Assessment of MTR Rs1805087 SNP as Possible Modifier of Sickle Cell Disease Severity in a Nigerian Population

BACKGROUND

Sickle cell disease is the commonest genetic disorder in Nigeria, affecting 2-3% of an estimated population of 160 million people. The role of genetic mutations in folate cycle genes, and the variable phenotypic expressions constituting disease severity, needs to be critically examined.

OBJECTIVE

This study was carried out to establish the pattern of methionine synthase gene mutations (rs1805087 SNP), and its possible association with disease severity in adults with sickle cell anaemia in Lagos, Nigeria.

METHODOLOGY

This is a cross-sectional study of seventy (70) subjects with sickle cell disease (HbSS) matched for age and gender with known apparently healthy haemoglobin genotype AA (HbAA) subjects, as cases and controls respectively. Structured questionnaires were used to obtain demographic, clinical and other phenotypic data needed to compute disease severity. Pattern of MTR A2756G gene mutation and homocysteine assay (Hcy) were assessed by Polymerase Chain Reaction and Enzyme- linked Immunosorbent Assay respectively. Full blood count analysis of participants was done using the KX-21 Automated Analyzer (Sysmex Corporation, Japan).

RESULTS

The mutant genotypes MTR 2756 AG/GG were recorded in 46.4% (n =55) of subjects with disease severity score >7. Elevated plasma homocysteine (HHcy) was significantly associated with disease severity among HbSS subjects (OR=17.2, CI: 3.490-86.079; p=0.0001). Conversely, no significant association was observed with the mutant genotypes MTR 2756 AG/GG and disease severity (p>0.05).

CONCLUSION

While HHcy is significantly associated with phenotypic expression of HbSS, the MTR 2756 SNPs did not appear to independently influence homocysteine level or disease severity in HbSS subjects.

Effects of selenium supplementation on pregnancy outcomes and disease progression in HIV-infected pregnant women in Lagos: A randomized controlled trial

OBJECTIVE

To examine the effects of selenium supplementation on pregnancy outcomes and disease progression among HIV-infected pregnant women in Lagos.

METHODS

A randomized, placebo-controlled trial conducted among HIV-positive pregnant women between September 2018 and August 2019. At enrollment, 90 women were randomly assigned into each treatment arm to receive either a daily tablet of 200 μg elemental selenium or a placebo. Relevant participants' sociodemographic and clinical data were collected at enrollment and delivery.

RESULTS

Women in the selenium arm had a significantly lower risk of preterm delivery (relative risk [RR] 0.32, 95% confidence interval [CI] 0.11-0.96) and a non-significant reduction in the risk of delivering term neonates with a low delivery weight (RR 0.24, 95% CI 0.05-1.19). Supplemental selenium does not increase the risk of perinatal death and adverse drug events.

CONCLUSION

The study reported a beneficial effect of prenatal selenium supplements on the risk of preterm delivery with no further reduction in risk among HIV-infected women who used the supplements for more than 14 weeks.

TRIAL REGISTRATION

Pan African Clinical Trial Registry (PACTR201809756724274).

Impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria (mHealth-Cervix): Protocol for a randomised controlled trial

Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery.

Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos.

Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square X ²or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as P-value less than 0.05.

Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence.

Registration: PACTR202002753354517 13/02/2020

Preparing medical students to recognize and respond to gender based violence in Nigeria

Background

Medical practitioners are ideally positioned to mitigate the impact of gender based violence (GBV) on the health of victims. However, there is a lack of information on students' ability and willingness to do so.

Objective

To identify factors which impact on students' attainment of the knowledge and perceived ability to manage victims.

Methods

A cross-sectional survey was conducted on 388 (91.5%) final year medical students from three medical schools in South West, Nigeria.

Results

Students were knowledgeable on sexual (63.7%) and physical (54.6%) forms of GBV and unfamiliar with other forms. The mean scores for knowledge (7.1 ± 2.5 out of 11); attitude (52.6 ± 10.3 out of 80); personal comfort (44.1 ± 10.0 out of 65) and skills (3.1 ± 2.6 out of 7) were calculated. Younger respondents, females and married students reported less skill to manage victims. The location of school, previous training and personal comfort remained significant determinants of students' self reported skills on GBV. Respondents with prior training on GBV and comfortable with managing patients, were four times more likely to perceive they were more skilled than their peers [AOR = 4.33, 95% CI: 2.37 – 7.90 and AOR 3.53; 95% CI 2.16–5.78 respectively].

Conclusion

Formalised skills training on GBV is a necessity, especially for young, female students and training cannot be left to serendipity. The medical curriculum should be reviewed.

Effects of selenium supplementation on pregnancy outcome and disease progression in HIV-infected pregnant women in Lagos, Nigeria: Study protocol for a randomised, double-blind, placebo-controlled trial

BACKGROUND

Micronutrient deficiencies are common during pregnancy, especially in pregnant women from economically disadvantaged settings where diets with low content of minerals and vitamins are consumed. Selenium is a non-metallic chemical element of great importance to human health. This study will assess the effect of selenium supplementation on major pregnancy outcomes and disease progression among HIV-infected pregnant women in Lagos, Nigeria.

METHODS

A randomized, double-blind, placebo-controlled trial involving confirmed HIV-positive pregnant women at the Lagos University Teaching Hospital (LUTH) between September 2018 and February 2019. Eligible participants are HIV-infected pregnant women aged 15 to 49 years and have a singleton gestation at 14 to 27 weeks' gestation. At enrolment, 90 women will be randomly assigned into each intervention arm to receive either a daily tablet of 200 μg elemental selenium or placebo. Relevant participants' data will be collected at enrolment and at delivery. Statistical analyses will be carried out using SPSS version 23.0 for Windows. The associations between any 2 groups of continuous variables will be tested using the t test or the Mann-Whitney U test and that of 2 groups of categorical variables with chi-square or Fishers exact test where appropriate. A series of multivariable analyses will also be carried out to identify and control for several possible confounders of the major pregnancy outcomes and HIV disease progression. Statistical significance will be defined as P < .05. Ethical approval for the study was obtained from the LUTH's Health Research and Ethics Committee (Approval number: ADM/DCST/HREC/APP/2438; 30th August 2018).

DISCUSSION

This trial will assess the effect of selenium supplementation on pregnancy outcome and HIV disease progression among HIV-infected pregnant women in Lagos. This will help to determine if routine selenium supplementation in HIV-infected pregnant women will contribute to the improvement in the major adverse pregnancy outcomes such as preterm birth and low birth weight and the HIV disease surrogate markers such as CD4+ cells count and viral load.

TRIAL REGISTRATION

PACTR, PACTR201809756724274. Registered on 3rd September 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3571.

Models for Predicting Time to Sputum Conversion Among Multi-Drug Resistant Tuberculosis Patients in Lagos, South-West Nigeria

Background: Multi-drug resistant tuberculosis (MDR-TB) develops due to problems such as irregular drug supply, poor drug quality, inappropriate prescription, and poor adherence to treatment. These factors allow the development and subsequent transmission of resistant strains of the pathogen. However, due to the chronic nature of MDR-TB, cure models allow us to investigate the covariates that are associated with the long-term effects of time-to-sputum conversion among multi-drug resistant (MDR-TB) tuberculosis individuals. Therefore, this study was designed to develop suitable cure models that can predict time to sputum conversion among MDR-TB patients. Methods: A retrospective clinic-based cohort study was conducted on 413 records of patients who were diagnosed of MDR-TB and met inclusion criteria from April 2012 to October 2016 at the Infectious Disease Hospital, Lagos. The main outcome measure (time-to-sputum conversion) was the time from the date of MDR-TB treatment to the date of specimen collection for the first of two consecutive negative smear and culture taken 30 days apart. The predictor variables of interest include: demographic (age, gender and marital status) and clinical (registration group, number of drugs resistant to at treatment initiation, HIV status, diabetes status, and adherence with medication) characteristics. Kaplan-Meier estimates of a detailed survivorship pattern among the patients were examined using Cox regression models. Mixture Cox cure models were fitted to the main outcome variable using Log-normal, Log-logistic and Weibull models as alternatives to the violation of Proportional Hazard (PH) assumption. Akaike Information Criterion (AIC) was used for models comparison based on different distributions, while the effect of predictors of time to sputum conversion was reported as Hazard Ratio (HR) at α0.05. Results: Age was 36.8 ± 12.7 years, 60.8% were male and 67.6% were married. Majority of the patients (58.4%) converted to sputum negatives. Patients who were resistant to two drugs at treatment initiation had 39% rate of conversion than those resistant to at least three drugs [HR: 1.39; CI: 0.98, 1.98]. The likelihood of sputum conversion time was shorter among non-diabetic patients compared to diabetics [HR: 0.55; CI: 0.24, 0.85]. The overall median time for sputum conversion was 5.5 (IQR: 1.5-11.5). In the cure model, resistance to more drugs at the time of initiation was significantly associated with a longer time to sputum culture conversion for Log normal Cox mixture [2.06 (1.36-3.47)]; Log-logistic Cox mixture cure [2.56(1.85-4.09)]; and Weibull Cox mixture [2.81(1.94-4.19)]. Diabetic patients had a significantly higher sputum conversion rate compared to non-diabetics; Log-normal Cox mixture [2.03(1.17-3.58)]; Log-logistic Cox mixture cure [2.11(1.25-3.82)]; and Weibull Cox mixture [2.02(1.17-3.34)]. However, Log-normal PH model gave the best fit and provided the fitness statistics [(-2LogL: 519.84); (AIC: 1053.68); (BIC: 1078.04)]. The best fitting Log-normal PH model was Y = 1.00X1+2.06X2+0.98X3+2.03X4+ε where Y is time to sputum conversion and Xs are age, number of drugs, adherence, and diabetes status. Conclusion: The models confirmed the presence of some factors related with sputum conversion time in Nigeria. The quantum of drugs resistant at treatment initiation and diabetes status would aid the clinicians in predicting the rate of sputum conversion of patients.

Birth plans and health insurance enrolment of pregnant women: a cross-sectional survey at two secondary health facilities in Lagos, Nigeria

OBJECTIVE

We evaluated birth plans and health insurance enrolment of pregnant women at secondary health care level as a strategy for post-2015 goals.

METHODS

This was a cross-sectional study at two secondary health facilities in Lagos state, Nigeria. A pre-tested questionnaire was used to collect data that were analysed and results presented with frequencies. An overall estimate with 95% confidence interval was used at significant p values of less than 0.05.

RESULTS

Five hundred and twenty-four women, with a mean age of 3 0 ± 4.1 years, participated. Most women chose hospital delivery (84%) and had plan for transportation (86.3%) during labour. Few women were well prepared for birth (9.7%) and had health insurance (10.1%). Compared with women without insurance, more health-insured women had plans for transport in labour (p = 0.1383) and identified a place of birth (p = 0.2294), but did not have as much plan for someone to accompany them in the case of an emergency (p = 0.3855) and donate blood (p = 0.5065). Few health insured women saved money for delivery (p = 0.7439).

CONCLUSION

Health insured women did not have better birth plans and expanding pregnant women's access to health insurance may be an insufficient strategy to achieve post MDG 2015 goals.

Quality of Referral Letters to the Paediatric Department of a Tertiary Hospital in Nigeria

BACKGROUND

The referral letter is a flexible means of transmitting information about the care of patients from one healthcare worker to another. In developing regions of the world like Africa, where it may serve as the only means of transferring patient's information, the referral letter has infrequently been studied.

OBJECTIVE

The study is to assess the quality of referral letters to the Paediatric department of a tertiary hospital in Nigeria.

METHODS

Referral letters sent to the Olikoye Ransome-Kuti Emergency Center (ORKCEC) and the Paediatric Outpatient Clinics of the Lagos University Teaching (LUTH) between December 2012 and February 2013 were reviewed for content of information. Letter sent to the emergency center were compared with letter sent from sources within LUTH.

RESULTS

A total of 356 letters were reviewed, with 196 (55.1%) letters sent to the Emergency center. The majority of the referral letters (262; 73.6%) were from hospitals other than LUTH-(inter-hospital). Patient's name (99.7%), name of referring hospital (93.3%) and presenting complaints (91.1%) were the most consistently filled. Information relating to adverse clinical warning (1.7%), request for feedback (4.2%) and urgency of referral (8.4%), were the least filled. Only in 28.4% of the letters were the results of any or all the investigations done included. More interhospital letters had information on findings on physical examination, treatment, urgency of referral and request for feed-back from the receiving specialists. Referral letters to the clinics were more likely than letters to emergency centre to contain information on presenting complaints, history of the presenting complaints, and findings on physical examination.

CONCLUSION

Referral letters sent to the paediatric department of LUTH are poorly written with significant information about patient care frequently missing. Interhospital referral letters and letters sent to the clinics, though similarly low in quality, were more likely to contain information on physical findings and treatment received.

Physical activity profile of senior civil servants in Lagos, Nigeria: need for effective strategies for improvement

AIMS AND OBJECTIVES

To investigate the profile of physical activity (PA) among Lagos State senior civil servants (LSCSs).

SUBJECTS AND METHODS

A cross-sectional survey in which 305 LSCSs (163 men, 142 women) with age range 25 65 years, in five ministries of the LSCS was carried out in May of 2011. The Global Physical Activity Questionnaire (GPAQ) was used to assess respondents' PA at work, for transport, and during leisure time during the last 7 days.

RESULTS

Overall, 56.7% of the respondents (58.3% men and 54.9% women) were active; equivalent to 43.3% inactive respondents (41.7% men and 54.9% women). In spite of the high prevalence of physical inactivity in the women, gender was not significantly associated with PA levels (p = 0.718). However, the educational status and cadre of respondents were significantly associated with PA levels (p < 0.05).

CONCLUSION

The findings of this study showed that close to half of LSCSs were physically inactive. There was no significant difference between the PA levels of men and women but educational status and cadre were associated with the PA levels of respondents. The results provided by this study suggests the need for the Lagos State government and stakeholders to formulate polices, plan programmes and interventions for LSCSs to get more physically active.

Prevention of dental caries: knowledge, practice and opinion of paediatricians in Lagos

BACKGROUND

Dental caries is the most prevalent oral disease in children and this is preventable. Paediatricians are the first professionals whom children visit and are in good position to begin the process of prevention of dental caries if they recognize and encourage good preventive habits.

OBJECTIVE

To determine the knowledge, practice and opinion of pediatricians in prevention of dental caries.

MATERIALS AND METHODS

A cross sectional survey was undertaken among pediatricians in Lagos. Questionnaires were administered to pediatricians practicing in Teaching hospitals, general and private hospitals in Lagos. The questionnaire assessed their personal details, knowledge about caries, practice guidelines and opinion towards its prevention.

RESULTS

Less than one-third (27.7%) of the pediatricians knew that bacteria causing caries can be transmitted from mother to child. Only about one-third (30.8 %) of the paediatricians examine children's teeth for dental caries. Majority (87.7%) were of the opinion that paediatricians have a role in promoting oral health. A total of 59% of the paediatricians had moderate knowledge, while (71%) of them had poor practice and their opinion for prevention of dental caries was positive in more than two-thirds of them (71%).

CONCLUSION

We concluded that most paediatricians in Lagos had moderate knowledge, poor practice and lacked proper awareness about prevention of dental caries. Recommendation: we recommend that preventive dentistry topics in oral health promotion and prevention of dental caries be part of their postgraduate curriculum, continued dental health education programme for paediatricians, referral of related cases to paediatric dentists and oral health related topics be published in paediatric medical journals.