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Anyaka CU, Alero BJ, Olukoya B, Envuladu EA, Musa J, Sagay AS. Parental Knowledge of HPV Infection, Cervical Cancer and the Acceptance of HPV Vaccination for their Children in Jos, Nigeria. J West Afr Coll Surg 2024; 14:146-153. [PMID: 38562384 PMCID: PMC10980327 DOI: 10.4103/jwas.jwas_309_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 10/25/2023] [Indexed: 04/04/2024]
Abstract
Background Despite the high prevalence of human papillomavirus (HPV) infections and cervical cancer in Nigeria, the utilization of the HPV vaccine as a highly effective preventive measure remains low. The aim of this study was to find out if parental knowledge of HPV infection and cervical cancer influenced the acceptance of HPV vaccines for their 9-14-year-old children. Materials and Methods This was a cross-sectional survey of 509 parents comprising 262 fathers and 247 mothers in 8 randomly selected communities in Jos, Plateau State Nigeria. A pretested semi-structured investigator-administered questionnaire, without identifiers, was used to collect information on parental knowledge of HPV, cervical cancer, HPV vaccine and its acceptance for their 9-14-year-old children. The data were analysed using SPSS version 23.0. Bivariate analysis was done using chi-square statistical test. Point estimates with corresponding 95% confidence interval (CI) were estimated with a value of P ≤ 0.05 was considered as statistically significant. Results Five hundred and nine parents were interviewed. The mean age of the respondents was 43.7 ± 9.43 years. Most of the participants (86.1%) had formal education from primary to tertiary level. Only 1.60%, 11.60% and 1.62% of respondents had knowledge of HPV, cervical cancer and HPV vaccines respectively, whereas 67.8% of parents were willing to pay for the cancer-preventing HPV vaccines out-of-pocket. There was no statistically significant associations between parental level of education (P = 0.056), parental knowledge of cancer of cervix (P = 0.483), religion of parents (P = 0.324) and the acceptance of HPV vaccination for their children. There was a statistically significant association between parental willingness to pay for HPV vaccines if not offered free (P = 0.001) with acceptance of vaccination. Vaccine acceptability was associated with positive attitude towards the vaccine (odds ratio [OR] = 4.178; 95% CI, 1.714-10.180; P = 0.002), whereas parental knowledge of HPV, cervical cancer and HPV vaccine did not show significant association with acceptability of HPV vaccination for their children. Conclusion Despite poor parental knowledge of HPV infection and cervical cancer, there was high acceptability of HPV vaccination for their children. HPV vaccination was acceptable to parents regardless of educational level or religion. Parents in Jos communities seems to have much faith in preventive vaccines as advertised by the health authorities. Accordingly, efforts should be geared towards ensuring availability, affordability and the provision of basic information regarding HPV vaccination in Northern Nigeria.
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Affiliation(s)
- Charles U Anyaka
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Babalola-Jacobs Alero
- Infectious Disease Unit (APIN), Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | | | - Esther A Envuladu
- Department of Community Health, University of Jos, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
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Ebonyi AO, Okpokwu J, Rawizza H, Chebu P, Chaplin B, Hamel D, Oguche S, Agbaji OO, Sagay AS, Kanki PJ, Imade GE. Pretreatment and Acquired Drug Resistance in Children With Human Immunodeficiency Virus Type 1 in Jos, Nigeria. Open Forum Infect Dis 2024; 11:ofae092. [PMID: 38464491 PMCID: PMC10921386 DOI: 10.1093/ofid/ofae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
We determined pretreatment and acquired human immunodeficiency virus (HIV) drug resistance among children with HIV type 1 (HIV-1) in Jos, Nigeria. The majority (71%) of those who failed first-line antiretroviral therapy were on a nevirapine-containing regimen. The prevalence of pretreatment (48%) and acquired (76%) HIV drug resistance mutations was high in our study. Wider access to HIV drug resistance testing after treatment failure is necessary to optimize second-line treatment options among children with HIV in Nigeria.
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Affiliation(s)
- Augustine O Ebonyi
- Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Jonathan Okpokwu
- AIDS Prevention Initiative in Nigeria–supported ISO 15189 Laboratory, Jos University Teaching Hospital, Jos, Nigeria
| | - Holly Rawizza
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Philippe Chebu
- APIN Public Health Initiatives, Plot 1551, Apo Resettlement, Apo District, Abuja, FCT, Nigeria
| | - Beth Chaplin
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Donald Hamel
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen Oguche
- Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O Agbaji
- Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Godwin E Imade
- AIDS Prevention Initiative in Nigeria–supported ISO 15189 Laboratory, Jos University Teaching Hospital, Jos, Nigeria
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
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Sagay AS, Hsieh SC, Dai YC, Chang CA, Ogwuche J, Ige OO, Kahansim ML, Chaplin B, Imade G, Elujoba M, Paul M, Hamel DJ, Furuya H, Khouri R, Boaventura VS, de Moraes L, Kanki PJ, Wang WK. Chikungunya virus antepartum transmission and abnormal infant outcomes in a cohort of pregnant women in Nigeria. Int J Infect Dis 2024; 139:92-100. [PMID: 38056689 PMCID: PMC10843725 DOI: 10.1016/j.ijid.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES Chikungunya virus (CHIKV), a reemerging global public health concern, which causes acute febrile illness, rash, and arthralgia and may affect both mothers and infants during pregnancy. Mother-to-child transmission (MTCT) of CHIKV in Africa remains understudied. METHODS Our cohort study screened 1006 pregnant women with a Zika/dengue/CHIKV rapid test at two clinics in Nigeria between 2019 and 2022. Women who tested positive for the rapid test were followed through their pregnancy and their infants were observed for 6 months, with a subset tested by reverse transcription-polymerase chain reaction (RT-PCR) and neutralization, to investigate seropositivity rates and MTCT of CHIKV. RESULTS Of the 1006, 119 tested positive for CHIKV immunoglobulin (Ig)M, of which 36 underwent detailed laboratory tests. While none of the IgM reactive samples were RT-PCR positive, 14 symptomatic pregnant women were confirmed by CHIKV neutralization test. Twelve babies were followed with eight normal and four abnormal outcomes, including stillbirth, cleft lip/palate with microcephaly, preterm delivery, polydactyly with sepsis, and jaundice. CHIKV IgM testing identified three possible antepartum transmissions. CONCLUSION In Nigeria, we found significant CHIKV infection in pregnancy and possible CHIKV antepartum transmission associated with birth abnormalities.
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Affiliation(s)
- Atiene S Sagay
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - Szu-Chia Hsieh
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Yu-Ching Dai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Charlotte Ajeong Chang
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Olukemi O Ige
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | | | - Beth Chaplin
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Godwin Imade
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | | | - Michael Paul
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - Donald J Hamel
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Hideki Furuya
- Department of Biomedical Science, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Ricardo Khouri
- Instituto Gonçalo Moniz -Oswaldo Cruz Foundation (FIOCRUZ), Bahia, Brazil
| | | | - Laíse de Moraes
- Instituto Gonçalo Moniz -Oswaldo Cruz Foundation (FIOCRUZ), Bahia, Brazil
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
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Magaji FA, Mashor MI, Anzaku SA, Hinjari AR, Cosmas NT, Kwaghe BV, Ali JM, Christian EN, Sagay AS, Chandler A, Khan I, Murphy RL, Hou L, Musa J. Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria. BMC Public Health 2024; 24:193. [PMID: 38229083 PMCID: PMC10790377 DOI: 10.1186/s12889-024-17739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/10/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. METHODS A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. RESULTS Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. CONCLUSIONS The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.
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Affiliation(s)
- F A Magaji
- Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria.
- College of Health Sciences, University of Jos, Jos, Nigeria.
| | - M I Mashor
- Department of Histopathology, Jos, Nigeria
- Bingham University Teaching Hospital, Jos, Nigeria
| | - S A Anzaku
- Bingham University Teaching Hospital, Jos, Nigeria
| | - A R Hinjari
- Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
- College of Health Sciences, University of Jos, Jos, Nigeria
| | - N T Cosmas
- Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
- Department of Medical Microbiology, Jos, Nigeria
| | - B V Kwaghe
- Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - J M Ali
- Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
- College of Health Sciences, University of Jos, Jos, Nigeria
| | - Elizabeth N Christian
- Robert J. Havey, MD Institute for Global Health, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A S Sagay
- Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
- College of Health Sciences, University of Jos, Jos, Nigeria
| | - Ariel Chandler
- Program Department Health Analytics, School of Professional Studies, Northwestern University, Chicago, IL, USA
| | - Imran Khan
- Program Department Health Analytics, School of Professional Studies, Northwestern University, Chicago, IL, USA
| | - Robert L Murphy
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Global Oncology, Institute for Global Health, Chicago, IL, USA
| | - Lifang Hou
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Division of Cancer Epidemiology & Prevention, Chicago, IL, USA
| | - J Musa
- Gynecologic-Oncology Division, Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
- College of Health Sciences, University of Jos, Jos, Nigeria
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Habila MA, Sagay E, Obeng-Kusi M, Ali MJ, Magaji FA, Shambe IH, Daru PH, Jacobs ET, Madhivanan P, Sagay AS, Musa J. Utilization of opportunistic cervical cancer screening in Nigeria. Cancer Causes Control 2024; 35:9-20. [PMID: 37530986 DOI: 10.1007/s10552-023-01764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While various interventions have been conducted to decrease cervical cancer's burden in Nigeria, no study has examined the trends in cervical cancer screening uptake over time. The present study sought to fill this gap in knowledge using data collected at Jos University Teaching Hospital (JUTH) in Nigeria. METHODS Data collected continuously between 2006 and 2016 were analyzed to identify trends in screening uptake, changes in risk factors for cervical cancer, and to identify factors for women screened at Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Categorical analyses and logistic regression models were used to describe patient characteristics by year, and to identify factors associated with repeated screening uptake. RESULTS A total of 14,088 women who were screened between 2006 and 2016 were included in the database; 2,800 women had more than one screening visit. Overall, screening uptake differed significantly by year. On average women were first screened at age 38. About 2% of women screened were women living with HIV. Most women (86%) had normal pap smear at first screening, with the greatest decreased risk of abnormalities observed between 2011 and 2014. Odds of a follow-up screening after a normal result decreased significantly between 2008 and 2016 compared to women screened in 2006 and 2007. Finally, women living with HIV had increased odds of follow-up screening after having a normal pap smear. CONCLUSIONS These findings contribute to our understanding of the potential social and health system barriers to cervical cancer control in Nigeria. The findings may assist policy makers to design interventions to increase access and compliance to recommended screening schedules in this vulnerable population.
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Affiliation(s)
- Magdiel A Habila
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Emmanuel Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Mavis Obeng-Kusi
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Maryam J Ali
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Public Health Research Institute of India, Mysore, India
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ogwuche J, Chang CA, Ige O, Sagay AS, Chaplin B, Kahansim ML, Paul M, Elujoba M, Imade G, Kweashi G, Dai YC, Hsieh SC, Wang WK, Hamel DJ, Kanki PJ. Arbovirus surveillance in pregnant women in north-central Nigeria, 2019-2022. J Clin Virol 2023; 169:105616. [PMID: 37944259 PMCID: PMC10841754 DOI: 10.1016/j.jcv.2023.105616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The adverse impact of Zika (ZIKV), dengue (DENV), and chikungunya (CHIKV) virus infection in pregnancy has been recognized in Latin America and Asia but is not well studied in Africa. Although originally discovered in sub-Saharan Africa the non-specific clinical presentation of arbovirus infection may have hampered our detection of adverse clinical outcomes and outbreak. OBJECTIVE This prospective study of arbovirus infection in pregnant women in north-central Nigeria sought to characterize the prevalence of acute arbovirus infection and determine the impact on pregnancy and infant outcomes. METHODS In Nigeria, we screened 1006 pregnant women for ZIKV, DENV and CHIKV IgM/IgG by rapid test (2019-2022). Women with acute infection were recruited for prospective study and infants were examined for any abnormalities from delivery through six months. A subset of rapid test-reactive samples were confirmed using virus-specific ELISAs and neutralization assays. RESULTS The prevalence of acute infection (IgM+) was 3.8 %, 9.9 % and 11.8 % for ZIKV, DENV and CHIKV, respectively; co-infections represented 24.5 % of all infections. The prevalence in asymptomatic women was twice the level of symptomatic infection. We found a significant association between acute maternal ZIKV/DENV/CHIKV infection and any gross abnormal birth outcome (p = 0.014). CONCLUSIONS Over three rainy seasons, regular acute infection with ZIKV, DENV, and CHIKV was observed with significantly higher rates in pregnant women without symptoms. The potential association arbovirus infection with abnormal birth outcome warrants further prospective study to ascertain the clinical significance of these endemic arboviruses in Africa.
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Affiliation(s)
| | - Charlotte Ajeong Chang
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Olukemi Ige
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - Atiene S Sagay
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | - Beth Chaplin
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Michael Paul
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | | | - Godwin Imade
- Jos University Teaching Hospital, University of Jos, Jos, Nigeria
| | | | - Yu-Ching Dai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Szu-Chia Hsieh
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Donald J Hamel
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Habila MA, Obeng-Kusi M, Ali MJ, Magaji FA, Shambe IH, Daru PH, Jacobs ET, Madhivanan P, Sagay AS, Musa J. The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria. BMC Womens Health 2023; 23:640. [PMID: 38037005 PMCID: PMC10687784 DOI: 10.1186/s12905-023-02782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria. METHODS Longitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions. RESULTS We included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care. CONCLUSIONS Overall, we found that COVID-19 pandemic mitigation efforts significantly influenced women's ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations.
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Affiliation(s)
- Magdiel A Habila
- Mel and Enid, Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Mavis Obeng-Kusi
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Maryam J Ali
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Elizabeth T Jacobs
- Mel and Enid, Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Purnima Madhivanan
- Mel and Enid, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Public Health Research Institute of India, Mysore, India
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Musa J, Kocherginsky M, Magaji FA, Maryam AJ, Asufi J, Nenrot D, Burdett K, Katam N, Christian EN, Palanisamy N, Odukoya O, Silas OA, Abdulkareem F, Akpa P, Badmos K, Imade GE, Akanmu AS, Gursel DB, Zheng Y, Joyce BT, Achenbach CJ, Sagay AS, Anorlu R, Wei JJ, Ogunsola F, Murphy RL, Hou L, Simon MA. Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria. Infect Agent Cancer 2023; 18:68. [PMID: 37915091 PMCID: PMC10619301 DOI: 10.1186/s13027-023-00550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. METHODS We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. RESULTS A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC + (P < 0.001). Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV +/ICC + diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC +. The HIV-/ICC + women had better OS compared to HIV +/ICC + participants (p = 0.018), with 12-month OS 84.1% (95%CI 75-90%) and 67.6% (95%CI 42-84%) respectively. CONCLUSION ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria.
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA.
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Masha Kocherginsky
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Ali J Maryam
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Joyce Asufi
- Department of Nursing, Oncology Unit and Nursing Education, Jos University Teaching Hospital, Jos, Nigeria
| | - Danjuma Nenrot
- Information Technology and Data Management Unit, Adult HIV Clinic, Jos University Teaching Hospital, Jos, Nigeria
| | - Kirsten Burdett
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Neelima Katam
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth N Christian
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Nisha Palanisamy
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Olukemi Odukoya
- Department of Community Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olugbenga A Silas
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Fatimah Abdulkareem
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Philip Akpa
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Kabir Badmos
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Godwin E Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Alani S Akanmu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Demirkan B Gursel
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Brian T Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Chad J Achenbach
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Robert L Murphy
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Melissa A Simon
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Musa J, Kocherginsky M, Magaji FA, Maryam AJ, Asufi J, Nenrot D, Burdett K, Katam N, Christian EN, Palanisamy N, Odukoya O, Silas OA, Abdulkareem F, Akpa P, Badmos K, Imade GE, Akanmu AS, Gursel DB, Zheng Y, Joyce BT, Achenbach CJ, Sagay AS, Anorlu R, Wei JJ, Ogunsola F, Murphy RL, Hou L, Simon MA. Epidemiology and Survival outcomes of HIV-associated cervical cancer in Nigeria. medRxiv 2023:2023.08.08.23293820. [PMID: 37609183 PMCID: PMC10441483 DOI: 10.1101/2023.08.08.23293820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Introduction Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. Methods We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. Results A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC+), and 47 (19.7%) were HIV-positive (HIV+/ICC+). The HIV+/ICC) patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC+) (P<0.001. Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV+/ICC+ diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC+. The HIV-/ICC+ women had better OS compared to HIV+/ICC+ participants (p=0.018), with 12-month OS 84.1% (95%CI: 75% - 90%) and 67.6% (95%CI: 42%-84%) respectively. Conclusion ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Masha Kocherginsky
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Francis A. Magaji
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Ali J. Maryam
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Joyce Asufi
- Department of Nursing, Oncology Unit and Nursing Education, Jos University Teaching Hospital, Jos, Nigeria
| | - Danjuma Nenrot
- Information Technology and Data Management Unit, Adult HIV clinic, Jos University Teaching Hospital, Jos, Nigeria
| | - Kristen Burdett
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Neelima Katam
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth N. Christian
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Nisha Palanisamy
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Olukemi Odukoya
- Department of Community Medicine, College of Medicine, University of Lagos, Nigeria
| | - Olugbenga A. Silas
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Nigeria
| | - Fatimah Abdulkareem
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Nigeria
| | - Philip Akpa
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Nigeria
| | - Kabir Badmos
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Nigeria
| | - Godwin E. Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Nigeria
| | - Alani S. Akanmu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, Nigeria
| | - Demirkan B. Gursel
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
| | - Brian T. Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
| | - Chad J. Achenbach
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S. Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Nigeria
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Nigeria
| | - Robert L. Murphy
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Melissa A. Simon
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Sagay AS, Hsieh SC, Dai YC, Chang CA, Ogwuche J, Ige OO, Kahansim ML, Chaplin B, Imade G, Elujoba M, Paul M, Hamel DJ, Furuya H, Khoury R, Boaventura VS, de Moraes L, Kanki PJ, Wang WK. Chikungunya virus antepartum transmission and abnormal infant outcomes in Nigeria. medRxiv 2023:2023.08.05.23293675. [PMID: 37609297 PMCID: PMC10441498 DOI: 10.1101/2023.08.05.23293675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Chikungunya virus (CHIKV) has become a global public health concern since the reemergence of the Indian Ocean lineage and expansion of the Asian genotype. CHIKV infection causes acute febrile illness, rash, and arthralgia and during pregnancy may affect both mothers and infants. The mother-to-child transmission (MTCT) of CHIKV in Africa remains understudied. We screened 1006 pregnant women at two clinics in Nigeria between 2019 and 2022 and investigated the prevalence and MTCT of CHIKV. Of the 1006, 119 tested positive for CHIKV IgM, of which 36 underwent detailed laboratory tests. While none of the IgM reactive samples were RT-PCR positive, 14 symptomatic pregnant women were confirmed by CHIKV neutralization test. Twelve babies were followed with 8 normal and 4 abnormal outcomes, including stillbirth, cleft lip/palate with microcephaly, preterm delivery, polydactyly with sepsis and jaundice. CHIKV IgM testing identified 3 antepartum transmissions, further studies will determine its impact in antepartum infection.
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11
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Ogwuche J, Chang CA, Ige O, Sagay AS, Chaplin B, Kahansim ML, Paul M, Elujoba M, Imade G, Kweashi G, Dai YC, Hsieh SC, Wang WK, Hamel DJ, Kanki PJ. Arbovirus surveillance in pregnant women in north-central Nigeria, 2019-2022. medRxiv 2023:2023.08.04.23293671. [PMID: 37609234 PMCID: PMC10441490 DOI: 10.1101/2023.08.04.23293671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
The adverse impact of Zika (ZIKV), dengue (DENV), and chikungunya (CHIKV) virus infection in pregnancy has been recognized in Latin America and Asia but is not well studied in Africa. In Nigeria, we screened 1006 pregnant women for ZIKV, DENV and CHIKV IgM/IgG by rapid test (2019-2022). Women with acute infection were recruited for prospective study and infants were examined for any abnormalities from delivery through six months. A subset of rapid test-reactive samples were confirmed using virus-specific ELISAs and neutralization assays. Prevalence of acute infection (IgM+) was 3.8%, 9.9% and 11.8% for ZIKV, DENV and CHIKV, respectively; co-infections represented 24.5% of all infections. Prevalence in asymptomatic women was twice the level of symptomatic infection. We found a significant association between acute maternal ZIKV/DENV/CHIKV infection and any gross abnormal birth outcome (p=0.014). Further prospective studies will contribute to our understanding of the clinical significance of these endemic arboviruses in Africa.
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Musa J, Maiga M, Green SJ, Magaji FA, Maryam AJ, Okolo M, Nyam CJ, Cosmas NT, Silas OA, Imade GE, Zheng Y, Joyce BT, Diakite B, Morhason-Bello I, Achenbach CJ, Sagay AS, Ujah IAO, Murphy RL, Hou L, Mehta SD. Vaginal microbiome community state types and high-risk human papillomaviruses in cervical precancer and cancer in North-central Nigeria. BMC Cancer 2023; 23:683. [PMID: 37474918 PMCID: PMC10360349 DOI: 10.1186/s12885-023-11187-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND High risk human papillomaviruses (HR-HPV) have a causal role in cervical oncogenesis, and HIV-mediated immune suppression allows HR-HPV to persist. We studied whether vaginal microbiome community state types (CSTs) are associated with high-grade precancer and/or invasive cervical cancer (HSIL/ICC). METHODS This was a cross-sectional study of adult women with cervical cancer screening (CCS) at the Jos University Teaching Hospital (JUTH) in Jos, Nigeria, between January 2020 and February 2022. Cervical swabs underwent HPV genotyping (Anyplex™ II HPV28). Cervico-vaginal lavage (CVL) sample was collected for 16 S rRNA gene amplicon sequencing. We used multivariable logistic regression modelling to assess associations between CSTs and other factors associated with HSIL/ICC. RESULTS We enrolled 155 eligible participants, 151 with microbiome data for this analysis. Women were median age 52 (IQR:43-58), 47.7% HIV positive, and 58.1% with HSIL/ICC. Of the 138 with HPV data, 40.6% were negative for HPV, 10.1% had low-risk HPV, 26.8% had single HR-HPV, and 22.5% had multiple HR-HPV types. The overall prevalence of any HR-HPV type (single and multiple) was 49.3%, with a higher proportion in women with HSIL/ICC (NILM 31.6%, LSIL 46.5%, HSIL 40.8%, and 81.5% ICC; p = 0.007). Women with HIV were more likely to have HSIL/ICC (70.3% vs. 29.7% among women without HIV). In crude and multivariable analysis CST was not associated with cervical pathology (CST-III aOR = 1.13, CST-IV aOR = 1.31). However, in the presence of HR-HPV CST-III (aOR = 6.7) and CST-IV (aOR = 3.6) showed positive association with HSIL/ICC. CONCLUSION Vaginal microbiome CSTs were not significantly associated with HSIL/ICC. Our findings suggest however, that CST could be helpful in identifying women with HSIL/ICC and particularly those with HR-HPV. Characterization of CSTs using point-of-care molecular testing in women with HR-HPV should be studied as an approach to improve early detection and cervical cancer prevention. Future longitudinal research will improve our understanding of the temporal effect of non-optimal CST, HR-HPV, and other factors in cervical cancer development, prevention, and control.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria.
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA.
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Mamoudou Maiga
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for innovations in Healthcare Technologies, McCormick's School of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Stefan J Green
- Genomics and Microbiome Core Facility, Rush University, Chicago, IL, USA
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Ali J Maryam
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Mark Okolo
- Department of Medical Microbiology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Chuwang J Nyam
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Nanma T Cosmas
- Department of Medical Microbiology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Olugbenga A Silas
- Department of Anatomic Pathology and Forensic Medicine, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Godwin E Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Brian T Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Brehima Diakite
- University of Sciences, Technique and Technologies of Bamako, Bamako, Mali
| | - Imran Morhason-Bello
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chad J Achenbach
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Innocent A O Ujah
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
- Federal University of Health Sciences, Otukpo, Benue State, Nigeria
| | - Robert L Murphy
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Supriya Dinesh Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
- Department of Epidemiology and Biostatistics, Rush University, Chicago, IL, USA
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Davwar PM, Okeke E, Duguru M, Nyam D, Bell K, Odeghe EA, Oyeleke G, Lesi OA, Singh R, Kim KY, Imade G, Akanmu AS, Sagay AS, Ogunsola FT, Peters MG, Roberts LR, Hou L, Murphy RL, Hawkins CA. Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV. PLoS One 2023; 18:e0282539. [PMID: 36877687 PMCID: PMC9987777 DOI: 10.1371/journal.pone.0282539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is an increasing cause of mortality in Nigeria among persons with HIV (PLH), as access to antiretroviral therapy (ART) improves. In this study we describe clinical, radiological, and laboratory characteristics in Nigerian adults with HCC, with and without HIV, and examine how HIV impacts survival. METHODS This prospective observational study was conducted between August 2018 and November 2021 at two Nigerian hospitals [Jos University Teaching Hospital (JUTH) and Lagos University Teaching Hospital (LUTH)]. Subjects ≥18 years with HCC diagnosed according to American Association for the Study of Liver Diseases (AASLD) criteria were included. Baseline characteristics were compared, and Kaplan-Meier curves were generated to estimate survival. RESULTS 213 subjects [177 (83%) without HIV and 36 (17%) with HIV (PLH)] were enrolled. Median age was 52 years (IQR 42,60) and most subjects were male (71%). 83% PLH were on antiretroviral therapy (ART). Hepatitis B surface antigen (HBsAg) positivity was similar between the two groups [91/177 (51%) without HIV vs. 18/36 (50%) with HIV; p = 0.86]. 46/213 (22%) subjects had active hepatitis C (anti-HCV+/HCV RNA>10 IU/mL). Cirrhosis was more common in PLH but there were no other significant differences in clinical and tumor characteristics between the groups. Overall, 99% subjects were symptomatic and 78% in late-stage HCC. Median overall survival was significantly shorter in PLH vs. without HIV (0.98 months vs 3.02 months, HR = 1.55, 95%CI 1.02, 2.37, p = 0.04). This association was not significant after adjusting for known risk factors including gender, current alcohol use, alpha-fetoprotein (AFP), albumin, and total bilirubin (HR = 1.38, 95%CI 0.84, 2.29, p = 0.21). CONCLUSION HCC presented late with an extremely poor overall prognosis, highlighting the urgent need for more intensive surveillance in Nigeria to diagnose HCC at earlier stages. Early diagnosis and management of viral hepatitis, and access to HCC therapies, could prevent early mortality among persons with HCC, especially among PLH.
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Affiliation(s)
| | | | | | | | - Kristen Bell
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | | | | | | | - Revika Singh
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Kwang-Youn Kim
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | | | | | | | | | - Marion G. Peters
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Lewis R. Roberts
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States of America
| | - Lifang Hou
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Robert L. Murphy
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
| | - Claudia A. Hawkins
- Feinberg School of Medicine - Northwestern University, Chicago, Illinois, United States of America
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Anejo-Okopi J, Okeke E, Davwar PM, Onwuamah C, Onywera H, Omaiye P, Duguru M, Okojokwu OJ, Ujah OI, Jonathan B, George CA, Crown RS, Yakubu FB, Sokei JO, Okoli LC, Audu O, Inzaule SC, Abah IO, Agaba P, Agbaji OO, Sagay AS, Hawkins C. Molecular detection of hepatitis B virus genotype E with immune escape mutations in chronic hepatitis B patients on long-term antiviral therapy in Jos, Nigeria. Afr J Lab Med 2022; 11:1677. [PMID: 36337771 PMCID: PMC9634812 DOI: 10.4102/ajlm.v11i1.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 04/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background Previous studies in Nigeria have reported the presence of hepatitis B virus (HBV) genotype E and the availability of immune escape mutants. There is a paucity of data on chronic patients on long-term antiviral therapy for HBV infection. Objective This study assessed HBV genotypes and drug resistance variants among patients with chronic HBV infection receiving tenofovir in Jos, Nigeria. Methods This cross-sectional study consecutively enrolled 101 patients (51 with HIV/HBV co-infection and 50 with HBV infection only) on antiviral therapy from February 2018 to May 2019 at four hospitals in Jos, Nigeria. DNA quantification of HBV was performed on all samples; 30 samples with detectable viral load were selected for genotyping using Sanger sequencing by targeting the full-length sequences of reverse transcriptase gene of the HBV genome. Phylogenetic analysis was performed with reference sequences from GenBank. Escape mutant and drug resistance analysis were performed using HBV drug resistance interpretation and Geno2pheno. Results Only 30 (29.7%) of the 101 study participants had detectable HBV DNA. Of these, six (20.0%) isolates were successfully amplified and sequenced. The identified genotype was E, including escape mutations L127R (16.7%) and G145A (16.7%). Conclusion This study revealed exclusive dominance of genotype E in Nigeria. The S gene mutations G145A and L271R are known to be associated with modified antigenicity and impaired serologic assays, which may cause false negatives in the detection of anti-HBV surface antigen. The presence of mutants that are associated with vaccine immune escape may also have diagnostic and vaccine immune response implications.
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Affiliation(s)
- Joseph Anejo-Okopi
- Department of Microbiology, University of Jos, Jos, Nigeria
- AIDS Prevention Initiative in Nigeria, Jos University Teaching Hospital, Jos, Nigeria
| | - Edith Okeke
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Pantong M. Davwar
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Chika Onwuamah
- Center for Human Virology and Genomics Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Harris Onywera
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Research, Innovations, and Academics Unit, Tunacare Services Health Providers Limited, Nairobi, Kenya
| | - Patience Omaiye
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Mary Duguru
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Otobo I. Ujah
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Bulus Jonathan
- Department of Family Medicine, Plateau State Specialist Hospital, Jos, Nigeria
| | - Chima A. George
- Department of Family Medicine, Bingham University Teaching Hospital, Jos, Nigeria
| | - Ramyil S. Crown
- Department of Medical Microbiology and Parasitology, Bingham University Teaching Hospital, Jos, Nigeria
| | - Fiyaktu B. Yakubu
- Department of Chemical Pathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Judith O. Sokei
- Center for Human Virology and Genomics Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Leona C. Okoli
- Center for Human Virology and Genomics Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Onyemocho Audu
- Department of Epidemiology and Community Health, Benue State University, Makurdi, Nigeria
| | - Seth C. Inzaule
- Department of HIV and Global Hepatitis Program, World Health Organization, Geneva, Switzerland
| | - Isaac O. Abah
- Department of Pharmacology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia Agaba
- AIDS Prevention Initiative in Nigeria, Jos University Teaching Hospital, Jos, Nigeria
- Department of Family Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O. Agbaji
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S. Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Claudia Hawkins
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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Silas OA, Abdulkareem F, Novo JE, Zheng Y, Nannini DR, Gursel DB, Anorlu R, Musa J, Wehbe FH, Sagay AS, Ogunsola FT, Murphy RL, Hou L, Wei JJ. Telepathology in Nigeria for Global Health Collaboration. Ann Glob Health 2022; 88:81. [PMID: 36196362 PMCID: PMC9479662 DOI: 10.5334/aogh.3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Inadequate pathology personnel and high cost of running a Pathology facility are factors affecting access to timely and quality pathology services in resource-constrained settings. Telepathology is a novel technology that allows Pathologists to remotely assess collected samples. Though the initial cost of setting up a telepathology facility is high, its overall benefits far outweigh the cost. Its usefulness as a quality assurance measure, as a permanent image data storage system, in reducing costs associated with repeated slide preparations, reducing turn-around time of pathology reports, in collaborative research and in teaching has been well documented. This paper highlights the experiences, gains and challenges encountered in the deployment of telepathology in two resource-constrained settings in Nigeria. Overcoming the challenges associated with setting up a telepathology service in sub-Saharan Africa is important as it has the potential to improve overall health outcomes in a medically underserved region while ensuring technology and knowledge transfer are achieved.
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Affiliation(s)
| | - Fatimah Abdulkareem
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jorge Eduardo Novo
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Yinan Zheng
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Drew R. Nannini
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Demirkan B. Gursel
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Nigeria
| | - Firas H. Wehbe
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Atiene S. Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Nigeria
| | - Folasade T. Ogunsola
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Robert L. Murphy
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Guktur RE, Nep EI, Kemas CU, Olorunfemi PO, Ngwuluka NC, Ochekpe NA, Sagay AS. Effects of Autoclaving and Freeze-Drying on Physicochemical Properties of Plectranthus esculentus Starch Derivatives. AAPS PharmSciTech 2022; 23:172. [PMID: 35739364 DOI: 10.1208/s12249-022-02300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
The goal of this research was to assess the effects of autoclaving followed by freeze-drying on acetylated xerogel (AXS) and carboxymethylated (CMS) derivatives of Plectranthus esculentus starch as potential vaccine stabilizers. Starch extracted from tubers of P. esculentus were modified by single (carboxymethylation) and dual (acetylation followed by xerogel formation) methods. The derivatives were formulated into vaccine stabilizer suspensions, autoclaved, and freeze-dried without additives or antigen. The derivatives and freeze-dried products were assessed by physical appearance, titration, moisture content (MC), TGA, DSC, XRD, SEM, and FTIR analyses. The degrees of substitution (DS) of the CMS and AXS derivatives were 0.345 and 0.033, respectively. Modification significantly reduced the MC of the derivatives. Freeze-dried AXS (FAXS) had lower MC than freeze-dried CMS (FCMS). The lower degree of hydrophilicity/MC of AXS and FAXS was confirmed by TGA and FTIR band intensities and shifts. Reduction in DSC water desorption/evaporation enthalpies (ΔH) from - 1168.8 mJ (NaS) to - 407.48 mJ (AXS) confirmed the influence of modification on moisture. FTIR confirmed acetylation and carboxymethylation of the derivatives by the presence of 1702.9 cm-1 and 1593 cm-1 bands, respectively (FTIR). Increasing concentrations of the derivatives yielded uncollapsed/unshrunken lyophilisates. SEM and XRD showed that modification, autoclaving, and freeze-drying yielded beehive-like microstructures of FCMS and FAXS that were completely amorphous. Processing (autoclaving and freeze-drying), therefore, enhanced the amorphousness of the starch derivatives which is required in vaccine stability during processing and storage. These findings indicate that these starch derivatives have potential as novel vaccine stabilizers.
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Affiliation(s)
- Ruth E Guktur
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria.,Viral Vaccines Production Division, National Veterinary Research Institute, PMB 01, Vom, Nigeria
| | - Elijah I Nep
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria
| | - Chinwe U Kemas
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria
| | - Patrick O Olorunfemi
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria
| | - Ndidi C Ngwuluka
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria
| | - Nelson A Ochekpe
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria.
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
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Guktur RE, Nep EI, Asala O, Olorunfemi PO, Ngwuluka NC, Ochekpe NA, Sagay AS. Carboxymethylated and acetylated xerogel derivatives of Plectranthus esculentus starch protect Newcastle disease vaccines against cold chain failure. Vaccine 2021; 39:4871-4884. [PMID: 34253418 DOI: 10.1016/j.vaccine.2021.06.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
Developing vaccine stabilizers from local natural sources is desirable especially if the stabilizer would enhance the ability of the antigen to withstand frequent failures in cold chains. The study was undertaken to formulate immunogenic live Newcastle Disease (ND) LaSota vaccines stabilized with modified native starches for use at cold and ambient temperatures and to assess the immunogenicity of the starch stabilized vaccines in vaccinated chickens. Native starch extracted from the tubers of Plectranthus esculentus (Family, Lamiaceae) was modified by carboxymethylation and acetylation/xerogel formation and used as vaccine stabilizers of ND LaSota virus with/without buffers/bulking excipients. Cold Chain Failure (CCF) was simulated by storing the vaccines at 5 ± 2 °C for one month then at 37 ± 1 °C for 96 h. The stability of the samples were evaluated in comparison with peptone stabilized ND vaccines using pH, residual moisture, XRD, reconstitution time, mean embryo infective dose (EID50) and haemagglutination (HA) tests. Haemagglutination inhibition was used to evaluate the efficacy of the vaccines in conferring positive serum antibody titers (≥23 log2) in vaccine-naïve 2-week old broilers that were orally administered a single dose of the vaccines kept at 37 ± 1 °C for 96 h and bled weekly over four weeks. Temperature, pH, moisture content and amorphousness impacted vaccine stability. Peptone stabilized vaccines were significantly less stable and most affected by temperature changes with 1.2log10EID50 loss while buffered/bulked trehalose, carboxymethylated and acetylated/xerogelized starch stabilized vaccines were most stable (0.2-0.5log10EID50 loss in titer) after 96 h in CCF. Buffered trehalose stabilized vaccine (TVB) had lower HA titres than peptone and starch stabilized vaccines containing D-mannitol and Na2HPO4. Antibody titres of vaccinated broilers were between 3.3 ± 1.398 and 8.35 ± 2.678. All the vaccines were immunogenic (HI ≥ 23) and developed HI titres (≥24) considered to be protective. Carboxymethylated and acetylated/xerogel derivatives of P. esculentus starch have a great potential as vaccine stabilizers especially in areas prone to CCF.
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Affiliation(s)
- R E Guktur
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria; Viral Vaccines Production Division, National Veterinary Research Institute, PMB 01, Vom, Nigeria
| | - E I Nep
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria
| | - O Asala
- Viral Vaccines Production Division, National Veterinary Research Institute, PMB 01, Vom, Nigeria
| | - P O Olorunfemi
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria
| | - N C Ngwuluka
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria
| | - N A Ochekpe
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, University of Jos, PMB 2084, Jos, Nigeria.
| | - A S Sagay
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
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Ofakunrin AOD, Okpe ES, Afolaranmi TO, Olaosebikan RR, Kanhu PU, Adekola K, Dami N, Sagay AS. Level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of sickle cell disease patients in Jos, North-Central Nigeria. Afr Health Sci 2021; 21:765-774. [PMID: 34795734 PMCID: PMC8568227 DOI: 10.4314/ahs.v21i2.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hydroxyurea is underutilized by sickle cell health-care providers in Nigeria despite available evidence of its effectiveness in reducing the manifestations and complications of sickle cell disease (SCD). OBJECTIVES To assess the level of utilization and provider-related barriers to the use of hydroxyurea in SCD therapy in Jos, Nigeria. METHODS A cross-sectional study conducted among 132 medical doctors providing care for SCD patients. Data on sociodemographics, utilization and barriers to hydroxyurea use were obtained. The barriers were fed cumulatively into the logistic regression model as predictors of utilization. RESULTS Of the 132 care providers, 88 (67%) had been in medical practice for ≥6years. The level of utilization of hydroxyurea was 24.2%. The significant barriers that predicted the non-utilization of hydroxyurea included lack of expertise (OR=5.1; 95% CI=2.65-9.05), lack of clinical guidelines (OR=3.84; 95% CI=2.37-14.33), fear of side-effects (OR=0.50; 95% CI=0.22-0.68) and doubt about its effectiveness (OR=0.30; 95% CI=0.20-0.90). CONCLUSION The level of utilization of hydroxyurea in the treatment of SCD among the care providers is sub-optimal with the lack of expertise in its use identified as the most prominent barrier. There is an urgent need for the training of sickle cell care-providers and the development of clinical guidelines on hydroxyurea use.
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Affiliation(s)
- Akinyemi OD Ofakunrin
- Department of Paediatrics, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Edache S Okpe
- Department of Paediatrics, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Tolulope O Afolaranmi
- Department of Community Medicine, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Rasaq R Olaosebikan
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia Pennsylvania, USA
| | - Patience U Kanhu
- Department of Paediatrics, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Kehinde Adekola
- Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, USA
| | - Nantok Dami
- Department of Community Medicine, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos / Jos University Teaching Hospital, Jos, Nigeria
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19
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Ebonyi AO, Oguche S, Abok II, Isa YO, Ani CC, Akhiwu HO, Ihekaike MM, Yiltok ES, Ochoga MO, Sagay AS. Improving the diagnosis of pulmonary tuberculosis using line probe assay and determining the factors associated with the disease in children in Jos, Nigeria. Germs 2021; 10:328-337. [PMID: 33489948 DOI: 10.18683/germs.2020.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/11/2020] [Accepted: 10/11/2020] [Indexed: 11/08/2022]
Abstract
Introduction Diagnosing tuberculosis (TB), including pulmonary tuberculosis (PTB), in children remains a challenge, partly due to its paucibacillary nature in young children. Data on the use of line probe assay (LPA), on gastric and sputum samples, for diagnosing PTB in children are scarce. We determined the proportion of samples positive for Mycobacterium tuberculosis (MTB) by smear microscopy (SM) and LPA in presumptive PTB cases as well as the factors associated with PTB confirmed by LPA, in children in Jos, Nigeria. Methods An observational study in children aged 6 months-16 years. Gastric and sputum samples were examined by SM and by LPA for MTB using GenoType MTBDRplus Ver 2.0 (Hain Lifescience). Multivariate logistic regression was performed to determine the factors associated with PTB. Results Out of 103 children with presumptive PTB, 47 had confirmed PTB, 26 unconfirmed PTB and 30 unlikely PTB by LPA. In 67 gastric samples, MTB was identified by SM in 2 (3.0%) compared to 28 (41.8%) by LPA while in 31 sputum samples, MTB was identified by SM in 5 (16.1%) compared to 18 (58.1%) by LPA. The factors associated with pulmonary tuberculosis were an abnormal chest X-ray (adjusted odds ratio (AOR))=12.39 [3.75-40.90], p<0.001), sleeping in the same room with more than three persons (AOR=3.30 [1.23-8.85], p=0.018) and sleeping in a room with none or one window (AOR=2.86 [1.03-7.95], p=0.044). Conclusions Line probe assay improves the diagnosis of pulmonary TB in children, especially with gastric samples, while an abnormal chest X-ray is a useful adjunct in PTB diagnosis. Avoiding overcrowding and having windows in sleeping rooms are a necessary part of TB prevention.
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Affiliation(s)
- Augustine O Ebonyi
- MBBS, MSc, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Stephen Oguche
- BMBCh, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Ibrahim I Abok
- MBBS, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Yetunde O Isa
- BMLS, MSc, MPH, APIN Laboratory, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Charles C Ani
- MBBS, Department of Radiology, University of Jos and Department of Radiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Helen O Akhiwu
- MBBS, Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | | | - Esther S Yiltok
- MBBS, MEd, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Martha O Ochoga
- BMBCH, Department of Paediatrics, Benue State University, PMB 102119, Makurdi, Nigeria
| | - Atiene S Sagay
- BSc, MBChB, Department of Obstetrics and Gynaecology, University of Jos and Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
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Ige OO, Afolanranmi TO, Yilgwan CS, Ayatse F, Nkereuwem E, Sagay AS, Kanki P, Bode-Thomas F. Study of congenital heart defects among neonates in Jos, Nigeria: prevalence and spectrum. Cardiovasc J Afr 2021; 32:21-27. [PMID: 33605299 PMCID: PMC8756051 DOI: 10.5830/cvja-2020-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/30/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There are few reports of the prevalence of CHD in the neonatal period in sub-Saharan Africa. The only available study in Nigeria was carried out before the widespread availability of echocardiography in the country. We sought to determine the prevalence and spectrum of congenital heart defects (CHD) among neonates in Jos, Nigeria. METHODS This cross-sectional study enrolled neonates less than one week of age from the two largest hospitals and their immunisation centres. Relevant information was obtained and an echocardiogram was performed on each neonate. RESULTS There were 3 857 neonates recruited over a two-year period; male-to-female ratio was 1.1:1. A total of 111 babies had CHD, with a prevalence of 28.8 per 1 000. Sixty-four neonates had mild CHD, with a prevalence of 16.6 per 1 000, while moderate and severe CHD were found in 27 (7.0 per 1 000) and 20 (5.2 per 1 000), respectively. CONCLUSIONS CHD is prevalent in Nigerian neonates and there is therefore a need for advocacy to improve access to its diagnosis at birth for appropriate management.
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Affiliation(s)
- Olukemi O Ige
- Department of Pediatrics, University of Jos, Jos, Nigeria; Department of Pediatrics, Jos University Teaching Hospital, Jos, Nigeria. ;
| | | | - Christopher S Yilgwan
- Department of Pediatrics, University of Jos, Jos, Nigeria; Department of Pediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Fanen Ayatse
- Department of Pediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Esin Nkereuwem
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, London, UK
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Phyllis Kanki
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Fidelia Bode-Thomas
- Department of Pediatrics, University of Jos, Jos, Nigeria; Department of Pediatrics, Jos University Teaching Hospital, Jos, Nigeria
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21
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Agbo HA, Zoakah AI, Isichei CO, Sagay AS, Achenbach CJ, Okeahialam BN. Cardiovascular Anthropometry: What Is Best Suited for Large-Scale Population Screening in Sub-Saharan Africa? Front Cardiovasc Med 2020; 7:522123. [PMID: 33344511 PMCID: PMC7744454 DOI: 10.3389/fcvm.2020.522123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background : Body mass index (BMI) measures overweight/obesity. It, however, especially in sub-Saharan Africa (SSA), misclassifies cardiometabolic risk. Central obesity measures are superior. We therefore sought to compare BMI, waist-to-hip ratio (WHR) and abdominal height (AH) in predicting cardiovascular disease risk in sub-Saharan Africa. Methods : Subjects had blood pressures, BMI, and WHR determined. Blood pressure was taken, weight and height measured to generate BMI, and AH measured with a new locally fabricated abdominometer. The ability of the anthropometric indices in identifying abnormal individuals needing intervention was assessed with sensitivity, specificity, and area under the receiver operator characteristic curve. Results : Adults totaling 1,508 (728 M/780 F) adults were studied. For BMI, 985 (65.3%) were normal, while 375 (24.9%), consisting of 233 males and 142 females, had normal WHR. Blood pressure was normal in 525 (34.8%) and 317 (21.0%) for systolic and diastolic blood pressures, respectively. Using BMI as gold standard, sensitivity, specificity, positive, and negative predictive values for WHR in males were 80.7, 37.5, 62.5, and 19.3%, respectively. For females and in the same order, they were 62.0, 34.3, 65.7, and 38.0%. For AH, it was equal in both genders at 82.6, 39.2, 60.8, and 17.4%. By receiver operating curves comparing AH, WHR, and BMI against blood pressure detection, the area under the curve was 0.745, 0.604, and 0.554 for AH, BMI, and WHR, respectively. Conclusion : Abdominometer-derived AH has a better sensitivity and greater area under the receiver operator curve compared with BMI and WHR in this sub-Sahara African population; implying superiority as a cardiovascular anthropometric index.
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Affiliation(s)
- Hadiza A Agbo
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Ayuba I Zoakah
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Christian O Isichei
- Department of Chemical Pathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Chad J Achenbach
- Department of Medicine, North Western University Feinberg School of Medicine, Chicago, IL, United States
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Yilgwan CS, Pam VC, Ige OO, Golit WN, Anzaku S, Imade GE, Sagay AS, Yilgwan G, Mutihir JT, Meshak D, Zoakah AI, Bode-Thomas F. Neonatal Blood Pressure and Anthropometric Indices in Newborns of Pre-Eclamptic and Normal Mothers in Jos, Nigeria. West Afr J Med 2020; 37:423-427. [PMID: 32835407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Preeclampsia is a significant public health problem associated with increased risk of hypertension for offsprings. We compared the blood pressure and presence of hypertension between neonates born to women with preeclampsia and those with normal pregnancy as well as its relationship to anthropometric indices. METHODS This is a comparative cross-sectional study of 40 neonates born to women with preeclampsia and those born following normal pregnancy in four tertiary health facilities located in Jos, Nigeria. Anthropometric and blood pressure values were measured within 6-12 hours of delivery using standard protocols. SPSS version 25 was used in all analyses. Statistical significance was taken at p <0.05. RESULTS The mean birth weight for neonates of preeclamptic women was 2,476.1±810.8 grams, compared with 2,994.2±529.6 grams in babies of normal pregnancy (p=0.002). The mean birth length for neonates of preeclamptic women was 45.4±6.2 cm compared with 49.8±3.1 cm in babies of normal pregnancy (p<0.001). The mean ponderal index (PI) in neonates of preeclamptic women was 2.6±0.6 g/cm3 compared with 2.4±0.4 g/cm3 in babies of normal pregnancy (p=0.17). The mean systolic blood pressure in neonates of women with preeclampsia was 74.53±16.99 mmHg compared with 75.26±15.20 mmHg in neonates following normal pregnancy (p=0.85). The mean diastolic blood pressure in neonates born following preeclampsia was 47.52±15.76 mmHg compared with 45.12±16.9 mmHg in those following normal pregnancy (p=0.46). Six (16%) of the neonates born to women with preeclampsia had systolic hypertension compared with 3(8%) of neonates of women with normal pregnancy. Similarly, 5(14%) of neonates born to women with preeclampsia had diastolic hypertension compared with 2(5%) of neonates of women with normal pregnancy. No significant association between neonatal hypertension and anthropometric indices. CONCLUSION Newborns of women with preeclampsia have associated higher odds of elevated blood pressure. Elevated blood pressure has no significant relationship to birthweight, length or ponderal index. Early infant blood pressure surveillance is advocated in order to monitor and hence prevent complications ensuing in later life.
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Affiliation(s)
- C S Yilgwan
- Department of Paediatrics, University of Jos,Nigeria
| | - V C Pam
- Department of Obstetrics and Gynaecology, University of Jos,Nigeria
| | - O O Ige
- Department of Paediatrics, University of Jos,Nigeria
| | - W N Golit
- Department of Obstetrics and Gynaecology, Plateau Specialist Hospital,Nigeria
| | - S Anzaku
- Department of Obstetrics and Gynaecology, Bingham University,Jos,Nigeria
| | - G E Imade
- Department of Obstetrics and Gynaecology, University of Jos,Nigeria
| | - A S Sagay
- Department of Obstetrics and Gynaecology, University of Jos,Nigeria
| | - G Yilgwan
- Department of Human Physiology, University of Jos,Nigeria
| | - J T Mutihir
- Department of Obstetrics and Gynaecology, University of Jos,Nigeria
| | - D Meshak
- Department of Family Medicine, University of Jos,Nigeria
| | - A I Zoakah
- Department of Community Medicine, University of Jos,Nigeria
| | - F Bode-Thomas
- Department of Paediatrics, University of Jos,Nigeria
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23
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Musa J, Mehta SD, Achenbach CJ, Evans CT, Jordan N, Magaji FA, Pam VC, Daru PH, Silas OA, Sagay AS, Anorlu R, Zheng Y, Maiga M, Adewole IF, Murphy RL, Hou L, Simon MA. HIV and development of epithelial cell abnormalities in women with prior normal cervical cytology in Nigeria. Infect Agent Cancer 2020; 15:50. [PMID: 32760435 PMCID: PMC7392708 DOI: 10.1186/s13027-020-00316-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
Background HIV-associated cellular immune dysfunction has been linked to higher risk of cervical dysplasia and cancer in HIV infected women. We sought to understand the relationship between HIV and development of epithelial cell abnormalities (ECA) at follow-up in women with prior normal cervical cytology (NCC). Methods Retrospective cohort analysis of women who received a Pap test at the Operation Stop Cervical Cancer Unit in Jos, Nigeria over a 10-year period (2006-2016). We analyzed the data of women with NCC at first Pap who had at least one follow-up cytology result for time-to-detection of ECA. We determined follow-up time in years from date of first NCC to date of first ECA report or date of last NCC follow up report with censoring at last follow-up date or December 31st, 2016 whichever came first. The primary outcome was development of any ECA as defined by the Bethesda 2001 reporting system. We identified demographic and clinical factors associated with incident ECA using multivariable Cox regression. Results A total of 1599 women were eligible for this analysis. Overall, 3.7% (57/1556) of women reported being HIV infected. The median age at first Pap was 39 years (IQR; 33-45). The HIV infected women were younger (36.3 ± 8.1) compared to those uninfected (39.3 ± 6.6), p = 0.005. After an accrued follow-up time of 3809 person-years (PYs), 243 women (15%) had an ECA with an event rate of 6.38 per 100 PYs. Women ≥35 years at first Pap were more likely to have an ECA compared to those < 35 years (7.5 per 100 PYs vs 3.8 per 100 PYs, HR = 1.96; 95% CI: 1.4, 2.8). HIV status was not significantly associated with developing ECA in either unadjusted (7.4 per 100 PYs vs 6.4 per 100 PYs, HR = 1.17; 95% CI: 0.53, 2.3) or adjusted analyses (aHR = 1.78; 95% CI: 0.87, 3.65). Conclusion Women living with HIV and on successful antiretroviral treatment may not have a differential hazard in the development of ECA during follow up after a prior normal Pap. Offering a repeat CCS to women who are 35 years or older irrespective of HIV status is likely an effective strategy in resource limited settings.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria.,Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Supriya D Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL USA
| | - Chad J Achenbach
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Charlesnika T Evans
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA.,Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL USA
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL USA.,Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Victor C Pam
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Olugbenga A Silas
- Department of Pathology, Faculty of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Jos, Nigeria
| | - Yinan Zheng
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Mamoudou Maiga
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Techniques and Technologies of Bamako, University of Sciences, Bamako, Mali
| | - Isaac F Adewole
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Robert L Murphy
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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24
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Agbaji OO, Abah IO, Ebonyi AO, Gimba ZM, Abene EE, Gomerep SS, Falang KD, Anejo-Okopi J, Agaba PA, Ugoagwu PO, Agaba EI, Imade GE, Sagay AS, Okonkwo P, Idoko JA, Kanki PJ. Long Term Exposure to Tenofovir Disoproxil Fumarate-Containing Antiretroviral Therapy Is Associated with Renal Impairment in an African Cohort of HIV-Infected Adults. J Int Assoc Provid AIDS Care 2020; 18:2325958218821963. [PMID: 30672363 PMCID: PMC6546287 DOI: 10.1177/2325958218821963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES AND METHOD There are growing concerns of tenofovir disoproxil fumarate (TDF)-associated renal toxicity. We evaluated the effect of long-term TDF exposure on renal function in a cohort of HIV-1-infected Nigerians between 2006 and 2015. Multivariate logistic regression was used to identify predictors of renal impairment at different time over 144 weeks of antiretroviral therapy (ART). RESULTS Data of 4897 patients, median age 42 years (interquartile range: 36-49), and 61% females were analyzed. The prevalence of renal impairment increased from 10% at week 24 to 45% at 144 weeks in TDF-exposed participants compared to an increase from 8% at 24 weeks to 14% at 144 weeks in TDF-unexposed participants. Tenofovir disoproxil fumarate exposure predicted the risk of renal impairment at 144 weeks of ART (odds ratio: 2.36; 95% confidence interval: 1.28-4.34). CONCLUSION Long-term exposure to TDF-based ART significantly increases the likelihood of renal impairment. The continued use of TDF-based regimen in our setting should be reviewed. We recommend the urgent introduction of tenofovir alafenamide-based regimen in the HIV treatment guidelines of Nigeria and other resource-limited countries.
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Affiliation(s)
- Oche O Agbaji
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.,2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria
| | - Isaac O Abah
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,3 Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria
| | - Augustine O Ebonyi
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,4 Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Zumnan M Gimba
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Esla E Abene
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Simji S Gomerep
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.,2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria
| | - Kakjing D Falang
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,5 Department of Pharmacology, University of Jos, Jos, Nigeria
| | - Joseph Anejo-Okopi
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,6 Department of Microbiology, University of Jos, Jos, Nigeria
| | - Patricia A Agaba
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,7 Department of Family Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Placid O Ugoagwu
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel I Agaba
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Godwin E Imade
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,8 Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,8 Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | | | - John A Idoko
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Phyllis J Kanki
- 10 Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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25
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Yilgwan CS, Pam VC, Ige OO, Golit WN, Anzaku S, Imade GE, Yilgwan G, Mutihir JT, Sagay AS, Odili A, Zoakah AI, Bode-Thomas F, Simon MA. Profile of congenital heart disease in infants born following exposure to preeclampsia. PLoS One 2020; 15:e0229987. [PMID: 32214332 PMCID: PMC7098553 DOI: 10.1371/journal.pone.0229987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Events in pregnancy play an important role in predisposing the newborn to the risk of developing CHD. This study evaluated the association between maternal preeclampsia and her offspring risk of CHD. METHODS This is a cohort study of 90 sex-matched neonates (45 each born to women with preeclampsia and normal pregnancy) in Jos, Nigeria. Anthropometry was taken shortly after delivery using standard protocols. Echocardiography was performed within 24 hours of life and repeated 7 and 28 days later. SPSS version 25 was used in all analyses. Statistical significance was set at p<0.05. RESULTS Congenital heart disease (CHD) was observed in 27 (30.0%) of newborns of women with preeclampsia compared with 11 (12.1%) of newborns without preeclampsia (p<0.001) at the end of 7 days and in 19 (21.1%) of newborns of women with preeclampsia and 3 (3.3%) of newborns of women without preeclampsia by the end of the 4th week of life (p<0.001). Overall, ASD (4 newborns), PDA (21 newborns), patent foramen ovale (14 newborns) and VSD (2 newborns) were the prevalent lesions found among all the newborns studied in the first week of life. Isolated atrial and ventricular septal defects were seen in 4 (4.4%) of the newborns of women with preeclampsia. Being the infant of a woman with preeclampsia was associated with about 8-fold increased risk of having CHD (OR = 7.9, 95% CI = 2.5-24.9, p<0.001). CONCLUSION CHD may be more common in newborns of women with preeclampsia underscoring the need for fetal and newborn screening for CHD in women with preeclampsia so as to improve their infant's well being.
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Affiliation(s)
| | - Victor C. Pam
- Department of Obstetrics and Gynaecology, University of Jos, Jos, Nigeria
| | - Olukemi O. Ige
- Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Williams N. Golit
- Department of Obstetrics and Gynaecology, Plateau Specialist Hospital, Jos, Nigeria
| | - Stephen Anzaku
- Department of Obstetrics and Gynaecology, Bingham University, Karu LGA, Nigeria
| | - Godwin E. Imade
- Department of Obstetrics and Gynaecology, University of Jos, Jos, Nigeria
| | - Gavou Yilgwan
- Department of Human Physiology, University of Jos, Jos, Nigeria
| | - Josiah T. Mutihir
- Department of Obstetrics and Gynaecology, University of Jos, Jos, Nigeria
| | - Atiene S. Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos, Nigeria
| | - Augustine Odili
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria
| | - Ayuba I. Zoakah
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria
| | | | - Melissa A. Simon
- Department of Community Medicine, University of Jos, Jos, Nigeria
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, United States of America
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26
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Ahmad AEF, Bakari AG, Musa BOP, Mustapha SK, Abdullahi IN, Tahir MI, Jamoh BY, Olatunji AO, Maishanu SH, Hali B, Hawkins CA, Sagay AS, Olayinka AT. Distribution of hepatitis B virus-positive individuals in Zaria, Nigeria, according to risk-associated practices. ACTA ACUST UNITED AC 2020; 3:25-30. [PMID: 32095787 PMCID: PMC7039646 DOI: 10.25259/cjhs_7_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: An estimated 75% of Nigerians are at risk of hepatitis B virus (HBV) exposure. In an attempt to reduce the menace, the assessment of risk factors associated with HBV infection and general perception of infected individuals is a step in that direction. Aim of the Study: This study, therefore, identified exposure to risk factors and general perceptions associated with HBV infection in infected individuals in Zaria, Nigeria. Methodology: Four milliliters of blood were collected in ethylenediaminetetraacetic acid container from each of 165 HBV surface antigen (HBsAg)-positive participants recruited purposively from the gastroenterology clinic of ABUTH Zaria from May to August 2017. Plasma was separated and used to screen for HBsAg with Fastep® rapid strip. Epi Info® questionnaire database was used to collate data on sociodemographics, risk factors, and perception indices. GraphPad Prism 6 was used for statistical analysis. Results: The median interquartile range age of the participants was 31.0 (25.5–39.0) years with 107 (64.8%) male participants. Sharing hair clippers, commercial pedicure, and body piercing among others were some of the risks that the study participants reported to be exposed to. One-quarter of health workers involved in the study had needlestick injury. Less than half of the study participants (47.7%) knew of hepatitis B before testing HBsAg seropositive. Knowledge of the HBV vaccine before testing and adherence was generally poor (38.6% and 44.6%, respectively). There was a significant linear relationship between the level of education and knowledge of hepatitis B. Conclusion: Considering the myriads of already established risks of HBV seen in Zaria, massive enlightenment campaigns need to be embarked on continuously through all available media, including social media.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bello Hali
- Department of Microbiology, Infectious Diseases Laboratory, Usmanu Danfodiyo University Teaching Hospital, Sokoto
| | - Claudia A Hawkins
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos, Nigeria
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27
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Musa J, Achenbach CJ, Evans CT, Jordan N, Daru PH, Silas O, Sagay AS, Anorlu R, Mehta SD, Wehbe F, Simon MA, Adewole IF, Hou L, Murphy RL. HIV status, age at cervical Cancer screening and cervical cytology outcomes in an opportunistic screening setting in Nigeria: a 10-year Cross sectional data analysis. Infect Agent Cancer 2019; 14:43. [PMID: 31798680 PMCID: PMC6884842 DOI: 10.1186/s13027-019-0263-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/20/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Invasive cervical cancer (ICC) is more prevalent in HIV infected women and occurs at younger median age than in HIV negative women. Organized cervical cancer screening (CCS) is presently lacking in Nigeria, and the age at CCS is not known in this population. We sought to examine the age at CCS, the cytology outcomes and whether outcomes differ by HIV infection status in an opportunistic screening setting. METHODS Cross-sectional analysis of data on a sample of women who had received a CCS in an opportunistic screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used logistic regression models to estimate the independent effect of patient-reported HIV and age at CCS and odds ratios for abnormal cytology outcomes adjusting for other covariates. We also assessed the correlation between median age at CCS and severity of abnormal cervical cytology outcomes. Statistical analyses were done on STATA version 14, College Station, Texas, USA. RESULTS In a sample of 14,088, the median age at CCS was 37 years (IQR; 30-45). For HIV infected women vs. uninfected women, CCS occurred at earlier ages (35.0 ± 7.4 vs 38.2 ± 10.2 years, p < 0.001). All women, regardless of HIV status, who completed at least 7 or more years of education were 1.27 to 3.51 times more likely to have CCS before age 35 than women with less education. The predictors of an abnormal cervical cytology outcome at CCS were: age at CCS ≥ 35 (aOR = 3.57; 95% CI: 2.74, 4.64), multiparity ≥5 (aOR = 1.27; 95% CI: 1.03, 1.56), and provider-referral (aOR = 1.34; 95% CI: 1.09, 1.64). Irrespective of reported HIV status, we found a positive correlation between median age at CCS and severity of cytology outcome. DISCUSSION The age at CCS in women who have utilized cervical cancer screening in the study population is relatively late compared to the recommended age by most guidelines from developed settings. Late age at CCS correlates positively with severity of abnormal cytology outcome irrespective of HIV status. More educated women are more likely to have CCS at early age and less likely to have underlying abnormal cytology outcomes.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Chad J. Achenbach
- Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Charlesnika T. Evans
- Department of Preventive Medicine, Center for Health Care Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL USA
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL USA
- Department of Psychiatry & Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Patrick H. Daru
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau Nigeria
| | - Olugbenga Silas
- Department of Pathology, College of Health Sciences, University of Jos, Jos, Plateau State Nigeria
| | - Atiene S. Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Lagos Nigeria
| | - Supriya D. Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL USA
| | - Firas Wehbe
- Department of Preventive Medicine, Division of Health and Biomedical Informatics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Isaac F. Adewole
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Oyo Nigeria
| | - Lifang Hou
- Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Robert L. Murphy
- Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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28
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Ocheke AN, Agaba PA, Imade GE, Silas OA, Ajetunmobi OI, Echejoh G, Ekere C, Sendht A, Bitrus J, Agaba EI, Sagay AS. Re: Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients. Int J STD AIDS 2019; 30:101-102. [PMID: 30803410 DOI: 10.1177/0956462418803820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Amaka N Ocheke
- 1 Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia A Agaba
- 2 Department of Family Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Godwin E Imade
- 1 Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Olugbenga A Silas
- 3 Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Olanrewaju I Ajetunmobi
- 3 Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Godwins Echejoh
- 3 Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Clement Ekere
- 1 Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Ayuba Sendht
- 1 Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - James Bitrus
- 1 Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel I Agaba
- 4 Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- 1 Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
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29
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Egesie OJ, Agaba PA, Silas OA, Achenbach C, Zoakah A, Agbaji OO, Madaki JA, Okeke EN, Hou L, Sagay AS, Murphy R. Presentation and survival in patients with hematologic malignancies in Jos, Nigeria: A retrospective cohort analysis. ACTA ACUST UNITED AC 2018; 20:49-56. [PMID: 29963503 DOI: 10.4103/jomt.jomt_8_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Haematologic malignancies cause significant morbidity and mortality and are not uncommon in resource-limited-low income countries. However, the types, pattern of presentation and treatment outcomes vary across regions. We assessed the presentation and overall survival over an 11-year period in adult patients presenting with haematologic cancers in Jos, North Central Nigeria. Materials and Methods This retrospective outcome study evaluated patients who presented with haematologic malignancies between 2005-2015 at the Jos University Teaching Hospital (JUTH), Jos. Variables of interest were abstracted through chart reviews. Descriptive statistics were used to evaluate baseline and follow-up parameters. Overall survival (OS) was assessed using Kaplan-Meier method. Results Sixty patients, contributing 25,994 person-days of follow-up were evaluated. The mean age was 43+17 years and 61.7% were males. Thirty-one patients (51.7%) presented with leukemia, 45.0% with lymphoma, and 3.3% with multiple myeloma. Forty-two (70.0%) presented with advanced disease, 5 (5.2%) were HIV positive and 4 (6.7%) had died at the end of follow-up. OS was 84.3% (95% CI: 58.1-94.7). Survival differed by disease group (p=0.01) and having fever at presentation (p=0.02). Conclusion We found long-term OS to be impacted by disease type and status of fever at presentation. Disease-specific Strategies to improve early diagnosis and therapies are needed to ensure optimal outcomes in Nigerian patients.
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Affiliation(s)
- Ochaka J Egesie
- Department of Haematology and Blood Transfusion, Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia A Agaba
- Department of Family Medicine, University of Jos/Jos University Teaching Hospital, Nigeria
| | - Olugbenga A Silas
- Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Chad Achenbach
- Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Ayuba Zoakah
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O Agbaji
- Department of Internal Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Jeremiah A Madaki
- Department of Family Medicine, University of Jos/Jos University Teaching Hospital, Nigeria
| | - Edith N Okeke
- Department of Internal Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Lifang Hou
- Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA.,Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Robert Murphy
- Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
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Agaba PA, Genberg BL, Sagay AS, Agbaji OO, Meloni ST, Dadem NY, Kolawole GO, Okonkwo P, Kanki PJ, Ware NC. Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria. ACTA ACUST UNITED AC 2018; 9. [PMID: 29682399 PMCID: PMC5909978 DOI: 10.4172/2155-6113.1000756] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective Differentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at “hub” (central) and “spoke” (decentralized) sites in a large public HIV treatment program in north central Nigeria. Methods This retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patient- level (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables. Results Of 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (−4.5%, 95% CI: −3.5, −5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08). Conclusion Decentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures.
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Affiliation(s)
| | - Becky L Genberg
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Oche O Agbaji
- Faculty of Medical Sciences, University of Jos, Nigeria
| | | | - Nancin Y Dadem
- APIN Centre, Jos University Teaching Hospital, Jos, Nigeria
| | | | | | | | - Norma C Ware
- Harvard Medical School, Boston MA, USA.,Brigham & Women's Hospital, Boston, MA, USA
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Talib Z, van Schalkwyk S, Couper I, Pattanaik S, Turay K, Sagay AS, Baingana R, Baird S, Gaede B, Iputo J, Kibore M, Manongi R, Matsika A, Mogodi M, Ramucesse J, Ross H, Simuyeba M, Haile-Mariam D. Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries. Acad Med 2017; 92:1723-1732. [PMID: 29045275 PMCID: PMC5730703 DOI: 10.1097/acm.0000000000002003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. METHOD Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. RESULTS The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. CONCLUSIONS Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.
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Affiliation(s)
- Zohray Talib
- Z. Talib is associate professor of medicine and of health policy, George Washington University School of Medicine and Health Sciences, Washington, DC. S. van Schalkwyk is professor of health professions education and director, Center for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. I. Couper is director, Ukwanda Center for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. S. Pattanaik is a doctoral student, Community Health Behavior and Education, Georgia Southern University, Statesboro, Georgia. K. Turay was senior research associate, Department of Health Policy, George Washington University, Washington, DC, at the time of this study. A.S. Sagay is professor of obstetrics and gynecology and honorary consultant obstetrician and gynecologist, University of Jos/Jos University Teaching Hospital, Jos, Nigeria. R. Baingana is a lecturer, Department of Biochemistry, Makerere University, Kampala, Uganda. S. Baird is associate professor of global health and economics, Department of Global Health, George Washington University, Washington, DC. B. Gaede is head, Department of Family Medicine, University of Kwazulu Natal, Durban, South Africa. J. Iputo is head, Department of Medical Education, Walter Sisulu University, Mthatha, Eastern Cape, South Africa. M. Kibore is a pediatrician and public health specialist, University of Nairobi, Nairobi, Kenya. R. Manongi is senior lecturer, Department of Community Health, Kilimanjaro Christian Medical Center, Moshi, Tanzania. A. Matsika is an administrator, University of Zimbabwe College of Health Sciences-Novel Education Clinical Trainees & Researchers Program, Harare, Zimbabwe. M. Mogodi is a lecturer, Department of Medical Education, Faculty of Medicine, University of Botswana, Gaborone, Botswana. J. Ramucesse is assistant professor, Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, and government advisor, Health Policies, Maputo, Mozambique. H. Ross is senior proposal writer, IntraHealth International, and adjunct professor, Department of Global Health, George Washington University, Washington, DC. M. Simuyeba is a lecturer, School of Public Health, University of Zambia, Lusaka, Zambia. D. Haile-Mariam is professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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N. Ocheke A, Samuels E, E. Ocheke I, A. Agaba P, Ekere C, Bitrus J, I. Agaba E, S. Sagay A. An Audit of Perineal Trauma and Vertical Transmisson Of HIV. Afr J Reprod Health 2017; 21:67-72. [PMID: 29624952 DOI: 10.29063/ajrh2017/v21i4.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p value= 0.79 and 0.061). There was no mother-to-child HIV transmission. Episiotomies should be given when needed irrespective of HIV status because of the risk of consequent perineal tear and with HAART the risk of MTCT from perineal trauma is minimal.
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Agaba PA, Meloni ST, Sule HM, Agbaji OO, Sagay AS, Okonkwo P, Idoko JA, Kanki PJ. Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria. Open Forum Infect Dis 2017; 4:ofx031. [PMID: 29497627 PMCID: PMC5780650 DOI: 10.1093/ofid/ofx031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria. Methods This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU) and determined factors associated with these outcomes at 24 months. Results Of 8352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 vs 132 (P = .0005) at 12 months and 185 vs 151 cells/mm3 (P = .03) at 24 months for younger and older patients, respectively. A total of 68.9% vs 71.6% (P = .13) and 69.6% vs 74.8% (P = .005) of younger and older patients achieved viral suppression at 12 and 24 months, with similar incidence of mortality and LTFU. In adjusted hazard models, factors associated with increased risk of mortality were male sex, World Health Organization (WHO) stage III/IV, and having a gap in care, whereas being fully suppressed was protective. The risk of being LTFU was lower for older patients, those fully suppressed virologically and with adherence rates >95%. Male sex, lack of education, WHO stage III/IV, body mass index <18.5 kg/m2, and having a gap in care independently predicted LTFU. Conclusions Older patients achieved better viral suppression, and older age was not associated with increased mortality or LTFU in this study.
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Affiliation(s)
- Patricia A Agaba
- Departments of Family Medicine.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | - Seema T Meloni
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
| | - Halima M Sule
- Departments of Family Medicine.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | - Oche O Agbaji
- Medicine, and.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | - Atiene S Sagay
- Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Nigeria.,APIN Centre, Jos University Teaching Hospital, Nigeria
| | | | | | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
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Ebonyi AO, Oguche S, Agbaji OO, Sagay AS, Okonkwo PI, Idoko JA, Kanki PJ. Mortality among pulmonary tuberculosis and HIV-1 co-infected Nigerian children being treated for pulmonary tuberculosis and on antiretroviral therapy: a retrospective cohort study. Germs 2016; 6:139-150. [PMID: 28053917 DOI: 10.11599/germs.2016.1099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mortality data, including the risk factors for mortality in HIV-infected children with pulmonary TB (PTB) being treated for PTB and who are on antiretroviral therapy (ART), are scarce in Nigeria. We determined the mortality rate and risk factors for mortality among such children, at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Jos, Nigeria. METHODS We performed a retrospective cohort study on 260 PTB-HIV-1 co-infected children, aged 2 months to 13 years, being treated for PTB and on ART from July 2005 to March 2013. The mortality rate and associated risk factors were determined using multivariate Cox proportional hazards modelling. RESULTS The mortality rate for the study cohort was 1.4 per 100 child-years of follow-up. Median follow-up time was 5.2 years (IQR, 3.5-6.0 years) with total study time being 1159 child-years. The median age of those who died was lower than that of survivors, 1.9 years (IQR, 0.6-3.6 years) versus 3.8 years (IQR, 1.8-6.0 years), p=0.005). The majority of the deaths occurred in males (13, 81.2%), those <5 years of age (14, 87.4%) and those who had severe immunosuppression (11, 68.8%). Risk factors for death were age (with the risk of dying decreasing by 25% for every 1 year increase in age, adjusted hazard ratio (AHR)=0.75 [0.58-0.98], p=0.032), male gender (AHR=3.80 [1.07-13.5], p=0.039) and severe immunosuppression (AHR=3.35 [1.16-9.66], p=0.025). CONCLUSION In our clinic setting, mortality among our PTB-HIV co-infected children being treated for PTB and on ART was low. However, those presenting with severe immunosuppression and who are males and very young, should be monitored more closely during follow-up in order to further reduce mortality.
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Affiliation(s)
- Augustine O Ebonyi
- MBBS, MSc, Department of Pediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Stephen Oguche
- MBCH, Department of Pediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O Agbaji
- MBBS, Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- MBBS, Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Prosper I Okonkwo
- MBBS, AIDS Prevention Initiative in Nigeria (APIN) Ltd. Gte, Abuja, Nigeria
| | - John A Idoko
- MBBS, National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - Phyllis J Kanki
- DVM, SD, Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Sagay AS. Histological Chorioamnionitis. J West Afr Coll Surg 2016; 6:x-xiii. [PMID: 28856130 PMCID: PMC5555723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A S Sagay
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
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Ocheke AN, Ocheke IE, Agaba PA, Imadde GE, Silas OA, Ajetunmobi OI, Godwins EJ, Ekere C, Sendeht A, Bitrus J, Agaba EI, Sagay AS. MATERNAL AND NEONATAL OUTCOMES OF HISTOLOGICAL CHORIOAMNIONITIS. J West Afr Coll Surg 2016; 6:1-14. [PMID: 28856121 PMCID: PMC5555724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Clinical Chorioamnionitis contributes to maternal and neonatal morbidity and mortality but the effect of histological chorioamnionitis is sparse in our environment. AIM To determine the maternal and neonatal outcomes of histological chorioamnionitis amongst pregnant women and their babies. DESIGN OF THE STUDY Cross sectional longitudinal study. SETTING Jos University Teaching Hospital (JUTH), Jos, Nigeria. METHODOLOGY Parturients were interviewed and examined as well as had their placenta examined histologically for chorioamnionitis. They and their babies were followed up for 6 weeks after delivery to monitor for any complications that may arise. RESULTS A total of 148 parturients were enrolled from the labour ward of Jos University Teaching Hospital and of these 90 (60.8%) had histologic chorioamnionitis (HCA). As regards outcome, 9(10%) with histologic chorioamnionitis as well as 5(8.62%) of those without HCA had premature delivery. Low birth weight occurred in 12(13.33%) and 6(10.34 %) of those with HCA and without HCA respectively. In all, 1(1.47%) and 1(2.56%) of women with HCA and without HCA correspondingly had neonatal sepsis. Puerperal sepsis occurred in 2(2.94%) of those with HCA and 2(5.13%) of those without HCA. CONCLUSION Our study has demonstrated that histological chorioamnionitis had no adverse maternal or neonatal effect. There is the need for more studies investigating the cause and the implication of histological chorioamnionitis.
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Affiliation(s)
- A N Ocheke
- Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - I E Ocheke
- Department of Paediatrics,Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - P A Agaba
- Department of Family medicine, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - G E Imadde
- Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - O A Silas
- Department of Histopathology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - O I Ajetunmobi
- Department of Histopathology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Eche John Godwins
- Department of Histopathology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - C Ekere
- Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - A Sendeht
- Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - J Bitrus
- Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - E I Agaba
- Department of Medicine, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - A S Sagay
- Department of Obstetrics and Gynaecology,Faculty of Medical Sciences, University of Jos, Jos, Nigeria
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Musa J, Nankat J, Achenbach CJ, Shambe IH, Taiwo BO, Mandong B, Daru PH, Murphy RL, Sagay AS. Cervical cancer survival in a resource-limited setting-North Central Nigeria. Infect Agent Cancer 2016; 11:15. [PMID: 27014366 PMCID: PMC4806480 DOI: 10.1186/s13027-016-0062-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organized cervical cancer screening services are presently lacking in Nigeria contributing to late presentation and diagnosis of invasive cervical cancer cases (ICCs) at advanced stages in most gynecologic units in Nigeria. We evaluated outcomes of ICCs diagnosed at Jos University Teaching Hospital (JUTH) to better understand factors associated with cervical cancer survival in similar resource limited settings. METHODS We performed a retrospective cohort study with a prospective follow up data to estimate time from diagnosis to mortality among women diagnosed with ICCs at JUTH. Women who were diagnosed with ICCs between January 2011 and May 2013 were followed up after initial evaluation at JUTH and subsequent referral for specialized treatment in one of the national oncology treatment centers in Nigeria. The main outcome measured was all-cause mortality rate and overall survival (OS) after diagnosis of ICC. The follow up data were updated and observations were censored March 31, 2015. The overall death rate was estimated using the total number of death events and the cumulative follow-up time from diagnosis to death. We conducted Cox proportional hazard regression to assess factors associated with death. RESULTS A total of 65 histologically confirmed ICCs were followed up. The median age of the cohort was 50 years with a median parity of 7. The HIV prevalence in the cohort was 8.2 % and the majority (72.3 %) were diagnosed at advanced stages (AD) of ICC. Simple total abdominal hysterectomy (TAH) was performed in 38.9 % of patients who were diagnosed at early stage disease (ED). After a cumulative follow up of 526.17 months, 35 deaths occurred with an overall death rate of 79.8 per 100 women-years. We also found a significantly higher hazard of death in women with AD (HR = 3.3) and baseline anemia (HR = 3.0). In the subgroup of women with ED, the OS was significantly higher for those who had TAH compared to those who did not (26.5 versus 11.6 months respectively). CONCLUSION Advanced stage disease and baseline anemia were independently associated with higher death rate. Cervical cancer patients diagnosed at early stages by non-oncologic specialist in settings lacking the standard of care may benefit from improve survival with simple hysterectomy.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Joseph Nankat
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Chad J Achenbach
- Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Babafemi O Taiwo
- Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Barnabas Mandong
- Department of Pathology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Robert L Murphy
- Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
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Ebonyi AO, Oguche S, Ejeliogu EU, Agbaji OO, Shehu NY, Abah IO, Sagay AS, Ugoagwu PO, Okonkwo PI, Idoko JA, Kanki PJ. Prevalence of and risk factors for pulmonary tuberculosis among newly diagnosed HIV-1 infected Nigerian children. Germs 2016; 6:21-8. [PMID: 27019829 DOI: 10.11599/germs.2016.1085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Studies on the prevalence of and risk factors for tuberculosis (TB) among newly diagnosed human immunodeficiency virus (HIV)-infected children in sub-Saharan Africa are scarce and in Nigeria there is paucity of reported data. We determined the prevalence of and risk factors for pulmonary TB (PTB) in newly diagnosed (treatment-naïve) HIV-1 infected children at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Nigeria. METHODS We performed a retrospective analysis of 876 children, aged 2 months - 13 years, diagnosed with HIV-1 infection between July 2005 and December 2012, of which 286 were diagnosed with PTB at presentation after TB screening. The study site was the AIDS Prevention Initiative in Nigeria (APIN)-supported Pediatric HIV clinic at JUTH, Jos. A multivariate forward logistic regression modelling was used to identify risk factors for PTB-HIV co-infection. RESULTS The prevalence of PTB-HIV co-infection was 32% (286/876). Severe immunosuppression (SI) and World Health Organization (WHO) HIV clinical stage 3/4 were identified as independent risk factors for PTB-HIV co-infection in HIV infected children. The odds of PTB-HIV co-infection was increased two-fold in HIV-infected children with WHO clinical stage 3/4 compared to those with stage 1/2 (adjusted odds ratio (AOR) 1.76 [1.31-2.37], p<0.001) and 1.5-fold in children with SI compared to those without SI (AOR 1.52 [1.12-2.06], p=0.007). CONCLUSION In our setting, the burden of PTB was high among newly diagnosed HIV-infected children, and late WHO HIV clinical stage and severe immunosuppression were associated with PTB-HIV co-infection. Therefore there is a clear need to improve strategies for early diagnosis of both HIV and PTB to optimize clinical outcomes.
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Affiliation(s)
- Augustine O Ebonyi
- MBBS, MSc, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Stephen Oguche
- BM. Bch, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Emeka U Ejeliogu
- MBBS, Department of Pediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O Agbaji
- MBBS, Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Nathan Y Shehu
- MBBS, Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Isaac O Abah
- BPharm, MSc, Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- BSc, MBChB, Department of Obstetrics and Gynecology, University of Jos/ Jos University Teaching Hospital, Jos, Nigeria
| | - Placid O Ugoagwu
- BSc, MSc, AIDS Prevention Initiative in Nigeria (APIN), Jos University Teaching Hospital, Jos, Nigeria
| | - Prosper I Okonkwo
- MBBS, AIDS Prevention Initiative in Nigeria (APIN) Ltd. Gte, Abuja, Nigeria
| | - John A Idoko
- MBBS, National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - Phyllis J Kanki
- DVM, SD, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Rawizza HE, Chang CA, Chaplin B, Ahmed IA, Meloni ST, Oyebode T, Banigbe B, Sagay AS, Adewole IF, Okonkwo P, Kanki PJ. Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria. Curr HIV Res 2016; 13:201-9. [PMID: 25986371 DOI: 10.2174/1570162x1303150506183256] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/22/2015] [Accepted: 02/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The 2013 WHO guidelines incorporated simplified and more effective antiretroviral regimens for the purposes of preventing mother-to-child transmission of HIV. With ideal implementation of these recommendations, perinatal HIV transmission could be reduced to less than 2%. However, loss to follow-up (LTFU) has the potential to erode the success of programs and a number of studies report high rates of LTFU within the prevention of mother-to-child transmission (PMTCT) care cascade. We evaluated the timing and magnitude of LTFU in a large programmatic PMTCT cohort in Nigeria in order to focus future efforts to reduce loss in this high burden setting. METHODS From 2004-2014, the APIN/Harvard PEPFAR program supported antenatal HIV screening for nearly one million pregnant women and provided PMTCT care to over 30,000 women. The care cascade for women enrolling in the PMTCT program includes antenatal, delivery, and infant follow-up services through 12-18 months of life. In this retrospective cohort analysis, we examined data collected between 2004-2014 from 31 clinical sites in Nigeria and assessed the numbers of mothers and infants enrolled and LTFU at various points along the care cascade. RESULTS Among 31,504 women (median age 30, IQR: 27-34) entering PMTCT care during the antenatal period, 20,679 (66%) completed the entire cascade of services including antenatal, delivery, and at least one infant follow-up visit. The median gestational age at presentation for antenatal care services was 23 weeks (IQR: 17-29). The median infant age at last follow-up visit was 12 months (IQR: 5-18). The greatest loss in the PMTCT care cascade occurred prior to delivery care (21%), with a further 16% lost prior to first infant visit. Of the 38,223 women who entered at any point along the PMTCT cascade, an HIV DNA PCR was available for 20,202 (53%) of their infants. Among infants for whom DNA PCR results were available, the rate of HIV transmission for infants whose mothers received any antenatal and/or delivery care was 2.8% versus 20.0% if their mother received none. CONCLUSION In this large cohort analysis, the proportion of women LTFU in the PMTCT care cascade was lower than that reported in previous cohort analyses. Nevertheless, this proportion remains unacceptably high and inhibits the program from maximally achieving the goals of PMTCT care. We also provide the largest analysis to date on rates of perinatal HIV transmission, with low rates among women receiving NNRTI- or PI-based regimens, approaching that reported in clinical trials. However, among mothers who received any antenatal care, infant outcomes were unknown for 48%, and women presented later in pregnancy than that recommended by current guidelines. Implementation research to evaluate ways to improve integration of services, particularly transitions from antenatal to delivery and pediatric care, are critically needed to reduce LTFU within PMTCT programs and achieve the ultimate goal of eliminating pediatric HIV infection.
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Affiliation(s)
- Holly E Rawizza
- Brigham & Women's Hospital, Boston, USA; 2Harvard School of Public Health, Boston, USA.
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Agbaji OO, Abah IO, Falang KD, Ebonyi AO, Musa J, Ugoagwu P, Agaba PA, Sagay AS, Jolayemi T, Okonkwo P, Idoko JA, Kanki PJ. Treatment Discontinuation in Adult HIV-Infected Patients on First-Line Antiretroviral Therapy in Nigeria. Curr HIV Res 2016; 13:184-92. [PMID: 25986369 DOI: 10.2174/1570162x1303150506181945] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria. METHOD A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively. RESULT Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86). CONCLUSION Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.
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Affiliation(s)
| | - I O Abah
- Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria.
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Sagay AS, Ebonyi AO, Meloni ST, Musa J, Oguche S, Ekwempu CC, Oyebode T, Ejeliogu E, Imade GE, Agbaji OO, Okonkwo P, Kanki PJ. Mother-to-Child Transmission Outcomes of HIV-Exposed Infants Followed Up in Jos North-Central Nigeria. Curr HIV Res 2016; 13:193-200. [PMID: 25986370 DOI: 10.2174/1570162x1303150506182534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 10/31/2014] [Accepted: 02/23/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Since 2010, Nigeria has adopted World Health Organization (WHO) 'Option B' which requires administration of triple antiretroviral prophylaxis or treatment (ART) to all HIVinfected pregnant women. We studied the transmission outcomes of HIV-exposed children up to 18 months of age. DESIGN This was a retrospective, observational study of HIV-infected pregnant women and their exposed infants who accessed prevention of mother to child transmission (PMTCT) services at Jos University Teaching Hospital, Jos, North-central Nigeria. METHODS HIV-infected women were enrolled during antenatal care or at labor/delivery between January 1, 2010 and December 31, 2012. Antiretroviral (ARV) prophylaxis/therapy was provided according to the 2010 Nigerian PMTCT guidelines (adapted WHO 2010 guidelines); Infant HIV diagnosis was performed at 6 weeks and at 6 months. HIV antibody diagnosis was used for exposed children at 18 months. RESULTS A total of 996 HIV-exposed children were followed up. Of those children, 140 (14.1%) were lost to follow up by 18 months of age. Twelve children (1.4%) died (all HIV negative) before 18 months of age and six infants (0.7%) were confirmed to be HIV-infected (4 by the age of 6 months and 2 thereafter) and were referred for treatment. A total of 838 (84.1%) children tested HIV negative at 18 months and were discharged. Mother-to-child transmission (MTCT) of HIV by 18 months was lower among women on ART before pregnancy compared to those women who started ART/Triple ARV prophylaxis during pregnancy/delivery. (0.4%; 3/700 vs 2.0%; 3/150 P=0.05). Home delivery was associated with higher transmission than facility delivery (p=0.03). Mode of delivery or method of infant feeding had no significant impact on vertical transmission by 18 months. CONCLUSION In North-central Nigeria where HIV is prevalent, ART started before pregnancy is enormously effective in preventing mother-to-child transmission. Adoption of WHO 'Option B+' deserves serious consideration in such settings.
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Affiliation(s)
- Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria.
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Ocheke AN, Agaba PA, Imade GE, Silas OA, Ajetunmobi OI, Echejoh G, Ekere C, Sendht A, Bitrus J, Agaba EI, Sagay AS. Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients. Int J STD AIDS 2015; 27:296-304. [PMID: 25887063 DOI: 10.1177/0956462415580887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/16/2015] [Indexed: 11/15/2022]
Abstract
Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of histologic chorioamnionitis (HCA) in HIV-positive and HIV-negative pregnant women. HIV-positive and -negative parturients were interviewed, examined and had their placentas examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women (p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of HCA in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity, which were related to severity of the disease.
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Affiliation(s)
- Amaka N Ocheke
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia A Agaba
- Department of Family Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Godwin E Imade
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Olugbenga A Silas
- Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Olanrewaju I Ajetunmobi
- Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Godwins Echejoh
- Department of Histopathology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Clement Ekere
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Ayuba Sendht
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - James Bitrus
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel I Agaba
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
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Musa J, Achenbach C, Taiwo B, Berzins B, Silas O, Daru PH, Agbaji O, Imade G, Sagay AS, Idoko JA, Kanki PJ, Murphy RL. High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology. Infect Agent Cancer 2014; 9:36. [PMID: 25395987 PMCID: PMC4230523 DOI: 10.1186/1750-9378-9-36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/07/2014] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection. Methods Between May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA. Results We conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+). Conclusion HIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Chad Achenbach
- Center for Global Health, Northwestern University, Chicago, IL USA
| | - Babafemi Taiwo
- Center for Global Health, Northwestern University, Chicago, IL USA
| | - Baiba Berzins
- Center for Global Health, Northwestern University, Chicago, IL USA
| | - Olugbenga Silas
- Department of Pathology, University of Jos, Jos, Plateau State Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria
| | - Oche Agbaji
- Department of Medicine, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Godwin Imade
- Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - John A Idoko
- Department of Medicine, University of Jos, Jos, Plateau State Nigeria
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA USA
| | - Robert L Murphy
- Center for Global Health, Northwestern University, Chicago, IL USA
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Imade GE, Musa J, Sagay AS, Kapiga SH, Sankale JL, Idoko J, Kanki P. Association of Bacterial vaginosis and other Sexually Transmitted Infections with HIV among pregnant women in Nigeria. Afr J Med Med Sci 2014; 43:23-28. [PMID: 26681823 PMCID: PMC4679194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the association of Bacterial vaginosis (BV) and other sexually transmissible infections (STIs) with HIV prevalence among pregnant women in Jos, Nigeria. METHODS This was a cross- sectional study of pregnant women who participated in the Prevention of Mother-to-Child Transmission of HIV program of the AIDS Prevention Initiative in Nigeria, between April 2002 and July 2004, at the Jos University Teaching Hospital in Jos, Nigeria. Blood, high vaginal and endocervical samples were obtained for diagnosis of HIV, BV and other STIs. Data were analyzed for prevalence of HIV, BV and other STIs. Univariate and multivariate logistic regression models generated unadjusted and adjusted odds ratios (OR) as well as 95% confidence intervals (CI) of the association of BV and other STIs with HIV prevalence. P value <0.05 was considered statistically significant. RESULTS A total of 4,046 pregnant women were studied and 97.6% (3,950/4,046) had complete laboratory records for analysis. The prevalence of HIV was 8.2% (CI: 7.4-9.1); BV 11.9% (CI: 10.9-12.9); Candida 10.7% (CI: 9.7-11.7); mixed infection of BV and Candida 2.8% (CI: 2.3-3.4); Trichomonads 0.6% (CI: 0.3-0.8) and syphilis 0.35% (0.16-0.54). BV, Candida, mixed BV and Candida; and Trichomonads were independently associated with HIV infection [adjusted OR (95% CI), 2.9 (CI: 2.2-3.9); 2.0 (CI: 1.5-2.9); 3.4 (CI: 2.0-5.6), and 3.3 (CI: 1.1-9.7) respectively]. CONCLUSION HIV prevalence is higher among pregnant women who have BV, Candida and Trichomonads vaginal infections compared with women who have no evidence of infection. The practice of routine screening for BV and other STIs among pregnant women as a strategy for identifying women at risk for prevalent HIV infection should be sustained/ encouraged and the syndromic management of STIs should be integrated into all antenatal care management protocols in antenatal clinics in order to curb the epidemic of heterosexual HIV transmission.
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Affiliation(s)
- Godwin E. Imade
- Department of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Atiene S. Sagay
- Department of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Saidi H. Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA
| | - Jean-Louis Sankale
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston MA, USA
| | - John Idoko
- Department of Medicine, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Phyllis Kanki
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston MA, USA
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Pam VC, Musa J, Mutihir JT, Karshima JA, Anyaka CU, Sagay AS. BODY WEIGHT CHANGES IN WOMEN USING IMPLANON IN JOS, NIGERIA. Afr J Med Med Sci 2014; 43:15-21. [PMID: 31217663 PMCID: PMC6582964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The fear of weight gain is one of the adverse events that make women to discontinue Implanon® (etonorgestrel) contraceptive. Black women are more prone to gain weight with the use of such progestogen-only contraceptives than women of other racial groups. The weight of women is also an important consideration since it influences the concentration of the active drug and may predispose to failure at a higher weight profile.Information on weight changes with the use of etonorgestrel implant is scarce in our sub-region. We therefore explored the direction and extent of weight changes among women in different weight categories and determined the predictors of the final body weight during use of Implanon®. MATERIALS AND METHOD This was a retrospective study of all women that accepted implanon at the Family Planning Unit of the Jos University Teaching Hospital, Jos Nigeria from March 2007 to March 2014. Data analysis was carried out using Stata version 12.1. The socio-demographic data and reproductive histories were extracted from the records and the duration of use of the implant, reasons for discontinuation and the initial weight and at follow up were analysed. RESULTS Over 99% of the women who had Implanon® were parous and the commonest contraceptive they had used previously was the injectables. However, almost a quarter (22.8%) were accepting Implanon® as their first ever contraceptive method. The mean baseline weight was 64.4 ± 12.1 kg and the median weight was 63.0 kg. The average months of use of Implanon® in this study was 27 months and there was a mean increase in body weight of 2.5 kg during the study. However, there was a broad variability in the individual change in body weight with about 38.6% losing weight or not having any net weight change. Over three-fifths (61.4%) of the women had a net weight gain while using Implanon®. Of these women, 36.0% gained 1-5 kg, 19.2% gained 6-10 kg, 4.2% gained 11-15 kg and 2.0% gained more than 16 kg with the maximum gain at 26 kg. The mean weight changes were 0.8 kg, 1.6 kg, 3.2 kg and 3.3 kg respectively for the first, second, third and fourth years of Implanon® use respectively. Implanon® was removed on account of weight gain in 3.8% of those women who had removed the implant. There was no statistically significant difference in weight gain among the different weight categories: women who had an initial weight above 90 kg gained less than 1 kg compared to those who had normal weight (for this study <70 kg) at the baseline that gained on average more than 2.0 kg. The most significant predictor of the final body weight with Implanon® use was the initial body weight which predicts it in 83.5% of the time (p-value 0.000, CI 0.99, 1.05). CONCLUSION There was a broad variability in weight changes with the use of Implanon® and the initial body weight is the most significant predictor of the final body weight. Therefore implanon can be used by women of all weight categories including those considered to be obese.
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Affiliation(s)
- VC Pam
- Corresponding author Victor C. Pam,
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Ogbe AE, Sagay AS, Imade GE, Musa J, Pam VC, Egah D, Onwuliri V, Short R. DECLINING PREVALENCE OF HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS AMONG FEMALE SEX WORKERS IN JOS, NORTH-CENTRAL NIGERIA. Afr J Med Med Sci 2014; 43:5-13. [PMID: 29578211 PMCID: PMC4682905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Female Sex Workers (FSWs) are key reservoirs of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) from which transmission to the general population fuels epidemics. STIs amplify HIV infectiousness and susceptibility. We determined the status of HIV and STIs among brothel-based FSWs in Jos as part of an ongoing prevention intervention. METHOD Between January and May 2012, consenting consecutive brothel-based FSWs were recruited from previously designated brothels across Jos. HIV counseling and testing as well as screening for gonorrhoea, syphilis, trichomonasis, candidasis and Bacteria vaginosis (BV) were performed. Positive cases were provided free treatment and follow-up at Solat Women Hospital, Jos. Ethical clearance was obtained from Jos University Teaching Hospital (JUTH) ethical committee. RESULT Two hundred FSWs aged 27.6 ± 4.6 years (range 15-55 years) were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV. The association between HIV and bacterial vaginosis was statistically significant (OR of 2.2, 95% CI of 1.1-4.2, P-value=0.02). In comparison to similar prevalence in 2006, the current findings represent 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV. CONCLUSION The prevalence of HIV and STIs among brothel-based FSWs in Jos remain unacceptably high, although, there is a declining trend. A comprehensive HIV prevention program targeting these women is required to block transmission to the general population.
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Affiliation(s)
- AE Ogbe
- Departments of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - AS Sagay
- Departments of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - GE Imade
- Departments of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - J Musa
- Departments of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - VC Pam
- Departments of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - D Egah
- Medical Microbiology, University of Jos, Jos, Plateau State, Nigeria
| | - V Onwuliri
- Biochemistry, Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - R Short
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Olaleye DO, Odaibo GN, Carney P, Agbaji O, Sagay AS, Muktar H, Akinyinka OO, Omigbodun AO, Ogunniyi A, Gashau W, Akanmu S, Ogunsola F, Chukwuka C, Okonkwo PI, Meloni ST, Adewole I, Kanki PJ, Murphy RL. Enhancement of health research capacity in Nigeria through north-south and in-country partnerships. Acad Med 2014; 89:S93-7. [PMID: 25072590 PMCID: PMC5207797 DOI: 10.1097/acm.0000000000000353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Research productivity in Sub-Saharan Africa has the potential to affect teaching, student quality, faculty career development, and translational country-relevant research as it has in developed countries. Nigeria is the most populous country in Africa, with an academic infrastructure that includes 129 universities and 45 medical schools; however, despite the size, the country has unacceptably poor health status indicators. To further develop the research infrastructure in Nigeria, faculty and research career development topics were identified within the six Nigerian universities of the nine institutions of the Medical Education Partnership Initiative in Nigeria (MEPIN) consortium. The consortium identified a training model that incorporated multi-institutional "train-the-trainers" programs at the University of Ibadan, followed by replication at the other MEPIN universities. More than 140 in-country trainers subsequently presented nine courses to more than 1,600 faculty, graduate students, and resident doctors throughout the consortium during the program's first three years (2011-2013). This model has fostered a new era of collaboration among the major Nigerian research universities, which now have increased capacity for collaborative research initiatives and improved research output. These changes, in turn, have the potential to improve the nation's health outcomes.
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Affiliation(s)
- David O Olaleye
- Dr. Olaleye is professor of virology, Department of Virology, and former dean, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Odaibo is a reader, Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria. Prof. Carney is assistant provost for graduate and professional studies and associate professor of health studies, Chicago State University, Chicago, Illinois. Dr. Agbaji is senior lecturer, Department of Medicine, Jos University Teaching Hospital and University of Jos, Jos, Nigeria. Dr. Sagay is professor of obstetrics and gynecology, Faculty of Medical Sciences, Jos University Teaching Hospital, Jos, Nigeria. Dr. Muktar is senior lecturer in hemato-oncology/retrovirology, Department of Hematology and Blood Transfusion, Ahmadu Bello University, and consultant hematologist, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Dr. Akinyinka is provost and professor of pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Omigbodun is professor of obstetrics and gynecology and former provost, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Ogunniyi is professor of neurology, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. Dr. Gashau is chief consultant physician, University of Maiduguri Teaching Hospital, Borno, Maiduguri, Nigeria. Dr. Akanmu is professor of hematology and blood transfusion, College of Medicine, University of Lagos, Lagos, Nigeria. Dr. Ogunsola is professor of medical microbiology and provost, College of Medicine, University of Lagos, Lagos, Nigeria. Dr. Chukwuka is senior lecturer and consultant respiratory physician, College of Medicine, University of Nigeria, Enugu, Nigeria. Dr. Okonkwo is CEO, AIDS Prevention Initiative in Nigeria LLC, Abuja, FCT Territory, Nigeria. Dr. Meloni is research associate, Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Mass
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Imade GE, Sagay AS, Chaplin B, Chebu P, Musa J, Okpokwu J, Hamel DJ, Pam IC, Agbaji O, Samuels J, Meloni S, Sankale JL, Okonkwo P, Kanki P. Short communication: Transmitted HIV drug resistance in antiretroviral-naive pregnant women in north central Nigeria. AIDS Res Hum Retroviruses 2014; 30:127-33. [PMID: 24164431 DOI: 10.1089/aid.2013.0074] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The World Health Organization (WHO) recommends periodic surveillance of transmitted drug resistance (TDR) in communities in which antiretroviral therapy (ART) has been scaled-up for greater than 3 years. We conducted a survey of TDR mutations among newly detected HIV-infected antiretroviral (ARV)-naive pregnant women. From May 2010 to March 2012, 38 ARV-naive pregnant women were recruited in three hospitals in Jos, Plateau state, north central Nigeria. Eligible subjects were recruited using a modified version of the binomial sequential sampling technique recommended by WHO. HIV-1 genotyping was performed and HIV-1 drug resistance mutations were characterized according to the WHO 2009 surveillance drug resistance mutation (SDRM) list. HIV subtypes were determined by phylogenetic analysis. The women's median age was 25.5 years; the median CD4(+) cell count was 317 cells/μl and the median viral load of 16 was 261 copies/ml. Of the 38 samples tested, 34 (89%) were successfully genotyped. The SDRM rate was <5% for all ART drug classes, with 1/34 (2.9%) for NRTIs/NNRTIs and none for protease inhibitors 0/31 (0%). The specific SDRMs detected were M41L for nucleoside reverse transcriptase inhibitors (NRTIs) and G190A for nonnucleoside reverse transcriptase inhibitors (NNRTIs). HIV-1 subtypes detected were CRF02_AG (38.2%), G' (41.2%), G (14.7%), CRF06-CPX (2.9%), and a unique AG recombinant form (2.9%). The single ARV-native pregnant woman with SDRMs was infected with HIV-1 subtype G'. Access to ART has been available in the Jos area for over 8 years. The prevalence of TDR lower than 5% suggests proper ART administration, although continued surveillance is warranted.
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Affiliation(s)
- Godwin E. Imade
- Jos University Teaching Hospital (JUTH), APIN Centre, Jos, Nigeria
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Atiene S. Sagay
- Jos University Teaching Hospital (JUTH), APIN Centre, Jos, Nigeria
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Beth Chaplin
- Harvard School of Public Health, Boston, Massachusetts
| | - Philippe Chebu
- Jos University Teaching Hospital (JUTH), APIN Centre, Jos, Nigeria
| | - Jonah Musa
- Jos University Teaching Hospital (JUTH), APIN Centre, Jos, Nigeria
| | - Jonathan Okpokwu
- Jos University Teaching Hospital (JUTH), APIN Centre, Jos, Nigeria
| | | | - Ishaya C. Pam
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Oche Agbaji
- Jos University Teaching Hospital (JUTH), APIN Centre, Jos, Nigeria
| | - Jay Samuels
- AIDS Prevention Initiative in Nigeria Ltd, Abuja, Nigeria
| | - Seema Meloni
- Harvard School of Public Health, Boston, Massachusetts
| | | | | | - Phyllis Kanki
- Harvard School of Public Health, Boston, Massachusetts
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49
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Imade GE, Sagay AS, Musa J, Ocheke AN, Adeniyi DS, Idighri M, Powl R, Sendeht A, Ogwuche JP, Elujoba M, Egbodo CO, Oyebode T, Daru PH, Agbaji O, Pam IC, Meloni ST, Okonkwo P, Kanki PJ. Declining rate of infection with maternal human immunodeficiency virus at delivery units in north-central Nigeria. Afr J Reprod Health 2013; 17:138-145. [PMID: 24689325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
HIV testing during labour and delivery provides a critical opportunity for administering appropriate interventions to prevent mother-to-child-transmission (PMTCT). We studied current HIV rates and infection trend among women tested during delivery following scale-up of PMTCT and antiretroviral therapy (ART) programs in Jos, north central Nigeria. Between March 2010 and January 2012, provider-initiated HIV testing and counselling was offered in early labour. Women were recruited from a government tertiary health centre, a faith-based hospital, and a private health centre. Those who previously tested HIV negative during antenatal care (ANC) and those who presented at the labour ward with unknown HIV status were tested. A total of 944 subjects (727 re-tested for HIV infection and 217 with unknown HIV status) were enrolled and tested during labour. The HIV incidence and sero-conversion rates during pregnancy among women who repeated HIV testing at delivery was 1.7 per 100 person-years of observation (pyo) and 0.6% (4/727), respectively, while the rate among those who tested for the first time in labour was 1.8% (4/217). Women who accessed ANC were older and had achieved a higher educational status than those who did not access ANC. A 3- to 5-fold decline in HIV incidence and prevalence rates was detected among women tested at delivery when compared to data from a report in 2004. It is not certain whether the decline in maternal HIV infection is due to the major state-wide scale-up of PMTCT and HIV treatment programs. A broader and purposefully designed evaluation study would be required to verify observed occurrence.
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Musa J, Taiwo B, Achenbach C, Olugbenga S, Berzins B, Sagay AS, Idoko JA, Kanki PJ, Murphy RL. High-risk human papillomavirus among HIV-infected women with normal cervical cytology: a pilot study in Jos, Nigeria. Arch Gynecol Obstet 2013; 288:1365-70. [PMID: 23700253 DOI: 10.1007/s00404-013-2885-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cervical cancer is strongly linked to high-risk human papillomavirus (HR-HPV) and is typically preceded by cytological abnormalities. Less is known in patients with normal cervical cytology (NCC). We investigated the epidemiology of HR-HPV among HIV-infected women with NCC. METHODOLOGY We conducted a cross-sectional study between January and June 2011 among HIV-infected women with NCC at an adult HIV clinic in Jos, Nigeria. Cervical sampling and analysis for HR-HPV by hybrid capture (HC2) with signal amplification was done to determine presence of one or more of the following HR-HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 or 68. Epidemiologic factors associated with HR-HPV were determined using bivariate statistics and multivariate logistic regression. RESULTS We evaluated 103 HIV-infected women with Pap cytology. The median age of the women was 32 years (range 21-49). Ninety-seven (94.2%) had NCC. Cervical samples for HR-HPV DNA testing were available from 89/97 (91.8%) of the HIV-infected women with NCC. Of the 89 women with cervical samples for HR-HPV DNA testing, 40 (44.9%) had detectable HR-HPV by HC2 giving a HR-HPV prevalence of 44.9% (95% CI 33.9-55.5%). Age < 30 years was associated with HR-HPV (OR 2.69 [95% CI 1.05-6.91, p = 0.039]) while history of previous abortion showed an inverse association with HR-HPV (OR 0.33[95% CI 0.15-0.94, p = 0.039]). CONCLUSION The prevalence of HR-HPV is seemingly high among HIV-infected women with NCC in our clinical setting. These data provide support for further investigation of the clinical implications of positive HR-HPV among HIV-infected women with NCC report in cervical cancer prevention programs in Nigeria.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria,
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