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Brown BJ, Madu A, Sangeda RZ, Nkya S, Peprah E, Paintsil V, Mmbando BP, Gyamfi J, Okocha CE, Asala SA, Nembaware V, Jonas M, Kengne AP, Chimusa ER, Nguweneza A, Isa HA, Nnebe-Agumadu U, Adekile AD, Osei-Akoto A, Ohene-Frempong K, Balandya E, Nnodu OE, Wonkam A. Utilization of Pneumococcal Vaccine and Penicillin Prophylaxis in Sickle Cell Disease in Three African Countries: Assessment among Healthcare Providers in SickleInAfrica. Hemoglobin 2021; 45:163-170. [PMID: 34355623 PMCID: PMC10022452 DOI: 10.1080/03630269.2021.1954943] [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: 03/31/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
Sickle cell disease is a genetic disease with a predisposition to infections caused by encapsulated organisms, especially Streptococcus pneumoniae. Pneumococcal vaccines and prophylactic penicillin have reduced the rate of this infection and mortality in sickle cell disease. However, implementation of these interventions is limited in Africa. The objectives of the study were to assess health care providers' behaviors with the implementation of pneumococcal vaccination and penicillin prophylaxis and to identify barriers to their use. A 25-item online questionnaire was administered through SickleinAfrica: a network of researchers, and healthcare providers, in Ghana, Nigeria, and Tanzania, working to improve health outcomes of sickle cell disease in Africa. Data was collected and managed using the Research Electronic Data Capture (REDCap), tools and data analysis was done using STATA version 13 and R statistical software. Eighty-two medical practitioners responded to the questionnaire. Only 54.0 and 48.7% of respondents indicated the availability of published guidelines on sickle cell disease management and pneumococcal vaccine use, respectively, at their facilities. The majority (54.0%) perceived that the vaccines are effective but over 20.0% were uncertain of their usefulness. All respondents from Ghana and Tanzania affirmed the availability of guidelines for penicillin prophylaxis in contrast to 44.1% in Nigeria. Eighty-five percent of respondents affirmed the need for penicillin prophylaxis but 15.0% had a contrary opinion for reasons including the rarity of isolation of Streptococcus pneumoniae in African studies, and therefore, the uncertainty of its benefit. Lack of published guidelines on the management of sickle cell disease and doubts about the necessity of prophylactic measures are potential barriers to the implementation of effective interventions.
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Affiliation(s)
- Biobele J. Brown
- Department of Paediatrics, Haematology & Oncology Unit, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Nigeria
| | - Anazoeze Madu
- Department of Haematology, University of Nigeria, Nsukka, Nigeria
| | - Raphael Z. Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Department of Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Emmanuel Peprah
- Department of Social & Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruno P. Mmbando
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Joyce Gyamfi
- Department of Social & Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Chide E. Okocha
- Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Samuel A. Asala
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Victoria Nembaware
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Mario Jonas
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council & Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile R. Chimusa
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Arthemon Nguweneza
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Hezekiah A. Isa
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Uche Nnebe-Agumadu
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Adekunle D. Adekile
- Faculty of Medicine, Department of Paediatrics, Kuwait University, Jabriya, Kuwait
| | - Alex Osei-Akoto
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Obiageli E. Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Ambroise Wonkam
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - The SickleInAfrica Consortium
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Nnodu OE, Sopekan A, Nnebe-Agumadu U, Ohiaeri C, Adeniran A, Shedul G, Isa HA, Owolabi O, Chianumba RI, Tanko Y, Iyobosa JH, Adekile AD, Olopade OI, Piel FB. Implementing newborn screening for sickle cell disease as part of immunisation programmes in Nigeria: a feasibility study. Lancet Haematol 2020; 7:e534-e540. [PMID: 32589979 PMCID: PMC7322555 DOI: 10.1016/s2352-3026(20)30143-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 01/25/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sickle cell disease is highly prevalent in sub-Saharan Africa, where it accounts for substantial morbidity and mortality. Newborn screening is paramount for early diagnosis and enrolment of affected children into a comprehensive care programme. Up to now, this strategy has been greatly impaired in resource-poor countries, because screening methods are technologically and financially intensive; affordable, reliable, and accurate methods are needed. We aimed to test the feasibility of implementing a sickle cell disease screening programme using innovative point-of-care test devices into existing immunisation programmes in primary health-care settings. METHODS Building on a routine immunisation programme and using existing facilities and staff, we did a prospective feasibility study at five primary health-care centres within Gwagwalada Area Council, Abuja, Nigeria. We systematically screened for sickle cell disease consecutive newborn babies and infants younger than 9 months who presented to immunisation clinics at these five centres, using an ELISA-based point-of care test (HemoTypeSC). A subgroup of consecutive babies who presented to immunisation clinics at the primary health-care centres, whose mothers gave consent, were tested by the HemoTypeSC point-of-care test alongside a different immunoassay-based point-of-care test (SickleSCAN) and the gold standard test, high-performance liquid chromatography (HPLC). FINDINGS Between July 14, 2017, and Sept 3, 2019, 3603 newborn babies and infants who presented for immunisation were screened for sickle cell disease at five primary health-care centres using the ELISA-based point-of-care test. We identified 51 (1%) children with sickle cell anaemia (HbSS), four (<1%) heterozygous for HbS and HbC (HbSC), 740 (21%) with sickle cell trait (HbAS), 34 (1%) heterozygous for HbA and HbC (HbAC), and 2774 (77%) with normal haemoglobin (HbAA). Of the 55 babies and infants with confirmed sickle cell disease, 41 (75%) were enrolled into a programme for free folic acid and penicillin, of whom 36 (88%) completed three visits over 9 months (median follow-up 226 days [IQR 198-357]). The head-to-head comparison between the two point-of-care tests and HPLC showed concordance between the three testing methods in screening 313 newborn babies, with a specificity of 100% with HemoTypeSC, 100% with SickleSCAN, and 100% by HPLC, and a sensitivity of 100% with HemoTypeSC, 100% with SickleSCAN, and 100% by HPLC. INTERPRETATION Our pilot study shows that the integration of newborn screening into existing primary health-care immunisation programmes is feasible and can rapidly be implemented with limited resources. Point-of-care tests are reliable and accurate in newborn screening for sickle cell disease. This feasibility study bodes well for the care of patients with sickle cell disease in resource-poor countries. FUNDING Doris Duke Charitable Foundation, Imperial College London Wellcome Trust Centre for Global Health Research, and Richard and Susan Kiphart Family Foundation.
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Affiliation(s)
- Obiageli E Nnodu
- Sickle Cell Disease Desk, Non-Communicable Disease Unit, Federal Ministry of Health, Federal Secretariat, Abuja, Nigeria.
| | - Alayo Sopekan
- Sickle Cell Disease Desk, Non-Communicable Disease Unit, Federal Ministry of Health, Federal Secretariat, Abuja, Nigeria
| | | | - Chinatu Ohiaeri
- Department of Paediatrics, Federal Medical Centre, Keffi, Nigeria
| | - Adeyemi Adeniran
- Department of Health, Gwagwalada Area Council Secretariat, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Pharmacy Department, University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Hezekiah A Isa
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Olumide Owolabi
- Department of Computer Science, University of Abuja, Abuja, Nigeria
| | - Reuben I Chianumba
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Yohanna Tanko
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Juliet H Iyobosa
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | | | - Olufunmilayo I Olopade
- Centre for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, IL, USA
| | - Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Nwegbu MM, Isa HA, Nwankwo BB, Okeke CC, Edet-Offong UJ, Akinola NO, Adekile AD, Aneke JC, Okocha EC, Ulasi T, Abjah U, Ugwu NI, Okolo AA, Madu A, Emodi I, Girei A, Balogun TM, Diaku-Akinwumi IN, Ohiaeri C, Brown BJ, Olaniyi JA, Hassan A, Awwalu S, Okoh DA, Nnodu OE. Preliminary Evaluation of a Point-of-Care Testing Device (SickleSCAN™) in Screening for Sickle Cell Disease. Hemoglobin 2017; 41:77-82. [PMID: 28617057 DOI: 10.1080/03630269.2017.1329151] [Citation(s) in RCA: 7] [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] [Indexed: 12/17/2022]
Abstract
Sickle cell disease affects about 150,000 births annually in Nigeria. Early diagnosis is hampered by factors such as centralized and urban localization of laboratories, high cost of diagnostic equipment and inadequate skilled manpower to operate them. The need for a low-cost, portable, easy-to-use diagnostic test for sickle cell disease is critical, especially in resource-poor countries. In this study, we evaluated the performance characteristics of a novel point-of-care testing device (SickleSCAN™), and its acceptability and feasibility, as a possible screening tool for sickle cell disease. In the first phase, we assessed the performance characteristics of SickleSCAN™ by evaluating 57 subjects comprising both children and adults attending a primary health center, for Hb SS (βS/βS; HBB: c.20A>T), Hb SC (βS/βC; HBB: c.19G>A) and Hb AS (βA/βS) using SickleSCAN™, cellulose acetate electrophoresis (CAE) and high performance liquid chromatography (HPLC). Performance characteristics such as diagnostic sensitivity and specificity were compared to HPLC as a standard method. We subsequently undertook a second phase wherein the acceptability and feasibility of the device for sickle cell disease screening, was evaluated using semi-structured and structured questionnaires among 197 healthcare personnel and 221 subjects, respectively. Sickle cell disease was carried by 3.4% of the subjects. The diagnostic sensitivity, specificity and test efficiency of SickleSCAN™ for sickle cell disease (Hb SS and Hb SC), were 100.0, 98.2 and 98.2%, respectively. Findings from this study showed SickleSCAN™ to be a viable screening tool that can easily be applied in community-based screening for early diagnosis of sickle cell disease with little expertise and low cost.
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Affiliation(s)
- Maxwell M Nwegbu
- a Department of Chemical Pathology, College of Health Sciences , University of Abuja , Abuja , Nigeria.,d Centre of Excellence for Sickle Cell Research & Training , University of Abuja (CESRTA) , Abuja , Nigeria
| | - Hezekiah A Isa
- b Department of Haematology, College of Health Sciences , University of Abuja , Abuja , Nigeria.,d Centre of Excellence for Sickle Cell Research & Training , University of Abuja (CESRTA) , Abuja , Nigeria
| | - Biyaya B Nwankwo
- c Department of Community Medicine, College of Health Sciences , University of Abuja , Abuja , Nigeria.,d Centre of Excellence for Sickle Cell Research & Training , University of Abuja (CESRTA) , Abuja , Nigeria
| | - Chinedu C Okeke
- b Department of Haematology, College of Health Sciences , University of Abuja , Abuja , Nigeria.,d Centre of Excellence for Sickle Cell Research & Training , University of Abuja (CESRTA) , Abuja , Nigeria
| | - Uduak J Edet-Offong
- d Centre of Excellence for Sickle Cell Research & Training , University of Abuja (CESRTA) , Abuja , Nigeria
| | - Norah O Akinola
- e Department of Haematology & Immunology, Faculty of Basic Medical Sciences , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Adekunle D Adekile
- f Department of Pediatrics, Faculty of Medicine , Kuwait University , Kuwait
| | - John C Aneke
- g Departments of Paediatrics & Haematology , Nnamdi Azikiwe Teaching Hospital , Nnewi , Anambra State , Nigeria
| | - Emmanuel C Okocha
- g Departments of Paediatrics & Haematology , Nnamdi Azikiwe Teaching Hospital , Nnewi , Anambra State , Nigeria
| | - Thomas Ulasi
- g Departments of Paediatrics & Haematology , Nnamdi Azikiwe Teaching Hospital , Nnewi , Anambra State , Nigeria
| | - Usman Abjah
- h Department of Haematology , University of Maiduguri , Maiduguri , Borno State , Nigeria
| | - Ngozi I Ugwu
- i Federal Teaching Hospital , Abakaliki, Ebonyi State , Abakaliki , Nigeria
| | - Angela A Okolo
- j Department of Paediatrics , University of Benin , Benin City , Edo State , Nigeria.,k Departments Paediatrics, Haematology & Immunology , University of Nigeria Faculty of Medical Sciences , Enugu State , Nigeria
| | - Anazoeze Madu
- k Departments Paediatrics, Haematology & Immunology , University of Nigeria Faculty of Medical Sciences , Enugu State , Nigeria
| | - Ifeoma Emodi
- k Departments Paediatrics, Haematology & Immunology , University of Nigeria Faculty of Medical Sciences , Enugu State , Nigeria
| | - Ahmed Girei
- l Federal Medical Centre , Gombe , Gombe State , Nigeria
| | - Taiwo M Balogun
- m Departments of Paediatrics & Haematology , Lagos State University Teaching Hospital , Ikeja, Lagos , Nigeria
| | - Ijeoma N Diaku-Akinwumi
- m Departments of Paediatrics & Haematology , Lagos State University Teaching Hospital , Ikeja, Lagos , Nigeria
| | - Chinatu Ohiaeri
- n Department of Paediatrics , Federal Medical Centre , Keffi , Nassarawa State , Nigeria
| | - Biobele J Brown
- o Departments of Haematology and Paediatrics , University College, Hospital , Ibadan , Oyo State , Nigeria
| | - John A Olaniyi
- o Departments of Haematology and Paediatrics , University College, Hospital , Ibadan , Oyo State , Nigeria
| | - Abdulaziz Hassan
- p Department of Haematology & Blood Transfusion , Ahmadu Bello University Teaching Hospital , Zaria , Kaduna State , Nigeria
| | - Sani Awwalu
- p Department of Haematology & Blood Transfusion , Ahmadu Bello University Teaching Hospital , Zaria , Kaduna State , Nigeria
| | - Dorothy A Okoh
- q Braithwaite Memorial Hospital , Port Harcourt , Rivers State , Nigeria
| | - Obiageli E Nnodu
- b Department of Haematology, College of Health Sciences , University of Abuja , Abuja , Nigeria.,d Centre of Excellence for Sickle Cell Research & Training , University of Abuja (CESRTA) , Abuja , Nigeria
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Abstract
BACKGROUND There has been few published reports of primary bone tumours and tumour-like lesions in Zaria. OBJECTIVE To determine the relative frequencies of primary bone tumours and tumour-like lesions of bone and the anatomical sites of their occurrence. METHODS A retrospective review of histopathology reports of all bone specimens received in the Department of Histopathology, Ahmadu Bello University, Teaching Hospital Zaria between 1995 and 2004. RESULTS Of the 127 histologically diagnosed tumours and tumour-like lesions, 74 (58.3%) were males and 53 (41.7%) were females, giving a male to female ratio of 1.5:1. Benign Tumours accounted for 38.6% of the tumours while the malignant tumours and the tumour-like lesions made up 39.4% and 22% respectively. Osteochondroma [20(15.7%)] and osteosarcoma [17 (13.4%)] were the most commonly encountered tumours while fibrous dysplasia [26(20.4%)] was the most common tumour-like lesion. The peak age incidence of occurrence of these tumours was in the 2(n) [47 (37.0%)] and 3rd [28(22.0%)] decades. The face was the most common site with 62 (48.8%) of occurrence followed by the femur accounting for 8 (6.3%). CONCLUSION Bone tumours, of which the most common benign and malignant tumours were osteochondroma and Osteosarcoma respectively appear to be mainly a problem of young adults in Zaria.
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Affiliation(s)
- A Mohammed
- Department of Pathology, Ahmadu Bello University Teaching Hospital Zaria.
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