Musa M. Borodo

Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: A systematic review and meta-analysis

Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria, HBV is reported to be the most common cause of liver disease. However, the extent of HBV exposure among Nigerians at average risk is unknown. Our aim, therefore, was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34,376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%). The pooled prevalence (% [95% CI]) among subgroups was: 14.0% (11.7, 16.3) for blood donors; 14.1% (9.6, 18.6) for pregnant women attending antenatal clinics; 11.5% (6.0, 17.0) for children; 14.0% (11.6, 16.5) among adults; and 16.0% (11.1, 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [% (95% CI)]: 12.3% (10.1, 14.4) by using enzyme-linked immunosorbent assay; 17.5% (12.4, 22.7) by immunochromatography; and 13.6% (11.5, 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria.

Prevalence of hepatitis B and C virus infections among HIV-infected patients in a tertiary hospital in North-Western Nigeria

Introduction: Infections from HIV, Hepatitis B and to some extent Hepatitis C viruses constitute a major public health challenge in sub-Saharan Africa, and there are evidences to suggest that there is faster progression of HIV in those co-infected with either HBV or HCV. The aim of this study was to determine the prevalence of HBV and HCV infections among HIV-infected patients, and describe the socio-demographic features and correlates of HIV and HBV/HCV co-infected patients at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Materials and Methods: This was a cross-sectional study carried out among HIV-positive individuals seen at the adult HIV clinic of AKTH. Four Hundred and forty (440) consecutive HIV-positive adult patients who consented to the study were screened for markers of HBV and HCV using Enzyme-linked Immunosorbent Assay (ELISA) technique. CD 4 Count and serum ALT were also obtained from the recruited patients. Socio-demographic characteristics and Body Mass Index (BMI) were obtained. Differences and relationships between groups were determined using students t-test and Chi-square test where appropriate, and a P < 0.05 was regarded as significant. Results: Prevalence rates of Hepatitis B and C virus infections obtained were 12.3% and 1.6%, respectively. Individuals who were 40 years or younger were the most affected. HBV co-infection was more common among males than females (16.9% vs 9.2%, respectively, P = 0.0153). Mean serum ALT among participants with HIV alone was 31.6 International Units (IU), but was significantly higher (45.3 IU) for those with HIV/HBV co-infection, P = 0.048. Mean CD 4 count for HIV/HBV co-infected participants (259.7 c/mm 3 ) was significantly higher than that for participants with HIV alone (240.0 c/mm 3 ), P = 0.0170 whereas the mean BMI was not significantly different between participants with HIV alone (21.3 kg/m 2 ) versus HIV/HBV co-infected participants (22.2 kg/m 2 ), P = 0.1385. Conclusion: Co-infection with hepatitis B virus is common among HIV-infected patients in our setting and this further reaffirms the need for routine baseline screening for this marker, as it is a major consideration in the initiation and choice of highly active antiretroviral therapy. Furthermore, those found to be negative should be immunized with HBV vaccine to improve the prognosis of their HIV status.

Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART−). Symptomatic HAND was found among 40% of the HAART− individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p = 0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04–1.44, p = 0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART− patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease.

Prevalence and burden of human immunodeficiency virus and hepatitis B virus co-infection in Nigeria: a systematic review and meta-analysis.

Background: Studies on HIV/HBV co-infection in Nigeria yielded prevalence ranging between 10% and 70%, giving the widest variation in prevalence of HIV/HBV co-infection from studies emanating from any country all over the world. However, estimation of clinical and public health impacts of HIV/HBV co-infection requires a robust and reliable epidemiological data for an appropriate estimation of the logistical, economic, and humanitarian impact of the two viruses in Nigeria. Objective: The aim of this review was to estimate the prevalence and burden of HBV infections in HIV-infected patients in Nigeria. Methods: Estimates were derived from a random effects meta-analysis of observational studies reporting the prevalence of HBV/HIV in Nigeria. The derived estimate for the prevalence of HBV/HIV co-infection was applied to the total HIV-infected populations in Nigeria to give an estimated burden of HBV/HIV co-infection in Nigeria. Result: Thirty three studies with quality data from seventeen states in Nigeria, up to December 16, 2013, were included. I-squared heterogeneity was 98%. Random effect model (REM) estimate of prevalence among HIV-infected patients from the 33 studies was 15% (95% CI 13-17). The prevalence of HIV/HB co-infection among attendees of HIV clinics was 17% [95% CI 13-20], among pregnant HIV-infected patients were 10% [95% CI 6-15], 12% [95% CI 6-17] among HIV-infected children and among newly discovered HIV-infected voluntary blood donor (VBD) patients 10% [95% CI 6-15]. Meta- regression showed no significant associations between the mean age of the patients, the proportion of female patients, year of the study and prevalence of co-infection. The burden of HBV/HIV co-infection in Nigeria, based on the estimate, was 984 000 C.I. [852 800-1115 200]. Conclusion: In Nigeria, the estimated prevalence of HBV/HIV infection is 15% resulting in a substantial burden for the country.

Pattern of acute blood transfusion reactions in Kano, North-Western Nigeria

Background : Advancement in transfusion medicine has led to the use of large quantities of blood and blood components in modern clinical practice. The purpose of this study is to determine the pattern of acute blood transfusion reactions among adults in North-Western Nigeria. Materials and Methods: This was a descriptive observational study over a 3-month period that evaluated 302 blood transfusions in 180 consenting recipients in Aminu Kano Teaching Hospital. Data was analyzed using descriptive and inferential statistics, and P -values of ≤ 0.05 were regarded as significant. Results: The mean age of the recipients was 37.2 ± 13.7 (95% CI: 35.2 - 39.2) years. The incidence of acute transfusion reaction (ATRs) was 3.6%, out of which 3.3% were febrile non-hemolytic transfusion reaction (FNHTR) and 0.3% were acute allergic reaction (AAR). All the recipients that reacted presented clinically with fever and more than 90% of them had associated chills and/or rigors. There was a significant relationship between ATRs and history of previous transfusion (χ 2 = 4.12; P = 0.04) and stored blood of more than 3 days (χ 2 = 5.20; P = 0.02). Conclusion: Patients with previous history of transfusion should be monitored closely as they have a higher risk of developing transfusion reaction, and transfusion of blood stored for more than 3 days should as much as possible be avoided, especially in patients that have a potential risk of transfusion reaction.

Clinical profile of diabetic sensorimotor polyneuropathy in a tertiary hospital in Northwestern Nigeria

Objective: To determine the frequency, severity, and determinants of diabetic sensorimotor polyneuropathy (DSPN) in adults from a tertiary hospital in Northwestern Nigeria. Materials and Methods: A cross-sectional hospital-based study where 400 type 2 diabetes mellitus patients attending clinic in a tertiary hospital were screened for DSPN and graded for severity using the United Kingdom screening test (UKST). Logistic regression was used to identify independent predictors of DSPN after controlling for other covariates. All data were analysed using Predictive Analysis Software (PASW) version 18.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: Frequency of DSPN among the study (comprising 59 males and 66 females) subjects was 125 (31.2%), of which 105 (26.3%) patients were symptomatic. Sixty-eight (17%) patients were at high risk of developing diabetic feet ulceration. Multivariate logistic regression showed that marital status (OR = 0.55; 95% CI = 0.31-0.98) was protective, while the duration of diabetes (OR 5.80; 95% CI = 3.38-9.95) was a significant independent predictor of DSPN. Conclusions: The high frequency of DSPN in patients with high risk of feet ulceration from this study prompt the need to adopt efficacious and less-expensive strategies for screening and preventing diabetic foot complications in our resource-constraint settings.