was greater in younger children with higher D0 Hbs and D0 parasitaemias and longer illnesses but less in sickle cell trait. Older G6PDd children with lower starting Hbs and greater factional falls were more likely to achieve Hb recovery, whilst lower D42 Hb concentrations were associated with younger G6PD normal children with lower fractional falls, sickle cell disease, α-thalassaemia silent carrier and trait, and late treatment failures. Ten blood transfusions were given in the first week (5 SLDPQ, 5 placebo). CONCLUSIONS In these falciparum-infected African children, posttreatment Hb changes were unaffected by SLDPQ, and G6PDd patients had favourable posttreatment Hb changes and a higher probability of Hb recovery. These reassuring findings support SLDPQ deployment without G6PD screening in Africa. TRIAL REGISTRATION The trial is registered at ISRCTN 11594437.
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Affiliation(s)
- Marie A Onyamboko
- Kinshasa School of Public Health, University of Kinshasa, Avenue Tombalbaye 68-78, Kinshasa, Democratic Republic of Congo
| | - Peter Olupot-Olupot
- Busitema University, P.O. Box 1460, Mbale, Uganda
- Mbale Clinical Research Institute (MCRI), P.O. Box 1966, Mbale, Uganda
| | - Winifred Were
- Mbale Clinical Research Institute (MCRI), P.O. Box 1966, Mbale, Uganda
| | - Cate Namayanja
- Mbale Clinical Research Institute (MCRI), P.O. Box 1966, Mbale, Uganda
| | - Peter Onyas
- Mbale Clinical Research Institute (MCRI), P.O. Box 1966, Mbale, Uganda
| | - Harriet Titin
- Mbale Clinical Research Institute (MCRI), P.O. Box 1966, Mbale, Uganda
| | - Joy Baseke
- Mbale Clinical Research Institute (MCRI), P.O. Box 1966, Mbale, Uganda
| | - Rita Muhindo
- Mbale Clinical Research Institute (MCRI), P.O. Box 1966, Mbale, Uganda
| | - Daddy K Kayembe
- Kinshasa School of Public Health, University of Kinshasa, Avenue Tombalbaye 68-78, Kinshasa, Democratic Republic of Congo
| | - Pauline O Ndjowo
- Kinshasa School of Public Health, University of Kinshasa, Avenue Tombalbaye 68-78, Kinshasa, Democratic Republic of Congo
| | - Benjamin B Basara
- Kinshasa School of Public Health, University of Kinshasa, Avenue Tombalbaye 68-78, Kinshasa, Democratic Republic of Congo
| | | | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, SW7 2AS, UK
| | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Chiraporn Taya
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Adeola Bamisaiye
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Caterina Fanello
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, SW7 2AS, UK
| | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Walter R J Taylor
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ladu AI, Jeffery C, Farate A, Farouk AG, Abba AM, Adekile A, Bates I. Determinants of splenic preservation among patients with sickle cell disease in North-Eastern Nigeria. Trop Med Int Health 2023; 28:620-628. [PMID: 37460787 DOI: 10.1111/tmi.13910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVE In patients with sickle cell disease (SCD), the spleen commonly enlarges during early childhood, but undergoes reduction in size and fibrosis from repeated episodes of vaso-occlusion and infarction. The rate of progression of this process varies markedly among these patients. The aim of current study was to explore clinical and laboratory factors associated with the preservation of the spleen among these patients. METHODS Two hundred four patients with SCD (103 females; age 1-45 years) underwent abdominal ultrasonography at the University of Maiduguri Teaching Hospital, Nigeria between October 2020 and November 2021 to assess for splenic visualisation and echotexture. Steady-state clinical parameters and blood samples for full blood count, serum chemistry, high-performance liquid chromatography and malaria parasitemia were obtained from all the patients. RESULTS The spleen was visualised in 107 (52.4%; 95% confidence interval [CI], 46%-59%) patients with SCD on ultrasonography. While the spleen was visualised in all children less than 5 years of age, it was visualised in only 23.5% of those aged 15 years and older. Visualisation of the spleen was significantly associated with low mean corpuscular haemoglobin concentration and high haemoglobin F (HbF) in those younger than 10 years. The odds of visualisation of the spleen on ultrasonography increased by a factor of 1.17% for every 1% increase in HbF level. Only 32 (15%) patients were on regular hydroxyurea therapy. The HbF level was significantly higher among patients on hydroxyurea (median 12.7 vs. 7.4; p < 0.0001). CONCLUSION In patients with SCD, failure to visualise the spleen was not found in children less than 5 years old. Patients with visualised spleens had a higher level of HbF than those with non-visualised spleens. HbF was significantly associated with visualisation of the spleen before 10 years of age. Since early administration of hydroxyurea will increase HbF level, we expect that it would help to preserve the spleen.
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Affiliation(s)
- Adama I Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Caroline Jeffery
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Abubakar Farate
- Department of Radiology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Abubakar G Farouk
- Department of Paediatrics, Faculty of Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Aisha M Abba
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Adekunle Adekile
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Nardo‐Marino A, Glenthøj A, Brewin JN, Petersen J, Braunstein TH, Kurtzhals JAL, Williams TN, Rees DC. The significance of spleen size in children with sickle cell anemia. Am J Hematol 2022; 97:1520-1528. [PMID: 36054667 PMCID: PMC9827862 DOI: 10.1002/ajh.26703] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 01/31/2023]
Abstract
It is well established that splenic dysfunction occurs in early childhood in sickle cell anemia (SCA), although the determinants and consequences of splenic injury are not fully understood. In this study, we examined spleen size and splenic function in 100 children with SCA aged 0-16 years at King's College Hospital in London. Spleen size was assessed by abdominal ultrasound (US) and splenic function by pitted red blood cells (PIT counts). In our cohort, 5.6% of children aged 6-10 years and 19.4% of children aged 11-16 years had no visible spleen on US (autosplenectomy). Splenomegaly was common in all age groups, with 28% of children overall having larger spleens than the average for their age. Only one child had a PIT count suggesting preserved splenic function. We found no correlation between hemoglobin F levels and spleen size, nor was there any difference in spleen size between children treated with or without hydroxyurea. Although there was a trend toward increased spleen length in children with co-inherited α-thalassemia, this did not reach statistical significance. Finally, we found a strong association between erythrocyte deformability measured with oxygen gradient ektacytometry, spleen size, and PIT counts. In conclusion, our results do not agree with the general perception that most children with SCA undergo autosplenectomy within the first decade of life and indicate that loss of erythrocyte deformability contributes to loss of splenic filtration capacity in SCA, as well as phenotypical variations in spleen size.
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Affiliation(s)
- Amina Nardo‐Marino
- Danish Centre for Haemoglobinopathies, Department of HaematologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
- Department of Immunology and Microbiology, Centre for Medical ParasitologyUniversity of CopenhagenCopenhagenDenmark
- Department of Haematological MedicineKing's College HospitalLondonUnited Kingdom
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUnited Kingdom
| | - Andreas Glenthøj
- Danish Centre for Haemoglobinopathies, Department of HaematologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - John N. Brewin
- Department of Haematological MedicineKing's College HospitalLondonUnited Kingdom
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUnited Kingdom
| | - Jesper Petersen
- Danish Centre for Haemoglobinopathies, Department of HaematologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Thomas H. Braunstein
- Core Facility for Integrated Microscopy, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Jørgen A. L. Kurtzhals
- Department of Immunology and Microbiology, Centre for Medical ParasitologyUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical MicrobiologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Thomas N. Williams
- KEMRI‐Wellcome Trust Research ProgrammeKilifiKenya
- Department of Surgery and CancerInstitute of Global Health Innovation, Imperial College LondonLondonUnited Kingdom
| | - David C. Rees
- Department of Haematological MedicineKing's College HospitalLondonUnited Kingdom
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUnited Kingdom
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Uyoga S, Olupot-Olupot P, Connon R, Kiguli S, Opoka RO, Alaroker F, Muhindo R, Macharia AW, Dondorp AM, Gibb DM, Walker AS, George EC, Maitland K, Williams TN. Sickle cell anaemia and severe Plasmodium falciparum malaria: a secondary analysis of the Transfusion and Treatment of African Children Trial (TRACT). THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:606-613. [PMID: 35785794 PMCID: PMC7613576 DOI: 10.1016/s2352-4642(22)00153-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sickle cell anaemia (SCA) has historically been associated with high levels of childhood mortality in Africa. Although malaria has a major contribution to this mortality, to date, the clinical pathology of malaria among children with SCA has been poorly described. We aimed to explore the relationship between SCA and Plasmodium falciparum malaria in further detail by investigating the burden and severity of malaria infections among children recruited with severe anaemia to the TRACT trial of blood transfusion in Africa. METHODS This study is a post-hoc secondary analysis of the TRACT trial data, conducted after trial completion. TRACT was an open-label, multicentre, factorial, randomised controlled trial enrolling children aged 2 months to 12 years who presented with severe anaemia (haemoglobin <6·0 g/dL) to four hospitals in Africa. This secondary analysis is restricted to Uganda, where the birth prevalence of SCA is approximately 1% and malaria transmission is high. Children were classified as normal (HbAA), heterozygous (HbAS), or homozygous (HbSS; SCA) for the rs334 A→T sickle mutation in HBB following batch-genotyping by PCR at the end of the trial. To avoid confounding from SCA-specific medical interventions, we considered children with an existing diagnosis of SCA (known SCA) separately from those diagnosed at the end of the trial (unknown SCA). The outcomes considered in this secondary analysis were measures of P falciparum parasite burden, features of severe malaria, and mortality at day 28 in malaria-positive children. FINDINGS Between Sept 17, 2014, and May 15, 2017, 3944 children with severe anaemia were enrolled into the TRACT trial. 3483 children from Uganda were considered in this secondary analysis. Overall, 1038 (30%) of 3483 Ugandan children had SCA. 1815 (78%) of 2321 children without SCA (HbAA) tested positive for P falciparum malaria, whereas the prevalence was significantly lower in children with SCA (347 [33%] of 1038; p<0·0001). Concentrations of plasma P falciparum histidine-rich protein 2 (PfHRP2), a marker of the total burden of malaria parasites within an individual, were significantly lower in children with either known SCA (median 8 ng/mL; IQR 0-57) or unknown SCA (7 ng/mL; 0-50) than in HbAA children (346 ng/mL; 21-2121; p<0·0001). In contrast to HbAA children, few HbSS children presented with classic features of severe and complicated malaria, but both the frequency and severity of anaemia were higher in HbSS children. We found no evidence for increased mortality at day 28 in those with SCA compared with those without SCA overall (hazard ratios 1·07 [95% CI 0·31-3·76] for known SCA and 0·67 [0·15-2·90] for unknown SCA). INTERPRETATION The current study suggests that children with SCA are innately protected against classic severe malaria. However, it also shows that even low-level infections can precipitate severe anaemic crises that would likely prove fatal without rapid access to blood transfusion services. FUNDING UK Medical Research Council, Wellcome, and UK National Institute for Health and Care Research.
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Affiliation(s)
- Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peter Olupot-Olupot
- Busitema University Faculty of Health Sciences, Mbale Regional Referral Hospital, Mbale, Uganda; Mbale Clinical Research Institute, Mbale, Uganda
| | - Roisin Connon
- Medical Research Council Clinical Trials Unit (MRC CTU) at University College London, London, UK
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Robert O Opoka
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | | | - Rita Muhindo
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | - Arjen M Dondorp
- Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit (MRC CTU) at University College London, London, UK
| | - A Sarah Walker
- Medical Research Council Clinical Trials Unit (MRC CTU) at University College London, London, UK
| | - Elizabeth C George
- Medical Research Council Clinical Trials Unit (MRC CTU) at University College London, London, UK
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Disease and Institute of Global Health Innovation, Division of Medicine, Imperial College London, London, UK
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Disease and Institute of Global Health Innovation, Division of Medicine, Imperial College London, London, UK.
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Smart LR, Ambrose EE, Balyorugulu G, Songoro P, Shabani I, Komba P, Charles M, Howard TA, McElhinney KE, O'Hara SM, Odame J, Nakafeero M, Adams J, Stuber SE, Lane A, Latham TS, Makubi AN, Ware RE. Stroke Prevention with Hydroxyurea Enabled through Research and Education: A Phase 2 Primary Stroke Prevention Trial in Sub-Saharan Africa. Acta Haematol 2022; 146:95-105. [PMID: 35977532 PMCID: PMC10100573 DOI: 10.1159/000526322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Stroke is a severe complication of sickle cell anemia (SCA), with devastating sequelae. Transcranial Doppler (TCD) ultrasonography predicts stroke risk, but implementing TCD screening with suitable treatment for primary stroke prevention in low-resource environments remains challenging. SPHERE (NCT03948867) is a prospective phase 2 open-label hydroxyurea trial for SCA in Tanzania. METHODS After formal training and certification, local personnel screened children 2-16 years old; those with conditional (170-199 cm/s) or abnormal (≥200 cm/s) time-averaged mean velocities (TAMVs) received hydroxyurea at 20 mg/kg/day with dose escalation to maximum tolerated dose (MTD). The primary study endpoint is change in TAMV after 12 months of hydroxyurea; secondary endpoints include SCA-related clinical events, splenic volume and function, renal function, infections, hydroxyurea pharmacokinetics, and genetic modifiers. RESULTS Between April 2019 and April 2020, 202 children (average 6.8 ± 3.5 years, 53% female) enrolled and underwent TCD screening; 196 were deemed eligible by DNA testing. Most had numerous previous hospitalizations and transfusions, with low baseline hemoglobin (7.7 ± 1.1 g/dL) and %HbF (9.3 ± 5.4%). Palpable splenomegaly was present at enrollment in 49 (25%); average sonographic splenic volume was 103 mL (range 8-1,045 mL). TCD screening identified 22% conditional and 2% abnormal velocities, with hydroxyurea treatment initiated in 96% (45/47) eligible children. CONCLUSION SPHERE has built local capacity with high-quality research infrastructure and TCD screening for SCA in Tanzania. Fully enrolled participants have a high prevalence of elevated baseline TCD velocities and splenomegaly. SPHERE will prospectively determine the benefits of hydroxyurea at MTD for primary stroke prevention, anticipating expanded access to hydroxyurea treatment across Tanzania.
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Affiliation(s)
- Luke R. Smart
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emmanuela E. Ambrose
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Idd Shabani
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Thad A. Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathryn E. McElhinney
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara M. O'Hara
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jodie Odame
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Maria Nakafeero
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Janet Adams
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susan E. Stuber
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam Lane
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Teresa S. Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Abel N. Makubi
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | - Russell E. Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Keramari S, Poutoglidis A, Chatzis S, Keramaris M, Savopoulos C, Kaiafa G. Parvovirus B19-Associated Myocarditis: A Literature Review of Pediatric Cases. Cureus 2022; 14:e21726. [PMID: 35251800 PMCID: PMC8886913 DOI: 10.7759/cureus.21726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 12/03/2022] Open
Abstract
Parvovirus B19 (B19V) infection may lead to myocarditis, a life-threatening condition in pediatric patients. In this review, we aim to present published pediatric cases of B19V-associated myocarditis in order to understand the deep complex connections and draw useful conclusions. We performed a comprehensive search of MEDLINE, Science Direct, and Google Scholar electronic databases. A total of 32 cases were included in our study. The most common presenting symptom was tachycardia in 22/32 patients (68.7%), followed by tachypnoea (21/32, 65.6%), fever, and rash (12/32, 37.5% for both of them). Cardiac arrest, loss of consciousness, and systemic infection were associated with the worst prognosis, with statistically significant differences (p-value 0.001, 0.02, 0.001. respectively). A percentage as high as 90.4% of patients with left ventricular (LV) dysfunction and reduced ejection fraction (EF) were discharged. Twelve patients required ventilatory support, five required extracorporeal membrane oxygenation (ECMO), and three underwent heart surgery. Treatment with immunosuppressive agents and immunoglobulin was found to be beneficial for patients (p-value 0.006 and 0.004, respectively). In conclusion, B19V myocarditis has high mortality rates in children. There is no specific antiviral treatment for B19V infection and therapeutic strategies for myocarditis aim to delay the worsening of heart failure and to preserve the LV function. Inotropic drugs, diuresis, ventilatory support, Intravenous immunoglobulin (IVIG), and immunosuppressive therapy seem to help the recovery of the myocardium in children with LV dilation, dysfunction, and reduced EF. Children with cardiac arrest, arrhythmias, and loss of consciousness have the worst prognosis.
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Abubakar R, Dabo H, Badamasi S, Abubakar A. Clinical status of sickle cell anemia and the impact on the caregivers finances at a tertiary hospital, North-West Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_174_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ibrahim HA, Yakubu YM, Farouk AG, Ambe P, Gadzama GB. Profile of bacterial pathogens causing infections in children with sickle cell anaemia in Maiduguri. Niger Postgrad Med J 2021; 28:218-224. [PMID: 34708710 DOI: 10.4103/npmj.npmj_531_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Sickle cell disease (SCD) is a major cause of morbidity and mortality in African children. Infection has been found to be a major cause of hospitalisation, a major precipitant of crises and one of the greatest causes of death among SCD patients at all ages. Objectives The objective of the study was to determine the prevalence of bacterial infection, pattern of the isolates and the antibiotic sensitivity of isolated bacteria among children with sickle cell anaemia (SCA). Materials and Methods A cross-sectional study carried out in the University of Maiduguri Teaching Hospital. A total of 242 hospitalised children with SCA with symptoms and signs of infection were recruited for the study using consecutive sampling technique. Sociodemographic and clinical data were obtained. Blood, urine, aspirates, swabs and cerebrospinal fluid samples were collected based on their clinical presentation and subjected to microbiological analysis. Results A total of 242 patients were studied. The age range was 9 months-15 years, with a mean age of 6.36 years ± 3.75 years. Male-to-female ratio was 1:1.14, with 41.7% of them belonging to low social class. Seventy seven of the 242 had confirmed bacterial infection giving an incidence of bacterial infection in SCA patients of 31.8%. Gram-negative organisms accounted for 64.5% of the isolates and they include Salmonella, Klebsiella, Escherichia coli and Coliforms. However, Staphylococcus aureus (32.9%) was the most frequent microorganism isolated, followed by Salmonella, (20.3%), Klebsiella (12.6%) and Coliforms (12.6%). Amoxicillin-clavulanate, cefixime and gentamicin showed more than 50% activity against the isolated bacterial pathogens while chloramphenicol was found to have low activity against Salmonella. Conclusion High index of suspicion of bacterial infection should be borne in mind of the attending physician when children with SCA present with features of infection. Detailed clinical evaluation and appropriate sample collection for microbiological analysis are recommended. Empirical treatment should be started on SCA patients who have clinical evidence of infection and should be broad enough to cover for common bacterial pathogens.
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Affiliation(s)
- Halima Abubakar Ibrahim
- Department of Paediatrics, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Yakubu Mohammed Yakubu
- Department of Medical Microbiology, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Abubakar Garba Farouk
- Department of Paediatrics, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Pwavimbo Ambe
- Department of Paediatrics, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Galadima Bala Gadzama
- Department of Medical Microbiology, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
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Watson JA, Ndila CM, Uyoga S, Macharia A, Nyutu G, Mohammed S, Ngetsa C, Mturi N, Peshu N, Tsofa B, Rockett K, Leopold S, Kingston H, George EC, Maitland K, Day NPJ, Dondorp AM, Bejon P, Williams TN, Holmes CC, White NJ. Improving statistical power in severe malaria genetic association studies by augmenting phenotypic precision. eLife 2021; 10:e69698. [PMID: 34225842 PMCID: PMC8315799 DOI: 10.7554/elife.69698] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022] Open
Abstract
Severe falciparum malaria has substantially affected human evolution. Genetic association studies of patients with clinically defined severe malaria and matched population controls have helped characterise human genetic susceptibility to severe malaria, but phenotypic imprecision compromises discovered associations. In areas of high malaria transmission, the diagnosis of severe malaria in young children and, in particular, the distinction from bacterial sepsis are imprecise. We developed a probabilistic diagnostic model of severe malaria using platelet and white count data. Under this model, we re-analysed clinical and genetic data from 2220 Kenyan children with clinically defined severe malaria and 3940 population controls, adjusting for phenotype mis-labelling. Our model, validated by the distribution of sickle trait, estimated that approximately one-third of cases did not have severe malaria. We propose a data-tilting approach for case-control studies with phenotype mis-labelling and show that this reduces false discovery rates and improves statistical power in genome-wide association studies.
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Affiliation(s)
- James A Watson
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Carolyne M Ndila
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Alexander Macharia
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Gideon Nyutu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Shebe Mohammed
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Caroline Ngetsa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Norbert Peshu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Benjamin Tsofa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Kirk Rockett
- The Wellcome Sanger InstituteCambridgeUnited Kingdom
- Wellcome Trust Centre for Human Genetics, University of OxfordOxfordUnited Kingdom
| | - Stije Leopold
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Hugh Kingston
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Elizabeth C George
- Medical Research Council Clinical Trials Unit, University College LondonLondonUnited Kingdom
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
- Institute of Global Health Innovation, Imperial College, LondonLondonUnited Kingdom
| | - Nicholas PJ Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Philip Bejon
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-CoastKilifiKenya
- Institute of Global Health Innovation, Imperial College, LondonLondonUnited Kingdom
| | - Chris C Holmes
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Department of Statistics, University of OxfordOxfordUnited Kingdom
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
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10
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Ali EH, Alkindi S, Osman MA, Hilali W, Mirgani HM, Adam G, Morsi MM, Hussein IS, Ghebremeskel K. Nutritional and Hematological Status of Sudanese Women of Childbearing Age with Steady-state Sickle Cell Anemia. Oman Med J 2021; 36:e270. [PMID: 34164159 PMCID: PMC8204634 DOI: 10.5001/omj.2021.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/11/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES We sought to investigate the nutritional and hematological status of Sudanese women of childbearing age with sickle cell anemia (SCA). Anthropometry and hematology were used to assess nutritional status and health and disease conditions, respectively. METHODS Women with steady-state (HbSS, n = 39; age = 19.0±2.7) and without (HbAA, n = 36; age, 19.8±2.7) SCA were recruited during a routine visit to the Hematology Clinic, Ibn-Auf Teaching Hospital, Khartoum, Sudan. RESULTS The two groups of women lived in similar environmental conditions and ate similar diets three times a day. However, despite taking regular meals, the women with sickle anemia were thinner and lighter (p < 0.001) and shorter (p = 0.002) compared with those who do not have the disease. Also, they had higher levels of mean corpuscular hemoglobin (Hb) concentration and white cell count (p < 0.001), mean corpuscular volume (p = 0.003), and platelet (p = 0.002) and lower packed cell volume and Hb (p < 0.001). There was no difference in levels of anthropometric and hematological variables between the hydroxyurea treated and untreated SCA patients (p > 0.050). CONCLUSIONS The low anthropometric (height, weight, and body mass index) and abnormal hematological values in the women with SCA in steady-state reflect sustained nutritional insults inflected by the disease and poverty. Tailored nutritional counseling/advice must be an integral part of managing patients with SCA. Such advice is particularly vital for women of childbearing age because of the adverse effects of prepregnancy nutritional deficiency on outcomes.
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Affiliation(s)
- Eltigani Hassan Ali
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, London, UK
| | - Salam Alkindi
- Department of Hematology, Sultan Qaboos University, Muscat, Oman
| | - Mohamed A. Osman
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Wafa Hilali
- Department of Haematology, Ibn Auf Teaching Hospital, Khartoum, Sudan
| | - Hind M. Mirgani
- Department of Haematology, Ibn Auf Teaching Hospital, Khartoum, Sudan
| | - Gareeba Adam
- Department of Educational Technology, Faculty of Higher Studies, Al-Zaiem Al Azhari University, Khartoum, Sudan
| | - Magdi M. Morsi
- Directorate of Planning, Ministry of Health, Muscat, Oman
| | - Izzeldin S. Hussein
- Department of Micronutrient, Iodine Global Network, Middle East and North Africa
| | - Kebreab Ghebremeskel
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, London, UK
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11
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Ladu AI, Aiyenigba AO, Adekile A, Bates I. The spectrum of splenic complications in patients with sickle cell disease in Africa: a systematic review. Br J Haematol 2020; 193:26-42. [PMID: 33161568 DOI: 10.1111/bjh.17179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 01/31/2023]
Abstract
The majority of the global population of sickle cell disease (SCD) patients resides in Africa. Individuals with this condition are at great risk of serious infections and early mortality secondary to splenic dysfunction without preventative measures. This review investigated the spectrum of splenic complications encountered in SCD among populations in Africa. We systematically searched several databases for all articles published through March 3, 2020. We included 55 studies from 14 African countries. This review reveals the difference in frequency of splenic complications in SCD in Africa when compared with their counterparts in the United State and Europe. While several studies (n = 45) described splenomegaly with a prevalence of 12% to 73% among children, and 4% to 50% among adults with HbSS, the reported prevalence for acute splenic sequestration crisis (n = 6 studies) and hypersplenism (n = 4 studies) was <10% and <5% respectively. A total of 30 surgical splenectomy was reported across eight studies. Only two (3.7%) studies provided data on spleen function. A conflicting pattern was observed amongst studies that evaluated the relationship between splenomegaly and the presence of bacterial and malaria infections. This review reveals the paucity of studies describing the role of SCD-induced splenic dysfunction in morbidity and infection related mortality in Africa.
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Affiliation(s)
- Adama I Ladu
- Department of International Public Health, Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Abiola O Aiyenigba
- Department of International Public Health, Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adekunle Adekile
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait
| | - Imelda Bates
- Department of International Public Health, Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
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12
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Uyoga S, Macharia AW, Mochamah G, Ndila CM, Nyutu G, Makale J, Tendwa M, Nyatichi E, Ojal J, Otiende M, Shebe M, Awuondo KO, Mturi N, Peshu N, Tsofa B, Maitland K, Scott JAG, Williams TN. The epidemiology of sickle cell disease in children recruited in infancy in Kilifi, Kenya: a prospective cohort study. Lancet Glob Health 2019; 7:e1458-e1466. [PMID: 31451441 PMCID: PMC7024980 DOI: 10.1016/s2214-109x(19)30328-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sickle cell disease is the most common severe monogenic disorder in humans. In Africa, 50-90% of children born with sickle cell disease die before they reach their fifth birthday. In this study, we aimed to describe the comparative incidence of specific clinical outcomes among children aged between birth and 5 years with and without sickle cell disease, who were resident within the Kilifi area of Kenya. METHODS This prospective cohort study was done on members of the Kilifi Genetic Birth Cohort Study (KGBCS) on the Indian Ocean coast of Kenya. Recruitment to the study was facilitated through the Kilifi Health and Demographic Surveillance System (KHDSS), which covers a resident population of 260 000 people, and was undertaken between Jan 1, 2006, and April 30, 2011. All children who were born within the KHDSS area and who were aged 3-12 months during the recruitment period were eligible for inclusion. Participants were tested for sickle cell disease and followed up for survival status and disease-specific admission to Kilifi County Hospital by passive surveillance until their fifth birthday. Children with sickle cell disease were offered confirmatory testing and care at a dedicated outpatient clinic. FINDINGS 15 737 infants were recruited successfully to the KGBCS, and 128 (0·8%) of these infants had sickle cell disease, of whom 70 (54·7%) enrolled at the outpatient clinic within 12 months of recruitment. Mortality was higher in children with sickle cell disease (58 per 1000 person-years of observation, 95% CI 40-86) than in those without sickle cell disease (2·4 per 1000 person-years of observation, 2·0-2·8; adjusted incidence rate ratio [IRR] 23·1, 95% CI 15·1-35·3). Among children with sickle cell disease, mortality was lower in those who enrolled at the clinic (adjusted IRR 0·26, 95% CI 0·11-0·62) and in those with higher levels of haemoglobin F (HbF; adjusted IRR 0·40, 0·17-0·94). The incidence of admission to hospital was also higher in children with sickle cell disease than in children without sickle cell disease (210 per 1000 person-years of observation, 95% CI 174-253, vs 43 per 1000 person-years of observation, 42-45; adjusted IRR 4·80, 95% CI 3·84-6·15). The most common reason for admission to hospital among those with sickle cell disease was severe anaemia (incidence 48 per 1000 person-years of observation, 95% CI 32-71). Admission to hospital was lower in those with a recruitment HbF level above the median (IRR 0·43, 95% CI 0·24-0·78; p=0·005) and those who were homozygous for α-thalassaemia (0·07, 0·01-0·83; p=0·035). INTERPRETATION Although morbidity and mortality were high in young children with sickle cell disease in this Kenyan cohort, both were reduced by early diagnosis and supportive care. The emphasis must now move towards early detection and prevention of long-term complications of sickle cell disease. FUNDING Wellcome Trust.
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Affiliation(s)
- Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | - Gideon Nyutu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | - John Ojal
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Norbert Peshu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Medicine, Imperial College, St Mary's Hospital, London, UK
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; London School of Hygiene & Tropical Medicine, London, UK; INDEPTH Network, Accra, Ghana
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; London School of Hygiene & Tropical Medicine, London, UK; INDEPTH Network, Accra, Ghana.
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13
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Kazadi AL, Ngiyulu RM, Gini-Ehungu JL, Mbuyi-Muamba JM, Aloni MN. The clinical characteristics of Congolese children and adolescents suffering from sickle-cell anemia are marked by the high frequencies of epistaxis compared to Western series. Pediatr Hematol Oncol 2019; 36:267-276. [PMID: 31339399 DOI: 10.1080/08880018.2017.1365397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Sickle cell anaemia (SCA) is the most common genetic diseases in the Democratic Republic of Congo (DRC). It is estimated 30,000 to 40,000 neonates with SCA are born annually. Despite this high incidence rate, and the severity of the Bantu haplotype found in Congolese patients, major clinical characteristics remain poorly defined. The objective of this study was to assess the clinical and haematological profile of the SCA in patients less than 24 years of age. Methods: A cross-sectional study was conducted in Kinshasa, the large city of the DRC. Patients were consecutively selected in three health institutions. Results: The study includes 256 sickle cell patients. The mean age of 8.4 (SD = 4.9) years. The Hand-foot syndrome was most common (52.7%) first presentation revealing the disease in our series. The most prevalent crises found in our series were vaso-occlusive crises (VOC) in 170 cases (66.4%) and severe hemolysis in 136 cases (53.1%). Splenic sequestration was noted in 19 cases (7.4%). The age at the first pain crisis was 18.2±15.2 months-of-age and the age at the first transfusions was 29.2±27.6 months-of -age. The most common signs associated with sickle cell disease in our series were hepatomegaly (53.9%), splenomegaly (41.7%), and adenotonsillar hypertrophy (34.8%). Epistaxis was reported in 9.4%. Conclusion: The clinical course of patients in DRC was comparable to reports from Western countries, with the notable exception of epistaxis which was significantly higher in patients in the DRC.
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Affiliation(s)
- Aimé L Kazadi
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - René M Ngiyulu
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - Jean L Gini-Ehungu
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - Jean M Mbuyi-Muamba
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
| | - Michel N Aloni
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa,Faculty of Medicine, University of Kinshasa , Kinshasa , Democratic Republic of Congo
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14
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Abstract
Introduction: In human physiology, the spleen is generally neglected, and its role is considered anecdotal. In sickle cell disease, splenic dysfunction is the main cause of life-threatening complications, particularly in early childhood with the risk of pneumococcal overwhelming sepsis and acute splenic sequestration crisis, notably. During the course of the disease, the spleen functionally declines and anatomically disappears, albeit with great individual variability depending on modulating genetic and environmental factors. Areas covered: The present review aims to provide an overview of spleen structure and function in order to highlight its role in sickling disorders. The clinical features of spleen damage in sickle cell disease, as well as complications and short- and long-term consequences, are reviewed, along with the main therapeutic options. Expert opinion: Management of acute splenic sequestration recurrence and timing of splenectomy in children with sickling disorders are two main areas in which clinical studies are needed.
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Affiliation(s)
- Sara El Hoss
- a Université de Paris, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, F-75015 , Paris , France.,b Institut National de la Transfusion Sanguine , Paris , France.,c Laboratoire d'Excellence GR-Ex , Paris , France
| | - Valentine Brousse
- a Université de Paris, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, F-75015 , Paris , France.,b Institut National de la Transfusion Sanguine , Paris , France.,c Laboratoire d'Excellence GR-Ex , Paris , France.,d Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Necker-Enfants Malades, Centre de Référence de la Drépanocytose, AP-HP , Paris , France
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15
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Bwire GM, Majigo M, Makalla R, Nkinda L, Mawazo A, Mizinduko M, Makani J. Immunoglobulin G responses against falciparum malaria specific antigens are higher in children with homozygous sickle cell trait than those with normal hemoglobin. BMC Immunol 2019; 20:12. [PMID: 31029083 PMCID: PMC6486967 DOI: 10.1186/s12865-019-0294-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/12/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND High Immunoglobulin G (IgG) response to Plasmodium falciparum antigens is associated with partial malaria protection in sickle hemoglobin (HbS) children. However, this response has been more studied in children with heterozygous sickle cell trait (HbAS) but little explored in those with homozygous sickle cell trait (HbSS). The current study was conducted to determine the IgG responses against specific Plasmodium falciparum antigens in children with homozygous sickle cell trait (HbSS) by comparing to those with normal hemoglobin (HbAA). METHODS A cross sectional study was conducted between April and July 2018 in Dar es Salaam tertiary hospitals. Parents were consented for their child to give about 5 ml of venous blood. IgG concentration from the blood plasma of 220 children (110 HbAA vs. 110 HbSS) were determined using indirect Enzyme Linked Immunosorbent Assay (ELISA). Then IgG medians were compared between the groups with prism 5 software (GraphPad) using Mann Whitney U test. Where the differences in age, hemoglobin levels and body weight between the groups was analyzed using independent sample t test. Multiple linear regressions were used to control cofounding variables such as body weight, age and hemoglobin level using statistical package for social sciences software (SPSS version 23). P value <0.05 was considered statistically significant. RESULTS The median IgG concentration to PfEBA-175, Pfg27, yPfs28C antigens were HbSS; 20.7 ng/ml (IQR; 18.1-25.6) vs. HbAA; 2.3 ng/ml (IQR; 1.21-3.04), HbSS; 2.76 ng/ml (IQR: 2.08-5.69) vs. HbAA; 1.36 ng/ml (IQR: 1.28-1.76), and HbSS; 26,592 ng/ml (IQR: 10817-41,462) vs. HbAA; 14,164 ng/ml (IQR; 3069-24,302) respectively (p < 0.0001 for all IgG). In both groups; age, body weight and hemoglobin level had no impact on the levels of IgG responses to Plasmodium falciparum antigens except for HbAA group which showed a significant increase in IgG against Pfg27 by 0.004 ng/ml with 1 g/dl increase in Hb level (p = 0.028). CONCLUSIONS This study found significant higher levels of specific Plasmodium falciparum IgG responses in children with homozygous sickle cell trait than those with normal hemoglobin.
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Affiliation(s)
- George Msema Bwire
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania. .,Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania.
| | - Mtebe Majigo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
| | - Robert Makalla
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly and Children, Box 143, Babati, Manyara, Tanzania
| | - Lillian Nkinda
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
| | - Akili Mawazo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
| | - Mucho Mizinduko
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
| | - Julie Makani
- Department of Hematology and Blood Transfusion, School of Medicine, Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
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16
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Jesus ACDSD, Konstantyner T, Lôbo IKV, Braga JAP. SOCIOECONOMIC AND NUTRITIONAL CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH SICKLE CELL ANEMIA: A SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2018; 36:491-499. [PMID: 30540112 PMCID: PMC6322809 DOI: 10.1590/1984-0462/;2018;36;4;00010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/22/2017] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To describe the socioeconomic and nutritional characteristics of children and adolescents with sickle cell anemia. DATA SOURCES The present study is a systematic literature review based on published scientific articles. The searches were carried out using the electronic database of the National Library of Medicine, National Institutes of Health- PubMed. Two searches of articles published in the last 20years and without limitation of language were carried out. Thefirst one started from the Medical Subject Headings term "Anemia, Sickle Cell" associated with "Socioeconomic Factors"; and the second started from the term "Anemia, Sickle Cell" associated with "Anthropometry". Thesearches were directed to research conducted on humans in the age group from 0 to 18years. DATA SYNTHESIS The final selection was composed by 11 articles on socioeconomic characteristics and 21articles on nutritional characteristics. Allstudies included children and adolescents with sickle cells disease (age range 0-18years), both genders, and most of them of black ethnicity. Families of children and adolescents with sickle cell anemia were of predominantly low socioeconomic status. Parents had lower educational levels when compared to parents of healthy children and adolescents. Body measurements (weight and height) and anthropometric indicators of children with sickle cell anemia were often lower when compared to healthy groups or reference populations. CONCLUSIONS Children and adolescents with sickle cell anemia have socioeconomic limitations and worse nutritional conditions, when compared to reference populations. These limitations may lead to worse growth and greater occurrence of possible complications that can impair their quality of life.
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Affiliation(s)
| | - Tulio Konstantyner
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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17
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Hagag AA, El-Asy HM, Badraia IM, Hablas NM, El-Latif AEA. Thyroid Function in Egyptian Children with Sickle Cell Anemia in Correlation with Iron Load. Endocr Metab Immune Disord Drug Targets 2018; 19:46-52. [PMID: 30207251 DOI: 10.2174/1871530318666180912153349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/01/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sickle Cell Disease (SCD) is characterized by defective hemoglobin synthesis, hemolytic anemia, frequent thrombosis and chronic organ damage including endocrine organs. AIM To assess thyroid function in children with SCD in correlation and iron load. PATIENTS AND METHOD This study was conducted on 40 children with SCD with iron overload (serum ferritin more than 1000 ng/ml) including 22 males and 18 females with their ages ranging from 11-14 years and mean age value of 11.63±1.36 years and 40 healthy children of matched age and sex as a control group. For all patients; complete blood count, hemoglobin electrophoresis, serum ferritin, serum iron, iron binding capacity and thyroid function including Free Thyroxine (FT4), Free Triiodothyronine (FT3), Thyroid Stimulating Hormone (TSH), Thyroid Peroxidase Antibody (TPOAb) and Thyroglobulin Antibody (TgAb) were done. RESULTS Significantly higher serum ferritin and iron and significantly lower Total Iron Binding Capacity (TIBC) were found in patients compared with controls (mean serum ferritin was 1665.2±1387.65ng/ml in patients versus 192.55±107.2ng/ml in controls with p-value of 0. 007, mean serum iron was 164±83.9 ug/dl in patients versus 89.5±4.5ug/dl in controls with p-value of 0.039, mean TIBC was 238±44.5ug/dl in patients versus 308±11ug/dl in controls with p-value of 0.001). Significantly higher serum TSH and significantly lower Free T3 and Free T4 were found in patients compared with controls with no significant correlation between thyroid hormones and serum ferritin (mean serum TSH was 4.61±1.2 µIU/mL in patients versus 2.11 ± 0.54 µIU /mL in controls with p-value of 0. 045, mean serum FT3 was 2.61 ±1.3 pg/mL versus 3.93±0.47pg/mL in controls with p-value of 0.027, mean serum FT4 was 0.91±0.174 ng/dL versus 1.44± 0.164 ng/dLin controls with p-value of 0.047, r = - 0. 008 and p-value was 0. 973 for correlation between free T4 and serum ferritin, r = -0. 028 and p-value was 0. 9 for correlation between TSH and serum ferritin and r= - 0.259 and p-value was 0.27 for correlation betweenT3 and serum ferritin). There were no significant differences between patients and controls regarding thyroid peroxidase antibody and thyroglobulin antibody (mean serum thyroid peroxidase antibody was 22.45± 4.32 in patients versus 22.45 ± 3.21 in controls with p-value of 0.98 while mean serum thyroglobulin antibody was 12.32 ± 2.65 in patients versus 12.99 ± 2.34 in controls with p-value of 0.76. CONCLUSION Thyroid hormones deficiency may occur in some patients with SCD. RECOMMENDATIONS Regular assessment of thyroid function in children with SCD may be recommended as they are more vulnerable to develop hypothyroidism and may require replacement therapy.
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Affiliation(s)
- Adel A Hagag
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Hassan M El-Asy
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Ibrahim M Badraia
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Nahed M Hablas
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Amal Ezzat Abd El-Latif
- Clinical Pathology Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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Aloni MN, Kadima BT, Ekulu PM, Budiongo AN, Ngiyulu RM, Gini-Ehungu JL. Acute Crises and Complications of Sickle Cell Anemia Among Patients Attending a Pediatric Tertiary Unit in Kinshasa, Democratic Republic Of Congo. Hematol Rep 2017. [PMID: 28626540 PMCID: PMC5472240 DOI: 10.4081/hr.2017.6952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the Democratic Republic of Congo, the incidence of sickle cell anemia (SCA) is estimated to affect 30,000 to 40,000 neonates per year. However, there is paucity of data on acute clinical manifestations in sickle cell children. In these circumstances, it is difficult to develop a health care policy for an adequate management of sickle cell patients. This was a seven years’ retrospective study of children admitted with acute sickle cell crisis in the Department of Pediatrics in University Hospital of Kinshasa, Kinshasa, the Democratic Republic of Congo. A total of 108 patients were identified as having SCA. There were 56 (51%) girls and 52 (49%) boys. Median age was 10.5 years (range 1-24 years). No child was diagnosed by neonatal screening. The median age of diagnosis of sickle cell anemia was 90 months (range: 8-250 months). The median age at the first transfusion was 36 months (range 4-168). In this series, 61 (56.5%) patients were eligible for hydroxyurea. However, this treatment was only performed in 4 (6.6%) of them. Pain episodes, acute anemic crisis and severe infection represent respectively 38.2%, 34.3% and 21.9% of events. Altered sensorium and focal deficit were encountered occasionally and represented 3.4% of acute events. Acute renal manifestations, cholelithiasis and priapism were rarely reported, in this cohort. In Kinshasa, the care of patients suffering from sickle cell anemia is characterized by the delayed diagnosis and low detection of organ complications compared to reports of Western countries. This situation is due to resources deficiencies.
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Affiliation(s)
- Michel Ntetani Aloni
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Bertin Tshimanga Kadima
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Pépé Mfutu Ekulu
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Aléine Nzazi Budiongo
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - René Makuala Ngiyulu
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Jean Lambert Gini-Ehungu
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Democratic Republic of Congo
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19
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Tubman VN, Makani J. Turf wars: exploring splenomegaly in sickle cell disease in malaria-endemic regions. Br J Haematol 2017; 177:938-946. [PMID: 28493472 DOI: 10.1111/bjh.14592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sickle cell disease (SCD) is a group of recessively inherited disorders of erythrocyte function that presents an ongoing threat to reducing childhood and adult morbidity and mortality around the world. While decades of research have led to improved survival for SCD patients in wealthy countries, survival remains dismal in low- and middle-income countries. Much of the early mortality associated with SCD is attributed to increased risk of infections due to early loss of splenic function. In the West, bacterial infections with encapsulated organisms are a primary concern. In sub-Saharan Africa, where the majority of infants with SCD are born, the same is true. However malaria presents an additional threat to survival. The search for factors that define variability in sickle cell phenotypes should include environmental modifiers, such as malaria. Further exploration of this relationship could lead to novel strategies to reduce morbidity and mortality attributable to infections. In this review, we explore the interactions between SCD, malaria and the spleen to better understand how splenomegaly and splenic (dys)function may co-exist in patients with SCD living in malaria-endemic areas.
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Affiliation(s)
- Venée N Tubman
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
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20
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Maeder MN, Rabezanahary HM, Zafindraibe NJ, Randriatiana MR, Rasamoelina T, Rakotoarivo AT, Vanhems P, Hoffmann J, Bénet T, Rakoto Andrianarivelo M, Rakoto-Alson OA. Sickle-cell disease in febrile children living in a rural village of Madagascar and association with malaria and respiratory infections. BMC HEMATOLOGY 2016; 16:30. [PMID: 27980789 PMCID: PMC5134128 DOI: 10.1186/s12878-016-0069-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
Background In Madagascar, the last study on sickle cell disease (SCD) was done in the early 1980s. The country is known as endemic for malaria and respiratory infections. The main objective of this study was to estimate the prevalence of SCD; the secondary objective was to evaluate its association with malaria and respiratory infections. Methods This is a cross-sectional study which was carried out in a rural village in the south east coast of Madagascar between May 2011 and November 2013. Participants were children aged between 2–59 months presenting with fever measured by axillary temperature ≥37.5 °C at inclusion. Genotyping of haemoglobin S was done by PCR and malaria was diagnosed by Rapid Diagnostic Test. Research for viral and atypical bacterial respiratory pathogens was performed on nasopharyngeal swabs. Uni-and multivariate polytomous logistic regression was done to assess associations between microbiological results and SCD status, with HbAA phenotype as reference. Results A total of 807 children were analysed. Prevalence of SCD among febrile children was 2.4% (95% CI, 1.5–3.7%) and that of SCT was 23.8% (95% CI, 20.9–26.9%). There was no difference in the prevalence of malaria infection according to haemoglobin status (p = 0.3). Rhinovirus (22.5%), adenovirus (14.1%), and bocavirus (11.6%) were the most common respiratory pathogens detected. After univariate analysis, patients with SCD were more frequently infected by parechovirus (p = 0.01), while patients with SCT were more prone to RSV A or B infection (p = 0.01). After multivariate analysis, HbAS phenotype was associated with higher risk of RSV A and B infection compared to HbAA (adjusted OR = 1.9; 95% CI: 1.2–3.1, p = 0.009), while HbSS phenotype was associated with higher risk of parechovirus infection (adjusted OR = 6.0; 95% CI: 1.1–31.3, p = 0.03) compared to HbAA, independently of age, gender, period per quarter, and the other viruses. Conclusion The prevalence of SCD among under-five children presenting with fever was high in the study population. No association was found between SCT and malaria but few viruses, especially parechovirus, seem to play an important role in the occurrence of pneumoniae among SCD patients.
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Affiliation(s)
- Muriel N Maeder
- Centre d'Infectiologie Charles Mérieux, Université Antananarivo, P.O. Box 4299, Antananarivo, Madagascar
| | - Henintsoa M Rabezanahary
- Centre d'Infectiologie Charles Mérieux, Université Antananarivo, P.O. Box 4299, Antananarivo, Madagascar
| | - Norosoa J Zafindraibe
- Centre d'Infectiologie Charles Mérieux, Université Antananarivo, P.O. Box 4299, Antananarivo, Madagascar
| | | | - Tahinamandranto Rasamoelina
- Centre d'Infectiologie Charles Mérieux, Université Antananarivo, P.O. Box 4299, Antananarivo, Madagascar ; UPFR Biochimie-Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | - Andry T Rakotoarivo
- UPFR Biochimie-Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | - Philippe Vanhems
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1 Lyon, France ; Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jonathan Hoffmann
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1 Lyon, France
| | - Thomas Bénet
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1 Lyon, France ; Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Mala Rakoto Andrianarivelo
- Centre d'Infectiologie Charles Mérieux, Université Antananarivo, P.O. Box 4299, Antananarivo, Madagascar
| | - Olivat A Rakoto-Alson
- UPFR Hématologie-Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona & Département de Microbiologie, Faculté de Médecine, Antananarivo, Madagascar
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Olatunya OS, Olu-Taiwo A, Ogundare EO, Oluwayemi IO, Olaleye AO, Fadare JO, Adekoya-Benson T, Fatunla O, Agaja OT, Omoniyi E, Oluwadiya KS. Evaluation of a Portable Haemoglobin Metre Performance in Children with Sickle Cell Disease and Implications for Healthcare in Resource-poor Settings. J Trop Pediatr 2016; 62:316-23. [PMID: 26995011 DOI: 10.1093/tropej/fmw015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sub-Saharan Africa has the largest burden and worst outcome of sickle cell disease (SCD). This gloomy outlook has been attributed to the lack of use of simple and cost-effective measures for diagnosis and treatment of the disease. Although haematology analysers are the gold standard for accurate measurement of haemoglobin (Hb) concentration, they are often out of reach of most health facilities in resource-poor settings, thus creating a care gap. We conducted this study to examine the agreement between a point-of-care device and haematology analyser for determining the Hb concentration in children with SCD and its usefulness in resource-poor settings. METHODS Ethylenediaminetetraacetic acid blood samples collected from participants were processed to estimate their Hb concentration using two devices (Sysmex KX21N haematology analyser and portable mission Hb device). The agreement between the two sets of measurements was assessed by the Bland and Altman method. RESULTS The intraclass and concordance correlation coefficients were 0.854 and 0.936, respectively. Sensitivity and specificity were 84.2% and 98.6%, respectively. The positive and negative predictive values were 94.1% and 96.0%, respectively. The Bland and Altman's limit of agreement was -2.3 to 1.6 and the mean difference was -0.34 with non-significant variability between the two measurements (p = 0.949). CONCLUSION Hb concentration determined by the portable testing system is comparable with that determined by the haematology analyser. We recommend its use as a point-of-care device for determining Hb concentration of SCD children in resource-poor settings where haematology analysers are not available.
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Affiliation(s)
| | - Adebola Olu-Taiwo
- Department of Haematology and Blood Transfusion, Ekiti State University, Ado Ekiti, 360101 Nigeria
| | | | | | - Abiola Olukayode Olaleye
- Department of Community Medicine, Obafemi Awolowo University Teaching Hospital, Ile -Ife, 220105 Nigeria
| | | | - Tolulope Adekoya-Benson
- Department of Haematology and Blood Transfusion, Ekiti State University Teaching Hospital, Ado Ekiti, 360101 Nigeria
| | - Odunayo Fatunla
- Department of Paediatrics, Ekiti State University, Ado Ekiti, 360101 Nigeria
| | | | - Evenly Omoniyi
- Department of Paediatrics, Ekiti State University, Ado Ekiti, 360101 Nigeria
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22
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L'Esperance VS, Ekong T, Cox SE, Makani J, Newton CR, Soka D, Komba A, Kirkham FJ, Hill CM. Nocturnal haemoglobin oxygen desaturation in urban and rural East African paediatric cohorts with and without sickle cell anaemia: a cross-sectional study. Arch Dis Child 2016; 101:352-5. [PMID: 26699539 PMCID: PMC4819640 DOI: 10.1136/archdischild-2014-306468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Abstract
Low haemoglobin oxygen saturation (SpO2) predicts complications in children with sickle cell anaemia (SCA) in the North but there are few data from Africa, where the majority of the patients reside. We measured daytime and overnight SpO2 in children with SCA in routine follow-up clinic, and controls without symptoms of SCA, comparing rural (Kilifi, Kenya) and urban (Dar-es-Salaam, Tanzania) cohorts. Daytime SpO2 was lower in 65 Tanzanian children with SCA (TS; median 97 (IQR 94-100)%); p<0.0001) than in 113 Kenyan children with SCA (KS; 99 (98-100)%) and 20 Tanzanian controls (TC; 100 (98-100)%). Compared with 95 Kenyan children with SCA, in 54 Tanzanian children with SCA and 19 TC who returned for overnight oximetry, mean (KS 99.0 (96.7-99.8)%; TS 97.9 (95.4-99.3)%; TC 98.4 (97.5-99.1)%; p=0.01) and minimum nocturnal SpO2 (92 (86-95)%; 87 (78.5-91)%; 90 (83.5-93)% p=0.0001) were lower. The difference between children with SCA persisted after adjustment for haemoglobin (p=0.004). Urban Tanzanian children, with and without SCA, experience greater exposure to low daytime and night-time SpO2 compared with rural Kenyan children with SCA. Possible explanations include differences in the prevalence of obstructive sleep apnoea or asthma, alterations in the oxyhaemoglobin desaturation curve or cardiovascular compromise, for example, to shunting at atrial or pulmonary level secondary to increased pulmonary artery pressure. The fact that non-SCA siblings in the urban area are also affected suggests that environmental exposures, for example, air pollution, nutrition or physical exercise, may play a role. Further studies should determine aetiology and clinical relevance for the SCA phenotype in children resident in Africa.
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Affiliation(s)
- VS L'Esperance
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - T Ekong
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - SE Cox
- MRC International Nutrition Group, London School of Tropical Medicine and Hygiene, London, UK,Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - J Makani
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania,Neuroassessment department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - CR Newton
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania,Neuroassessment department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya,Department of Psychiatry, University of Oxford, Oxford, UK,Neurosciences Unit, UCL Institute of Child Health, London, UK
| | - D Soka
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - A Komba
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania,Neuroassessment department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - FJ Kirkham
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK,Neurosciences Unit, UCL Institute of Child Health, London, UK
| | - CM Hill
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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McGann PT, Tshilolo L, Santos B, Tomlinson GA, Stuber S, Latham T, Aygun B, Obaro SK, Olupot‐Olupot P, Williams TN, Odame I, Ware RE. Hydroxyurea Therapy for Children With Sickle Cell Anemia in Sub-Saharan Africa: Rationale and Design of the REACH Trial. Pediatr Blood Cancer 2016; 63:98-104. [PMID: 26275071 PMCID: PMC4825070 DOI: 10.1002/pbc.25705] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/19/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sickle cell anemia (SCA) is an inherited hematological disorder that causes a large but neglected global health burden, particularly in Africa. Hydroxyurea represents the only available disease-modifying therapy for SCA, and has proven safety and efficacy in high-resource countries. In sub-Saharan Africa, there is minimal use of hydroxyurea, due to lack of data, absence of evidence-based guidelines, and inexperience among healthcare providers. PROCEDURE A partnership was established between investigators in North America and sub-Saharan Africa, to develop a prospective multicenter research protocol designed to provide data on the safety, feasibility, and benefits of hydroxyurea for children with SCA. RESULTS The Realizing Effectiveness Across Continents with Hydroxyurea (REACH, ClinicalTrials.gov NCT01966731) trial is a prospective, phase I/II open-label dose escalation study of hydroxyurea that will treat a total of 600 children age 1-10 years with SCA: 150 at each of four different clinical sites within sub-Saharan Africa (Angola, Democratic Republic of Congo, Kenya, and Uganda). The primary study endpoint will be severe hematological toxicities that occur during the fixed-dose treatment phase. REACH has an adaptive statistical design that allows for careful assessment of toxicities to accurately identify a safe hydroxyurea dose. CONCLUSIONS REACH will provide data that address critical gaps in knowledge for the treatment of SCA in sub-Saharan Africa. By developing local expertise with the use of hydroxyurea and helping to establish treatment guidelines, the REACH trial results will have the potential to transform care for children with SCA in Africa.
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Affiliation(s)
| | | | | | | | - Susan Stuber
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Teresa Latham
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Banu Aygun
- Cohen Children's Medical CenterNew Hyde ParkNew York
| | | | | | - Thomas N. Williams
- KEMRI/Wellcome Trust Research ProgrammeKilifiKenya,Department of MedicineImperial CollegeLondonUK
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Olatunya OS, Ogundare EO, Fadare JO, Oluwayemi IO, Agaja OT, Adeyefa BS, Aderiye O. The financial burden of sickle cell disease on households in Ekiti, Southwest Nigeria. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:545-53. [PMID: 26622186 PMCID: PMC4639479 DOI: 10.2147/ceor.s86599] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Studies on economic impact of sickle cell disease (SCD) are scanty despite its being common among children in developing countries who are mostly Africans. Objective To determine the financial burden of SCD on households in Ado Ekiti, Southwest Nigeria. Methods A longitudinal and descriptive study of household expenditures on care of 111 children with SCD managed at the pediatric hematology unit of the Ekiti State University Teaching Hospital was conducted between January and December 2014. Results There were 64 male and 47 female children involved, aged between 15 and 180 months. They were from 111 households, out of which only eight (7.2%) were enrolled under the National Health Insurance Scheme. The number of admissions and outpatients’ consultations ranged from 1 to 5 and 1 to 10 per child, respectively. Malaria, vaso-occlusive crisis, and severe anemia were the leading comorbidities. The monthly household income ranged between ₦12,500 and ₦330,000 (US$76 and US$2,000) with a median of ₦55,000 (US$333), and health expenditure ranged between ₦2,500 and ₦215,000 (US$15 and US$1,303) with a mean of ₦39,554±35,479 (US$240±215). Parents of 63 children lost between 1 and 48 working days due to their children’s ill health. Parents of 23 children took loans ranging between ₦6,500 and ₦150,000 (US$39 and US$909) to offset hospital bills. The percentage of family income spent as health expenditure on each child ranged from 0.38 to 34.4. Catastrophic health expenditure (when the health expenditure >10% of family income) occurred in 23 (20.7%) households. Parents who took loan to offset hospital bills, low social class, and patients who took ill during the study period significantly had higher odds for catastrophic health expenditure (95% confidence interval [CI] 5.399–87.176, P=0.000; 95% CI 2.322–47.310, P=0.002; and 95% CI 1.128–29.694, P=0.035, respectively). Conclusion SCD poses enormous financial burden on parents and households.
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Affiliation(s)
- Oladele Simeon Olatunya
- Department of Paediatrics, Ekiti State University, Ado Ekiti, Nigeria ; Department of Paediatrics, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Ezra Olatunde Ogundare
- Department of Paediatrics, Ekiti State University, Ado Ekiti, Nigeria ; Department of Paediatrics, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | | | - Isaac Oludare Oluwayemi
- Department of Paediatrics, Ekiti State University, Ado Ekiti, Nigeria ; Department of Paediatrics, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | | | | | - Odunayo Aderiye
- Department of Paediatrics, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
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25
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Lubega I, Ndugwa CM, Mworozi EA, Tumwine JK. Alpha thalassemia among sickle cell anaemia patients in Kampala, Uganda. Afr Health Sci 2015; 15:682-9. [PMID: 26124820 DOI: 10.4314/ahs.v15i2.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sickle cell anaemia is prevalent in sub Saharan Africa. While α+-thalassaemia is known to modulate sickle cell anaemia, its magnitude and significance in Uganda have hitherto not been described. OBJECTIVES To determine the prevalence of α+thalassaemia among sickle cell anaemia patients in Mulago Hospital and to describe the clinical and laboratory findings in these patients. METHODS A cross sectional study was carried out on patients with sickle cell anaemia in Kampala. Dried blood spots were used to analyze for the deletional α+ thalassaemia using multiplex polymerase chain reaction. RESULTS Of the 142 patients with sickle cell anaemia, 110 (77.5%) had the αα+thalassaemia deletion. The gene frequency of (-α) was 0.425. Ninety one percent (100/110) of those with α+thalassaemia were heterozygous (αα/α-). Amongst the patients older than 60 months, 15 (83.3%) of those without αα+thalassaemia had significant hepatomegaly of greater than 4 cm compared to 36 (45.6%) of those with α+thalassaemia (p=0.003). CONCLUSION The gene frequency of (-α) of 0.425 noted in this study is higher than that reported from many places in Africa. Concurrent alpha thalassemia might be a protective trait against significant hepatomegaly in sickle cell anaemia patients more than 60 months of age at Mulago hospital.
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Affiliation(s)
- Irene Lubega
- Makerere University College of Health Sciences, Paediatrics and Child Health
| | | | - Edison A Mworozi
- Makerere University College of Health Sciences, Paediatrics and Child Health
| | - James K Tumwine
- Makerere University College of Health Sciences, Paediatrics and Child Health
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Muszlak M, Pissard S, Badens C, Chamouine A, Maillard O, Thuret I. Genetic Modifiers of Sickle Cell Disease: A Genotype-Phenotype Relationship Study in a Cohort of 82 Children on Mayotte Island. Hemoglobin 2015; 39:156-61. [DOI: 10.3109/03630269.2015.1023897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mulumba LL, Wilson L. Sickle cell disease among children in Africa: An integrative literature review and global recommendations. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2015. [DOI: 10.1016/j.ijans.2015.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Adjei GO, Goka BQ, Enweronu-Laryea CC, Rodrigues OP, Renner L, Sulley AM, Alifrangis M, Khalil I, Kurtzhals JA. A randomized trial of artesunate-amodiaquine versus artemether-lumefantrine in Ghanaian paediatric sickle cell and non-sickle cell disease patients with acute uncomplicated malaria. Malar J 2014; 13:369. [PMID: 25236838 PMCID: PMC4176868 DOI: 10.1186/1475-2875-13-369] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/12/2014] [Indexed: 12/23/2022] Open
Abstract
Background Sickle cell disease (SCD) is a genetic disorder common in malaria endemic areas. In endemic areas, malaria is a major cause of morbidity and mortality among SCD patients. This suggests the need for prompt initiation of efficacious anti-malarial therapy in SCD patients with acute malaria. However, there is no information to date, on the efficacy or safety of artemisinin combination therapy when used for malaria treatment in SCD patients. Methods Children with SCD and acute uncomplicated malaria (n = 60) were randomized to treatment with artesunate-amodiaquine (AA), or artemether-lumefantrine (AL). A comparison group of non-SCD children (HbAA genotype; n = 59) with uncomplicated malaria were also randomized to treatment with AA or AL. Recruited children were followed up and selected investigations were done on days 1, 2, 3, 7, 14, 28, 35, and 42. Selected clinical and laboratory parameters of the SCD patients were also compared with a group of malaria-negative SCD children (n = 82) in steady state. Results The parasite densities on admission were significantly lower in the SCD group, compared with the non-SCD group (p = 0.0006). The parasite reduction ratio (PRR) was lower, clearance was slower (p < 0.0001), and time for initial parasitaemia to decline by 50 and 90% were longer for the SCD group. Adequate clinical and parasitological response (ACPR) on day 28 was 98.3% (58/59) in the SCD group and 100% (57/57) in the non-SCD group. Corresponding ACPR rates on day 42 were 96.5% (55/57) in the SCD group and 96.4% (53/55) in the non-SCD group. The fractional changes in haemoglobin, platelets and white blood cell counts between baseline (day 0) and endpoint (day 42) were 16.9, 40.6 and 92.3%, respectively, for the SCD group, and, 12.3, 48.8 and 7.5%, respectively, for the non-SCD group. There were no differences in these indices between AA- and AL-treated subjects. Conclusions The parasite clearance of SCD children with uncomplicated malaria was slower compared with non-SCD children. AA and AL showed similar clinical and parasitological effects in the SCD and non-SCD groups. The alterations in WBC and platelet counts may have implications for SCD severity. Trial registration Current controlled trials ISRCTN96891086.
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Affiliation(s)
- George O Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana.
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Brousse V, Buffet P, Rees D. The spleen and sickle cell disease: the sick(led) spleen. Br J Haematol 2014; 166:165-76. [DOI: 10.1111/bjh.12950] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/31/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Valentine Brousse
- Department of Paediatrics; Reference Centre for Sickle Cell Disease; Hôpital Universitaire Necker-Enfants Malades; APHP; Paris France
- Université Paris Descartes; Paris France
- Laboratory of Excellence GR-Ex; Paris France
| | - Pierre Buffet
- Laboratory of Excellence GR-Ex; Paris France
- Centre d'Immunologie et des Maladies Infectieuses de Paris; CIMI-PARIS; U 1135 INSERM/UPMC Université Paris VI; Paris France
- Service de Parasitologie; AP-HP; Hôpital Pitié-Salpêtrière; Paris France
| | - David Rees
- Department of Paediatric Haematology; King's College Hospital NHS Foundation Trust; King's Health Partners; Denmark Hill London UK
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Ndila C, Bauni E, Nyirongo V, Mochamah G, Makazi A, Kosgei P, Nyutu G, Macharia A, Kapesa S, Byass P, Williams TN. Verbal autopsy as a tool for identifying children dying of sickle cell disease: a validation study conducted in Kilifi district, Kenya. BMC Med 2014; 12:65. [PMID: 24755265 PMCID: PMC4022330 DOI: 10.1186/1741-7015-12-65] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is common in many parts of sub-Saharan Africa (SSA), where it is associated with high early mortality. In the absence of newborn screening, most deaths among children with SCD go unrecognized and unrecorded. As a result, SCD does not receive the attention it deserves as a leading cause of death among children in SSA. In the current study, we explored the potential utility of verbal autopsy (VA) as a tool for attributing underlying cause of death (COD) in children to SCD. METHODS We used the 2007 WHO Sample Vital Registration with Verbal Autopsy (SAVVY) VA tool to determine COD among child residents of the Kilifi Health and Demographic Surveillance System (KHDSS), Kenya, who died between January 2008 and April 2011. VAs were coded both by physician review (physician coded verbal autopsy, PCVA) using COD categories based on the WHO International Classification of Diseases 10th Edition (ICD-10) and by using the InterVA-4 probabilistic model after extracting data according to the 2012 WHO VA standard. Both of these methods were validated against one of two gold standards: hospital ICD-10 physician-assigned COD for children who died in Kilifi District Hospital (KDH) and, where available, laboratory confirmed SCD status for those who died in the community. RESULTS Overall, 6% and 5% of deaths were attributed to SCD on the basis of PCVA and the InterVA-4 model, respectively. Of the total deaths, 22% occurred in hospital, where the agreement coefficient (AC1) for SCD between PCVA and hospital physician diagnosis was 95.5%, and agreement between InterVA-4 and hospital physician diagnosis was 96.9%. Confirmatory laboratory evidence of SCD status was available for 15% of deaths, in which the AC1 against PCVA was 87.5%. CONCLUSIONS Other recent studies and provisional data from this study, outlining the importance of SCD as a cause of death in children in many parts of the developing world, contributed to the inclusion of specific SCD questions in the 2012 version of the WHO VA instruments, and a specific code for SCD has now been included in the WHO and InterVA-4 COD listings. With these modifications, VA may provide a useful approach to quantifying the contribution of SCD to childhood mortality in rural African communities. Further studies will be needed to evaluate the generalizability of our findings beyond our local context.
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Affiliation(s)
- Carolyne Ndila
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
- INDEPTH Network of Demographic Surveillance Sites, Accra, Ghana
| | - Evasius Bauni
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
- INDEPTH Network of Demographic Surveillance Sites, Accra, Ghana
| | | | - George Mochamah
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
| | - Alex Makazi
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
| | - Patrick Kosgei
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
| | - Gideon Nyutu
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
| | - Alex Macharia
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
| | - Sailoki Kapesa
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
| | - Peter Byass
- INDEPTH Network of Demographic Surveillance Sites, Accra, Ghana
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
- WHO Collaborating Centre for Verbal Autopsy, Umeå University, 90187 Umeå, Sweden
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, P.O Box 230, Kilifi, Kenya
- INDEPTH Network of Demographic Surveillance Sites, Accra, Ghana
- Department of Medicine, Imperial College, London W21NY, UK
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Amendah DD, Mukamah G, Komba A, Ndila C, Williams TN. Routine paediatric sickle cell disease (SCD) outpatient care in a rural Kenyan hospital: utilization and costs. PLoS One 2013; 8:e61130. [PMID: 23593408 PMCID: PMC3621890 DOI: 10.1371/journal.pone.0061130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 03/07/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND More than 70% of children with sickle cell disease (SCD) are born in sub-Saharan Africa where the prevalence at birth of this disease reaches 2% or higher in some selected areas. There is a dearth of knowledge on comprehensive care received by children with SCD in sub-Saharan Africa and its associated cost. Such knowledge is important for setting prevention and treatment priorities at national and international levels. This study focuses on routine care for children with SCD in an outpatient clinic of the Kilifi District Hospital, located in a rural area on the coast of Kenya. OBJECTIVE To estimate the per-patient costs for routine SCD outpatient care at a rural Kenyan hospital. METHODS We collected routine administrative and primary cost data from the SCD outpatient clinic and supporting departments at Kilifi District Hospital, Kenya. Costs were estimated by evaluating inputs - equipment, medication, supplies, building use, utility, and personnel - to reflect the cost of offering this service within an existing healthcare facility. Annual economic costs were similarly calculated based on input costs, prorated lifetime of equipment and appropriate discount rate. Sensitivity analyses evaluated these costs under different pay scales and different discount rate. RESULTS We estimated that the annual economic cost per patient attending the SCD clinic was USD 138 in 2010 with a range of USD 94 to USD 229. CONCLUSION This study supplies the first published estimate of the cost of routine outpatient care for children born with SCD in sub-Saharan Africa. Our study provides policy makers with an indication of the potential future costs of maintaining specialist outpatient clinics for children living with SCD in similar contexts.
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Aygun B, Odame I. A global perspective on sickle cell disease. Pediatr Blood Cancer 2012; 59:386-90. [PMID: 22535620 DOI: 10.1002/pbc.24175] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 03/27/2012] [Indexed: 11/06/2022]
Abstract
The global burden of sickle cell disease (SCD) is now being increasingly realized. SCD poses a significant public health problem in sub-Saharan Africa, the Middle East, some regions of India, the Caribbean, and Brazil. In many of these regions, progress in the management of SCD has been slow. Long-term North-South and South-South partnerships between SCD professionals, funding agencies, governments, and industry are needed to help reduce the high disease burden in developing countries, through widespread SCD education, relevant research and implementation of evidence-based cost-effective interventions. A group of SCD professionals have responded with action by forming a global network.
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Affiliation(s)
- Banu Aygun
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Cox SE, Makani J, Fulford AJ, Komba AN, Soka D, Williams TN, Newton CR, Marsh K, Prentice AM. Nutritional status, hospitalization and mortality among patients with sickle cell anemia in Tanzania. Haematologica 2011; 96:948-53. [PMID: 21459787 DOI: 10.3324/haematol.2010.028167] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Reduced growth is common in children with sickle cell anemia, but few data exist on associations with long-term clinical course. Our objective was to determine the prevalence of malnutrition at enrollment into a hospital-based cohort and whether poor nutritional status predicted morbidity and mortality within an urban cohort of Tanzanian sickle cell anemia patients. DESIGN AND METHODS Anthropometry was conducted at enrollment into the sickle cell anemia cohort (n=1,618; ages 0.5-48 years) and in controls who attended screening (siblings, walk-ins and referrals) but who were found not to have sickle cell anemia (n=717; ages 0.5-64 years). Prospective surveillance recorded hospitalization at Muhimbili National Hospital and mortality between March 2004 and September 2009. RESULTS Sickle cell anemia was associated with stunting (OR=1.92, P<0.001, 36.2%) and wasting (OR=1.66, P=0.002, 18.4%). The greatest growth deficits were observed in adolescents and in boys. Independent of age and sex, lower hemoglobin concentration was associated with increased odds of malnutrition in sickle cell patients. Of the 1,041 sickle cell anemia patients with a body mass index z-score at enrollment, 92% were followed up until September 2009 (n=908) or death (n=50). Body mass index and weight-for-age z-score predicted hospitalization (hazard ratio [HZR]=0.90, P=0.04 and HZR=0.88, P=0.02) but height-for-age z-score did not (HZR=0.93, NS). The mortality rate of 2.5 per 100 person-years was not associated with any of the anthropometric measures. CONCLUSIONS In this non-birth-cohort of sickle cell anemia with significant associated undernutrition, wasting predicted an increased risk of hospital admission. Targeted nutritional interventions should prioritize treatment and prevention of wasting.
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Affiliation(s)
- Sharon E Cox
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar-es-Salaam, Tanzania.
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Williams TN, Obaro SK. Sickle cell disease and malaria morbidity: a tale with two tails. Trends Parasitol 2011; 27:315-20. [PMID: 21429801 DOI: 10.1016/j.pt.2011.02.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/15/2011] [Accepted: 02/18/2011] [Indexed: 01/19/2023]
Abstract
More than 230,000 children are born in Africa with sickle cell disease (SCD) each year: approximately 85% of all affected births worldwide. Although malaria is commonly viewed as a major problem for African patients with this condition, questions still remain about its relative importance as a cause of ill heath and death. In the absence of definitive studies investigating the contribution of malaria to morbidity and mortality in African children with SCD, policy makers will continue to lack the evidence on which to base appropriate management guidelines.
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Affiliation(s)
- Thomas N Williams
- KEMRI Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
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The pathogenesis of Plasmodium falciparum malaria in humans: insights from splenic physiology. Blood 2010; 117:381-92. [PMID: 20852127 DOI: 10.1182/blood-2010-04-202911] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Clinical manifestations of Plasmodium falciparum infection are induced by the asexual stages of the parasite that develop inside red blood cells (RBCs). Because splenic microcirculatory beds filter out altered RBCs, the spleen can innately clear subpopulations of infected or uninfected RBC modified during falciparum malaria. The spleen appears more protective against severe manifestations of malaria in naïve than in immune subjects. The spleen-specific pitting function accounts for a large fraction of parasite clearance in artemisinin-treated patients. RBC loss contributes to malarial anemia, a clinical form associated with subacute progression, frequent splenomegaly, and relatively low parasitemia. Stringent splenic clearance of ring-infected RBCs and uninfected, but parasite-altered, RBCs, may altogether exacerbate anemia and reduce the risks of severe complications associated with high parasite loads, such as cerebral malaria. The age of the patient directly influences the risk of severe manifestations. We hypothesize that coevolution resulting in increased splenic clearance of P. falciparum-altered RBCs in children favors the survival of the host and, ultimately, sustained parasite transmission. This analysis of the RBC-spleen dynamic interactions during P falciparum infection reflects both data and hypotheses, and provides a framework on which a more complete immunologic understanding of malaria pathogenesis may be elaborated.
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McAuley CF, Webb C, Makani J, Macharia A, Uyoga S, Opi DH, Ndila C, Ngatia A, Scott JAG, Marsh K, Williams TN. High mortality from Plasmodium falciparum malaria in children living with sickle cell anemia on the coast of Kenya. Blood 2010; 116:1663-8. [PMID: 20530796 PMCID: PMC3073423 DOI: 10.1182/blood-2010-01-265249] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 05/24/2010] [Indexed: 11/20/2022] Open
Abstract
Although malaria is widely considered a major cause of death in young children born with sickle cell anemia (SCA) in sub-Saharan Africa, this is poorly quantified. We attempted to investigate this question through 4 large case-control analyses involving 7164 children living on the coast of Kenya. SCA was associated with an increased risk of admission to hospital both with nonmalaria diseases in general (odds ratio [OR] = 4.17; 95% confidence interval [CI], 1.95-8.92; P < .001) and with invasive bacterial diseases in particular (OR = 8.73; 95% CI, 4.51-16.89; P < .001). We found no evidence for a strongly increased risk of either uncomplicated malaria (OR = 0.43; 95% CI, 0.09-2.10; P = .30) or malaria complicated by a range of well-described clinical features of severity (OR = 0.80; 95% CI, 0.25-2.51; P = .70) overall; nevertheless, mortality was considerably higher among SCA than non-SCA children hospitalized with malaria. Our findings highlight both the central role that malaria plays in the high early mortality seen in African children with SCA and the urgent need for better quantitative data. Meanwhile, our study confirms the importance of providing all children living with SCA in malaria-endemic areas with effective prophylaxis.
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