Distribution of Kell phenotype among pregnant women in Sokoto, North Western Nigeria.

INTRODUCTION: Kell antigen is highly immunogenic and is the common cause of antibody production in mismatched blood transfusions, haemolytic transfusion reaction (HTR) and maternal alloimmunization, which causes severe anaemia in neonates. The aim of this study is to determine the prevalence and ethnic variation of the Kell phenotype among pregnant women in Sokoto, Nigeria. METHODS: Kell antigen status of 150 pregnant women aged 18-45 years and mean age 27.19 ±4.69 years attending antenatal clinic in UDUTH Sokoto Nigeria was determined using the conventional tube method and anti-Kell reagents (Lorne Laboratories, UK). RESULTS: Among the 150 subjects studied, 3 (2.0%) of subjects were positive and 147 (98.0) were negative for K antigen. Of the 150 pregnant subjects; 32 (21.3%) were primigravidae while 118 (78.7%) were multigravidae. Kell phenotype was more prevalent among primigravidae (3.1%) compared to multigravidae (1.7%) women. The distribution of Kell phenotype among the pregnant subjects was compared based on ethnicity. The prevalence of Kell antigen was significantly higher among the Hausa ethnic group (3.2%) compared to other ethnic groups which indicated zero prevalence (p = 0.001). Kell negative phenotype was ≥ 96.8% among all the ethnic groups. CONCLUSION: Our observed prevalence of Kell phenotype is consistent with previous studies among Blacks and Asians but significantly lower than values observed in previous studies among Caucasians. We recommend that all pregnant women should be screened for the presence clinically significant red cell antigens including Kell antigen on their first antenatal visit. Kell negative red cell should be routinely provided for all pregnant women and women with child bearing potential to reduce the risk of Kell-associated HDFN. There is need to introduce routine screening of pregnant women for clinically significant red cell antibodies to facilitate the effective management of HDFN as well as prevent HTR. There is also need for sustained health education of pregnant women in the area to encourage early booking for antenatal care.

Prevalence of p24 antigen among a cohort of HIV antibody negative blood donors in Sokoto, North Western Nigeria--the question of safety of blood transfusion in Nigeria.

INTRODUCTION: Blood transfusions remain a substantial source of HIV in SSA particularly among children and pregnant women. AIMS AND OBJECTIVES: This aim of this retrospective study was to investigate the prevalence of p24 antigen among HIV antibody seronegative blood donors in Sokoto, North West Nigeria. METHODS: A total of 15,061 HIV antibody negative blood donors with mean age and age range (29.2 ± 8.18 and 18-50 years) were screened for p24 antigen between January 2010 to July 2013 using the Diapro Diagnostic immunoassay kit for P24 antigen (King Hawk Pharmaceuticals Beijing China). RESULTS: The overall prevalence of p24 antigen among the HIV antibody negative donors sample was 5.84%. The yearly prevalence was 9.79, 8.12, 2.7 and 2.84% respectively in 2010, 2011, 2012 and 2013. Of the total number of blood donor tested, 14,968 (99.38%) were males while 93 (0.62%) were females. The prevalence of P24 antigen was significantly higher among male blood donors 873 (5.8%) compared to females 7(0.05%), (p= 0.001). P24 positivity was significantly higher among blood group O blood donors compared to A, B and AB donors (494 (3.29%) compared to 184 (1.89%), 196 (1.30%) and 6 (0.04%)) respectively, p = 0.001). The prevalence of P24 antigen was significantly higher among Rhesus positive blood donors compared to Rhesus negative (807 (5.36%) versus 73 (0.48%), p =0.001). CONCLUSION: Blood transfusion in Nigeria is associated with increased risk of HIV transmission. There is the urgent need to optimize the screening of blood donors in Nigeria by the inclusion of p24 antigen testing into the blood donor screening menu. The Nigerian government urgently need to adopt the WHO blood safety strategies to reduce the risk of transmission of HIV through blood transfusion.

Harmony in health sector: a requirement for effective healthcare delivery in Nigeria.

Harmony is defined as the pleasing combination of elements of a system to form an all-inclusive, all involving and more productive team. The aim of this present review was to investigate the factors militating against harmony among healthcare professional in the Nigerian healthcare delivery system. This review was carried out by searching through literature on the topic that bother on harmony among health professions in the health sector. Literature search and reports from previous studies indicates that harmony among health workers is pivotal to improving the health indices. However, available evidence suggests that unlike in the developed world, health care professionals do not collaborate well together in Nigeria because of the claim of superiority of a particular health professional over others. This has often resulted in inter-professional conflict which is threatening to tear the health sector apart to the detriment of the patients. The Nigeria health system should be based on team work. Health professionals from a variety of disciplines should work together to deliver the best possible healthcare services to all Nigerians. All members of the team are equally valuable and essential to the smooth running of hospitals. Hospitals should ideally be headed by health administrators or by a qualified member of any of the professions in the health sector.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Kidd blood group phenotypes among pregnant women in Sokoto, North Western Nigeria

OBJECTIVE@#To investigate the prevalence of Kidd antigens among pregnant women in Sokoto, North Western Nigeria.@*METHODS@#One hundred and sixty two pregnant women aged 18-45 years [mean age (27.19±4.72) years] attending antenatal clinic in Usmanu Danfodiyo University Teaching Hospital, Sokoto, were screened for the presence of Kidd blood group antigens using the conventional tube method and anti-Jka and Jkb reagents (Lorne Laboratories, UK).@*RESULTS@#Out of the 162 pregnant women tested, 82 (50.6%) were Hausa, 26 (16%) were Igbo, 23 (14.2%) were Fulani and 20 (12.3%) were Yoruba while the minority ethnic groups were 11 (6.8%). The distribution of Kidd antigen was compared based on the ethnic groups of subjects. Jka antigen was the highest among the Yoruba ethnic group (10.0%) followed by the Hausa ethnic group (7.31%). The prevalence of Jkb was highest among Hausa subjects (10.97%) followed by the Yoruba ethnic group (10.0%). Subjects were categorized based on parity. Majority of the subjects were multigravidae, 122 (75.3%) compared to primigravidae 40 (24.7%). Subjects were stratified based on trimester. A significant number of women were in the second trimester, 111 (68.5%) compared to the third trimester 38 (23.5%) and the first 13 (8.0%). The distribution of Kidd antigens among subjects studied indicated a prevalence of Jka, Jkb and Jk(a+b+) with 8 (4.9%), 13 (8.0%) and 0 (0.0%), respectively. A significant number of subject tested were negative for Kidd antigens. Of the 162 pregnant women tested, 154 (95.1%), 149 (75.3%) and 141 (87.04%) tested were negative for Jka, Jkb, and Jk(a-b-), respectively.@*CONCLUSIONS@#This study indicates that blood group antigens can be distributed differently within different nationalities. Kidd phenotypes observed among pregnant women in this study was similar to previous reports among blacks but at variance with report among Caucasians and Asians. We recommend that detailed routine phenotyping for all clinically significant red cell antigen including Kidd antigen being carried out routinely among all pregnant women in Nigeria. There is also the need to routinely screen all pregnant women for alloantibodies to facilitate the selection of antigen negative units for those with clinically significant alloantibodies who require a red cell transfusion. This can potentially optimise the obstetric management of haemolytic disease of foetus and newborn and prevent haemolytic transfusion reaction among pregnant women.

Kidd blood group phenotypes among pregnant women in Sokoto, North Western Nigeria

Objective: To investigate the prevalence of Kidd antigens among pregnant women in Sokoto, North Western Nigeria. Methods: One hundred and sixty two pregnant women aged 18-45 years [mean age (27.19±4.72) years] attending antenatal clinic in Usmanu Danfodiyo University Teaching Hospital, Sokoto, were screened for the presence of Kidd blood group antigens using the conventional tube method and anti-Jka and Jkb reagents (Lorne Laboratories, UK). Results: Out of the 162 pregnant women tested, 82 (50.6%) were Hausa, 26 (16%) were Igbo, 23 (14.2%) were Fulani and 20 (12.3%) were Yoruba while the minority ethnic groups were 11 (6.8%). The distribution of Kidd antigen was compared based on the ethnic groups of subjects. Jka antigen was the highest among the Yoruba ethnic group (10.0%) followed by the Hausa ethnic group (7.31%). The prevalence of Jkb was highest among Hausa subjects (10.97%) followed by the Yoruba ethnic group (10.0%). Subjects were categorized based on parity. Majority of the subjects were multigravidae, 122 (75.3%) compared to primigravidae 40 (24.7%). Subjects were stratified based on trimester. A significant number of women were in the second trimester, 111 (68.5%) compared to the third trimester 38 (23.5%) and the first 13 (8.0%). The distribution of Kidd antigens among subjects studied indicated a prevalence of Jka, Jkb and Jk(a+b+) with 8 (4.9%), 13 (8.0%) and 0 (0.0%), respectively. A significant number of subject tested were negative for Kidd antigens. Of the 162 pregnant women tested, 154 (95.1%), 149 (75.3%) and 141 (87.04%) tested were negative for Jka, Jkb, and Jk(a-b-), respectively. Conclusions: This study indicates that blood group antigens can be distributed differently within different nationalities. Kidd phenotypes observed among pregnant women in this study was similar to previous reports among blacks but at variance with report among Caucasians and Asians. We recommend that detailed routine phenotyping for all clinically significant red cell antigen including Kidd antigen being carried out routinely among all pregnant women in Nigeria. There is also the need to routinely screen all pregnant women for alloantibodies to facilitate the selection of antigen negative units for those with clinically significant alloantibodies who require a red cell transfusion. This can potentially optimise the obstetric management of haemolytic disease of foetus and newborn and prevent haemolytic transfusion reaction among pregnant women.

The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood.

As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.

Socio-demographic Characteristics of Adults Screened for Human Immunodeficiency Virus Infection in Ahoada-East Local Government Area in the Niger Delta of Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV), the pathogen responsible for the acquired immunodeficiency syndrome and the most significant emerging infectious disease is causing health, social, and developmental problems to mankind. AIMS, SETTING AND DESIGN: This is a cross-sectional study to evaluate the socio-demographic characteristics of adults screened for HIV infection in Ahoada Community in Rivers State in the Niger Delta of Nigeria. MATERIALS AND METHODS: HIV antibodies were detected using "Determine" (Abbott Laboratories, Japan), Start-Pak (Chembio Diagnostics, USA) and SD Bioline HIV-1/2 kits (Standard Diagnostics, Korea). All test procedures were carried out according to the manufacturers' instructions. Subjects included 152) consecutively recruited adults consisting of 955 females and 566 males aged 18-54 years with a mean age of 36.25±7.02 years. STATISTICAL ANALYSIS: Data were entered and analyzed using statistical package SPSS version 9. A P-value ≤0.05 were considered statistically significant in all statistical comparisms. RESULTS AND CONCLUSION: Out of a total of 1521 persons screened for HIV infection, 162 persons tested positive for HIV (10.6%). HIV infection was higher among females (10.9%) compared to males (10.1%) and in the 25-34 and 45-60 years age groups (11.1%) (P= 0.08). HIV-1 was the predominant subtype (74%) compared to 26% for dual HIV-1 and 2. This study indicates the urgent need for both government and non-governmental organizations to intensify awareness campaign programme to reduce the spread of the HIV infection in the area with emphasis on behavioral change and economic empowerment of the people as well as provision of universal access to antiretroviral therapy for those with HIV infection.

Rh isoimmunization in Sub-Saharan Africa indicates need for universal access to anti-RhD immunoglobulin and effective management of D-negative pregnancies.

Transplacental or fetomaternal hemorrhage (FMH) may occur during pregnancy or at delivery and lead to immunization to the D antigen if the mother is Rh-negative and the baby is Rh-positive. This can result in hemolytic disease of the fetus and newborn (HDFN) in subsequent D-positive pregnancies. The aim of this study is to highlight the challenges associated with the effective management and prevention of Rh alloimmunization among Rh-negative women in Sub-Saharan Africa. In most Sub-Saharan African countries, there is poor and sometimes no alloimmunization prevention following potentially sensitizing events and during medical termination of pregnancy in Rh-negative women. Information about previous pregnancies and termination are often lacking in patients' medical notes due to poor data management. These issues have made the management of Rh-negative pregnancy a huge challenge. Despite the fact that the prevalence of Rh-negative phenotype is significantly lower among Africans than Caucasians, Rh alloimmunization remains a major factor responsible for perinatal morbidity in Sub-Saharan Africa and may result in the compromise of the woman's obstetric care due to the unaffordability of anti-D immunoglobulin. There is the urgent need for the implementation of universal access to anti-D immunoglobulin for the Rh-negative pregnant population in Africa. Anti-D immunoglobulin should be available in cases of potentially sensitizing events such as amniocentesis, cordocentesis, antepartum hemorrhage, vaginal bleeding during pregnancy, external cephalic version, abdominal trauma, intrauterine death and stillbirth, in utero therapeutic interventions, miscarriage, and therapeutic termination of pregnancy. There is also the need for the availability of FMH measurements following potentially sensitizing events. The low-cost acid elution method, a modification of the Kleihauer-Betke (KB) test, can become a readily available, affordable, and minimum alternative to flow cytometric measurement of FMH. Knowledge of anti-D prophylaxis among obstetricians, biomedical scientist, midwives, traditional birth attendants, pharmacists, and nurses in Africa needs to be improved. This will facilitate quality antenatal and postnatal care offered to Rh-negative pregnant population and improve perinatal outcomes.

Human immunodeficiency virus prevalence in an unbooked obstetric population in the Niger Delta.

Despite recent advances in the prevention of transmission of human immunodeficiency virus (HIV) infection from mother to child during pregnancy, infants continue to be born and infected with HIV, particularly in Africa. This study was undertaken to determine the seroprevalence of HIV infection among unbooked pregnant women in the Niger Delta of Nigeria. One hundred and eighteen consecutively recruited unbooked subjects presenting to the isolation ward at the University of Port Harcourt Teaching Hospital were screened for HIV. Among the 118 subjects studied, 30 (25.4%) were positive for HIV. HIV-1 was the predominant viral strain. Gestational age of subjects at presentation was 28-40 weeks and mean age was 35.04 ± 8.06 years. The majority of subjects were primigravidas 66 (55.9%), while 52 (44.1%) were multigravidas. The prevalence of HIV was significantly higher among unbooked pregnant women with less formal education: 14 (11.9%) compared with 9 (7.6%), 5 (4.2%), and 2 (1.7%) for those with primary, secondary, and tertiary education, respectively (P = 0.01). Among the occupational groups, the prevalence of HIV was significantly higher among traders 14 (11.9%) than in career women 5 (4.2%, P = 0.04). Multigravid women were more susceptible to HIV infection 17 (14.4%) than primigravid women. Perinatal mortality and emergency cesarean section was high among unbooked pregnant women. The prevalence of HIV observed amongst unbooked antenatal subjects in this study is significantly higher than those of booked patients in previous studies. These findings are very pertinent to health care delivery, because this pool of unbooked patients may not be benefiting from the Prevention of Maternal to Child Transmission program, thus increasing the pediatric HIV burden in our environment.

Effect of combined therapy of diabinese and nicotinic acid on liver enzymes in rabbits with dithizone-induced diabetes.

The effects of diabinese, a known antidiabetic drug, and the combined effects of diabinese and nicotinic acid, a vitamin and antilipidemic drug, were studied in rabbits with dithizone-induced diabetes. Side effects of diabinese include hypoglycemia and liver toxicity. Dithizone was used to induce partial experimental diabetes and to increase blood glucose significantly (P < 0.05) by 31.3%, 23.5%, 19.5, 24.7%, and 23.9% in groups A (single therapy of diabinese 10 mg/kg body weight), B (10 mg of diabinese and nicotinic acid 150 mg/kg), C (10 mg diabinese and nicotinic acid 200 mg/kg), D (10 mg diabinese and nicotinic acid 250 mg/kg) and E control (distilled water 5 mL), respectively. Dithizone administration also increased bilirubin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels by 28.9%-35.6%, 41.2%-54.8%, 40.1%-46.1%, and 60.9%-68.4%, respectively. Diabinese monotherapy reduced bilirubin levels, while combined therapy reduced glucose, ALP, AST, and ALT levels more than single therapy. Reduction from the hyperglycemic level 48 hours after drug administration was 20.0%, 24.6%, 41.0%, and 42.0% for groups A, B, C, and D, respectively, and was concentration-dependent. Also, combined therapy produced a significant (P < 0.05) decrease in AST and ALT levels, especially at 72 hours after drug administration, but did not affect ALP levels. No significant changes in glucose, bilirubin, ALP, AST, and ALT levels were observed in Group E (control). This study shows that liver toxicity and the hypoglycemic side effects of diabinese could be managed by the concomitant administration of nicotinic acid.

FIOH-sponsored newsletter misrepresents asbestos hazards in Zimbabwe.

The Finnish Institute of Occupational Health (FIOH) has received support from the World Health Organization (WHO) and the International Labor Office (ILO) to publish the African Newsletter on Occupational Health and Safety. The African Newsletter on Occupational Health and Safety should not be a medium for industry propaganda, or the source of misinformation among the workers of Africa. Instead, FIOH should provide the same level of scientific information in Africa that it does in Finland and other developed countries.

Autologous blood transfusion--a review.

The discovery of HIV and other transfusion-transmissible infections has increased the demand for alternatives to allogeneic blood transfusion. One such alternative is autologous transfusion. This review presents an analysis of autologous transfusion. We conclude that autologous transfusion should form part of a strategy to minimise the risk associated with allogeneic transfusion in Nigeria and other developing countries.