Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria - A multi-facility study of 34 tertiary hospitals

Background

The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions.

Aims

We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments.

Materials and Methods

A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2).

Results

A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011].

Conclusions

The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.

Community resources support adherence to treatment for childhood cancer in El Salvador

OBJECTIVE

In order to reduce nonadherence and treatment abandonment of children with cancer in El Salvador, institutions located nearby the patients' homes were involved to provide support. Methodological approach: Health clinics and municipality offices in the patients' communities were asked to assist families who were not promptly located after missing hospital appointments, or those whose financial limitations were likely to impede continuation of treatment. Data was collected about the number of contacted institutions, the nature of help provided, staff's time investments, and parents' perceptions about the intervention.

FINDINGS

Local institutions (133 from 206 contacts) conducted home visits (83), and/or provided parents with money (55) or transportation (60). Parents found this support essential for continuing the treatment but they also encountered challenges regarding local institutions' inconsistencies. Nonadherence and abandonment decreased.

IMPLICATIONS

Economic burden was reduced on both the families and the hospital. Involvement of external institutions might become regular practice to support families of children with cancer.

A chemotherapy only therapeutic approach to pediatric Hodgkin lymphoma: AHOPCA LH 1999

BACKGROUND

AHOPCA is a collaborative group that designs uniform treatment regimens (protocols) for children diagnosed with cancer in Central America. Based on a preliminary report from one of the AHOPCA centers, AHOPCA adopted a treatment regimen to maintain a good event-free survival (EFS) as well as eliminate radiation therapy from the treatment of children with Hodgkin lymphoma.

PROCEDURE

Newly diagnosed patients with histologically proven Hodgkin lymphoma were staged according to the Ann Arbor classification and divided into favorable (stage I, stage IIA, and IIIA) and unfavorable (stage IIB, IIIB, and IV) groups. Subjects classified as group 1 (favorable) were treated with six 28-day cycles of chemotherapy (COPP/COPP ± ABV). Subjects classified as group 2 (unfavorable) were treated with eight 28-day cycles of COPP/ABV chemotherapy.

RESULTS

Of 269 patients registered, 216 were eligible for evaluation. The mean age at diagnosis was 7.5 years with a male to female ratio of 3.7-1. The predominant histology was nodular sclerosis (44%) but with a relatively high proportion of mixed cellularity (35.2%) The EFS at 5 and 10 years was 71% and 68%, respectively. There was a 14% rate of abandonment of therapy.

CONCLUSION

This treatment regimen for children with Hodgkin lymphoma, when applied as a multi-institutional regimen, had poorer outcome than our previously reported preliminary data and was inferior to the EFS reported in high-income countries. The major contributor adversely affecting EFS in this report is abandonment of therapy. Given these results, AHOPCA initiated a concerted effort to decrease abandonment of therapy.

Knowledge of human immunodeficiency virus post-exposure prophylaxis among doctors in a Nigerian tertiary hospital

BACKGROUND

The mainstay of prevention of occupationally-acquired HIV infection is compliance with universal precautions. Appropriate post-exposure prophylaxis is an integral part of prevention, control and workplace safety. This study was undertaken to assess the level of knowledge of post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) among doctors in Federal Medical Centre, Gombe, Nigeria.

MATERIALS AND METHODS

Ethical committee approval for the conduct of the study was obtained. Questionnaires were served to all cadres of doctors from house officers to consultants; it was completed and returned on anonymous basis.

RESULTS

Sixty six (88.0%) of the 75 distributed questionnaires were returned completed and formed the basis of further analysis. The overall knowledge level of post-exposure prophylaxis against human immunodeficiency virus infection was very low. About 62.1% are aware of the existence of PEP policy in the hospital. The level of knowledge concerning the high-risk fluid and three drugs used in PEP is high. Over 90% are not aware of the risk of sero-conversion following significant needle-sticks injury and mucous membrane exposure. The study also revealed poor knowledge concerning actions to be taken, how soon to commence the PEP treatment and the duration of medication following needle stick injury. More than 50% of the surveyed doctors had experienced significant exposure to potentially infective materials and none reported or sought PEP advice.

CONCLUSION

There is the need to educate the doctors and other health workers about the PEP guideline policy, what to do in the event of injury, whom to contact and the importance of seeking urgent advice following injury or exposure.

Pattern of head and neck cancers in a Nigerian tertiary health center: A 10-year review

e17054

Background: Cancer is a rising health problem worldwide, Nigeria inclusive. A variety of different tumour types may arise at a host of sites within the head and neck region. This 10-year review is to assess the various sites of primary lesion, gender and age distribution and histopathological types, so as to update data with an earlier study done in our centre between 1997–2001. Methods: This 10 year review of patients with head and neck cancers was carried out at the University of Ilorin teaching, Ilorin, North central Nigeria between January 1997 and December 2006.The hospital is one of 2 teaching hospitals in the zone of 6 constituent states out of 36 states in Nigeria, with an average population of 5 to 6 million (2003 Nigerian census). Information extracted from the case notes of patients with histological results included: Age, sex, clinical features, site of tumour, and the histological types of tumour. The International classification of disease oncology (ICDO) ninth version was used to categorize the sites of the tumour. Results: A total of 138 cases of head and cancers were seen over the 10 year period with an average occurrence of 14 cases/year, male/ female ratio of 1.1 to 1.0, age range of 1.5 years to 85 years with a mean age of 45.23 years, the peak age incidence of fifth to sixth decades of life being 47.2%.The commonest histological type was carcinoma (78.3%), then lymphomas (12.3%), blastomas (5.1%), sarcomas (4.3%). The commonest site were the nose, paranasal sinuses and ears (23.9%), eye (15.2%), nasopharynx (13%), neck (13% -metastatic unknown primary 4.3%), thyroid (12.3%), larynx (10.2%), oral cavity and oropharynx (6.5%), salivary glands (3.6%), mandible (1.4%), and skin (0.74%). Conclusions: This result shows that head and neck cancers occur among Nigerians with no sex differentiation in their prime of life, the histological types are similar to the previous series, however the site seems to have changed with the nose and paranasal sinuses, eye, and nasopharynx being the commonest sites. The metastatic unknown primaries in the neck are much lower. The devastating effects on the individual, family and the community are enormous in a setting with late presentations at the hospital and a strong belief in traditional medicine. Emphasis on prevention of these cancers is stressed.

No significant financial relationships to disclose.

Locked intramedullary nailing for the treatment of femoral shaft fractures: experience and result in 19 cases

BACKGROUND

Fractures in the proximal or distal third of the femoral shaft or those with severe comminution are known to be less suitable for intramedullary nailing with Kuntscher nail. With the introduction of interlocking intramedullary nailing the problems of rotational malalignment and shortening that accompany such fractures are now less common. At the National Orthopaedic Hospital Igbobi, Interlocking Intramedullary Nailing was introduced as a form of surgical treatment for fractures of the femur, our initial experience in this type of intramedullary nailing form the basis of this report.

METHOD

This is a retrospective study of all cases of fractured femur that were treated with locked intramedullary nailing between March 2002 and September 2003.

RESULTS

During a 19-month period, 19 patients with 19 fractures were treated for fracture of the femoral shaft with locked intramedullary nailing using the Russell-Taylor (18 fractures) and Grosse-Kempf (1 fracture) nails. Thirteen fractures (68.5%) had comminution of the Winquist-Hansen type III and IV 12 of which were statically locked. There were three intra-operative technical problems including the case of a subtrochanteric fracture, where the nail missed the medullary canal of the proximal segment. There were 2 cases of superficial wound infection, which responded to local wound care and antibiotics. Although limb length discrepancy and rotational mal-alignment were not assessed routinely during the follow-up of patients, no symptomatic malrotation was recorded. Sixteen out of the 19 patients were available for follow-up for an average period of 11 months. All these cases progressed to union, without the need for dynamization in statically locked fixations.

CONCLUSION

In spite of the initial problems encountered with this relatively new procedure in our centre, we were able to achieve a reasonably good result in addition to supporting the notion that dynamization of a statically locked nail is not always necessary for healing of fractures.

Prevalence of human immunodeficiency virus (HIV) antibodies in tuberculosis patients in Lagos, Nigeria

To establish the prevalence of HIV antibodies in patients with pulmonary tuberculosis, 536 new cases presenting with symptoms of bronchopulmonary disorders were randomly selected from the six referral chest clinics in Lagos and screened for tuberculosis and HIV infections. Sputum and serum samples were obtained from all the patients. The sputum samples were examined for acid-fast bacilli (AFB) by both microscopy and culture. The sera were screened for HIV-1 and HIV-2 antibodies by ELISA and confirmed by Western blot (WB). Of the 536 cases studied, 188 (35%) were positive for AFB while 13 (2.4%) were seropositive for HIV. Correlation between the AFB and HIV results revealed that 10 (5.3%) of the 188 AFB positives were also seropositive for HIV as compared to 3 (0.9%) in the 348 AFB negative cases. The difference in the HIV seroprevalence rates in the two groups was statistically significant (P < 0.001). The recorded higher frequency of HIV infections in the AFB positives strongly suggested some level of interaction between TB and HIV infections in Lagos. Infections with HIV-2 were more prevalent than HIV-1 in the patients with HIV and TB. No case of dual infection with HIV-1 and HIV-2 was recorded in this group of patients. However, in the 3 HIV-seropositive patients within the control group (non-tuberculosis patients), 2 (67%) were positive for both HIV-1 and HIV-2 while 1 (33%) was positive for HIV-2 only. Mycobacterium tuberculosis (70%), M. avium (20%) and M. kansasii (10%) were the mycobacteria strains isolated from the HIV/TB infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)