Evaluation of Prevention of Mother to Child Transmission Programme at a Tertiary Healthcare Facility in Southwestern Nigeria.

Most children acquire human immunodeficiency virus (HIV) infection through mother-to-child transmission (MTCT). The risk of MTCT of HIV is generally 15%-40% without prophylaxis. MTCT has been responsible for approximately 370,000 infant HIV infections worldwide, with Nigeria accounting for 30% of cases. The study evaluated the effectiveness of a prevention program for MTCT of HIV infection by determining the rate of MTCT of HIV in infants who underwent the program by reviewing health records of mother-infant pairs at the Olabisi Onabanjo University Teaching Hospital. This cross-sectional study conducted over 12 years used medical records of 545 mother-infant pairs. The rate of MTCT of HIV infection was 2.9% in this study compared to 7.1% reported by the center earlier. The rate of MTCT of HIV infection was the lowest among mother-infant pairs who received prophylaxis. Ages at recruitment are a strong determinant of the risk of infection. Late usage of the MTCT prevention service is a risk for HIV infection in exposed infants.

Assessment of Renal Function Status in Steady-State Sickle Cell Anaemic Children Using Urine Human Neutrophil Gelatinase-Associated Lipocalin and Albumin:Creatinine Ratio.

INTRODUCTION: Sickle cell anaemia is characterized by defective haemoglobin synthesis and is associated with both endocrine and metabolic alterations. The effects of this clinical condition on kidney function are multifactorial and often begin early in childhood. This study aims to assess renal function in children with sickle cell anaemia using urine albumin:creatinine ratio (ACR) and urine human neutrophil gelatinase-associated lipocalin (NGAL). METHODS: This case-control study was conducted on 200 children aged 5-15 years in 2 tertiary hospitals in South West Nigeria: 150 were of haemoglobin S genotype and 50 were of haemoglobin A genotype. Serum urea, creatinine, urine albumin, and NGAL were assayed by known standard methods. eGFR, urine ACR, and urine NGAL/creatinine ratio (urine NCR) were calculated. RESULTS: The weight, height, BMI, systolic blood pressure, plasma urea, plasma creatinine, and spot urine creatinine of the HbS genotype children were significantly lower compared to that of the HbA genotype children. The eGFR, spot urine albumin, and urine ACR were significantly higher in the HbS group compared to the HbA group. There was no significant difference in the spot urine NGAL and urine NCR between the 2 groups, though both were higher in the HbS group compared to the HbA group. CONCLUSIONS: Kidney injury probably starts early in childhood in sickle cell individuals as indicated by the higher urine ACR detected in them. We infer that urine NGAL and uNCR are not sensitive markers of kidney disease especially in young sickle cell individuals possibly because of the hyperfiltration present at this age.

Pulmonary functions of children with sickle cell anaemia in steady state in Lagos, Nigeria

Background: are responsible for considerable morbidity and mortality in children with sickle cell anaemia (SCA). Spirometry is a useful tool for the detection and monitoring of respiratory disorders, but it is under-utilized by healthcare workers who care for children with sickle cell anaemia. Most of the studies assessing pulmonary functions in sickle cell anaemia were conducted among adults.Objective: To describe the lung functions profile of children with sickle cell anaemia in steady state.Methodology: In this study, spirometric indices of 100 children with SCA (HbSS) aged five years to 12 years were compared with 100 matched normal children (HbAA) in the control group.Results: Irrespective of gender, the mean Peak Expiratory Flow Rate (PEFR) values were significantly higher among the HbAA controls than their HbSS counterparts. The mean Forced Expiratory Volume in one second (FEV1) values of males and all subjects irrespective of gender were also significantly higher among the controls compared to HbSS subjects. The mean Forced Vital Capacity (FVC) values were higher among HbSS subjects than the HbAA controls, but the observed differences were not significant. The mean FEV1/FVC values were also not significantly different between the SCA subjects and the controls. The overall prevalence of restrictive pulmonary abnormalities among the HbSS group was 6.0% whereas none of the HbAA group had restrictive pulmonary disorders.Conclusion: Children with SCA, irrespective of gender, have significantly lower PEFR and FEV1. Restrictive lung abnormalities occur exclusively among subjects with SCA

Erythrocyte indices in Pre-school Nigerian Children with Sickle Cell Anaemia in Steady State.

BACKGROUND: Sickle cell disease is a genetic haemoglobinopathy with consequent haemolysis and anaemia. It is of interest to study its effect on red cell indices beside haemoglobin concentration. OBJECTIVES: The objective of the study is to determine the values of red cell indices in preschool-age children with sickle cell anaemia. METHODS: we conducted a cross-sectional study including 97 children with sickle cell anaemia aged six months to five years and 97 age-and sex-matched healthy controls with haemoglobin genotype AA (Hb AA). The red cell indices such as packed cell volume, haemoglobin concentration, mean corpuscular volume, red blood cell count, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration were investigated, using an auto analyzer. RESULTS: The mean PCV, haemoglobin concentration and red blood cell count were significantly higher in HbAA controls (p = 0.000 in each case). The mean MCV was higher among HbSS subjects but it was only among females and when the result was analyzed irrespective of gender that the difference was statistically significant (p < 0.05). CONCLUSION: Children with sickle cell anaemia in steady state have lower values of all red cell parameters and higher values of MCV, compared to haemoglobin phenotype AA controls.

Acute soft head syndrome in children with sickle cell anaemia in lagos, Nigeria.

Acute soft head syndrome is rare complications seen in children with sickle cell anaemia. A case report of a child with sickle cell anaemia who developed acute soft head syndrome. A 12-year old known sickle cell anaemia patient presented with acute, rapidly progressive skull pain and swelling, manifestations indicative of the rare complication of SCD which is called acute soft head syndrome. Conservative treatment with intravenous fluids and analgesics and empirical use of broad-spectrum antibiotics resulted in recovery. Acute soft head syndrome is a rare complication in children with sickle cell anaemia probably related to skull infarction. It further draws attention to the importance of acute soft head syndrome as a differential to be considered for pains in the head and skull swellings in children with sickle cell anaemia.

Evaluation of arm span and sitting height as proxy for height in children with sickle cell anemia in Lagos, Nigeria.

BACKGROUND: Sickle cell anemia may affect linear growth, and complications like avascular necrosis of femoral head may make direct measurement of height difficult. OBJECTIVE: To determine the relationship between height and arm span as well as between height and sitting height among children with sickle cell anemia in Lagos, Nigeria. METHODOLOGY: A random sample of 200 children aged 8 months to 15 years were studied-100 with hemoglobin genotype SS and 100 with hemoglobin genotype AA, matched for age and sex. Height/length, sitting height, and arm span were measured. Correlations and regression analysis were performed to test the relationship between height as a dependent variable and the sitting height and arm span as independent variables. RESULTS: Height, arm span, and sitting height were slightly but not significantly lower in subjects with sickle cell anemia. Strong correlations (R ≥ 0.95) were observed between height and other measurements in both subgroups. Regression analysis with height as the independent variable showed that arm span had a higher coefficient of determination than sitting height in both subjects (R(2) = 0.94 vs 0.899) and controls (R(2) = 0.942 vs 0.940). On the other hand, sitting height had a lower mean difference between observed and predicted height (0.04 and -0.11, respectively). CONCLUSION: Sitting height may be the preferred proxy for height in children with sickle cell anemia.

Cormic index profile of children with sickle cell anaemia in lagos, Nigeria.

Background. Sickle cell disorders are known to have a negative effect on linear growth. This could potentially affect proportional growth and, hence, Cormic Index. Objective. To determine the Cormic Index in the sickle cell anaemia population in Lagos. Methodology. A consecutive sample of 100 children with haemoglobin genotype SS, aged eight months to 15 years, and 100 age and sex matched controls (haemoglobin genotype AA) was studied. Sitting height (upper segment) and full length or height were measured. Sitting height was then expressed as a percentage of full length/height (Cormic Index). Results. The mean Cormic Index decreased with age among primary subjects (SS) and AA controls. The overall mean Cormic Index among primary subjects was comparable to that of controls (55.0 ± 4.6% versus 54.5 ± 5.2%; 54.8 ± 4.5% versus 53.6 ± 4.9%) in boys and girls, respectively. In comparison with AA controls, female children with sickle cell anaemia who were older than 10 years had a significantly lower mean Cormic Index. Conclusion. There was a significant negative relationship between Cormic Index and height in subjects and controls irrespective of gender. Similarly, a significant negative correlation existed between age, sitting height, subischial leg length, weight, and Cormic Index in both subjects and controls.

Iron Deficiency Anaemia among Pre-School Children with Sickle Cell Anaemia: Still a Rare Diagnosis?

BACKGROUND: The frequent need for blood transfusion in children with SCA creates the impression that IDA is rare in this class of children. OBJECTIVES: The objective of the study is to determine the prevalence of IDA in a population of under-five children with SCA in Lagos, Nigeria. METHODOLOGY: Serum iron, total iron binding capacity, transferrin saturation and serum ferritin were assayed in 97 under-five children with SCAand 97 age/sex matched controls. THE DIAGNOSIS OF IDA WAS ESTABLISHED BASED ON THE FOLLOWING CRITERIA: haemoglobin <11.0 g/dl plus two or more of the following: MCV <70fl, transferrin saturation (Ts) <16% or serum ferritin (SF) <25ng/dL. RESULTS: Overall prevalence of IDA was significantly higher among AA controls. In the younger age group, the prevalence of IDA was significantly higher among HbAA controls while in the older age group the odds of having IDA was three times higher among HbSS subjects but the difference was not statistically significant. Two of the three SCA children with IDA have history of previous blood transfusion. CONCLUSION: IDA is uncommon in pre-school aged children with SCA. A multi-centre study is necessary to yield large number of transfused subjects to examine the effects of blood transfusion on prevalence of IDA.

Obesity--does it occur in Nigerian children with sickle cell anemia.

Children with sickle cell anemia are vulnerable to growth deficits; thus, it would be thought that obesity would be rare among them. The objective of the study is to examine the prevalence of obesity in a sickle cell anemia population in Lagos. A random sample of children with sickle cell anemia aged 2-15 years was interviewed and anthropometric measurements including weight and height were taken. Their body mass index (BMI) was calculated. Participants were classified as obese or not obese by their BMI or weight-for-height-for-age using World Health Organization standard definitions. The overall prevalence of obesity was 2.5% and 3.8% among hemoglobin genotype SS subjects and hemoglobin genotype AA controls, respectively. The age-specific prevalence for obesity was highest among the adolescent age category in hemoglobin genotype AA controls and the childhood age category in subjects with sickle cell anemia. All the obese subjects with sickle cell anemia were from upper socioeconomic strata, while two and one of the three subjects with hemoglobin genotype AA were from upper and middle socioeconomic strata, respectively. Obesity does exist among children with sickle cell anemia in Lagos, Nigeria. Public health programs aimed at prevention and control of obesity must include children with sickle cell anemia.