The Effect of Highly Active Antiretroviral Therapy (HAART) on Accommodative-Convergence Mechanism among HIV/AIDS Patients in North-Western Nigeria.

Background: The introduction of Highly Active Anti-Retroviral Therapy (HAART) has led to a dramatic decrease in Human Immune Deficiency Virus (HIV) related morbidity and mortality in the developed as well as developing world. Whilst HAART has been effective in reducing rapidly progressive retinopathies, there are other ocular manifestations of HIV which are yet to be determined, characterised and addressed. The aim of the study was to determine the effect of HAART on Accommodative-Convergence mechanism among HIV/AIDS patients in Northwestern, Nigeria. Methodology: This was hospital-based cohort study carried out from April 2019 to November 2019. Participants that met the inclusion criteria were recruited and were separated into two groups A and B. Group A were those about to commence HAART referred to as HAART naive, while group B were subdivided into four groups; comprising of B1: those that had been on HAART for 0 - 2½ years, group B2: >2½ - 5 years, group B3: >5 - 7½ years, and group B4: >7½ - 10 years, termed as HAART experience. Information obtained from the patients included sex, age, marital status, Near Point of Convergence (NPC), Amplitude of Accommodation (AA), Presbyopic reading Addition (ADD), CD4+ T cell count, HAART regimen and duration on HAART therapy. Results: There were 400 participants aged 25 - 55years with a mean age of 37.86 ± 7.5years. The participant's NPC mean was 6.4 ± 1.47cm with a range of 2 - 18cm. Most of the participants 336 (84.0%) had an abnormal Near Point of Convergence compared to 64 (16%) with normal NPC values. The mean AA was 4.18± 1.34DS, ranging from 0.75 to 10.0DS and about 273 (68.2%) of the participant's AA was within 3 to 5DS. The mean presbyopic addition was 1.39± 0.98 DS ranging from 1.00 to 3.50DS whilst majority of the participants, 305 (76.2%) had an abnormal Reading Addition. Conclusion: The study showed that the HIV/AIDS patients on HAART exhibit an abnormally low AA, receded NPC and High presbyopic reading addition as compared to age matched HAART naïve. There was a statistically significant association between AA and HAART (p = 0.002) and HAART duration (p = 0.00), but there was no association with their CD4+ T cell levels and HAART regimen (p = 0.12, p = 0.08). There was no statistically significant association between Abnormal reading addition and HAART (p= 0.46), CD4+4 T cell levels and HAART regimen (p=0.53 and p= 0.59), but there was a statistically significant association with HAART duration (p= 0.00).

Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study.

OBJECTIVES: This study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal and newborn health intervention. DESIGN: Quasi-experimental plausibility study. Repeat cross-sectional household and linked health facility surveys were implemented in intervention and comparison areas. SETTING: Gombe state, Northeast Nigeria. PARTICIPANTS: Each household survey included a sample of 1000 women aged 13-49 years with a live birth in the previous 12 months. Health facility surveys comprised a readiness assessment and birth attendant interview. INTERVENTIONS: Between 2016-2019 a complex package of evidence-based interventions was implemented to increase access, use and quality of maternal and newborn healthcare, spanning the six WHO health system building blocks. OUTCOME MEASURES: Eighteen indicators of maternal and newborn healthcare. RESULTS: Between 2016 and 2019, the coverage of all indicators improved in intervention areas, with the exception of postnatal and postpartum contacts, which remained below 15%. Greater improvements were observed in intervention than comparison areas for eight indicators, including coverage of at least one antenatal visit (71% (95% CI 62 to 68) to 88% (95% CI 82 to 93)), at least four antenatal visits (46% (95% CI 39 to 53) to 69% (95% CI 60 to 75)), facility birth (48% (95% CI 37 to 59) to 64% (95% CI 54 to 73)), administration of uterotonics (44% (95% CI 34 to 54) to 59% (95% CI 50 to 67)), delayed newborn bathing (44% (95% CI 36 to 52) to 62% (95% CI 52 to 71)) and clean cord care (42% (95% CI 34 to 49) to 73% (95% CI 66 to 79)). Wide-spread inequities persisted however; only at least one antenatal visit saw pro-poor improvement. CONCLUSIONS: This intervention achieved improvements in life-saving behaviours for mothers and newborns, demonstrating that multipartner action, coordinated through government leadership, can shift the needle in the right direction, even in resource-constrained settings.

The astigmatic effect of pterygium in a Tertiary Hospital in Kano, Nigeria.

AIM: This study aims to determine the effect of pterygium excision on the degree of corneal induced astigmatism and visual acuity. PATIENTS AND METHODS: This was a prospective interventional study conducted between September 2012 and June 2013. Consecutive patients with pterygium who met the inclusion criteria were recruited into the study. They had a basic eye examination, and those with existing comorbidity were excluded. Selected patients had pterygium excision using the bare sclera technique with intraoperative application of Mitomycin C. Detailed pre- and post-operative evaluation and refraction was done. RESULTS: There were 45 eyes of 33 patients aged 28-75 years. The mean age was 56.12 + 12.38 years. Six eyes had Grade I, 29 eyes had Grade II and 10 eyes had Grade III pterygium. The mean value for preoperative astigmatism was 2.12 ± 1.09 diopter cylinder (DC) while that for postoperative astigmatism was 0.72 ± 0.50 DC (P = 0.000). Surgery was associated with statistically significant increase in postoperative visual acuity. (P = 0.000). CONCLUSION: This study has shown that the degree of pterygium-induced astigmatism reduces significantly following surgical excision. Pterygium excision was associated with improvement in visual acuity.

Retinal nerve fiber layer thickness measurements of normal Northern Nigerian adults using optical coherence tomography.

OBJECTIVE: To assess retinal nerve fiber layer (RNFL) thickness measurements of normal Northern Nigerian adults using optical coherence tomography (OCT). SUBJECTS AND METHODS: The OCT procedure was carried out with the Carl Zeiss Stratus OCT Model 3000 software version 4.0 (Carl Zeiss Meditec AG, Jena, Germany). The fast RNFL scan protocol was used to obtain RNFL thickness measurements. Student's t-test was used to compare mean RNFL thickness values. P ≤ 0.05 was considered as statistically significant. Average RNFL thickness was correlated with age. RESULTS: Two hundred and twenty eyes of 110 subjects aged 18-51 years were examined. The average RNFL thickness was 104.17 ± 10.71 µm. The mean values for the RNFL thickness were 129.15 ± 16.87 µm, 135.34 ± 20.40 µm, 85.10 ± 23.60 µm, and 67.19 ± 13.27 µm for the inferior, superior, nasal, and temporal quadrants, respectively. A statistically significant difference was found between males and females for the mean RNFL thickness (t = 3.30, P = 0.001) and for the mean superior and inferior RNFL thickness. There was a statistically significant difference between right and left eyes (t = 3.73, P = 0.001) for the mean RNFL thickness. A negative correlation was found between RNFL thickness and age (r = -0.313, P = 0.002). CONCLUSION: Normal RNFL thickness measurements in healthy Nigerian adults are presented. The RNFL was found to be thicker in females and in right eyes. The values were comparable to those of the Indian population but higher than some Caucasian values.

Cycloplegic effect of atropine compared with cyclopentolate-tropicamide combination in children with hypermetropia.

BACKGROUND: Cycloplegic refraction is important in assessing children with hypermetropia. Atropine, though the gold standard cycloplegic agent for refraction in children, has a long duration of action and more severe side effects compared to short-acting cycloplegic agents. The aim of the study was to compare the cycloplegic effect of atropine with cyclopentolate and tropicamide combination in children with hypermetropia. SUBJECTS AND METHODS: This was a crossover interventional study in children with hypermetropia. Cycloplegic refraction using two separate regimens of cycloplegic drugs was done on all subjects. Data were analyzed using the statistical software SPSS version 22.0. The mean spherical equivalent values of regimen 1 (atropine 1%) and regimen 2 (cyclopentolate 1% and tropicamide 1%) were presented as mean and standard deviation. A P ≤ 0.05 was considered statistically significant. RESULTS: One hundred and twenty-six eyes of 63 subjects aged 5-12 years were examined. The mean spherical equivalent values for regimen 1 and regimen 2 for the right eyes were 4.73 ± 2.1 DS and 4.54 ± 1.9 DS, respectively (P = 0.59). The mean spherical equivalent values for regimens 1 and 2 for the left eyes were 4.74 ± 2.0 DS and 4.54 ± 1.8 DS, respectively (P = 0.56). CONCLUSION: The combination of 1% cyclopentolate and 1% tropicamide could be a useful alternative to atropine 1% for cycloplegic refraction in children with hypermetropia.

Macular volume and central foveal thickness measurements in normal eyes of healthy Nigerian adults using optical coherence tomography.

OBJECTIVE: To determine macular volume and central foveal thickness measurements in normal eyes of healthy Nigerian adults using Stratus optical coherence tomography. SUBJECTS AND METHODS: Consenting 100 adults Nigerians with normal eyes were recruited and examined using Carl Zeiss Stratus Optical Coherence Tomographer (OCT) machine Model 3000 software version 4.0. A fast macular thickness map scan protocol was employed. Central fovea is defined as locus of intersection of the radial scans. A default setting of six lines at 6 mm was used. Data was analyzed using the paired t-test for independence and linear regression. RESULTS: There were 200 eyes of 100 subjects with mean age of 36.4 + 11.7 years (M: F = 3.3:1). The mean macula volume was 6.79 + 0.392 µm 3 . It was 6.861 ± 0.297 in males, 6.496 ± 0.520 in females and was statistically higher in males than females (P = 0.000). The mean central foveal thickness (MCFT) was 149.58 ± 32.470 µm. It was 154.49 ± 34.652 µm in males and 133.33 ± 15.315 µm in females. MCFT was significantly higher in males than females (P = 0.000). CONCLUSION: Normal macular volume and central foveal thickness measurements in Nigerian adults is presented and is comparable to that of Indian and Chinese populations, but lower than reported in Caucasians.