Declining rate of infection with maternal human immunodeficiency virus at delivery units in north-central Nigeria.

HIV testing during labour and delivery provides a critical opportunity for administering appropriate interventions to prevent mother-to-child-transmission (PMTCT). We studied current HIV rates and infection trend among women tested during delivery following scale-up of PMTCT and antiretroviral therapy (ART) programs in Jos, north central Nigeria. Between March 2010 and January 2012, provider-initiated HIV testing and counselling was offered in early labour. Women were recruited from a government tertiary health centre, a faith-based hospital, and a private health centre. Those who previously tested HIV negative during antenatal care (ANC) and those who presented at the labour ward with unknown HIV status were tested. A total of 944 subjects (727 re-tested for HIV infection and 217 with unknown HIV status) were enrolled and tested during labour. The HIV incidence and sero-conversion rates during pregnancy among women who repeated HIV testing at delivery was 1.7 per 100 person-years of observation (pyo) and 0.6% (4/727), respectively, while the rate among those who tested for the first time in labour was 1.8% (4/217). Women who accessed ANC were older and had achieved a higher educational status than those who did not access ANC. A 3- to 5-fold decline in HIV incidence and prevalence rates was detected among women tested at delivery when compared to data from a report in 2004. It is not certain whether the decline in maternal HIV infection is due to the major state-wide scale-up of PMTCT and HIV treatment programs. A broader and purposefully designed evaluation study would be required to verify observed occurrence.

Assessment of the bone density of nomadic Fulani Herdsmen in northern Nigeria using calcaneal ultrasonography.

CONTEXT: Osteoporosis is characterized by decreased bone density and increased bone fragility. Genetics, diet, and physical activity are established determinants of bone density. The seminomadic Fulani of northern Nigeria trek long distances on foot daily to graze and water their animals, and have access to calcium-rich dairy products. OBJECTIVE: We sought to determine whether the high level of physical activity and presumed calcium-rich diet of the Fulani would promote a higher bone density, compared with their relatively inactive counterparts in the general population. DESIGN: Cross-sectional study. SETTING: Three Fulani settlements (Toro, Tilden Fulani, and Magaman Gumau) within 5 to 15 kilometers of Jos Metropolis on the Jos Plateau in northern Nigeria. PATIENTS: We assessed the calcaneal characteristics of a consecutive sample of 51 active seminomadic Fulani men using the Lunar Achilles+ ultrasonometer. MAIN OUTCOME MEASURES: Calcaneal broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI), and SI T-scores. RESULTS: The mean age of the herdsmen was 26 +/- 9 years (range, 16 to 49), and the mean BMI was 19.9 +/- 2.3 kg/m(2). The mean BUA was 124 +/- 13 dB/MHz (95% CI, 120 to 128), the mean SOS was 1572 +/- 33 m/s (95% CI, 1563 to 1581), the mean SI was 102 +/- 17 (95% CI, 97 to 107], and the mean SI T-score was -0.74 +/- 0.97 (95% CI, -0.47 to 1.01]. The mean SI was 1 T-score unit below that of an age-matched cohort in the general population. CONCLUSION: Fulani herdsmen have a theoretically increased risk for bone fracture in a background of low BMI and potentially high calcium intake.

Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study.

BACKGROUND: Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI) with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading. METHODS: We recruited 102 male athletes: these included football (n = 68), running (n = 15), handball (n = 7), taekwando (n = 6), cycling (n = 2), judo (1), badminton (1) and high jump (1). Anthropometric data were first recorded on a structured form and energy expenditure was indirectly estimated with a validated questionnaire. Bone density was assessed using the Lunar Achilles+ calcaneal ultrasonometer. RESULTS: The mean age of athletes was 25 +/- 6 years. The means of BMI and energy expenditure were 21.9 +/- 2.0 kg/m2 and 35.0 +/- 13.7 kcal/kg/day, respectively. Footballers were younger (p < 0.001) and heavier (p < 0.001) than runners. Football was a significant determinant of BUA independent of age, BMI and energy expenditure (p = 0.001). Football was also a significant determinant of SOS independent of age, height, weight and BMI (p < 0.001). The mean SI was 127 +/- 16 and the median T-score was 0.82 (-1.88, 3.35). The mean SI of footballers (130 +/- 15), runners (130 +/- 12) and other sportsmen (115 +/- 18) differed significantly (p = 0.001). Multivariate analyses revealed that football (p < 0.001) and running (p < 0.001) were significant determinants of SI independent of age and BMI. Footballers when compared with other sportsmen had a higher mean SI independent of age and BMI (p < 0.001). Age was not correlated with SI. The median T-score of footballers, 0.94 (-1.0, 3.35) was higher than that of other sportsmen. CONCLUSION: Repetitive skeletal loading at the heel has the potential to improve bone density in black male athletes. The magnitude of increase may be higher in medium impact sports such as soccer and running compared with low or non-impact sports such as judo or taekwando, and is independent of age and BMI. However, future longitudinal data will be required to support our observations.