Critical values notification: A nationwide survey of practices among clinical laboratories across Nigeria.

Background: Critical value notification (CVN) entails notifying doctors or other laboratory users of aberrant laboratory results that threaten the patient's life and of any values for which reporting delays could negatively impact the patient's health. Critical value notification practices in clinical laboratories in Nigeria and sub-Saharan Africa are largely unknown. Objective: We conducted a nationwide survey to obtain baseline information on CVN practice by Nigeria's laboratories. Methods: This cross-sectional study was conducted among purposively selected secondary- and tertiary-tier, public and private clinical laboratories across northern and southern Nigeria between October 2015 and December 2015. Consenting senior laboratory staff completed and returned a structured questionnaire, that gathered data on respondents' demographics, designations, and institutional characteristics and practices regarding CVN. Results: One hundred and thirty-four laboratories responded to the questionnaires. Only 69 (51.5 %) laboratories practised CVN; only 23 (33.3%) had existing written policies guiding the practice. Most (43; 62.3%) laboratories use similar critical values (CVs) for adult and paediatric populations. Most laboratories (27; 39.1%) obtained their CVs by combining published literature and local opinions from stakeholders. Physical dispatch (42; 60.9%) followed by telephone calls (38; 55.1%) were the most common means of notification. Private laboratories, compared with public hospital laboratories, were likelier to have separate paediatric CV lists (p = 0.019) and practise telephone notifications (p < 0.001). Conclusion: Critical value notification practices vary and are often suboptimal in many clinical laboratories in Nigeria, which is exacerbated by the absence of guiding policies and national recommendations for post-analytical procedures. What this study adds: This study provides baseline information on CVN practice by Nigeria's laboratories. The study explores the causes of practice variations that can serve as a foundation for enhancing critical reporting and post-analytical services, particularly in clinical laboratories in sub-Saharan Africa.

Neutralizing anti-polio antibody titre in newborn babies in post-polio eradication period in Nigeria.

BACKGROUND: According to Polio Eradication and Endgame Strategic Plan 2019-2023 (PEESP), countries that achieved wild polio elimination is expected to replace oral polio vaccine (OPV) which has a risk of vaccine-derived poliovirus, Inactivated Polio Vaccine (IPV). It is important to determine the earliest time in the age of a child at which IPV could be introduced into the country's routine immunization schedule for effectiveness especially as it concerns neutralizing effect of trans-placental transmitted antibodies which usually does not affect OPV. In this study, the level of poliovirus neutralizing antibody titre among neonates at birth was evaluated. METHODS: A cross-sectional study of mother-baby pair. The serum level of the neutralizing Poliovirus antibody IgG titre was done by the Enzyme Linked Immunosorbent Assay (ELISA) technique. RESULTS: There was 100% transfer of maternal passive antibodies to their babies. The mean poliovirus antibody titre among neonates was 21.8 IU/L which was above the neutralizing titre level. Most (85.7%) babies antibody level correlate positively with that of their mothers. CONCLUSION: The transferred maternal antibodies to the babies are still very high at birth, and capable of dampening the immunity of IPV if introduced early. Programme managers should evaluate the impact and benefit of given booster dose of IPV to pregnant mothers to increase the titre level in their babies. This will be very necessary when the OPV is withdrawn from the immunization schedule.

Relationship between glycaemic control and lipid profile in type 2 diabetes mellitus patients in a low-resource setting.

Introduction: diabetes mellitus can lead to complications including cardiovascular disease (CVD). Glycated haemoglobin (HbA1C) is a test of glycaemic control in T2DM patients, and its association with CVD can be mediated through modulation of risk factors such as dyslipidaemia. It is suggested that correlation of HbA1c with blood lipids may enable its use as a dual marker for glycaemic status and dyslipidaemia. The aim of this study was to determine the relationship between glycaemic control and blood lipid concentrations in T2DM patients. Methods: a cross-sectional study of T2DM patients at Enugu, Nigeria. After obtaining informed consent, questionnaires were administered, and then venous blood was collected for determination of HbA1c and fasting lipid profile. Student T-test was used to compare mean results of two groups and Pearson correlation coefficient was used to determine relationships. A p-value <0.05 was considered to be statistically significant. Results: fifty -five (55) T2DM patients comprising of 24 females and 31 males, with mean±SD age 57±12 years were studied. Prevalence of patients with poor glycaemic control (HbA1c≥7%) was 34 (61.8%). More males (36.4%) than females (25.4%) had poor glycaemic control. There was a positive, statistically significant correlation between HbA1c and TC (r=0.406); Low-Density Lipoprotein Cholesterol (LDL-C) (r=0.409); and triglyceride (TG) (r=0.273), p<0.05. Correlation between HbA1c and HDL-C was negative (r=-0.269, p<0.05). Conclusion: the significant correlation between HbA1c and various lipid parameters may suggest the importance of glycaemic control as well as managing dyslipidaemia in the reduction of risk for CVD in T2DM patients, for which HbA1c may be used to monitor both, thereby reducing cost.

A reference interval study of serum 25-Hydroxyvitamin D among an African elderly population.

Background: Elderly people have increased risk factors for low serum vitamin D levels, which is worsened among the black race. Therefore, elderly Africans constitute a reference population for vitamin D study. Aim: The aim of this study was to establish the reference interval of serum 25-hydroxyvitamin D (25(OH)D) among an African elderly population. Methodology: This was a cross-sectional study of rural community dwellers in Enugu, south-eastern Nigeria aged 50 years and above, that satisfied the criteria of the reference population. Ethical approval and informed consent were obtained. Venous blood was collected from reference individuals and serum 25(OH)D was determined by enzyme-linked immunosorbent assay. Data were analysed using a non-parametric, bootstrap method to obtain the central 95% reference limits and 90% confidence intervals of the lower and upper limits of the reference interval respectively. Results: One hundred and twenty-four (62 males and 62 females) participants were recruited. The median (25th -75th percentile) of serum 25(OH)D was 56 (35 - 71) ng/ml. The 2.5th percentile defined the lower reference limit and it was 21 ng/ml with 90% confidence interval (20 - 23) ng/ml; while the 97.5th percentile defined the upper reference limit and it was 93 ng/ml with 90% confidence interval (90 - 98) ng/ml. Conclusion: The reference interval for serum 25(OH)D for the selected African elderly population in Enugu, Nigeria was determined to be 21 to 93 ng/ml.

Heavy metal content of rice meals sold in a Nigerian market population with a high prevalence of hypertension.

Context: Some market populations in Nigeria have been shown to have high prevalence of hypertension. Current evidence includes environmental pollutants such as heavy metals as risk factors for hypertension. Aim: To study the heavy metal content of rice meals sold in a market population with a high prevalence of hypertension. Settings and Design: This was a descriptive, cross-sectional study conducted in Ogbete market in Enugu, Southeast Nigeria. Subjects and Methods: Five different cooked rice meals were obtained from 25 locations of the market. The rice meals included jollof rice, white rice and tomato stew, fried rice, white rice and vegetable sauce, and white rice and palm oil stew (ofeakwu). Accompanying protein (meat, fish, and egg) and vegetable salad were excluded. Similar rice meals were homogenized and analyzed in triplicates using spectrophotometric methods for mercury, copper, cadmium, lead, and arsenic determination. Statistical Analysis Used: The mean concentrations of the heavy metals were compared using analysis of variance, and P < 0.05 was considered statistically significant. Results: Twenty-five rice dishes were evaluated, five of each kind. Arsenic content ranged from 503 to 550 mg/kg and was comparable across the five rice dishes (P = 0.148). Copper was significantly highest (16767 mg/kg) in the white rice and tomato stew dish (P < 0.001), while mercury was significantly highest (33 mg/kg) in white rice and ofeakwu (P < 0.001). Jollof rice had the highest cadmium content (23 mg/kg), which was statistically significant (P = 0.021). Lead was not found in any of the rice dishes. Conclusions: Risk factors such as heavy metals may play a role in the high prevalence of hypertension observed in market populations, and rice meals may be a major source of these heavy metals.

RésuméContexte: Il a été démontré que certaines populations du marché au Nigéria présentent une prévalence élevée d'hypertension. Les preuves actuelles incluent l'environnement des polluants tels que les métaux lourds comme facteurs de risque d'hypertension. Objectif: étudier la teneur en métaux lourds des farines de riz vendues dans une population de marché avec une prévalence élevée d'hypertension. Paramètres et conception: il s'agit d'une étude descriptive et transversale menée sur le marché d'Ogbete en Enugu, sud-est du Nigéria. Sujets et méthodes: Cinq plats de riz cuit différents ont été obtenus dans 25 emplacements du marché. Le riz les repas comprenaient du riz jollof, du riz blanc et du ragoût de tomates, du riz frit, du riz blanc et de la sauce aux légumes, et du riz blanc et du ragoût d'huile de palme (ofeakwu). Les protéines d'accompagnement (viande, poisson et œuf) et la salade de légumes ont été exclues. Des farines de riz similaires ont été homogénéisées et analysées triplicats utilisant des méthodes spectrophotométriques pour la détermination du mercure, du cuivre, du cadmium, du plomb et de l'arsenic. Analyse statistique utilisée: le les concentrations moyennes des métaux lourds ont été comparées à l'aide d'une analyse de variance, et P <0.05 a été considéré comme statistiquement significatif. Résultats: Vingt-cinq plats de riz ont été évalués, cinq de chaque type. La teneur en arsenic variait de 503 à 550 mg / kg et était comparable dans les cinq plats de riz (P = 0,148). Le cuivre était significativement plus élevé (16767 mg / kg) dans le plat de ragoût de riz blanc et de tomate (P <0.001), tandis que le mercure était significativement plus élevé (33 mg / kg) dans le riz blanc et l'ofeakwu (P <0.001). Le riz Jollof avait la plus forte teneur en cadmium (23 mg / kg), qui était statistiquement significatif (P = 0.021). Le plomb n'a été trouvé dans aucun des plats de riz. Conclusions: Des facteurs de risque tels que les métaux lourds peuvent jouent un rôle dans la prévalence élevée de l'hypertension observée dans les populations du marché, et les farines de riz peuvent être une source majeure de ces métaux lourds.

Prevalence of hepatitis B and C virus co-infection in HIV positive patients attending a health institution in southeast Nigeria.

BACKGROUND: The health of people living with HIV/AIDS becomes progressively worse when co-infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), resulting in shortened life span. The modes of transmission of HIV, HBV and HCV are similar. OBJECTIVE: To determine the prevalence of HBV and HCV co-infection in HIV patients. METHOD: This was a retrospective study of serology test results for hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti-HCV) of HIV positive patients registered from 2008-2013 (6years) at the University of Nigeria Teaching Hospital. Adult patients with confirmed HIV seropositivity were included. Ethical approval was obtained and confidentiality of the patient information was maintained. Laboratory records were reviewed to obtain HBsAg, anti-HCV, and CD4 T-lymphocyte results. Prevalence was determined by the number of positive results over total number of patients tested. Chi-square test was used to determine relationships and p<0.05 was considered to be statistically significant. RESULTS: 4663 HIV patient records were included comprising 3024 (65%) females and 1639 (35%) males. Serology results showed 365/4663 (7.8%) tested HBsAg-positive only; 219/4663 (4.7%) tested anti-HCV-positive only; and 27/4663 (0.58%) tested both HBsAg and anti-HCV-positive. Correlation of age and sex were statistically significant with HBV and HCV (p<0.05) but not CD4 count (p>0.05). CONCLUSION: HBV co-infection was more prevalent than HCV, and triple infection was also observed. Screening for these viral infections in the HIV population is necessary for early identification to enable appropriate, holistic management of these patients.

Reductive effect of ursodeoxycholic acid on bilirubin levels in neonates on phototherapy.

BACKGROUND: Phototherapy is paramount in the management of high total serum bilirubin (TSB). Whether its effectiveness can be improved with ursodeoxycholic acid (UDCA) has not been evaluated among newborns of African descent. METHODS: A double-blind-controlled study was used to evaluate the effect of UDCA on the management of high TSB in neonates. Recruited neonates were categorized into the experimental group (given UDCA plus phototherapy) and the control group (phototherapy and plain syrup), and their TSB and conjugated bilirubin levels were measured. The data were analyzed using SPSS version 20. Statistical significance was set at a p-value of <0.05. RESULTS: The mean (SD) percentage reductions in TSB after 24 hrs were 40.73% (18.1) and 10.21% (7.1) in the experimental and control groups, respectively, and the difference was statistically significant (p=0.001). The mean (SD) durations on therapy were 3.0 days (0.58) in the experimental group and 5.5 days (1.35) in the control group (p=0.001). CONCLUSIONS: Phototherapy is still effective in the management of neonatal hyperbilirubinemia, but inclusion of UDCA accentuates the reductive effect of phototherapy on the TSB in neonates, reducing the duration of treatment and in-patient care.