Ok Obunge

Effectiveness of Cellulose Sulfate Vaginal Gel for the Prevention of HIV Infection: Results of a Phase III Trial in Nigeria

Background This trial evaluated the safety and effectiveness of 6% cellulose sulfate vaginal gel in preventing male-to-female vaginal transmission of HIV, gonorrhea and chlamydial infection. Methods This Phase III, double-blind, randomized, placebo-controlled trial was conducted between November 2004 and March 2007 in Lagos and Port Harcourt, Nigeria. We enrolled 1644 HIV-antibody negative women at high risk of HIV acquisition. Study participants were randomized 1∶1 to cellulose sulfate or placebo and asked to use gel plus a condom for each act of vaginal intercourse over one year of follow-up. The participants were evaluated monthly for HIV, gonorrhea and chlamydial infection, and for adverse events. Results The trial was stopped prematurely after the data safety monitoring board of a parallel trial concluded that cellulose sulfate might be increasing the risk of HIV. In contrast, we observed fewer infections in the active arm (10) than on placebo (13), a difference that was nonetheless not statistically significant (HR = 0.8, 95% CI 0.3–1.8; p = 0.56). Rates of gonorrhea and chlamydial infection were lower in the CS group but the difference was likewise not statistically significant (HR = 0.8, 95% CI 0.5–1.1; p = 0.19 for the combined STI outcome). Rates of adverse events were similar across study arms. No serious adverse events related to cellulose sulfate use were reported. Conclusions Cellulose sulfate gel appeared to be safe in the evaluated study population but we found insufficient evidence that it prevented male-to-female vaginal transmission of HIV, gonorrhea or chlamydial infection. The early closure of the trial compromised the ability to draw definitive conclusions about the effectiveness of cellulose sulfate against HIV. Trial Registration ClinicalTrials.gov NCT00120770

Reproductive tract infections and abortion among adolescent girls in rural Nigeria

Few studies from developing countries have investigated reproductive tract infections or other indicators of sexual health among unmarried adolescent girls in rural areas. We have obtained baseline demographic, clinical, and microbiological data on reproductive tract infections and induced abortion in girls in a rural area of southeast Nigeria, in order to assess the need for health care for adolescents. 868 females attended for interview and examination: 458 aged 20 and above and 410 aged 12-19, the latter representing 93.4%of the adolescent population. 43.6% of those < 17 and 80.1% aged 17-19 years were sexually active and at least 24.1% had undergone an induced abortion; only 5.3% had ever used a modern contraceptive. Vaginal discharge was reported by 82.4%, though few sought treatment. 94.1% of sexually active adolescents and 97.6% of sexually active women 20 years old or over were gynaecologically examined and screened for reproductive tract infections. Of those aged less than 17, 19.8% had symptomatic candida and 11.1% trichomonas infections. Among those aged 17-19 years, chlamydia was detected in 10.5%, and symptomatic candidosis in 25.6%; this was the group most likely to have any infection (43.8%). 42.1% of sexually active adolescents had experienced either an abortion or a sexually transmitted disease. Syphilis was the only infection for which the incidence clearly increased with age. Health-care services for adolescents in this community are needed and should include sex education, contraceptive provision (especially barrier methods), and access to treatment for reproductive tract infections. Investments in health for this age group will have an effect on subsequent reproductive health.

How do they grow? A study of south‐eastern Nigerian adolescent girls

This study assessed the nutritional status of Nigerian adolescent girls living in two areas of south‐eastern Nigeria. A cross sectional survey was undertaken in a rural village in Ogoniland, and five secondary schools in Port Harcourt, south‐eastern Nigeria. All (386) menarcheal girls aged 14–19 y living in the rural village, and a stratified cluster sample (845) of menarcheal girls aged 14–19 in the five urban schools were investigated. Mean heights and weights of rural girls were around ‐1 Z‐score below the British reference median. 10. 4% of rural and 4. 7% of urban girls were stunted (≤2nd centile, British 1990 reference values). After calculating mean body mass index‐for‐age, various cut‐off points for low body mass index were tested. At a cut‐off of ≤9th centile, 15. 6% of rural and 8. 0% of urban girls would be classified as thin. Girls with a haemoglobin < 10. 0 g/dl were significantly more likely to have a low body mass index than those with haemoglobin values a 10. 0 g/dl. More studies are needed to refine the definition and interpretation of low body mass index in adolescents.

Protecting adolescent girls against tetanus.

An estimated 8 million infants and 2 million children and adults may die from tetanus during the 1990s despite efforts by the World Health Organization (WHO) to eliminate it by 1995. Vaccination to prevent postabortal and maternal tetanus has been neglected. The immunization of preschool children and of pregnant women has omitted adolescent girls, who are therefore at risk. Data collected on 1101 cases of maternal tetanus in developing countries between 1958 and 1990 indicated that 27% were attributed to postabortal and 67% to postpartum sepsis. In southeastern Nigeria where abortion rates are high, a high proportion of girls were also seronegative for tetanus antibodies. Many unvaccinated pregnant women cite the lack of money for obtaining vaccination when obtaining prenatal services. The WHO is promoting vaccination of women of reproductive age by screening their tetanus toxoid status, but adolescents are poorly covered because they are not regular attenders. Expressly targeting girls would be feasible, as it would require 5 injections providing protection for life. Even 4 injections may protect for 20 years if delivered at the end of primary school. Thus a school health service delivering tetanus vaccination may improve the vaccination of adolescent girls. This could be combined with distribution of vitamin A and antihelminthics whereby the response to the vaccine could be improved significantly. In addition, it has also been suggested that a late dose of an acellular pertussis vaccine and a second dose of measles vaccine given in adolescence would reduce the pool of susceptible girls, just as girls have been targeted for rubella vaccination. Implementation of tetanus vaccination would require local schools vaccination days, immunization cards, high potency primary vaccination, and tetanus boosters free of charge with a system to monitor antibody responses.

A flowchart for managing sexually transmitted infections among Nigerian adolescent females

OBJECTIVE To devise a flowchart suitable for assessing risk of trichomoniasis, chlamydia and gonorrhoea in an adolescent population, not all of whom will be sexually experienced or currently in a relationship. METHODS The data used to derive the flowchart were generated from cross-sectional microbiological surveys of girls aged 14-19 years in Port Harcourt, Nigeria. The flowchart screened on the basis of: (i) sexual experience; (ii) recent sexual activity; (iii) a positive urine leukocyte esterase (LE) test; and (iv) among LE negatives, a history of malodorous/pruritic discharge. FINDINGS Using this flowchart, we found that 26.2% of all adolescents screened would receive treatment for cervicitis and vaginitis. Chlamydial, gonococcal, and trichomonal infections were correctly diagnosed in 37.5%, 66.7%, and 50% of the cases, respectively. CONCLUSION Although the flowchart is more suitable for an adolescent population than the vaginal discharge algorithm used in syndromic management protocols, it still lacks precision and needs adapting to local settings.

What predicts non-retention in microbicide trials?

BACKGROUND Poor retention can reduce study power and thwart randomization, possibly resulting in biased estimates of effect. Some HIV prevention trials conducted in developing countries have been challenged by high loss to follow-up. Identifying factors associated with non-retention could lead to recruitment of women more likely to remain in the trial, potentially yielding greater efficiency and validity. METHODS We summarized retention rates and, using Cox regression, evaluated factors associated with non-retention in four trials of two candidate vaginal microbicides (1% C31G or SAVVY® and 6% cellulose sulfate or CS) conducted in multiple sub-Saharan African countries. We defined retention as completion of the trial, including those with an HIV outcome. Non-retention comprised participants randomized to a study arm who were either lost to follow-up or discontinued prior to infection with HIV. RESULTS 7,367 women were enrolled and randomized in the four trials; 7,086 are included in this analysis. 1,514 (21.4%) participants were either lost to follow-up or had early discontinuation. In the final Cox model, the following baseline factors were associated with non-retention: younger age (hazard ratio [HR] = 0.95); less education (HR = 0.97); condom use at last sex (HR = 1.18); larger number of sex acts in a typical week (HR = 1.01); and baseline candidiasis or bacterial vaginosis (HR = 1.12). CONCLUSIONS Younger and less educated women were more difficult to retain in these microbicide trials. But these same traits may be associated with higher HIV infection rates. Enhanced retention methods focused on those at highest risk of non-retention and possibly infection will optimize study efficiency and validity.

Microbial Profile of wound infections in a Nigerian Teaching Hospital

Background : This study set out to investigate the aerobic and facultative anaerobic microbial profile of wound infections in the University of Port Harcourt Teaching Hospital. Methods : A total of 202 wound swabs samples were randomly collected from both in and out-patients presenting at the facility. One hundred and thirteen(55.9%) of the samples were collected from males while 89(44.6%) were from females. The age of the patients ranged from 32 days to 80 years. Samples were processed following standard operating protocols in the microbiology laboratory. Results : Of the 202 samples examined, 164(81.2%) had microbial isolates while 38(18.8%) yielded no growth. Among the 164 samples with positive microbial growth, 124(75.6%) had single isolates while 40(24.4%) had polymicrobial growth. Of the 113 males studied, 90(79.7%) had microbial growth while 23(20.4%) had no growth. Similarly, of the 89 females studied, 74(83.2%) had microbial growth while 15(16.9%) had no growth. Furthermore, the total microbial isolates from the study was 206. Gram-negative bacterial organisms accounted for 124(60.1%) as against 82(39.9%) from the Gram-positive’s (p Pseudomonads 28(23.3%) and Klebsiella spp 25(12.1). Organisms were more frequently isolated from patients within the age bracket 21-30 years, 93(45.2%) and least within age bracket 71 – 80 years, (0.5%). Antimicrobial susceptibility pattern of the bacterial isolates revealed that ceftazidime was the most effective with 143(70.1%) of the isolates being susceptible. Cotrimoxazole 23(11.3%) and tetracycline 17(8.3%) were less effective against the isolates. Conclusions : Constant bacteriological monitoring of the pathogens isolated in special disease conditions, and their antimicrobial susceptibility pattern are necessary for best practices in wound management.

Cutaneous larva migrans in an eleven-year-old boy in an urban setting in Rivers State

Background: Cutaneous larva migrans is a tropical infectious disease that is usually acquired from contact with soil contaminated with larvae of nonhuman hookworms or Strongyloides usually from faeces of dogs and cats. Aim: To report a case of a boy who presented with pruritic migratory serpiginous skin lesions. Case report: An eleven year old boy with a linear skin lesion was initially misdiagnosed as having an allergy at a private clinic. There was a history of playing regular football in a field contaminated by dog\s urine and faeces.. Later it was highly suspected that he had cutaneous larva migrans. He responded to treatment with albendazole. Conclusion: Physicians should be aware that such infestations are endemic in Nigeria and should be familiar with the typical features Keywords : CCutaneous larva migrans, Ancylostoma braziliense, Albendazole Port Harcourt Medical Journal Vol. 3 (1) 2008: pp. 108 -110