Sickle-Cell Disease in Nigerian Children: Parental Knowledge and Laboratory Results.

BACKGROUND: Sickle-cell disease (SCD) is the most common inherited genetic disorder in sub-Saharan Africa, and it is associated with early mortality and lifelong morbidity. Early diagnosis is essential for instituting appropriate care and preventive therapy. OBJECTIVE: To compare parental knowledge or perception of their offspring's hemoglobin phenotype prior to testing and actual validated laboratory test results. METHODS: In a prospective community-based survey, we assessed parental knowledge of their children's hemoglobin phenotype and corroborated this with the results from a laboratory confirmatory test determined by high-performance liquid chromatography. RESULTS: We screened 10,126 children aged less than 5 years. A total of 163 (1.6%) parents indicated that their offspring had been previously tested and had knowledge of the child's hemoglobin genotype. However, 51 (31.2%) of 163 parents of children who had been previously tested did not know the result of their offspring's test, and 18 (35.3%) of these 51 children were found to have SCD. Of those who claimed previous knowledge, 25 (15.3%) of 163 reported incorrect results. Overall, we identified 272 (2.76%) new cases from 9,963 children who had not been previously tested. CONCLUSION: There is the need to promote public awareness about SCD and the benefit of early diagnosis, quality assurance in laboratory diagnosis and institution of sustainable patient care pathways.

Comparison of Mycobacterium tuberculosis drug susceptibility using solid and liquid culture in Nigeria.

BACKGROUND: This study compares Mycobacterium tuberculosis culture isolation and drug sensitivity testing (DST) using solid (LJ) and liquid (BACTEC-MGIT-960) media in Nigeria. METHODS: This was a cross sectional survey of adults attending reference centres in Abuja, Ibadan and Nnewi with a new diagnosis of pulmonary tuberculosis (TB) or having failed the first-line TB treatment. Patients were requested to provide three sputum specimens for smear-microscopy and culture on LJ and BACTEC-MGIT-960. Positive cultures underwent DST for streptomycin, isoniazid, rifampicin and ethambutol. RESULTS: 527 specimens were cultured. 428 (81%) were positive with BACTEC-MGIT-960, 59 (11%) negative, 36 (7%) contaminated and 4 (1%) had non-tuberculosis mycobacteria (NTM). 411 (78%) LJ cultures were positive, 89 (17%) negative, 22 (4%) contaminated and 5 (1%) had NTM. The mean (SD) detection time was 11 (6) and 30 (11) days for BACTEC-MGIT-960 and LJ. DST patterns were compared in the 389 concordant positive BACTEC-MGIT-960 and LJ cultures. Rifampicin and isoniazid DST patterns were similar. Streptomycin resistance was detected more frequently with LJ than BACTEC-MGIT-960 and ethambutol resistance was detected more frequently with BACTEC-MGIT-960 than LJ, but differences were not statistically significant. MDR-TB was detected in 27 cases by LJ and 25 by BACTEC-MGIT-960 and using both methods detected 29 cases. CONCLUSIONS: There was a substantial degree of agreement between the two methods. However using the two in tandem increased the number of culture-positive patients and those with MDR-TB. The choice of culture method should depend on local availability, cost and test performance characteristics.

Clinical presentation of adults with pulmonary tuberculosis with and without HIV infection in Nigeria.

Our aim was to describe the frequency of HIV infection among patients with tuberculosis and compare their characteristics with patients with TB but not infected with HIV. Patients with cough >3 weeks duration attending 8 hospitals in Abuja, Nigeria were screened with smear microscopy and culture and tested for HIV. Chest X-rays were graded by 2 readers. 731 (62%) of 1186 patients had positive cultures and 353 (48%) of these 731 patients were smear positive. 1002 (85%) patients were tested for HIV and 546 (55%) were positive. 53% (329/625) of the culture positive patients and 58% (217/377) of the culture negative patients were HIV positive. Anorexia, weight loss, low BMI (<18.5), haemoglobin (<11 gm/dl) and albumin and high ESR and liver enzymes were more frequently observed among patients with TB coinfected with HIV than in patients without HIV. Coinfected patients had less cavitations and lung involvement on X-rays than patients without HIV. In conclusion, the prevalence of HIV is very high among patients with TB in Abuja, Nigeria. The presence of HIV decreases the sensitivity of smear microscopy and complicates the diagnosis of TB. Selected clinical and laboratory parameters could be used to identify individuals with TB who are likely to be coinfected with HIV.