Iroha Eo

Haematological abnormalities associated with paediatric HIV/AIDS in Lagos.

Abstract Introduction: In HIV-1-infected children, haematological disturbances include bone marrow abnormalities and peripheral cytopenias. All three major cell lineages can be depressed. Methods: A cross-sectional study of baseline haematological parameters was undertaken in 68 children with confirmed HIV infection. In all cases, a complete blood count was done and some had CD4+ counts and HIV RNA PCR. The CD4+ count was analysed by the Coulter manual latex particle monoclonal antibody method® and HIV RNA PCR by Roche© Amplicor Monitor, version 1.5. Results: Anaemia (<100 g/L) was present in 77.9%, severe (<60 g/L) in 5.9%, moderate (60–70 g/L) in 32.3% and mild (80–99 g/L) in 39.7%. The mean haemoglobin concentration decreased as disease progressed (p<0.05); 6% had leucopenia, 17.5% had neutropenia and 2.5% (one case) had thrombocytopenia; also, the four (6%) subjects with leucopenia were in clinical stages B and C. Neutropenia, lymphocytopenia and thrombocytopenia were seen more in clinical stages B and C, though this relationship was not statistically significant. Conclusion: Both the erythroid and other cells lines are affected by HIV/AIDS and other associated factors. Anaemia is the most common haematological abnormality. The severity of peripheral cytopenias is related to the disease burden.

Prevalence of proteinuria among HIV-infected children attending a tertiary hospital in Lagos, Nigeria.

Sub-Saharan Africa is the epicentre of the HIV pandemic but there are few reports of HIV-related kidney diseases in children in this region. This study aimed to determine the prevalence of proteinuria in HIV-infected children at the Lagos University Teaching Hospital. Proteinuria was determined using urine protein-creatinine ratio. CD4+ cell count was determined for all the HIV-infected children. The mean age of the HIV-infected children was 74.4 +/- 35.6 months with a male: female ratio of 3:2. Compared with 6% of the 50 controls 20.5% of the 88 HIV-infected children had proteinuria (p = 0.026). Of 20 children with advanced clinical stage 40% had proteinuria compared with 14.7% of 68 children with milder stage (p = 0.004). Similarly, proteinuria was commoner among those with severe immunosuppression (p = 0.014). HAART use was not associated with significant difference in proteinuria prevalence (p = 0.491). Proteinuria was frequent among HIV-infected children, especially among those with advanced disease.

Kidney function of HIV-infected children in Lagos, Nigeria: using Filler's serum cystatin C-based formula

BackgroundLimited data is available on kidney function in HIV-infected children in sub-Saharan Africa. In addition, malnutrition in these children further reduces the utility of diagnostic methods such as creatinine-based estimates of glomerular filtration rate. We determined the serum cystatin C level and estimated glomerular filtration rate of 60 antiretroviral-naïve, HIV-infected children and 60 apparently healthy age and sex matched children.MethodsSerum cystatin C level was measured using enzyme-linked immunosorbent assay technique, while glomerular filtration rate was estimated using Fillers serum cystatin C formula. Student t test, Mann Whitney U test, Pearson chi square and Fishers exact test were used, where appropriate, to test difference between groups.ResultsCompared to the controls, the HIV-infected group had significantly higher median (interquartile range) serum cystatin C levels {0.77 (0.29) mg/l versus 0.66 (0.20) mg/l; p = 0.025} and a higher proportion of children with serum cystatin C level >1 mg/l {10 (16.7%) versus one (1.7%); p = 0.004}. The HIV-infected children had a mean (± SD) eGFR of 96.8 (± 36.1) ml/min/1.73 m2 compared with 110.5 (± 27.8) ml/min/1.73 m2 in the controls (p = 0.021). After controlling for age, sex and body mass index, only the study group (HIV infected versus control) remained a significant predictor of serum cystatin C level (β = -0.216, p = 0.021). The proportion of HIV-infected children with eGFR <60 ml/min/1.73 m2 was eight (13.3%) versus none (0%) in the control group (p = 0.006). However, the serum cystatin C level, eGFR and proportions of children with serum cystatin C level >1 mg/l and eGFR <60 ml/min/1.73 m2 were not significantly different between the HIV-infected children with advanced disease and those with milder disease.ConclusionsHIV-infected children in Nigeria have higher serum cystatin C level and lower eGFR compared to age and sex matched controls.

The Impact of Recycled Neonatal Incubators in Nigeria: A 6-Year Follow-Up Study

Nigeria has a record of high newborn mortality as an estimated 778 babies die daily, accounting for a ratio of 48 deaths per 1000 live births. The aim of this paper was to show how a deteriorating neonatal delivery system in Nigeria may have, in part, been improved by the application of a novel recycled incubator technique (RIT). Retrospective assessment of clinical, technical, and human factors in 15 Nigerian neonatal centres was carried out to investigate how the application of RIT impacted these factors. Pre-RIT and post-RIT neonatal mortalities were compared by studying case files. Effect on neonatal nursing was studied through questionnaires that were completed by 79 nurses from 9 centres across the country. Technical performance was assessed based on 10-indices scores from clinicians and nurses. The results showed an increase in neonatal survival, nursing enthusiasm, and practice confidence. Appropriately recycled incubators are good substitutes to the less affordable modern incubators in boosting neonatal practice outcome in low-income countries.

Comparative study of Clinical Assessment of Nutritional status score and proportionality indices in the assessment of fetal malnutrition in term newborns

Background: Fetal malnutrition (FM) which describes the underweight/wasting seen in newborns is a significant contributor to perinatal morbidity and mortality and requires proper documentation. The objective of this study was to assess the nutritional status of term newborns at birth using Clinical Assessment of Nutritional (CAN) status score and four other anthropometric indices and to compare the efficiency of CAN score and the anthropometric indices in identifying FM in term newborns. Materials and Methods: The study was conducted on live singleton babies delivered ≥37–42 completed weeks of gestation at the inborn unit of Lagos University Teaching Hospital without major congenital abnormalities or severe perinatal illness. Birth weights and lengths were recorded at birth. Ponderal index (PI), body mass index (BMI), and mid-arm/head circumference (MAC/HC) ratio were calculated and the values were compared with standard curves. The CAN score consisted of inspection and estimation of loss of subcutaneous tissues and muscles. FM was defined as CAN score <25. Data were analyzed using the Statistical Package for Social Sciences statistics software version 17.0. Results: Two hundred and eighty-two newborns were analyzed. FM was identified in 14.5%, 10.3%, 13.1%, and 2.8% of newborns using CAN score, PI, BMI, and MAC/HC ratio, respectively. Out of the FM babies identified by CAN score, PI, MAC/HC, and BMI identified 19.5%, 12.3%, and 53.7% of them as FM also. BMI was the most sensitive anthropometric index for detecting FM. Conclusion: CAN score is a simple clinical tool for identifying FM and when used in conjunction with BMI will enhance FM detection.