Plasma Glucose in a Reference Population in Port Harcourt; Nigeria

Background: Reference intervals are important in the analysis of results obtained for patients in the Hospital. These intervals tend to change as population demographics change. Globally; there has been an increase in the prevalence of diabetes and a change in the criteria set in diagnosing this disease. Since we have used the same reference intervals since 1984; it became imperative to review the reference intervals in use in our Hospital; the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria. Methods : A total of 605 patients from the Out-Patient department and the Hospital community randomly following informed consent. Five milliliters (5mls) of blood was collected into fluorides oxalate bottles between 9.00-11.00 a.m. after an overnight fast for the determination of plasma glucose. The samples were assayed daily within two hours of collection. Serum glucose was determined using the glucose oxidase method (Randox Laboratories-Antrim UK). Results: The reference interval covering the central 95th centile as determined by non-parametric methods was 3.0-5.7 mmol/L (95confidence interval-2.7-3.2 and 5.6-5.8 mmol/L) for the entire study population; while that for males was 2.9-6.3 mmol/L and that for females was 3.3-5.6 mmol/L. Conclusion : It is essential to review reference intervals periodically as changes may occur due to changes in population demographics

Sero-Prevalence of Hepatitis C Antibodies in Pregnant Women in Port Harcourt; Nigeria

Background: Hepatitis C virus (HCV) infection is now a pandemic; with most of those infected thought to be in developing countries; including sub-Saharan Africa. HCV has emerged as the most important cause of chronic liver disease worldwide and an important cause of acute hepatitis and jaundice in pregnancy; with its attendant serious complications. Aim: To provide some preliminary data on HCV epidemiology in pregnant women in Port Harcourt; Nigeria. Methods: Serial recruitment of 600 patients attending the ante-natal clinic of the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria was carried out. HCV testing was done using a rapid ELISA kit. The results are reported as percentages of the total study population. Differences between the groups were compared using the chi-squared test and p0.05 was regarded as statistically significant. Results: Of the 600 subjects; 26 (4.3) tested positive to anti-HCV. Previous histories of blood transfusion; dental manipulations; tattooing and circumcision did not appear to be important modes of transmission of HCV in this locality. Conclusion: HCV infection is fairly common among pregnant women in Port Harcourt; Nigeria. It is sug- gested that in addition to improved compliance with universal safety precautions; ante-natal patients and healthcare staff should be routinely screened for their HCV status in order to reduce vertical transmission of HCV and transmission between patients and health staff

Effect of organo- phosphorus compounds on plasma cholinesterase levels in industrial and non-industrial workers in Port Harcourt.

BACKGROUND: Port Harcourt is a city with a high concentration of companies (Industries) using organo-phosphorus compounds with workers who have been exposed to these compounds for varying lengths of time. This study looks at the effects of exposure to these compounds on the health of these workers relative to the control group by measuring the plasma cholinesterase activity of the workers and the control group. METHODS: In this prospective study, 200 subjects were selected from the companies in Port Harcourt (40 from each of five companies using organo-phosphorus compounds) and 50 controls selected from the state secretariat complex. The subjects in each of the five companies were again subdivided into "directly exposed" and "non-exposed". Among the "exposed" a group of workers who had worked in the organo-phosphorous unit for more than four years (prolonged exposure) were sorted out. The popular kinetic colorimetric method using Butyrylthiocholine with liquid reagents was used for measuring plasma cholinesterase activity. RESULTS: Results obtained showed significant reduction in the plasma cholinesterase activity of subjects exposed to organo-phosphorous compounds (5466+/-948) when compared with the control group (8042+/-1011) P<0.05. This reduction was more marked in those subjects who had been exposed to organo-phosphorus compounds for more than 4 years (4614+/-532) P<0.05. There was no significant difference in the mean plasma cholinesterase activity between the "non-exposed" company workers (8133+/-1635) and the control (8042+/-1011) P>0.05. CONCLUSION: Exposure to organo-phosphorus compounds causes reduction in the plasma cholinesterase activity and this reduction is directly related to the duration of exposure.

Sero-prevalence of HIV antibodies in pregnant women in Port Harcourt, Nigeria.

BACKGROUND: The aim of the study was to determine the Sero-Prevalence of HIV antibodies in pregnant women attending the antenatal clinic at the University of Port Harcourt Teaching Hospital, Port Harcourt. METHOD: Serial recruitment of 600 women who attended the antenatal clinic. HIV screening was done by rapid ELISA technique. Positive samples were re-tested with a second rapid ELISA kit, with only samples sero-positive with both kits being taken as trulysero-positive. RESULTS: The sero-positivity rate was 7.3%, sixty-nine point seven percent (69.7%) of all sero-positive cases were primiparae, with 84% in advanced stages of pregnancy (2nd and 31rd trimesters). History of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HIV sero-positivity. CONCLUSION: There is high HIV sero-positivity rate among pregnant women attending antenatal clinic in Port Harcourt. The implications of this finding in relation to vertical transmission, transmission of nosocomial infection and increased occupational exposure of laboratory and hospital staff to HIV infection is discussed. Compulsory routine screening of all pregnant women attending antenatal clinics in Sub-Saharan Africa is advocated.

Sero-prevalence of HIV antibodies in pregnant women in Port Harcourt, Nigeria

BACKGROUND: The aim of the study was to determine the Sero-Prevalence of HIV antibodies in pregnant women attending the antenatal clinic at the University of Port Harcourt Teaching Hospital, Port Harcourt.METHOD:Serial recruitment of 600 women who attended the antenatal clinic. HIV screening was done by rapid ELISA technique. Positive samples were re-tested with a second rapid ELISA kit, with only samples sero-positive with both kits being taken as trulysero-positive.RESULTS:The sero-positivity rate was 7.3%, sixty-nine point seven percent (69.7%) of all sero-positive cases were primiparae, with 84% in advanced stages of pregnancy (2nd and 31rd trimesters). History of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HIV sero-positivity.CONCLUSION:There is high HIV sero-positivity rate among pregnant women attending antenatal clinic in Port Harcourt. The implications of this finding in relation to vertical transmission, transmission of nosocomial infection and increased occupational exposure of laboratory and hospital staff to HIV infection is discussed. Compulsory routine screening of all pregnant women attending antenatal clinics in Sub-Saharan Africa is advocated

Sero-prevalence of hepatitis B surface antigen (HBsAg) in pregnant women in Port Harcourt, Nigeria.

BACKGROUND/OBJECTIVE: Hepatitis B Virus (HBV) infection is a global public health problem and is endemic in Asia and Sub-Saharan Africa, including Nigeria. Vertical transmission of HBV infection is thought to be a major mode of transmission in endemic areas. This study was therefore undertaken to determine the sero-prevalence of Hepatitis B surface antigen (HBsAg) on pregnant women in Port Harcourt, Nigeria, in an effort to obtain baseline information on disease burden in this locality, in order to institute public health measures to reduce transmission. PATIENTS AND METHODS: Serial recruitment of 600 women attending the ante-natal clinic at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. HBsAg screening was done using a rapid ELISA Kit. RESULTS: 26(4.3%) of the 600 subjects tested positive to HBsAg. Blood transmission, dental manipulations, tattooing and circumcision were found not to be significant modes of transmission of HBV infection in Port Harcourt. CONCLUSION: There is an intermediate prevalence (4.3%) of HBV infection in pregnant women in Port Harcourt, Nigeria. The need to institute public health measures to reduce disease burden and transmission, including routine screening of all pregnant mothers for HBV infection and early passive/active immunisation of babies born to HBsAg--positive mothers is advocated.

Plasma lipids during pregnancy in women in Port Harcourt, Nigeria.

BACKGROUND: Pregnancy in Caucasian women is known to be associated with hyperlipidaemia. In a background of poor socio-economic conditions, early marriage, poor acceptance of contraceptives, poor spacing of pregnancies, high fertility rate and poor maternal and child health indices, this study was designed to investigate the pattern and degree of serum lipid changes during pregnancy in black African women in Port Harcourt, Nigeria. METHODS: Two hundred and thirty apparently healthy pregnant women at different stages of pregnancy and 51 non-pregnant control subjects of comparable age, height, and parity were serially recruited into the study. Plasma total cholesterol (TCHOL), LDL-Cholesterol (LDL-CHOL), HDL-Cholesterol (HDL-CHOL) and triglycerides (TG) were estimated for all study subjects and mean plasma lipid levels calculated for first, second and third trimesters of pregnancy. RESULTS: There was an increase in the mean concentration of plasma TCHOL, HDL-CHOL, and TG and a decrease in LDL-CHOL in the pregnant subjects as compared to the non-pregnant control subjects. Mean TCHOL, HDL-CHOL, LDL-CHOL and Triglycerides tended to increase with increasing gestational age. CONCLUSION: The results show that pregnancy in black Nigerian women is associated with hyperlipidaemia. The implications of this finding are discussed.

Knowledge, attitude and practice of aspects of laboratory safety in Pathology Laboratories at the University of Port Harcourt Teaching Hospital, Nigeria.

OBJECTIVE: To assess current knowledge, attitudes and practice of aspects of laboratory safety in pathology laboratories at the University of Port Harcourt Teaching Hospital in view of perceived inadequacies in safety practices in clinical laboratories in developing countries. MATERIALS AND METHODS: Sixty (60) self- administered questionnaires were distributed to all cadres of staff in four (4) different laboratories (Chemical Pathology, Haematology, Blood bank and Medical Microbiology) at the Hospital. RESULT: Gross deficiencies were found in the knowledge, attitudes and practice of laboratory safety by laboratory staff in areas of use of personal protective equipment, specimen collection and processing, centrifuge--related hazards, infective hazards waste disposal and provision and use of First Aid Kits. CONCLUSION: Issues pertaining to laboratory safety are not yet given adequate attention by both employers and employees in developing countries in this ear of resurgence of diseases such as HIV/AIDS and Hepatitis Band C, is emphasized.

The prevalence of hepatitis B surface antigen (HBsAg) among prospective blood donors and patients in Port Harcourt, Nigeria.

BACKGROUND: HBV infection with its associated sequelae is a disease of major public health importance worldwide. This study analyzed the results of HBsAg screening at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, over a five-year period (1996-2000), with a view to establishing the prevalence rate in this area of the Niger Delta of Nigeria. METHODS: RESULTS from the Hepatitis Laboratory of the Hospital for the five-year period (1996-2000) were reviewed. The subjects consisted of two (2) main groups, i.e. blood donors and hospital patients. Screening was done using latex agglutination kits manufactured by Biotec Laboratories, USA. RESULTS: A total of 7226 samples were screened for HBsAg over the five-year period. The overall sero-positivity rate was found to be 4.98%. The carrier rate among blood donors was 1.57%, while among hospital patients, the prevalence rate was 28.37%. CONCLUSION: Hepatitis B surface antigenaemia is common in Port Harcourt and its environs. Therefore adequate screening of patients and blood donors and the institution of adequate public health measures is advocated in order to reduce the transmission of this virus.

Health and safety in clinical laboratories in developing countries: safety considerations.

BACKGROUND: Clinical laboratories are potentially hazardous work areas. Health and safety in clinical laboratories is becoming an increasingly important subject as a result of the emergence of highly infectious diseases such as hepatitis and HIV. This is even more so in developing countries where health and safety have traditionally been regarded as low priority issues, considering the more important health problems confronting the health authorities in these countries. METHODS: We conducted a literature search using the medical subheadings titles on the INTERNET over a period of twenty years and summarized our findings. RESULTS: This article identifies hazards in the laboratories and highlights measures to make the laboratory a safer work place. It also emphasizes the mandatory obligations of employers and employees towards the attainment of acceptable safety standards in clinical laboratories in Third World countries in the face of the current HIV/AIDS epidemic in many of these developing countries especially in the sub-Saharan Africa while accommodating the increasing work load in these laboratories. CONCLUSION: Both the employer and the employee have major roles to play in the maintenance of a safe working environment. This can be achieved if measures discussed are incorporated into everyday laboratory practice.

HIV infection: risk of occupational exposure in a chemical pathology laboratory in Nigeria.

The prevalence of HIV/AIDS is rising globally, the worst affected area being Sub-Saharan African. In order to assess the risk of occupational exposure to HIV/AIDS in laboratory workers in Nigeria, we screened 210 consecutive serum sample sent to the Chemical Pathology Laboratory of the University of Port Harcourt Teaching Hospital, Port Harcourt, over a two-week period. 17 (8.1%) of all the sample screened tested positive. The Sero-positivity rate was 11.3% for adults and 2.6% for children. The implications of these findings with regards to the risk of occupational exposure of laboratory and health worker is discussed. The need for more attention to be paid to laboratory safety regulation in sub-saharan Africa in highlighted.

Maternal and neonatal thyroid status in Saki, Nigeria.

The influence of inadequate iodine intake on maternal and neonatal thyroid status in Saki, a locality known to have environmental iodine deficiency and located within the goitre belt of Southwestern Nigeria was investigated. One hundred and five (105) subjects and ninety (90) controls from Ibadan were recruited into the study. All subjects were apparently healthy with at least thirty-seven (37) completed weeks of gestation. Each subject was assessed for goitre and blood sample obtained by venepuncture for thyroid function tests before onset of labour. Spot urine samples were also obtained from the mothers at the time of examination for urinary iodine estimation. At delivery, cord blood samples were obtained from the babies for thyroid function tests. The mean maternal urinary iodine excretion was significantly less in Saki when compared with Ibadan (144.76 +/- 14.68 vs 213.36 +/- 9.89 ug/L P < 0.01). Maternal total goitre rates (TGR) were 46.8% and 2.2%, while maternal visible goitre rates (VGR) were 26.6% and 1.1% in Saki and Ibadan, respectively. Maternal mean plasma total T3 and total T4 were relatively lower in Saki as compared to Ibadan, though the differences were not statistically significant. Mean maternal plasma TSH in Saki was slightly above our laboratory reference interval (0.3-5.0 mU/L) and higher than the level seen in Ibadan mothers (6.54 +/- 1.58 vs 4.18 +/- 1.37 mU/L,), though the difference was also not statistically significant. Mean neonatal total T3 and T4 were lower in Saki when compared to Ibadan, but the differences were not statistically significant. The mean neonatal plasma TSH in Saki was above the adult reference interval and significantly higher than the level seen in Ibadan (9.82 +/- 1.64 vs 4.18 +/- 1.17 mU/L, P < 0.05). The incidence of neonatal chemical hypothyroidism (NCH) in Saki was 14.7 per 1000 babies. No case of NCH was seen in Ibadan. These results suggest environmental iodine deficiency and relative chemical hypothyroidism of mothers and neonates in Saki when compared to mothers and noenates from non-iodine deficient areas.

Endemic goitre prevalence in Ifedapo Local Government Area of Oyo State, Nigeria.

As part of efforts aimed at providing an adequate data base for the control of iodine deficiency disorders (IDD) in Nigeria, we undertook an extensive goitre survey of Ifedapo Local Government Area (LGA) of Oyo State, which lies within the goitre-belt of South-western Nigeria. Primary school pupils aged between six and twelve years were the subjects of the survey. From each of ten health districts of the LGA, one primary school was included in the survey. For each school, the entire school population was assessed for goitre by palpation and goitre graded according to WHO/ICCIDD criteria. The survey included 3599 pupils (1889 males and 1710 females). The total goitre rate (TGR) for the LGA was 23.4% while the visible goitre rate (VGR) was 6.4%. The highest goitre rate was recorded in District I (Sango, Saki) TGR = 39.5%; VGR = 17.3%), while the lowest rate was seen in District 4 (Wasengare) TGR = 5.2%; VGR = 0.7%). Females had higher goitre rates than males (TGR: 25.7% vs 21.3%; VGR: 7.5% vs 5.5%). Most of the goitres were Grades IA (36.7%) or IB (35.7%). Goitre grades 2 and 3 accounted for only 27.3% and 0.2%, respectively. These results show that there is a mild to moderate IDD problem in Ifedapo LGA. The implications of this finding, in view of the known deleterious consequences of IDD, are discussed and the need for correction highlighted.

The influence of iodine deficiency on the cognitive performance of school children in Saki, south-west Nigeria.

The influence of inadequate iodine intake on the thyroid status and cognitive performance of school children in Saki, a town within the goitre belt of South-western Nigeria with known environmental iodine deficiency, was assessed. One hundred and ninety-seven (197) study subjects from Saki and seventy (70) appropriately matched control subjects from Moniya, near Ibadan, the Oyo State capital were recruited into the study. The subjects were apparently healthy primary school pupils between the ages of 10 and 14 years and had been resident in the respective locality for at least two (2) years. After establishing the presence of goitre, blood was collected for thyroid function tests by venepuncture from each pupil. The cognitive function tests, Draw-A-Person (DAP) test and the Standard Progressive Matrices (SPM) were administered simultaneously to all the pupils in the class. Urine samples were collected for urinary iodine estimation. The mean urinary iodine concentration was significantly lower in Saki than in Moniya (134.81 +/- 69.86 vs 220.00 +/- 69.00 ug/L, P < 0.01). The total goitre rates (TGR) and the visible goitre rates (VGR) were 15.2% and 1.5% for Saki, and 8.6% and 4.3% for Moniya, respectively. The mean plasma total T4 was significantly lower in Saki pupils (97.55 +/- 26.64 nmol/L vs 122.52 +/- 26.51 nmol/L P < 0.05). The TSH level was higher in Saki pupils than in Moniya pupils (4.72 +/- 1.38 mU/L vs 4.26 +/- 1.28 mU/L), but the difference was not statistically significant. Scores on intelligence function tests (DAP and SPM) were lower for Saki pupils when compared with Moniya pupils, though the differences were not statistically significant. These results show that there is a mild but significant iodine deficiency disorder problem in Saki. However, the children in Saki still maintained euthyroidism and the mild degree of iodine deficiency did not seem to have adversely affected their cognitive performance.

Plasma glucose and insulin responses to oral glucose loading in nonobese Nigerian subjects with essential hypertension.

In assessing the relationship between insulin levels and blood pressure, we analyzed glucose and insulin data after standard 75 g oral glucose tolerance tests in 16 nonobese male Nigerian subjects with essential hypertension and compared their results with those obtained from 16 age- and sex-matched healthy normotensive subjects. The fasting plasma glucose and insulin as well as 2-hour postload insulin values were similar in both groups. The hypertensive subjects had significantly greater 2-hour glucose levels, larger incremental areas under the glucose/time curves, and smaller ratios of incremental insulin to incremental glucose areas (P < .05). These parameters suggest some impairment of glucose tolerance in the hypertensive subjects related to an inadequate insulin response to the oral glucose load. Model analysis of the glucose and insulin data confirmed these observations in that the estimated rate of glucose uptake into peripheral tissues (M value) was lower in the hypertensive subjects (P = .02). There was no correlation at any time point between insulin values and blood pressure in either group of subjects. These results suggest that essential hypertension in Nigerian diabetic subjects is associated with a reduced insulin response to glucose loading, which is at variance with reports in whites, and deserve further investigation.