Clinical Profile and Determinants of Loss to Follow-Up in Patients Enrolled in an Urban Antiretroviral Treatment Programme in Northwestern Nigeria.

INTRODUCTION: Loss of follow up in patients enrolled on antiretroviral treatment programmes has the potential to reduce their quality of life. We set out to describe the profile and risk factors for loss to follow up in patients enrolled on our programme. MATERIALS AND METHODS: In this retrospective study, we reviewed the records of patients who were identified as lost to follow up between August 2008 to July 2018. Determinants of loss to follow-up were identified by the use of binary logistic regression with SPSS to compare the data of patients lost to follow-up with randomly selected patients who were still in care. RESULTS: A total of 4,250 patients were enrolled on our programme during the study period. Of these, 965 patients were identified as lost to follow-up, giving a loss to follow up rate of 22.7%. Compared to patients still in care, patients who were lost to follow up were significantly male (male, n =395, 56% versus female, n= 310, 44%, p<0.0001), of younger age (33.53+9.05 versus 34.48+9.25 years, p = 0.028), married (married, n = 669, 58.9% versus not married n = 467, 41.1%, p<0.0001) and with evidence of low crude weight at the time of recruitment (58.58+12.12 versus 60.09+14.58 kg, p = 0.018). CONCLUSION: Our study showed that patients who are young, male, married, recently enrolled, with evidence of the low crude weight, with WHO Clinical Stages III and IV and anaemia at enrolment are commonly lost to follow-up. Clinicians need to target this population to reduce the loss of follow up in patients on antiretroviral therapy.

INTRODUCTION: La perte de suivi des patients inscrits dans des programmes de traitement antirétroviral peut réduire leur qualité de vie. Nous avons entrepris de décrire le profil et les facteurs de risque de perte de suivi chez les patients inscrits à notre programme. MATERIEL ET METHODES: Dans cette étude rétrospective, nous avons examiné les dossiers des patients qui ont été identifiés comme perdus de vue entre août 2008 et juillet 2018. Les déterminants de la perte de suivi ont été identifiés par l'utilisation d'une régression logistique binaire avec SPSS pour comparer les données des patients perdus de vue avec des patients sélectionnés au hasard qui étaient encore en soins. RESULTATS: Au total, 4 250 patients ont été inscrits à notre programme au cours de la période d'étude. Parmi eux, 965 patients ont été identifiés comme perdus de vue, soit un taux de perte de suivi de 22,7%. Comparés aux patients encore en soins, les patients perdus de vue étaient significativement des hommes (hommes, n =395, 56% contre femmes, n= 310, 44%, p<0.0001), plus jeunes (33.53+9.05 contre 34.48+9. 25 ans, p = 0.028), mariés (mariés, n = 669, 58.9% versus non mariés n = 467, 41.1%, p<0.0001) et avec un faible poids brut au moment du recrutement (58.58+12.12 versus 60.09+14.58 kg, p = 0.018). CONCLUSION: Notre étude a montré que les patients jeunes, de sexe masculin, mariés, récemment recrutés, présentant une insuffisance pondérale brute, des stades cliniques III et IV de l'OMS et une anémie au moment du recrutement sont souvent perdus de vue. Les cliniciens doivent cibler cette population pour réduire les pertes de suivi chez les patients sous thérapie antirétrovirale. Mots clés: Perte de suivi; VIH; Thérapie antirétrovirale.

Gender Disparity in Survival amongst End-Stage Renal Disease Patients on Haemodialysis.

BACKGROUND: Gender inequality in access and outcome of health care utilisation has been a major concern worldwide. We evaluated some demographic and clinical characteristics as well as compared the mortality rate between men and women with end-stage renal disease on haemodialysis (HD), to find out if gender has any influence on mortality. METHODS: This was a single centre retrospective study. All adult incident and prevalent haemodialysis patients with end-stage renal disease (ESRD) seen between July 2007 and June 2019 were enrolled in the study. Data collected included age, sex, hepatitis B and C viral status, vascular access at the commencement of haemodialysis, duration on haemodialysis, number of dialysis sessions ever conducted and outcome of haemodialysis. The outcome was stratified as alive, dead, or lost to follow up. The primary outcome measure was all-cause mortality. The IBM SPSS Statistical software version 23 was used to analyse the data. Kaplan Meier survival curve was used to compare all-cause mortality between men and women. RESULTS: This study included 995 HD patients of whom 704 (70.8%) were males. Mean age was 44.7 + 16.3 years. At the end of the study period, 878 (88.2%) patients died. The mortality rates for men and women did not significantly differ with a cumulative median survival of 17 and 16 days respectively (Log-rank = 0.85, p = 0.358). Hepatitis B seropositivity was significantly associated with increased mortality (Hazard Ratio (HR) = 1.2; 95% CI 1.025 - 1.526). CONCLUSIONS: Despite the perceived poor access to modern healthcare services by women in Northern Nigeria, there is no gender disparity in crude mortality in patients with end-stage renal disease on haemodialysis.

Hemodialysis among pregnancy related acute kidney injury patients: A single center experience in North-Western Nigeria.

Pregnancy related acute kidney injury (PRAKI) patients that underwent hemodialysis (HD) between May 2007 and April 2015 were studied with specific reference to clinical features, laboratory values, duration of pregnancy at the diagnosis of acute kidney injury and outcome. It involved 38 patients aged between 15 and 30 years. The main clinical features were fever, edema and oliguria. The leading etiological factors included ante/postpartum hemorrhage, septic abortion, and toxemia of pregnancy. The majority of cases occurred during the third trimester. PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. HD improved patient survival in our study.

Hemodialysis performance and outcomes among end stage renal disease patients from Sokoto, North-Western Nigeria.

The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated.

Malaria prophylaxis in post renal transplant recipients in the tropics: is it necessary?

OBJECTIVES: Malaria prophylaxis is usually not provided routinely for most post renal transplant recipients in malaria endemic zones. Therefore, very little information is known about the incidence and severity of this disease among the post-transplant recipients in our environment. Hence a prospective, non-randomized open label clinical trial to determine the incidence of malaria and the beneficial effect of malaria prophylaxis among renal transplant recipients in Nigeria was carried out. SUBJECTS: All seven consecutive patients who had renal transplants and returned to the unit not more than four weeks later were seen and followed up. This consisted of an initial four week period of no prophylaxis and another four weeks of prophylaxis with proguanil hydrochloride 200 mg daily. Weekly thin and thick blood films by Giemsa stain were examined and other routine investigations of liver function tests, full blood count, urea, creatinine, electrolytes and urinalysis were done. RESULTS: Only three out of the seven patients (42.8%) had positive smears for malaria parasites in the initial no prophylaxis phase. No malaria parasites were detected at the prophylactic phase. There was no significant difference in the results of other investigations including the renal function between the two phases. CONCLUSION: This study has shown the benefit of short term routine malaria prophylaxis among renal transplant recipients in malaria endemic zones.