Preference-based measure of health-related quality of life and its determinants in sickle cell disease in Nigeria

Background

Health-related quality of life (HRQL) and economic burden are important issues for people with sickle cell disease (SCD) owing to better survival due to medical advances. Preference-based or utility information is necessary to make informed economic decisions on treatment and alternative therapies. This study aimed to assess preference-based measures of HRQL in sickle cell patients.

Methods and findings

Data were collected from two SCD outpatient clinics in Ibadan, Nigeria. A standard algorithm was used to derive utility scores, and measure SF-6D from the SF-36. A multivariate regression model was used to assess predictors and their impact. A combination of socio-demographic, bio-physiological and psychosocial variables predicted utility score in people with SCD. Socio-demographic and bio-physiological factors explained 7.5% and 17.9% of the variance respectively, while psychosocial factors explained 4.9%. Women had lower utility scores with a small effect size (d = 0.17). Utility score increased with level of education but decreased with age, anxiety, frequency of pain episodes and number of co-morbidities.

Conclusions

Utility score in SCD was low indicating a substantial impact of the disease on HRQL of patients and the value they place on their health state due to the limitations they experienced. Interventions should include both clinical and psychosocial approach to help in improving their quality of life of the patients.

Predictors of the failure of treatment with pyrimethamine-sulfadoxine in children with uncomplicated falciparum malaria

The prevalence of pyrimethamine-sulfadoxine (PS)-resistant Plasmodium falciparum malaria has been increasing in sub-Saharan Africa or other parts of the world in the last one or two decades. The factors that identify children at risk of treatment failure after being given PS were evaluated in 291 children with acute, symptomatic, uncomplicated, P. falciparum malaria. The children took part in four antimalarial drug trials between July 1996 and July 2004 in a hyperendemic area of southwestern Nigeria. Following treatment, 64 (22%) of 291 children failed treatment by day 7 or 14. In a multivariate analysis, an age < or = 1.5 years (AOR=2.9, 95% CI 1.3-6.4, P = 0.009) and presence of fever (AOR = 3.3, 95% CI 1.28-7.14, P = 0.01) were independent predictors of the failure of treatment with PS at presentation. Following treatment, delay in parasite clearance >3 days (AOR = 2.56, CI 1.19-5.56, P = 0.016) was an independent predictor of the failure of treatment with PS. In addition, compared with the children who had no fever then, children with fever three or more days after starting treatment were more likely to be treatment failures. These findings may have implications for malaria control efforts in some sub-Saharan African countries where treatment of malaria disease depends almost entirely on PS monotherapy, and for programmes employing PS or PS-based combination therapy.

Effects of antifolates--co-trimoxazole and pyrimethamine-sulfadoxine--on gametocytes in children with acute, symptomatic, uncomplicated, Plasmodium falciparum malaria

Antimalarial drugs including the antifolate, pyrimethamine-sulfadoxine (PS), can modulate the prevalence and intensities of gametocytaemia following treatment of acute malaria infections. They may also directly influence the transmission and spread of drug insensitivity. Little is known of the effects of co-trimoxazole (Co-T), another antifolate antimalarial, on gametocytes in children with acute malaria infections. We compared the effects of Co-T and PS on the prevalence and intensities of gametocytaemia and gametocyte sex ratios in 102 children aged 0.5-12 years presenting with acute and uncomplicated falciparum malaria. Compared to pre-treatment, both drugs significantly increased gametocyte carriage post-initiation of treatment. However, gametocyte carriage was significantly lower on day 14 in those treated with Co-T than PS. Significant increase in gametocytaemia with time occurred in PS--but not Co-T-treated children. Kaplan-Meier survival curve of the cumulative probability of remaining gametocyte-free in children who were agametocytaemic at enrollment showed that by day 7 of follow up, children treated with PS had a significantly higher propensity to have developed gametocytes than in Co-T-treated children (Log-rank statistic 5.35, df = 1, P = 0.02). Gametocyte sex ratio changes were similar following treatment with both drugs. PS and Co-T treatment of acute malaria infections in children from this endemic area is associated with significant increases in prevalence and intensities of gametocytaemia but these effects are more marked in those treated with PS than Co-T.

Prevalence of rubella antibody in pregnant women in Ibadan, Nigeria

BACKGROUND

There is a dearth of information on the incidence and prevalence of rubella infection in Nigeria. The risk of congenital rubella in sero-negative pregnant women has been found to produce congenital abnormalities even in developed countries.

OBJECTIVE

The aim of this study is to determine the prevalence of rubella virus antibody in pregnant women.

SETTING

The place of study is the antenatal care clinic of Adeoyo State Hospital, Ibadan.

DESIGN

This is a cross-sectional study of primigravida women attending the antenatal care facilities in a general hospital The rubella IgG antibody of the women was detected in sera using the RUB IgG Test kit. This is a quantitative ELISA technique.

RESULT

The prevalence of rubella antibody in 159 pregnant women that participated in this study was 68.5% with a confidence interval of 64.8% - 72.2%. Women living in rural -urban areas have statistically significant higher prevalence of antibody than those in urban areas.

CONCLUSION

This prevalence of rubella antibody in pregnant women suggests 1 in 4 pregnant woman is susceptible and the foetus at risk of congenital rubella malformation.

Profile of some risk factors for coronary heart disease in a developing country: Nigeria

The profile of some risk factors for coronary heart disease was studied in 557 male and 325 female Nigerians aged 20 years and above from the low and medium income groups, respectively. Except for the weight of subjects in the low income level, values of all physical characteristics were significantly higher in females than males (P < 0.01). In the 20-39 years age group, the systolic blood pressure was higher in males than females, and among the medium income group than the low income group (P < 0.01); but this difference disappeared in the higher age groups. The mean diastolic blood pressure was higher (but not statistically significant) at medium income levels than low income levels (P > 0.05). In each age group, the mean plasma total cholesterol was significantly higher in the medium income group than in the low income group (P < 0.01). The percentage of smokers and alcohol consumers were higher in the high income group than the low income group (P < 0.01). A high percentage of the smokers and alcohol consumers were male subjects. Blood pressure was correlated with age, smoking and body fat, (P < 0.01). Waist to trochanter ratio, and percentage body fat were significantly related to plasma total cholesterol level (P < 0.01).

Toxoplasmosis: antitoxoplasma IgG antibody levels in patients with lymphoid neoplasia in Ibadan, Nigeria

The serum samples of 50 patients with lymphoid neoplasia, and of 112 control subjects from the normal population were analysed for the presence of antitoxoplasma IgG antibodies by the enzyme-linked immunosorbent assay technique. There was no significant difference between the prevalence rate of antitoxoplasma IgG antibodies in the control subjects (69%) and the patients with lymphoid neoplasia (66%). The prevalence of antitoxoplasma IgG antibody levels of 75 international units (i.u.) per ml and above was significantly higher in the patients (48%) than in the control subjects (18%). Antitoxoplasma IgG antibody levels of 150 i.u. and above per ml indicating active toxoplasmosis were present in 13 (26%) out of the 50 patients with lymphoid neoplasia. None of the sera from the control subjects had antitoxoplasma IgG antibody level up to 150 i.u. per ml of serum.

Serum cholesterol and diseases in Nigerians

A study of 3451 cholesterol determinations in different diseases was carried out. The mean cholesterol levels for male and female adults and children with different diseases were compared with values for their healthy counterparts. Sickle cell anemia, leukemia, liver cirrhosis, hepatosplenomegaly, tuberculosis, and diabetic, nutritional, ataxic, and tropical neuropathies in male and female adults were associated with reduced cholesterol level while in children malnutrition and anemia were the main causes of low cholesterol levels. Obesity and hypertension caused an elevated level but the mean values were within the range for adult Nigerians in the high income group. Only nephrotic syndrome in both adult and children was associated with a markedly increased cholesterol level in Nigerians of low income status.