Edamisan Olusoji Temiye

Neurological Complications of Sickle Cell Anemia in Nigerian Africans—A Case-Control Study

PURPOSE To determine the neurological complications associated with sickle cell anaemia (SCA) in Nigerians and evaluate the relative frequencies. METHODOLOGY Six-hundred-thirteen patients with SCA attending outpatient clinics of Lagos University Teaching Hospital and 616 control subjects were evaluated using a uniform structured questionnaire to determine the occurrence of neurological complications. The relative frequencies of neurological abnormalities in patients and controls were compared. RESULTS Neurological abnormalities occurred in a significantly higher percentage of patients (76%) compared to controls (32.1%). Among children, these abnormalities included stroke, febrile seizures and headache. Among adolescents and adults, the abnormalities included paraplegia, epileptic seizures and localized sensory neuropathy. Headache occurred in a significantly higher percentage in children and adolescents compared to controls, but not in adults. CONCLUSIONS We conclude that SCA is associated with neurological complications: stroke and febrile seizures in children, epileptic seizures, paraplegia and localized sensory neuropathy in adolescents and adults, headache in children and adolescents. Detailed studies of each of these complications would be required to provide further insight into their significance.

Relationship between Painful Crisis and Serum Zinc Level in Children with Sickle Cell Anaemia

Sickle cell anaemia (SCA) is associated with zinc deficiency; zinc supplementation may ameliorate some of its clinical manifestations including the relief of painful crisis. Subjects and Methods. Serum zinc levels were determined in 71 children with SCA and painful crisis and in equal numbers in steady state. Seventy-one children with AA genotype acted as controls. Qualitative assessment of zinc content of 24-hour dietary recall and the last meal consumed before blood was drawn was taken. Serum zinc was determined using atomic absorption spectrophotometer. Haemoglobin concentration and packed cell volume (PCV) were determined using standard methods. Results. The mean serum zinc concentration in the study was less than international reference range. The controls had significantly higher serum zinc concentrations than the SCA group (42.7 ± 13.6 versus 32.3 ± 14.0 μg/dL, P < .000); this difference was due to the significantly lower values of serum zinc in SCA with painful crisis compared with the remaining two groups F = 30.9, P<.000. There was a positive correlation between serum zinc and haemoglobin concentration only in the control group (r = 0.4; P = .001). Conclusion. The serum zinc levels in this study were low. Painful crisis in SCA may exert greater demand for zinc utilization in children with SCA thereby resulting in lower serum levels.

Adherence to antiretroviral therapy among HIV-infected children attending a donor-funded clinic at a tertiary hospital in Nigeria.

The success of antiretroviral therapy (ART) depends on a high level of adherence to a life-long regimen of antiretroviral drugs (ARVs). Since the scale-up of access to ARVs in Nigeria, few studies have determined the level of adherence of ART among children. This study was undertaken to determine the level of ART adherence among paediatric patients at an outpatient clinic, the reasons for non-adherence, and the factors associated with adherence, according to caregivers’ reports. Out of a total of 212 children, 183 (86%) were adherent in the three days preceding the interview, while 29 (14%) were not adherent. Drug exhaustion at home (16 children), followed by ‘child slept through’ (7 children) and ‘caregiver away’ were the most common reasons for a child having missed one or more ARV doses. Independent factors for adherence were male gender (odds ratio [OR] = 2.85; 95% confidence interval [CI]: 1.17–6.92) and attendance at last scheduled clinic appointment (OR = 4.76; 95% CI: 1.73–13.04). The caregivers highest educational attainment, distance travelled to the clinic, use of medication reminders, formulation of ARVs, duration of HAART usage, age of the child and orphan status were not significantly associated with adherence to drug treatment. The overall level of adherence was high and similar to the rate reported prior to free access to ART services in Nigeria. Among child patients on HAART, there is a need to identify factors affecting clinic attendance and drug exhaustion at home.

Anthropometric indices of infants born to HIV-1-infected mothers: a prospective cohort study in Lagos, Nigeria

Numerous studies have reported that HIV-infected pregnant women are at increased risk of delivery of low birth weight (LBW) infants, of preterm deliveries and of intrauterine growth restriction. The objective of the study was to determine the effect of maternal HIV infection on the anthropometric characteristics of the babies at birth. A prospective study was carried out at the Lagos University Teaching Hospital, Nigeria. There were three times more LBW babies in the HIV-positive group than in the uninfected mothers (odds ratio = 3.47, 95% confidence interval = 1.69, 7.27; χ2 = 12.99, P = 0.0003).The maternal weight (t = 15.85; P = 0.0001), maternal body mass index (BMI) (t = 15.07; P = 0.0003), birth weight of infants (t = 27.17; P = 0.0001) and birth length (t = 31.20; P = 0.001) were significantly less in HIV-positive mothers than in controls. In conclusion, poor maternal bodyweight and low BMI are significant contributors to LBW in HIV-infected women. Nutritional counselling, dietary intake and weight monitoring during pregnancy should be emphasized to improve pregnancy outcome in HIV-infected women.

Sexual maturation and psychiatric morbidity among persons with sickle cell anaemia in a Nigerian teaching hospital.

Background: Sickle Cell Anaemia (SCA), an inherited HbSS disease, is common in Nigeria with attendant high morbidity and mortality most especially in the setting of poor health care services. Impaired physical and sexual development is one of the prominent complications of SCA; and with attendant secondary psychiatric sequelae. Methods: A cross-sectional study was carried out at the haematology clinic of Lagos University Teaching Hospital (LUTH), among adolescent attendees (10–19 years) with SCA. Age and sex-matched controls were recruited from Action Health Incorporated (AHI), an NGO to promote adolescent health advocacy. The haemoglobin genotypes SS for subjects and AA for controls were confirmed with gel electrophoresis. Each subject and control was physically examined for the assessment of external genitalia (sexual) maturation using Tanner Staging Method, and were also evaluated with General Health Questionnaire—version 12 (GHQ-12). Results: In all, 136 adolescents with SCA and of equal sex distribution and equal number of controls were studied, with mean ages of 14.3 α 2.8 and 13.5 α 2.6 years, respectively. On GHQ assessment, 113 (83%) subjects and 25 (18.4%) controls had GHQ scores of ≥ 5, indicating probable presence of psychopathology. For both males and females, the subjects significantly lagged behind the controls in different areas of sexual maturation, with corresponding significant higher GHQ scores among the subjects. For example, in sexual maturation rate (SMR) stage 1 of pubic hair development, the mean ages for male subjects and controls were 11.9 α 1.5 and 10.7 α 0.9 years, respectively, with significant “t” of 5.06 at p < 0.03*; for females: 13.0 α 2.6 and 10.4 α 0.6 years for subjects and controls respectively with significant “t” of 4.36 at p < 0.04*. The corresponding GHQ scores were for subjects: < 5 for 6 and ≥ 5 for 20 of the subjects respectively; and for controls, the GHQ scores were < 5 for 9 and nil of controls for ≥ 5 score. The difference in GHQ scores for subjects and controls in this stage 1 pubic hair maturation was significant with χ2 = 16.15, df = 1, p = 0.00*. Conclusion: It is concluded that SCA subjects had significantly delayed sexual maturation and increased risk of psychiatric morbidity when compared to controls. The need for genetic counseling to reduce the prevalence of SCA was emphasized.

Human immunodeficiency virus status in malnourished children seen at Lagos

Introduction Human immunodeficiency virus and protein energy malnutrition are still prevalent in Nigeria and the occurrence of the two conditions together confers a poor prognosis. The aim of this study was to determine the current categories of malnutrition amongst under-5 children in Lagos, document their HIV status and determine any peculiarities in the clinical features, haematological and some biochemical profile in these children. Methods The study was a cross-sectional study conducted at the Paediatric departments of the Lagos University Teaching Hospital and the Massey Street Children’s Hospital, both in Lagos, over a 6-month period. All the subjects had anthropometry, HIV testing, full blood count and serum proteins done. The factors associated with HIV status were determined with the logistic regression analysis. Results Two hundred and fourteen (214) malnourished children ≤5 years, including 25 (11.7%) with HIV were recruited in the study. Among the study participants, 150 (70.1%) and 54 (29.9%) had moderate and severe malnutrition, respectively. Fever, cough and diarrhea were the most common symptoms in the study participants. The haematological indices were comparable in the two groups, the serum globulin levels though higher in the HIV infected group was not statistically significantly different from the non-infected group.(p = 0.66). None of the factors explored on multivariate analysis was able to predict the occurrence of the infection in this cohort. Conclusion Malnourished children remain a high risk group for HIV infection and the prevalence of the infection obtained in this group of children is still unacceptably high. Discriminatory features between malnutrition and HIV remains difficult. The presence of hyperglobulinaemia on laboratory analysis in a malnourished child may heighten the suspicion of possible underlying associated HIV infection. Screening of malnourished children for HIV infection and further longitudinal studies on malnourished children with HIV is advocated

Enuresis in children and adolescents with sickle cell anaemia is more frequent and substantially different from the general population

Background No large studies have examined the prevalence of enuresis, its various forms and risk factors in children with sickle cell anaemia (SCA) in Sub-Saharan Africa using standardised definitions. We determined age and gender-specific prevalence of enuresis and compared the nature of enuresis in children with and without SCA. We also identified predictors of enuresis in children with SCA. Methods Caregivers of children with SCA attending a tertiary centre haematology clinic in Nigeria were interviewed using a questionnaire. In addition, a separate questionnaire was completed for every sibling aged 5–17 years whose haemoglobin genotype was known. Enuresis and its various forms were defined using the definitions of the International Children’s Continence Society. Results The study involved 243 children with SCA and 243 controls matched for age and sex. The mean age of the study cohort was 9.9 (3.4). Females made up 45.7% of the cohorts. The prevalence of enuresis was 49.4% and 29.6% in children with and without SCA, respectively (p = 0.009). In both groups, the prevalence of enuresis declined with age but remained five times higher at 25% in children with SCA aged 14–17 years compared with controls. Also, children with SCA and enuresis were older, more likely to have non-monosymptomatic enuresis and wet at least three nights per week than controls. Independent predictors of enuresis in children with SCA were a family history of enuresis and young age. Conclusion Children with SCA had more frequent and more severe enuresis which persisted to late adolescence than age and sex-matched controls. These features indicate a subset of enuresis that is difficult to treat in the general population. Young age and enuresis in a family member define a subset of children with SCA more likely to have enuresis. Healthcare workers need to discuss enuresis with parents of children with SCA and offer referral to continence services.

Pulmonary hypertension among 5 to 18 year old children with sickle cell anaemia in Nigeria.

Background Pulmonary hypertension (PHT) is a significant cause of mortality in patients with sickle cell disease (SCD). Few studies on PHT in SCD have been carried out in children. This study aimed to estimate the prevalence of PHT in children with sickle cell anaemia (SCA) and determine its clinical and laboratory correlates. Methods In this cross sectional study, evaluation involved obtaining bio-data, history and physical examination findings in 175 SCA subjects with haemoglobin genotype SS aged 5 to 18 years and 175 age and sex matched controls with haemoglobin genotype AA. PHT was determined using peak Tricuspid Regurgitant Velocity (TRV) obtained from echocardiography as a marker. Complete blood count (CBC), lactate dehydrogenase (LDH) assay, reticulocyte count, foetal haemoglobin (HbF) estimation as well as Human Immunodeficiency Virus (HIV) I and II, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) screening were done for patients with SCA. Results The mean peak TRV of subjects with SCA and controls was 2.2 ± 0.4 m/s and 1.9 ± 0.3 m/s respectively and prevalence of PHT among children with SCA and controls was 22.9% and 2.3% respectively. PHT in SCA correlated negatively with body mass index, haematocrit and haemoglobin. Conclusion This study affirms that PHT prevalence is high in children with SCA in Nigeria. Cardiovascular examination for signs of PHT is recommended for children with SCA and if required, further echocardiographic assessment from as early as five years.

Potential drug–drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria

Background Multi-therapy is common in HIV-infected children, and the risk for clinically significant drug interactions (CSDIs) is high. We investigated the prevalence of CSDIs between antiretroviral (ARV) and co-prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria. Methods The case files of pediatric patients receiving treatment at the HIV clinic of the Lagos University Teaching Hospital (LUTH), Idi-Araba, between January 2005 and December 2010 were reviewed. The ARV and co-prescribed drug pairs were evaluated for potential interactions using the Liverpool HIV Pharmacology Group website. The potential interactions were rated as A (no known interaction), B (minor/no action needed), C (moderate/monitor therapy), D (major/therapy modification), and X (contraindicated/avoid combination). Results Of the 310 cases reviewed, 208 (67.1%) patients were at risk of CSDIs. Artemisinin-based combination therapy was prescribed for over one-half of the patients, accounting for 40% of the CSDIs. Excluding this drug class, the prevalence of CSDIs reduced from 67.1% to 18.7% in 58 patients. Most of the CSDIs (579; 97.2%) were moderately significant and frequently involved nevirapine and fluconazole (58; 9.7%), zidovudine and fluconazole (55; 9.2%), zidovudine and rifampicin (35; 5.9%), and nevirapine and prednisolone (31; 5.2%). Age (P=0.392), sex (P=0.783), and moderate (P=0.632) or severe (P=0.755) malnutrition were not associated with risk for CSDIs. Conclusion There is a tendency for CSDIs between ARV and co-prescribed drugs among the group of children evaluated in this study. Measures are necessary to prevent important drug interactions and to manage those that are unavoidable.