Distribution of Cancer and Cancer Screening and Treatment Services in Lagos: A 10-Year Review of Hospital Records

PURPOSE

In Lagos State, Nigeria, the population distribution of cancers is poorly described because studies are conducted at a few tertiary hospitals. Therefore, this study aims to map all health facilities where cancer screening takes place and describe the cases of cancer screened for and treated.

METHODS

A cross-sectional survey to identify facilities involved in screening and management of cancers was performed followed by extraction of data on individual cases of cancer screened for and treated at these facilities from 2011 to 2020. All health care facilities in the state were visited, and the survey was performed using standardized national tools modified to capture additional information on cancer screening and treatment. Data analysis was performed using STATA version 14 and R version 3.6.3.

RESULTS

Cervical cancer was the commonest cancer, accounting for 55% of 2,420 cancers screened, followed by breast (41%), prostate (4%), and colorectal cancers (0.2%). Of the 7,682 cancers treated among Lagos residents, the top five were breast (45%), colorectal (8%), cervical (8%), prostate (5%), and ovarian (4%). The female:male ratio of cancer cases was 3:1. The peak age for cancer among females and males was in the 40- to 49-year age group and 60- to 69-year age group, respectively. The Ikorodu local government area had the highest rate of reported cancer per million population.

CONCLUSION

Cancer screening is poor with a significant gap in screening for breast cancer since it is the commonest cancer in the state. The findings indicate the urgent need for the establishment of organized screening programs for the predominant cancers in the state and the prioritization of cancer research that addresses key policy and program questions.

Efficacy of Hexetidine, Thymol and Hydrogen Peroxide-Containing Oral Antiseptics in Reducing Sars-Cov-2 Virus in the Oral Cavity: A Pilot Study

BACKGROUND

Studies have demonstrated the role of sputum as a site of severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2) transmission. However, there is limited literature on the virucidal efficacy of oral antiseptics against SARS-CoV-2 virus. This study investigated the virucidal efficacy of three oral-antiseptics compared to a placebo-control in the sputum of SARS-CoV-2 infected individuals.

METHODOLOGY

A pilot study of adults with SARS-CoV-2 positive results, as determined by reverse transcription-polymerase chain reaction (RT-PCR) of <7 days. The oral antiseptics investigated were: Hexetidine (0.1% w/v); Thymol (0.063% w/v) and H2O2(1.5%) compared to de-mineralized sterile water (Placebo-control). The primary outcome measure was the proportion of negative RT-PCR results at 15-mins, 30-mins, 1-hour, 2-hours and 4-hours After Oral antiseptics Interventions (AOI) compared to the placebo-control. Statistical analysis was done using STATA 15.0 software with p-values of <0.05 considered statistically significant.

RESULTS

Data from a total of 66 participants that were RT-PCR SARS-CoV-2 positive at baseline (0-min) was analysed. At 15-mins AOI, the highest proportion of negativation from sputum samples was observed in the Hexedine group, with 69.2% of the baseline PCR positive cases converting to negative compared to 46.7% in the placebo-control group. In addition, H2O2 demonstrated efficacy at 2-hours AOI compared to placebo-control (62.5% vs 37.5% respectively) and other oral-antiseptics. Across all time-points, the oral-antiseptic groups compared to the placebo-control group, there was no statistically significant difference in the proportion of sputum samples which converted to a negative status (p>0.05).

CONCLUSION

The findings in this study suggest there was no significant difference in the proportion of participants who converted to a negative sputum status across the treatment groups at various time points. Future studies could compare the cycle threshold (ct) viral titre values of sputum samples to determine quantitative differences.

A qualitative analysis of the COVID-19 vaccination rollout in Lagos, Nigeria: Client and provider perspectives on the plan, the process and the progress

Mass vaccination has proven useful in the control of COVID-19, though vaccine rollout has met major challenges. The learning curve of this process has been valuable. This qualitative study aimed to assess the plan, the process and the progress of the COVID-19 vaccination rollout in Lagos, Nigeria. This study was conducted at vaccination centers in eight of the 20 Local Government Areas in Lagos State from May to July 2021 among healthcare administrators, health workers and vaccine recipients. Data were collected by conducting three key informant interviews, 24 in-depth interviews and eight focus group discussions to explore the vaccination experiences of participants and the challenges facing the vaccination plan and process. The interviews and discussions were recorded, transcribed verbatim and analyzed using the thematic approach. The four-phased plan for the vaccine rollout was clear to all the key informants because the vaccination process was preceded by training. The process was strengthened by the electronic registration system, though riddled by the frequently unstable electronic and internet data capturing. This was mitigated by a stopgap manual registration and recording of client details. Challenges in the logistics of maintaining supplies of the disposable materials required for the vaccination process were overcome by the creativity of the health professionals. Vaccine hesitancy, fueled by misinformation, myths and misconceptions about the vaccine and its side effects, played a huge role in the community response. The reported vaccine side effects were mild; fever, headaches, pain at the injection site, excessive eating and sleepiness. Though the COVID-19 vaccination process appeared to have largely made progress, the future of vaccination in Nigeria is predicated upon a bottom-up approach to programmatic planning, health education and local vaccine production. Collaborations such as public-private partnerships have the potential of boosting vaccine provision for Nigeria's large population to ensure equitable access to vaccines.

A multi-centre, randomized, double-blind, placebo-controlled clinical trial of the efficacy and safety of chloroquine phosphate, hydroxychloroquine sulphate and lopinavir/ritonavir for the treatment of COVID-19 in Lagos State: study protocol for a randomized controlled trial

Background

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that was first identified in Wuhan, Hubei, China, in December 2019. It was recognized as a pandemic by the World Health Organization on 11 March 2020. Outbreak forecasting and mathematical modelling suggest that these numbers will continue to rise. Early identification of effective remedies that can shorten the duration and severity of illness is critical for Lagos State, which is the epi-centre of the disease in Nigeria.

Methods

This is a multi-centre, randomized, double-blind placebo-controlled superiority trial. The study investigates the efficacy of chloroquine phosphate, hydroxychloroquine sulphate and lopinavir/ritonavir added on to standard of care compared to standard of care only in patients with COVID-19 disease. The primary outcome is the clinical status of patients measured using a 7-point ordinal scale at day 15. Research participants and clinicians will be blinded to the allocated intervention. Outcome measures will be directly assessed by clinicians. Statistical analysis will be done by a team blinded to the identity and allocation of research participants. Data analysis will follow intention-to-treat methods, using R software.

Discussion

The current study is of strategic importance for Lagos State in potentially curbing the health, social and economic burden of COVID-19 disease. Should the current study demonstrate that either of the three intervention drugs is more efficacious than standard therapy alone, the State Ministry of Health will develop an evidence-based guideline for the management of COVID-19 in Lagos State. The findings will also be shared nationally and with other states which may lead to a standardized national guideline for the treatment of COVID-19 in Nigeria.

Trial registration

Pan African Clinical Trials Register PACTR202004801273802. Registered prospectively on April 2, 2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05675-x.

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials

BACKGROUND

Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ).

METHODS

In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence.

RESULTS

A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis.

CONCLUSIONS

Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria

Previous efforts to estimate the travel time to comprehensive emergency obstetric care (CEmOC) in low- and middle-income countries (LMICs) have either been based on spatial models or self-reported travel time, both with known inaccuracies. The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Data on demographics, obstetric history and travel to CEmOC facilities of pregnant women with an obstetric emergency, who presented between 1st November 2018 and 31st December 2019 at a public CEmOC facility were collected from hospital records. Estimated travel times were individually extracted from Google Maps for the period of the day of travel. Bivariate and multivariate analyses were used to test associations between travel and health system-related factors with reaching the facility >60 minutes. Mean travel times were compared and geographical coverage mapped to identify ‘hotspots’ of predominantly >60 minutes travel to facilities. For the 4005 pregnant women with traceable journeys, travel time ranges were 2–240 minutes (without referral) and 7–320 minutes (with referral). Total travel time was within the 60 and 120 minute benchmark for 80 and 96% of women, respectively. The period of the day of travel and having been referred were significantly associated with travelling >60 minutes. Many pregnant women living in the central cities and remote towns typically travelled to CEmOC facilities around them. We identified four hotspots from which pregnant women travelled >60 minutes to facilities. Mean travel time and distance to reach tertiary referral hospitals were significantly higher than the secondary facilities. Our findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.

Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study

BACKGROUND

The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.

METHODS

In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 62,020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred. Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher's exact tests were used in determining associations between variables. Kaplan-Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant.

RESULTS

A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P < 0.001). After adjustment for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness: HR = 2.41, P = 0.001, 95%CI = 1.4-4.0, death: HR = 2.30, P = 0.001, 95%CI = 1.2-4.6, for those with hypertension only} {severe/critical illness: HR = 3.76, P = 0.001, 95%CI = 2.1-6.4, death: crude HR = 6.63, P = 0.001, 95%CI = 3.4-1.6, for those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities.

CONCLUSION

The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.

From Ebola to COVID-19: emergency preparedness and response plans and actions in Lagos, Nigeria

BACKGROUND

Lagos state is the industrial nerve centre of Nigeria and was the epicentre of the 2014 Ebola outbreak in Nigeria as it is now for the current Coronavirus Disease (COVID-19) outbreak. This paper describes how the lessons learned from the Ebola outbreak in 2014 informed the emergency preparedness of the State ahead of the COVID-19 outbreak and guided response.

DISCUSSION

Following the Ebola outbreak in 2014, the Lagos State government provided governance by developing a policy on emergency preparedness and biosecurity and provided oversight and coordination of emergency preparedness strategies. Capacities for emergency response were strengthened by training key staff, developing a robust surveillance system, and setting up a Biosafety Level 3 laboratory and biobank. Resource provision, in terms of finances and trained personnel for emergencies was prioritized by the government. With the onset of COVID-19, Lagos state was able to respond promptly to the outbreak using the centralized Incident Command Structure and the key activities of the Emergency Operations Centre. Contributory to effective response were partnerships with the private sectors, community engagement and political commitment.

CONCLUSION

Using the lessons learned from the 2014 Ebola outbreak, Lagos State had gradually prepared its healthcare system for a pandemic such as COVID-19. The State needs to continue to expand its preparedness to be more resilient and future proof to respond to disease outbreaks. Looking beyond intra-state gains, lessons and identified best practices from the past and present should be shared with other states and countries.

Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey

BACKGROUND

The presence of COVID-19 has led to the disruption of health systems globally, including essential reproductive, maternal, newborn and child health (RMNCH) services. This study aimed to assess the challenges faced by women who used RMNCH services in Nigeria's epicentre, their satisfaction with care received during the COVID-19 pandemic and the factors associated with their satisfaction.

METHODS

This cross-sectional survey was conducted in Lagos, southwest Nigeria among 1,241 women of reproductive age who had just received RMNCH services at one of twenty-two health facilities across the primary, secondary and tertiary tiers of health care. The respondents were selected via multi-stage sampling and face to face exit interviews were conducted by trained interviewers. Client satisfaction was assessed across four sub-scales: health care delivery, health facility, interpersonal aspects of care and access to services. Bivariate and multivariate analyses were used to assess the relationship between personal characteristics and client satisfaction.

RESULTS

About 43.51% of respondents had at least one challenge in accessing RMNCH services since the COVID-19 outbreak. Close to a third (31.91%) could not access service because they could not leave their houses during the lockdown and 18.13% could not access service because there was no transportation. The mean clients' satisfaction score among the respondents was 43.25 (SD: 6.28) out of a possible score of 57. Satisfaction scores for the interpersonal aspects of care were statistically significantly lower in the PHCs and general hospitals compared to teaching hospitals. Being over 30 years of age was significantly associated with an increased clients' satisfaction score (ß = 1.80, 95%CI: 1.10-2.50).

CONCLUSION

The COVID-19 lockdown posed challenges to accessing RMNCH services for a significant proportion of women surveyed. Although overall satisfaction with care was fairly high, there is a need to provide tailored COVID-19 sensitive inter-personal care to clients at all levels of care.

'Long COVID': persistent COVID-19 symptoms in survivors managed in Lagos State, Nigeria

BACKGROUND

Coronavirus disease once thought to be a respiratory infection is now recognised as a multi-system disease affecting the respiratory, cardiovascular, gastrointestinal, neurological, immune, and hematopoietic systems. An emerging body of evidence suggests the persistence of COVID-19 symptoms of varying patterns among some survivors. This study aimed to describe persistent symptoms in COVID-19 survivors and investigate possible risk factors for these persistent symptoms.

METHODS

The study used a retrospective study design. The study population comprised of discharged COVID-19 patients. Demographic information, days since discharge, comorbidities, and persistent COVID-19 like symptoms were assessed in patients attending the COVID-19 outpatient clinic in Lagos State. Statistical analysis was done using STATA 15.0 software (StataCorp Texas) with significance placed at p-value < 0.05.

RESULTS

A total of 274 patients were enrolled in the study. A majority were within the age group > 35 to ≤49 years (38.3%), and male (66.1%). More than one-third (40.9%) had persistent COVID-19 symptoms after discharge, and 19.7% had more than three persistent COVID-like symptoms. The most persistent COVID-like symptoms experienced were easy fatigability (12.8%), headaches (12.8%), and chest pain (9.8%). Symptomatic COVID-19 disease with moderate severity compared to mild severity was a predictor of persistent COVID-like symptoms after discharge (p < 0.05).

CONCLUSION

Findings from this study suggests that patients who recovered from COVID-19 disease may still experience COVID-19 like symptoms, particularly fatigue and headaches. Therefore, careful monitoring should be in place after discharge to help mitigate the effects of these symptoms and improve the quality of life of COVID-19 survivors.

Perspectives of different stakeholders on data use and management in public health emergencies in sub-Saharan Africa: a meeting report

During public health emergencies (PHEs), data are collected and generated from a variety of activities and sources, including but not limited to national public health programs, research and community-based activities. It is critical that these data are rapidly shared in order to facilitate the public health response, epidemic preparedness, as well as research during and after the epidemic. Nonetheless, collecting and sharing data during PHEs can be challenging, especially where there are limited resources for public health and research-related activities. In a symposium that brought together different stakeholders that were involved in the 2013-2016 Ebola outbreaks in West Africa, meeting attendees shared their perspectives on the values and management of data during PHEs in sub-Saharan Africa. Key factors that could inform and facilitate data management during PHEs in sub-Saharan Africa were discussed, including using data to inform policy decisions and healthcare; a coordinated data collection and management scheme; identifying incentives for data sharing; and equitable data  governance mechanism that emphasise principles of reciprocity, transparency and accountability rather that trust between stakeholders or collaborators. Empirical studies are required to explore how these principles could inform best practices for data management and governance during PHE in sub-Saharan Africa.

Outcomes of COVID-19 patients with comorbidities in southwest Nigeria

BACKGROUND

Data on the comorbidities that result in negative outcomes for people with COVID-19 are currently scarce for African populations. This study identifies comorbidities that predict death among a large sample of COVID-19 patients from Nigeria.

METHODS

This was a retrospective analysis of medical records for 2184 laboratory confirmed cases of COVID-19 in Lagos, southwest Nigeria. Extracted data included age, sex, severity of condition at presentation and self-reported comorbidities. The outcomes of interest were death or discharge from facility.

RESULTS

Most of the cases were male (65.8%) and the median age was 43 years (IQR: 33-55). Four hundred and ninety-two patients (22.5%) had at least one comorbidity and the most common amongst them were hypertension (74.2%) and diabetes (30.3%). The mortality rate was 3.3% and a significantly higher proportion of patients with comorbidities died compared to those with none. The comorbidities that predicted death were hypertension (OR: 2.21, 95%CI: 1.22-4.01), diabetes (OR: 3.69, 95% CI: 1.99-6.85), renal disease (OR: 12.53, 95%CI: 1.97-79.56), cancer (OR: 14.12, 95% CI: 2.03-98.19) and HIV (OR: 1.77-84.15].

CONCLUSION

Comorbidities are prevalent and the associated risk of death is high among COVID-19 patients in Lagos, Nigeria. Public enlightenment, early identification and targeted care for COVID-19 cases with comorbidities are recommended as the pandemic evolves.

Perspectives of different stakeholders on data use and management in public health emergencies in sub-Saharan Africa: a meeting report

During public health emergencies (PHEs), data are collected and generated from a variety of activities and sources, including but not limited to national public health programs, research and community-based activities. It is critical that these data are rapidly shared in order to facilitate the public health response, epidemic preparedness, as well research during and after the epidemic. Nonetheless, collecting and sharing data during PHEs can be challenging, especially where there are limited resources for public health and research-related activities during a PHE. In a symposium that brought together different stakeholders that were involved in the 2013-2016 Ebola outbreaks in West Africa, meeting attendees shared their perspectives on the values and management of data during PHEs in sub-Saharan Africa. Key factors that could inform and facilitate data management during PHEs in sub-Saharan Africa were discussed, including using data to inform policy decisions and healthcare; a coordinated data collection and management scheme; identifying incentives for data sharing; and equitable data  governance mechanism that emphasise principles of reciprocity, transparency and accountability rather that trust between stakeholders or collaborators. Empirical studies are required to explore how these principles could inform best practices for data management and governance during PHE in sub-Saharan Africa.

Presenting Symptoms and Predictors of Poor Outcomes Among 2,184 Patients with COVID-19 in Lagos State, Nigeria

INTRODUCTION

Lagos state remains the epicentre of COVID-19 in Nigeria. We describe the symptoms and signs of the first 2,184 PCR-confirmed COVID-19 patients admitted at COVID-19 treatment centers in Lagos State. We also assessed the relationship between patients' presenting symptoms, sociodemographic and clinical characteristics and COVID-19 deaths..

METHODS

Medical records of PCR-confirmed COVID-19 patients were extracted and analyzed for their symptoms, symptom severity, presence of comorbidities and outcome.

RESULTS

The ages of the patients ranged from 4 days to 98 years with a mean of 43.0(16.0) years. Of the patients who presented with symptoms, cough (19.3%) was the most common presenting symptom. This was followed by fever (13.7%) and difficulty in breathing, (10.9%). The most significant clinical predictor of death was the severity of symptoms and signs at presentation. Difficulty in breathing was the most significant symptom predictor of COVID-19 death (OR:19.26 95% CI 10.95-33.88). The case fatality rate was 4.3%.

CONCLUSION

Primary care physicians and COVID-19 frontline workers should maintain a high index of suspicion and prioritize the care of patients presenting with these symptoms. Community members should be educated on such predictors and ensure that patients with these symptoms seek care early to reduce the risk of deaths associated with COVID-19.

Comparative Bioaccumulation of PAH and BTEX in Malapterurus electricus (Siluriformes: Malapteruridae) and its Enteric Parasite, Electrotaenia malopteruri Sampled from Lekki Lagoon, Lagos, Nigeria

Contamination of Lekki lagoon by petrogenic chemicals such as polycyclic aromatic hydrocarbons (PAH) and benzene, toluene, ethylbenzene, and xylene (BTEX) has been widely reported. The study was aimed at investigating the bioaccumulation of PAH and BTEX in Malapterurus electricus collected from Lekki lagoon in Lagos, Nigeria. BTEX was analyzed in the intestine, water, and sediment samples using 8260B Agilent 7890B gas chromatograph coupled to a mass spectrometer (GC-MS). While PAHs were tested in the same media using a gas chromatograph coupled to a flame ionization detector (GC-FID). Histopathological analysis of the fish intestine was conducted using haematoxylin and eosin (H&E) stains. Parasite intensity, antioxidant enzymes, and lipid peroxidation activities were investigated in the fish. The parasitic infection detected in Malapterurus electricus was Electrotaenia malopteruri. The parasite showed weak and no depurative capacities for BTEX and PAH respectively. The decrease in superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) in conjunction with an increase in Malondialdehyde (MDA) characterized relatively higher susceptibility among the male fish. Varieties of tissue injuries increased with the standard length of the fish groups. Results suggest that lengthier and uninfected M. electricus were more susceptible to PAH in Lekki lagoon than the shorter and infected ones. The study demonstrated a promising tendency of the enteric parasite, E. malopteruri to depurate chlorobenzene, ethylbenzene, o-xylene, m+p-xylene, and 1,4-dichlorobenzene from the intestine of its host fish, M. electricus, while PAHs were poorly mediated by the parasite.

Clinical characteristics, predictors of symptomatic coronavirus disease 2019 and duration of hospitalisation in a cohort of 632 Patients in Lagos State, Nigeria

OBJECTIVE

The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still evolving. This study describes the clinical characteristics and investigates factors that predict symptomatic presentation and duration of hospitalisation in a cohort of coronavirus disease 2019 (COVID-19) patients managed in Lagos, Nigeria.

METHODOLOGY

This was a retrospective assessment of patients hospitalised with COVID-19 disease in six dedicated facilities in Lagos, Nigeria, between April 1^st and May 31^st 2020. Participants were individuals with laboratory-confirmed SARS-CoV-2 infection. The outcome measures were presence of symptoms and duration of hospitalisation. Demographic and comorbidity data were also obtained. Statistical analysis was done using STATA 15.0 software, with P < 0.05 being considered statistically significant.

RESULTS

A total of 632 cases were analysed. The median age was 40 years (IQR: 30.5-49); male patients accounted for 60.1%. About 63% of patients were asymptomatic at presentation. Among the symptomatic, the most common symptoms were cough (47.4%) and fever (39.7%). The most common comorbidities were hypertension (16.8%) and diabetes (5.2%). The median duration of hospitalisation was 10 days (IQR: 8-14). Comorbidities increased the odds of presenting with symptoms 1.6-fold (P = 0.025) for one comorbidity and 3.2-fold (P = 0.005) for ≥2 comorbidities. Individuals aged ≥50 years were twice as likely to be hospitalised for more than 14 days compared to individuals aged <50 years (P = 0.016).

CONCLUSION

Most individuals had no symptoms with comorbidities increasing the likelihood of symptoms. Older age was associated with longer duration of hospitalisation. Age and comorbidities should be used for COVID-19 triaging for efficient resource allocation.

Predictive ability of symptomatology in COVID-19 during Active case search in Lagos State, Nigeria

BACKGROUND

In April 2020, a community-based active case search surveillance system of coronavirus disease 2019 (COVID-19) was developed by the emergency outbreak committee in Lagos State. This followed the evidence of community transmission of coronavirus disease in the twenty Local Government Areas in Lagos State. This study assessed the value of respiratory and other symptoms in predicting positive SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR). It is hoped that if symptoms are predictive, they can be used in screening before testing.

METHODS

Communities were included based on the alerts from community members through the rumour alert system set up by the state. All members of the households of the communities from where the alert came were eligible. Household members who declined to participate were excluded from the study. A standardised interviewer-administered electronic investigation form was used to collect sociodemographic information, clinical details and history for each possible case. Data was analysed to see the extent of agreement or correlation between reported symptoms and the results of PCR testing for SARS-COV-2.

RESULTS

A total of 12,739 persons were interviewed. The most common symptoms were fever, general weakness, cough and difficulty in breathing. Different symptoms recorded different levels of sensitivity as follows: fever, 28.9%; cough, 21.7%; general body weakness, 10.9%; and sore throat, 10.9%. Sensitivity and specificity for fever, the most common symptom, were 28.3% and 50.2%, respectively, while similar parameters for general body weakness, the next most common symptom, were 10.9% and 73.2%, respectively.

CONCLUSION

From these findings, the predictive ability of symptoms for COVID-19 diagnosis was extremely weak. It is unlikely that symptoms alone will suffice to predict COVID-19 in a patient. An additional measure, such as confirmatory test by RT-PCR testing, is necessary to confirm the disease.

Bioaccumulation of Pyrethroid in Parasite Wenyonia acuminata (Cestoda: Caryophyllaeidae) and Host fish Synodontis clarias (Linnaeus, 1758) from Lekki Lagoon, Lagos Nigeria

This study was aimed at determining the concentration of pyrethroid in the surface water, sediment, Weyonia acuminata and Synodontis clarias fish in Lekki lagoon, Lagos, Nigeria. In-situ physicochemical analysis of the surface water was conducted using a calibrated handheld multi-parameter probe (Horiba Checker Model U-10). Intestinal samples from infected and uninfected fish were analyzed for pyrethroid concentrations, microbial colonization, proteins (PRO), superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), malonaldehyde (MDA) and glutathione peroxidase (GPx). The histopathology of infected and uninfected intestinal tissues were analyzed using Haematoxylin and Eosin (H&E) stains and examined under a binocular light microscope (Model 230485). A total of 39 out of 98 S. clarias fish were infected with cestode parasite, Wenyonia acuminate, amounting to 39% parasite prevalence. Among the tested pyrethroids, Cyfluthrin and Alpha -cypermethrin had significant sorption of 1.62 and 3.27 respectively from the aqueous phase to the bottom sediment of the lagoon. Pyrethroid concentration was in the order of sediment > parasite> water > intestine> liver. The cholesterol, triglycerides, and LDL (low density lipids) in the parasite were higher than in the host fish (p<0.05). On the other hand, the fish hepatic protein, high density lipids (HDL) and glucose were higher than the levels in the parasites (p<0.05). There was a high prevalence of gut microbes (30 - 40%), which include Salmonella sp, Escherichia coli, Pseudomonas sp and Bacillus sp among individuals infected with gut Cestodes, Wenyonia sp compared with uninfected individual which had higher gut Staphylococcus sp., Klebsiella sp., and Proteus sp. (10- 40%). among the congeners of pyrethroids analyzed, Cyfluthrin > Alpha-Cyermethrin had significant sorption on the sediment, however unlike a benthopelagic fish, no pyrethroid was accumulated in the S. clarias from the sediment. The fish however accumulated Alpha-Cypermethrin from the aqueous phase. The parasite on the other hand accumulated Bathroid significantly from the surface water and bottom sediment which may be linked to the higher stress levels observed in the parasite than the host fish. The parasite in turn inflicted histological alterations on the host intestine, marked by moderate inflammation of mucosa, alteration of the villi microstructure, moderate stunting of the villous structure and moderate fibrosis of villous structure. The study demonstrated the efficiency of histopathological and microbial analysis in biomonitoring studies enteric parasites and early detection of pyrethroid toxicity respectively compared to bioaccumulation analysis.

Clinical presentation, case management and outcomes for the first 32 COVID-19 patients in Nigeria

INTRODUCTION

Success in curtailing the pandemic coronavirus disease (COVID-19) depends largely on a sound understanding of the epidemiologic and clinical profile of cases in a population as well as the case management approach. This study documents the presenting characteristics, treatment modalities and outcomes of the first 32 COVID-19 patients in Nigeria.

METHODS

This retrospective study used medical records of the first 32 patients admitted and discharged from the Mainland Hospital, Lagos State, southwest Nigeria between February 27 and April 6, 2020. The outcomes of interest were death, promptness of admission process and duration of hospitalization.

RESULTS

The mean age of the patients was 38.1 years (SD: 15.5) and 66% were male. Three-quarters (75%) of the patients presented in moderately severe condition while 16% were asymptomatic. The most common presenting symptoms were fever (59%) and dry cough (44%). The mean time between a positive test result and admission was 1.63 days (SD: 1.31). Almost all (97%) the patients were treated with lopinavir-ritonavir with no recorded death. The median duration of hospital stay was 12 days (IQR: 9-13.5).

CONCLUSION

In this preliminary analysis of the first COVID-19 cases in Nigeria, clinical presentation was mild to moderate with no mortality. Processes to improve promptness of admission and reduce hospital stay are required to enhance the response to COVID-19 in Nigeria.

Negotiating Requests for Reimbursement for Community Engagement: Challenges in Developing an Educational Video for Genomic Biobanking Research in South Africa

Genomic research and the biobanking capacity it requires are experiencing considerable growth on the continent of Africa. However genomic research and biobanking raise a range of legal, ethical, social, and cultural issues, including concerns about broad consent, confidentiality, community stigmatization, discrimination, indefinite storage, and long-term use. There is a need to establish governance frameworks that address these issues, and many international health research ethics and biobanking guidelines now recommend that the best way to do so is by involving potential research participants and key community stakeholders in the research development and the process of acquiring samples and data through active community engagement (CE). This article describes the experience and challenges in developing an educational tool as part of a CE initiative in South Africa and the commentaries reflect on how this process may be improved going forward.

The Impact of Ebola Virus Disease on Government Expenditure in Sierra Leone

Ebola Virus Diseases (EVD) epidemic had a pronounced socio-economic impact in Guinea, Liberia and Sierra Leone, which led to a considerable negative effect on the total governments' budgets. One of the Ebola-welfare transmission mechanism is the decreasing government revenue resulting from the closure of mining and food companies of the affected countries, which impact negatively on the growth of the economy and government expenditures of the affected country. This study investigates the effect of Ebola outbreak on the capital expenditure of the Sierra Leonean government. The study employs Endogenous Growth Model of Public Expenditure, which assumes that Gross National Income (GNI) growth is determined by forces governing the production process rather than by forces outside it. The data for the study were obtained from the World Bank Data repository and the International Monetary Fund, and covered the period 2006–2014. The results show that EVD impacted negatively on government capital expenditure in Sierra Leone. Hence, it is suggested that focus should be given more to the prevention of the epidemic of communicable disease.

Emerging Infectious Diseases: A Historical and Scientific Review

The chapter defines Emerging Infectious Diseases (EIDs) and provides an historical and scientific overview, to illustrate how emerging diseases have evolved over the last few decades. For various reasons, including to control and curb the spread of these diseases, global funders, researchers and epidemiologists have established in Africa, and together with African governments set up research centers both during the pre- and post-colonial era to better understand the causative agents, epidemiology and control of infectious diseases. The chapter provides historical and current perspectives of some of these research centers, including their role in the detection and control of human and animal diseases in Africa. Given the immense health and economic burdens of EIDs on both the human and animal populations in Africa, there is an urgent need for African countries to own the means and processes of disease prevention and control, and invest in preparedness measures against the outbreak of diseases.

Context and Ethical Challenges During the Ebola Outbreak in West Africa

The philosophical discipline of ethics examines good, bad, right, wrong and how people live as individuals within a community. Bioethics investigates research in healthcare and medicine, examining public policy as it relates to healthcare and how resources are allocated. This includes: difficult, private, individual decisions, which occur in clinical settings; dilemmas during clinical trials; and controversies surrounding novel research. It is important to understand that ethical considerations related to health care ethics and those that pertain to public health are often seen from different perspectives. In public health, decisions are made within a context and a framework through principles which guide action that affect communities and populations. These decisions and actions are made with and involve, stakeholders to include: traditional, community and religious leaders; government officials; and private and commercial stake holders. The underlying principles of both public health ethics and bioethics are the same, namely equality, justice, beneficence, non-maleficence, veracity and fidelity. Health care ethics supports the rights of individuals. Under the same umbrella of health care ethics are medical ethics, clinical ethics and research ethics. These disciplines offer views that support the rights of individuals. Ethics in public health is very complex with a myriad of issues to include diverse groups of people in different situations, which have to be taken into account from the view of what is best for the population. Evaluating the components of a public health system, how resources are developed and the economic support available to communities is crucial. Access to care and the equitable and just allocation of resources are important factors; and questions about equal access for the poor, the socially disadvantaged and immigrants should be examined.

Baobab Laboratory Information Management System: Development of an Open-Source Laboratory Information Management System for Biobanking

A laboratory information management system (LIMS) is central to the informatics infrastructure that underlies biobanking activities. To date, a wide range of commercial and open-source LIMSs are available and the decision to opt for one LIMS over another is often influenced by the needs of the biobank clients and researchers, as well as available financial resources. The Baobab LIMS was developed by customizing the Bika LIMS software (www.bikalims.org) to meet the requirements of biobanking best practices. The need to implement biobank standard operation procedures as well as stimulate the use of standards for biobank data representation motivated the implementation of Baobab LIMS, an open-source LIMS for Biobanking. Baobab LIMS comprises modules for biospecimen kit assembly, shipping of biospecimen kits, storage management, analysis requests, reporting, and invoicing. The Baobab LIMS is based on the Plone web-content management framework. All the system requirements for Plone are applicable to Baobab LIMS, including the need for a server with at least 8 GB RAM and 120 GB hard disk space. Baobab LIMS is a server–client-based system, whereby the end user is able to access the system securely through the internet on a standard web browser, thereby eliminating the need for standalone installations on all machines.

African civil society initiatives to drive a biobanking, biosecurity and infrastructure development agenda in the wake of the West African Ebola outbreak

This paper describes the formation of a civil society consortium, spurred to action by frustration over the Ebola crises, to facilitate the development of infrastructure and frameworks including policy development to support a harmonized, African approach to health crises on the continent. The Global Emerging Pathogens Treatment Consortium, or GET, is an important example of how African academics, scientists, clinicians and civil society have come together to initiate policy research, multilevel advocacy and implementation of initiatives aimed at building African capacity for timely and effective mitigations strategies against emerging infectious and neglected pathogens, with a focus on biobanking and biosecurity. The consortium has been able to establish it self as a leading voice, drawing attention to scientific infrastructure gaps, the importance of cultural sensitivities, and the power of community engagement. The GET consortium demonstrates how civil society can work together, encourage government engagement and strengthen national and regional efforts to build capacity.

Taking the bull by the horns: Ethical considerations in the design and implementation of an Ebola virus therapy trial

Ebola virus is categorized as one of the most dangerous pathogens in the world. Although there is no known cure for Ebola virus, there is some evidence that the severity of the disease can be curtailed using plasma from survivors. Although there is a general consensus on the importance of research, methodological and ethical challenges for conducting research in an emergency situation have been identified. Performing clinical trials is important, especially for health conditions that are of public health significance (including rare epidemics) to develop new therapies as well as to test the efficacy and effectiveness of new interventions. However, routine clinical trial procedures can be difficult to apply in emergency public health crises hence require a consideration of alternative approaches on how therapies in these situations are tested and brought to the market. This paper examines some of the ethical issues that arise when conducting clinical trials during a highly dangerous pathogen outbreak, with a special focus on the Ebola virus outbreak in West Africa. The issues presented here come from a review of a protocol that was submitted to the Global Emerging Pathogens Treatment Consortium (GET). In reviewing the proposal, which was about conducting a clinical trial to evaluate the safety and efficacy of using convalescent plasma in the management of Ebola virus disease, the authors deliberated on various issues, which were documented as minutes and later used as a basis for this paper. The experiences and reflections shared by the authors, who came from different regions and disciplines across Africa, present wide-ranging perspectives on the conduct of clinical trials during a dangerous disease outbreak in a resource-poor setting.

Addressing ethical issues in H3Africa research – the views of research ethics committee members

In June 2014, the H3Africa Working Group on Ethics organised a workshop with members of over 40 research ethics committees from across Africa to discuss the ethical challenges raised in H3Africa research, and to receive input on the proposed H3Africa governance framework. Prominent amongst a myriad of ethical issues raised by meeting participants were concerns over consent for future use of samples and data, the role of community engagement in large international collaborative projects, and particular features of the governance of sample sharing. This report describes these concerns in detail and will be informative to researchers wishing to conduct genomic research on diseases pertinent to the African research context.

The H3Africa policy framework: negotiating fairness in genomics

Human Heredity and Health in Africa (H3Africa) research seeks to promote fair collaboration between scientists in Africa and those from elsewhere. Here, we outline how concerns over inequality and exploitation led to a policy framework that places a firm focus on African leadership and capacity building as guiding principles for African genomics research.

A perpetual source of DNA or something really different: ethical issues in the creation of cell lines for African genomics research

Background

The rise of genomic studies in Africa – not least due to projects funded under H3Africa – is associated with the development of a small number of biorepositories across Africa. For the ultimate success of these biorepositories, the creation of cell lines including those from selected H3Africa samples would be beneficial. In this paper, we map ethical challenges in the creation of cell lines.

Discussion

The first challenge we identified relates to the moral status of cells living in culture. There is no doubt that cells in culture are alive, and the question is how this characteristic is relevant to ethical decision-making. The second challenge relates to the fact that cells in culture are a source of cell products and mitochondrial DNA. In combination with other technologies, cells in culture could also be used to grow human tissue. Whilst on the one hand, this feature increases the potential utility of the sample and promotes science, on the other it also enables further scientific work that may not have been specifically consented to or approved. The third challenge relates to ownership over samples, particularly in cases where cell lines are created by a biobank, and in a different country than where samples were collected. Relevant questions here concern the export of samples, approval of secondary use and the acceptability of commercialisation. A fourth challenge relates to perceptions of blood and bodily integrity, which may be particularly relevant for African research participants from certain cultures or backgrounds. Finally, we discuss challenges around informed consent and ethical review.

Summary

In this paper, we sought to map the myriad of ethical challenges that need to be considered prior to making cell line creation a reality in the H3Africa project. Considering the relative novelty of this practice in Africa, such challenges will need to be considered, discussed and potentially be resolved before cell line creation in Africa becomes financially feasible and sustainable. We suggest that discussions need to be undertaken between stakeholders internationally, considering the international character of the H3Africa project. We also map out avenues for empirical research.

Diagnosis and management of lymphomas and other cancers in HIV-infected patients

Despite the introduction of highly active antiretroviral therapy or combination antiretroviral therapy (HAART and cART, respectively) patients infected with HIV might develop certain types of cancer more frequently than uninfected people. Lymphomas represent the most frequent malignancy among patients with HIV. Other cancer types that have increased in these patients include Kaposi sarcoma, cancer of the cervix, anus, lung and liver. In the post-HAART era, however, patients with HIV have experienced a significant improvement in their morbidity, mortality and life expectancy. This Review focuses on the different types of lymphomas that generally occur in patients with HIV. The combination of cART and antineoplastic treatment has resulted in remarkable prolongation of disease-free survival and overall survival among patients with HIV who develop lymphoma. However, the survival in these patients still lags behind that of patients with lymphoma who are not infected with HIV. We also provide an update of epidemiological data, diagnostic issues, and strategies regarding the most-appropriate management of patients with both HIV and lymphomas.

Challenges of biobanking in South Africa to facilitate indigenous research in an environment burdened with human immunodeficiency virus, tuberculosis, and emerging noncommunicable diseases

The high burden of infectious diseases and the growing problem of noncommunicable and metabolic disease syndromes in South Africa (SA) forces a more focused research approach to facilitate cutting-edge scientific growth and public health development. Increased SA research on these diseases and syndromes and the collection of associated biospecimens has ensured a plethora of biobanks created by individuals, albeit without the foresight of prospective and collective use by other local and international researchers. As the need for access to high-quality specimens in statistically relevant numbers has increased, so has the necessity for the development of national human biobanks in SA and across the Continent. The prospects of achieving sustainable centralized biobanks are still an emerging and evolving concept, primarily and recently driven by the launch of the H3Africa consortium, which includes the development of harmonized and standardized biobanking operating procedures. This process is hindered by a myriad of complex societal considerations and ethico-legal challenges. Efforts to consolidate and standardize biological sample collections are further compromised by the lack of full appreciation by national stakeholders of the biological value inherent in these collections, and the availability of high quality human samples with well-annotated data for future scientific research and development. Inadequate or nonexistent legislative structures that specifically regulate the storage, use, dispersal, and disposal of human biological samples are common phenomena and pose further challenges. Furthermore, concerns relating to consent for unspecified future uses, as well as access to information and data protection, are all new paradigms that require further consideration and public engagement. This article reviews important fundamental issues such as governance, ethics, infrastructure, and bioinformatics that are important foundational prerequisites for the establishment and evolution of successful human biobanking in South Africa.

Incidence of haemolytic disease of the newborn in Harare, Zimbabwe

BACKGROUND

Haemolytic Disease of Newborn is responsible for a number of neonatal deaths and complications worldwide. Its incidence in Zimbabwe is not clearly understood.

OBJECTIVE

To find out incidence of Haemolytic Disease of Newborn in Harare and ability to identify antibodies associated with HDN.

METHODS

A retrospective cross sectional study at the Parirenyatwa Group of Hospitals and National Blood Service, Zimbabwe (NBSZ). We studied 22493 infants at Parirenyatwa Hospital during the 1995-1997 and 2002-2003 periods. The main outcome measures were ABO and Rh blood group results, Direct Antiglobulin Test and Maternal Antibody Screening and Identification Results were obtained from the NBSZ.

RESULTS

One hundred and ninety-one (0.85%) infants had Haemolytic Disease of Newborn. One hundred and sixty-three (85.34%) of these were due to anti-AB, twenty five (13.09%) were due to anti-D and three (1.57%) due to anti-Kell. Incidence of Haemolytic Disease of Newborn during 1995-1997 and 2002-2003, were 0.93% and 0.64%, respectively (p = 0.014). ABO Haemolytic Disease of Newborn showed a statistically significant difference during the two periods (p = 0.003). Rhesus Haemolytic Disease of Newborn showed no statistically significant difference during same periods (p = 0.317).

CONCLUSION

The incidence of Haemolytic Disease of Newborn at Parirenyatwa Hospital is comparable with that found in other countries. It is recommended that K antigen be included in the pretransfusion testing to avoid anti-K related Haemolytic Disease of Newborn.

The human immunodeficiency virus epidemic: a race against time for millions and the role of flow cytometry. A Caribbean and resource-constrained country perspective

There is a race against time for millions in the world today. Both the technology and the manpower are currently available to deliver the services that are required to meet the needs of the 40 million people currently living with HIV/AIDS, but at what price? The reality is therefore that we are a long shot away from this realization. What are the facts and why have we not achieved even the simplest deadlines set by the World Health Organization (WHO)? Are these objectives realistic? What role does hard science have to play in the search for cost-effective solutions and futuristic effective options? To stem this unrelenting epidemic and convert the natural history of the disorder in those already living with the virus into one of chronicity, rather than one characterized by a dehumanizing and stigmatized death, requires a global commitment at all levels. This discussion examines the reality and offers a snapshot of capacity and experiences in the developing world. Crucially, it looks at the immediate and long term role of flow cytometry in the expanded care and treatment programs for developing nations.

Wireless networks for surveillance, data capture and data management in the human immunodeficiency virus epidemic care and treatment programmes

Biomedical and demographic data capture and the subsequent management of such information are critical factors in the implementation of any level of healthcare prevention and treatment program. The developing world is seriously handicapped by lack of infrastructure to acquire such data let alone manipulate the information banks for projections, forecasting and priority project planning. With this in mind we set about to use the recent proliferation of wireless cellular networks and easily accessible Personal Digital Assistants (PDA), to devise a means of collecting such data even from the most remote primary healthcare facility. Our priority is aimed at initially at providing a support technology for the HIV expanded program. This technology can be implemented in the absence of computerization and regular power supply. Utilizing a PDA to capture patient data (demographic, clinical and laboratory parameters), the healthcare giver can use a wireless link between the PDA and a cellular phone to transfer the data to a central medical data base. These can then become permanent and secure data banks for future use by health providers, either at the same location or at other health facility that have authorized access to the data bank. It also affords a platform for integrating reference labs into the network as well as the opportunity to disseminate continuing medical educational material. The network can also be adapted to electronic remote consultations and eventually its data banks can be assimilated into protocols of artificial intelligence and data mining.

Responding to the HIV epidemic in the developing world. Capacity building and technology transfer for monitoring with HAART: a Caribbean experience

This paper examines the concept of a developing nation that has a high HIV prevalence and lacks appropriate laboratory infrastructure necessary to cope with a treatment and care program. Several issues are discussed including personal experience in the context of project management for the creation and coordination of a facility aimed at providing the laboratory support required for the appropriate delivery and monitoring of HAART. Key issues about political will and prioritization are discussed in concert with current international guidelines and mechanisms of technology transfer and human resource development. The paper gives the benefit of the teams experience in coordinating the project, dealing specifically with issues such as the process of equipment procurement, staff recruitment, and capacity building. The need for the highest level of quality control and standard operating practices are discussed in the context of limited regional expertise and manpower support. Emphasis is placed on the long term objectives of operational research focusing on cheaper and simpler algorithms for monitoring and providing support for a comprehensive but affordable and sustainable program.

Demographic and social characteristics of regular donors who sero-converted in Harare

Zimbabwe, like any other country, is currently experiencing a fast growing HIV/AIDS pandemic. A considerable number of infections are caused by blood transfusion. The aim of this study is to determine risk factors, events and socio-demographic characteristics associated with incidence of HIV infections and to prevent sero-conversion of regular blood donor. A retrospective cross sectional study was done. 22,922 regular donors at National Blood Transfusion Services in Harare were used. The number of all regular donors who sero-converted and their status during the 1999 to 2001 period were determined. About 327 (1.4%) of the regular donors sero-converted. Two hundred and seventy-four (84%) were males and 53(16%) were females. 52.6% of the males were married, 46.7% were single and .7% separated. 30.2% of the females were married, single women 67.9% and separated women 1.9%. Increased sero-conversion was associated with unemployment, high-density area residence and the sexually active age group (21 to 45 year olds). There was an association between gender and marital status among sero-converters (c2 = 8.48; P-value = 0.014) and males were likely to be older than females (t = 2.9; P-value = 0.0019). It can be concluded that unemployment and living in high-density residential areas are highly associated with HIV sero-conversion among regular donors. Single females, working class males and the sexually active age group are highly exposed to risk factors. It is recommended that donor education schemes and knowledge of these factors should be considered during donor recruitment.

Characteristics of lymphocyte subsets in a normal Afro-Caribbean population and the implications in HIV management

The Caribbean relies on normal lymphocyte subsets ranges established in other geographical locations and from different racial ethnic groups for the basis of the clinical management of HIV and AIDS with Highly Active Anti Retroviral Therapy (HAART). Normal ranges of these parameters have not been previously established in an Afro-Caribbean population. So we set out to determine how the normal lymphocyte subset ranges compare to those reported in other, races and geographical locations. A prospective study was done on 112 healthy Afro-Caribbean clients who attended the Blood Collection Unit, Queen Elizabeth Hospital, Barbados from July 15th to November 12th 2004. Analysis for lymphocyte subsets was done by flow cytometry, which allows simultaneous identification and enumeration of total T Helper, cytotoxic T, natural killer and B lymphocyte cells. HIV-1, Hepatitis B and C, HTLV-1 and full blood count test were done as part of the normal screening routine of all blood donors. Absolute white blood cell counts and percentage lymphocytes for males and females were not significantly different, and the absolute and percentage of the T-Helper CD4 positive lymphocyte cells were not significantly higher in females than in males. Absolute Cytotoxic T cell CD8 positive lymphocyte cells were higher in males than in females. CD56 Natural Killer cells absolute and percentage counts were higher in males than females however CD19 B Lympocyte absolute and percentage counts were not different between the two sexes in this sample population. Compared to published normal ranges published by the WHO and CDC, there were no significantly differences observed in any of the lymphocyte subsets. These finding are very similar to what has been reported in previous studies. We conclude that WHO/CDC recommendations established for the treatment and monitoring of HIV/AIDS patients based on CD4 levels can be safely utilized in our population.

Quality control of the total lymphocyte count parameter obtained from routine haematology analyzers, and its relevance in HIV management

Lylmphocyte subsets/CD4 T Helper cell enumeration in HIV care and treatment in resource constrained settings can be difficult to ascertain as a result of the lack of the necessary instrumentation, capacity and infrastructure. However. it is imperative to gain such information for patient monitoring in HIV. The Total Lymphocyte Count (TLC) is useful as a surrogate marker for CD4 count as recommended by the World Health Organisation (WHO) and to calculate CD4% for pacdiatric use. This study therefore sets out to determine and compare the accuracy of the total lymphocyte counts obtained from three haematology analysers designated A. B and C. that are in regular use for routine haemnatological parameters at the main referral hospital in Barbados. West Indies. The TLC of 263 HIV treatment naive individuals attending the HIV Reference Unit in Barbados were enumnerated on the three haematology analysers. The lymphosumn (Sum of lymphocyte subsets: T-helper cell. T-cytotoxic cells. B lymphocytes and Natural killer cells) should be equal to the TLC. and is derived by immunophenotypic analysis on a 4-colour flowcytometer. Machine C had the highest positive correlation between the TLC and the lymphosumn with and R' of 0.9031 compared to machine A with an R values of 0.7119 and Machine B with R(2) values of 0.637. These results show that there can be dramatic inaccuracies when using routine haematology analysers for both routine use. as a surrogate marker of CD4 or for derivation of CD4% in HIV management. It further demonstrates that all haematology analyzers require some form of Quality control. The possible lack of accuracy of the TLC by haematology analysers should be taken into consideration when following the recommendations of the WHO in resource poor settings or using it as a denominator for calculating CD4%.

Prevalence of HIV infection in school based and other young donors during the 2002 and 2003 period

The majority of donor blood in Zimbabwe comes from school-based donors. Zimbabwe has one of the highest HIV prevalences in the world and the age at which the infection is acquired is decreasing. This is a serious threat to the safety of blood supply. The prevalence of HIV has been low among the youth the majority of whom are still going to school and between the ages of sixteen and nineteen years. However, due to the changing socio-economic environment, sexual behavioural patterns have also changed. It is now necessary to evaluate these changes in order to guarantee safe blood transfusion. To determine the prevalence of HIV among adolescent donors during the period between 2002 and 2003. Cross-sectional retrospective study, National Blood Transfusion Service (NBTS). All school based donors and others between 16 and 19 years of age. The number of donors who were HIV positive in this age group. Data on donors was collected from computer files at the National Blood Transfusion Service (NBTS) Information Technology (IT) department. Prevalence of HIV was determined and categorised according to gender, age and the type of school the donor attended. The prevalence of HIV in 2002 and 2003 were 0.48% and 0.38%, respectively. Sixty-six per cent (66%) of HIV positive donors had donated for the first time. The prevalence in both periods was much higher in female donors than male donors. In 2002 males and females had prevalence of 0.28% and 0.66%, respectively. In 2003 males and females had prevalence of 0.18% and 0.55%, respectively. The overall highest prevalence (0.90%) was found between the 16-19 year age group who were not going to school (others). In 2002 female day schools had the highest (0.87%). The lowest prevalence (0%) was found in male boarding schools. In 2003 the highest prevalence (1.61%) was found in the 16-19 year age group who were not going to school (others). The lowest prevalence (0) in the same year was found in male boarding scholars. It can be concluded that the majority of HIV positive school based donors are first time donors. Female scholars and those of the same age group who are not going to school have the highest risk of donating HIV positive blood than male donors. The prevalence of HIV in adolescent blood donors decreased with age. It is recommended that active donor recruitment should be in favour of the low prevalence groups.

Analysis of diurnal variation of lymphocyte subsets in healthy subjects in the Caribbean, and its implication in HIV monitoring and treatment

Absolute values of the lymphocyte subsets are known to be influenced by various biological factors. We set out to determine if diurnal variations in lymphocyte subsets occur in our population. A prospective study was done on 25 randomly chosen healthy subjects. Persons were enrolled for the early morning to mid afternoon study i.e. 8:30, 12:30 and 15:30. In a second study, samples were collected at hourly intervals from 08:30 to 12:30. The EDTA samples were analyzed for lymphocyte subsets by flowcytomery. In the first study, the results have shown that there was a progressive increase in CD4 cell count throughout the day, while CD8 and CD19 cell counts increased between 08:30am and mid-day and then there was no further change between midday and mid afternoon. CD56 was uniform throughout the whole day. As most clinics and venesections take place in the morning, the aim of the second part of the study was to focus on the nature of the changes observed in the morning to midday phase. The results have shown that there were no significant changes in the lymphocyte subset counts before 11:30, thereafter there was a progressive increase in all of the lymphocyte subsets between 11:30 and 12:30 except for the CD56 cell count. This study has shown that diurnal rhythms influence the lymphocyte subsets in a normal population. This may have major implications in the use of CD4 subset analysis in the management of HIV infected persons as an indicator for initiation of treatment. In our setting. pending the results of diurnal variation studies on PLWHA, we have set the latest blood collection time at 11:30 am.