Evaluation of the accuracy of the Asanté assay as a point-of-care rapid test for HIV-1 recent infections using serum bank specimens from blood donors in South Africa, July 2018 - August 2021.

BACKGROUND: Point-of-care (POC) rapid recency testing can be used as a cost-effective tool to identify recently infected individuals (i.e. infected within the last 12 months) in near-real time, support epidemic control and identify hotspots for transmission as part of recent infection surveillance. OBJECTIVE: To evaluate the performance of the Asanté (HIV-1) rapid recency assay as a POC rapid test among blood donors in South Africa (SA). METHODS: The study was a cross-sectional and validity study of the Asanté HIV-1 Rapid Recency Assay performed on 715 consecutively archived plasma donor specimens from the SA National Blood Services to determine their recency and established HIV infection status. ELISA and rapid assays for HIV antibody detection were used as the reference-testing standard for confirming an infection, while the Maxim HIV-1 limiting antigen (LAg) avidity assay was used as a reference for comparing HIV recency status. Validity tests (sensitivity, specificity, negative and positive predictive values) and Cohen-Kappa tests of the agreement were conducted to compare the Asanté HIV-1 rapid recency assay results with the reference tests. RESULTS: Of the 715 studied blood samples, 63.1% (n=451/715) were confirmed to be HIV-positive based on the reference standard. The sensitivity and specificity of the Asanté HIV-1 rapid recency assay in diagnosing established HIV infection compared to the ELISA were 98.4% (95% CI 96.7 - 99.3) and 99.6% (95% CI 97.6 - 100), respectively. Compared with HIV rapid assay, the sensitivity and specificity of the Asanté HIV-1 rapid recency assay was 98.7% (95% CI 97.0 - 99.4) and 99.2% (95% CI 97.1 - 100), respectively. Of the 451 HIV-positive blood samples, 43% were confirmed as recent HIV infections by the Maxim HIV-1 LAg avidity assay. There was high agreement between the Asanté HIV-1 rapid recency assay and the Maxim HIV-1 LAg avidity assay (94.1%, k=0.879, p<0.0001). The sensitivity and specificity of the Asante HIV-1 assay was 89.4% (95% CI 84.0 - 93.0) and 97.7% (95% CI 94.8 - 99.0), respectively. CONCLUSION: The Asanté HIV-1 rapid recency assay test results demonstrated high accuracy (>90%) compared with the HIV ELISA and rapid assays for determining established infection and the Maxim HIV-1 LAg avidity assay for classifying recent HIV-1 infections. The assay's sensitivity for established infections was below the World Health Organization criteria (<99%) for POC devices. The Asanté HIV-1 rapid recency assay can be used to distinguish between recent and long-term infections, but may not be considered a POC test for determining HIV infection.

44-year temporal trends and causes of maternal mortality at the Lagos University Teaching Hospital, LUTH, Lagos, Nigeria (1976-2019).

Background: Nigeria has committed to global initiatives aimed at improving maternal and child health. Institutional audit of maternal mortality over a long period can provide useful information on the trends in maternal death and the impact of interventions. Aim: To evaluate the trends in annual deliveries, maternal mortality ratio and causes of maternal death at a tertiary institution in Nigeria over a period of 44 years (1976-2019). Materials and Methods: We conducted a temporal trend analysis of annual births, maternal deaths, maternal mortality ratio (MMR), and ranking of causes of maternal deaths at a Teaching Hospital, in Southwest Nigeria using available data from 1976 to 2019. Overall and segmental annual percent change (APC) of the observed trends were conducted using Joinpoint version 4.5.0.1 software. Results: Over the 44-year study period, 1323 maternal deaths occurred at approximately 30 maternal deaths per annum. There was a four-fold increase in MMR from 881/100,000 total births in 1976 to 3389.8/100,000 total births in 2019, at an average increase of 3.1% per annum. (APC: 3.1%; P value < 0.001). The leading causes of maternal mortality were hypertension, sepsis, haemorrhage, and abortion, which together contributed to more than 70% of maternal deaths. All the leading causes of maternal deaths except abortion had constant ranking during the study period. Conclusion: The four-fold increase in MMR at our hospital from 1976-2019 is worrying and may suggest that previous efforts at reducing maternal mortality in our institution did not lead to significant improvement toward the attainment of Sustainable Development Goal 3 (SDG3). The hospital increasingly managed complex cases especially the unbooked patients who were referred to the hospital as a last resort.

Clinical predictors of Covid-19 mortality in a tertiary hospital in Lagos, Nigeria: A retrospective cohort study.

Background: The predictors of mortality among patients presenting with severe to critical disease in Nigeria are presently unknown. Aim: The aim of this study was to identify the predictors of mortality among patients with COVID-19 presenting for admission in a tertiary referral hospital in Lagos, Nigeria. Patients and Methods: The study was a retrospective study. Patients' sociodemographics, clinical characteristics, comorbidities, complications, treatment outcomes, and hospital duration were documented. Pearson's Chi-square, Fischer's Exact test, or Student's t-test were used to assess the relationship between the variables and mortality. To compare the survival experience across medical comorbidities, Kaplan Meir plots and life tables were used. Univariable and multivariable Cox-proportional hazard analyses were conducted. Results: A total of 734 patients were recruited. Participants' age ranged from five months to 92 years, with a mean ± SD of 47.4 ± 17.2 years, and a male preponderance (58.5% vs. 41.5%). The mortality rate was 9.07 per thousand person-days. About 73.9% (n = 51/69) of the deceased had one or more co-morbidities, compared to 41.6% (252/606) of those discharged. Patients who were older than 50 years, with diabetes mellitus, hypertension, chronic renal illness, and cancer had a statistically significant relationship with mortality. Conclusion: These findings call for a more comprehensive approach to the control of non-communicable diseases, the allocation of sufficient resources for ICU care during outbreaks, an improvement in the quality of health care available to Nigerians, and further research into the relationship between obesity and COVID-19 in Nigerians.

Effectiveness and safety of membrane sweeping in the prevention of post-term pregnancy: a randomised controlled trial.

There is a rising concern with increasing rates of pharmacologically induced labour and its complications. Membrane sweeping is a simple and less invasive means of initiating spontaneous labour onset. We compared the safety and efficacy of membrane sweeping. A total of 186 women (62 in each arm) were recruited at the antenatal clinic at 39 weeks. The intervention groups had membrane sweeping once and twice weekly respectively while the control arm had no membrane sweeping. They were all monitored and followed up till delivery. The trial was registered with the South Africa registry www.pactr.org (PACTR202112841108933) The incidence of prolonged pregnancy was 32.3%, 19.4% and 11.7% among the control, once-weekly, and twice-weekly groups respectively. The sweeping to the delivery interval was significantly shorter for the twice-weekly group (7.4 days) compared to once weekly (8.8 days) and the control group (10.6 days). There were significantly higher odds of spontaneous labour onset in the twice-weekly group (HR 1.53, p = .029) compared to the control group (HR 0.65, p = .033) and the once-weekly group using once weekly as reference. Membrane sweeping is a safe and effective means of preventing prolonged pregnancy. Twice-weekly sweeping of foetal membranes is more effective than once-weekly or no sweeping without added adverse feto-maternal outcomes.IMPACT STATEMENTWhat is already known about the subject? There is no evidence supporting any increase in maternal or foetal morbidity suggesting that membrane sweeping is a safe procedure to offer to all low-risk pregnant women so as to initiate spontaneous labour onset.What do the results of the study add? Membrane sweeping twice weekly after 39weeks for low-risk pregnant women is more effective than once weekly or no sweep with no added adverse maternal or perinatal risks.What are the implications of these findings for clinical practice and or further research? Twice-weekly membrane sweeping is encouraged in selected patients to reduce the risks associated with post-term pregnancy.

Prevalence of Rhesus C and D Alloantibodies among Rhesus-Negative Women of Child Bearing Age at a Tertiary Hospital in South-West Nigeria.

BACKGROUND: A major cause of hemolytic disease of the fetus and newborn (HDFN) is an incompatibility of the Rhesus (Rh) blood group between the mother and fetus. AIM: To determine the prevalence of Rh c and D alloantibodies among Rh-negative women of childbearing age (18-49 years). We conducted a cross-sectional study among women who attended the antenatal, gynecology and blood donor clinics at a Tertiary Hospital in South-West Nigeria from January to August 2019. Serological typing of Rh c and D was done manually with the tube test using anti-c and anti-D antisera, while indirect antiglobulin test was then performed to screen for Rh antibodies. SUBJECTS AND METHODS: Data was analyzed using Stata 16.1 software; Categorical data was summarized using frequency and percentages while continuous variables were described using the mean and standard deviation or median and interquartile range. Pearson's Chi-square (or Fisher's exact) test was used to test for association between categorical variables and Rh status. P values of ≤0.05 were assumed to be statistically significant. RESULTS: A total of 700 consenting women, comprising 505 pregnant (72.1%) and 195 non-pregnant (27.9%) women were recruited into this study. The mean age was 30.7 ± 4.9 years. All (100%) participants were Rhc positive while 641 (91.6%) were RhD positive and 59 (8.4%) were RhD negative. All 59 RhD negative subjects tested negative for anti-D. There was no statistically significant difference between proportion of RhD-negative women who had a jaundiced baby and the proportion of RhD-positive women who had a jaundiced baby (15.6% vs. 18.6%, P = 0.540). CONCLUSIONS: This study did not identify any Rhc and D alloantibodies in the study population suggesting there is a low risk of alloimmunization and HDFN due to anti-Rhc and D in this population.

Patterns of paediatric emergency admissions and predictors of prolonged hospital stay at the children emergency room, University of Calabar Teaching Hospital, Calabar, Nigeria.

BACKGROUND: There is a high prevalence of paediatric emergency cases in less developed countries. However, prolonged hospital stay at emergency units may further overstretch the facilities. OBJECTIVE: To assess the patterns of presentations, services offered and predictors of a prolonged stay at the Children Emergency Room of a tertiary hospital in Southern Nigeria. METHODS: This prospective cross-sectional, study was conducted at the University of Calabar Teaching Hospital, Nigeria from 1st January-31st December 2014. Socio-demographic and clinical characteristics of consecutively recruited children (n=633) were recorded in a proforma. Binary logistic regression was conducted to determine predictors of prolonged stay (>72 hours). RESULT: The median age of participants was 2 (1 - 4.6) years. Three-fifths of children were admitted at off-hours and the commonest symptom was fever (73.9%). About 16.4% (95%CI:13.6% - 19.4%, n= 103/633) of the children had prolonged stay while those with sepsis had the longest mean stay (65.5±72.1 hours). Children admitted on account of Sickle cell disease (OR:11.2, 95%CI:1.3-95.1, P-value = 0.03), Malaria (OR:10.7, 95%CI:1.4-82.5, P-value = 0.02) or sepsis (OR:10.5, 95%CI:1.3 - 82.7, P-value = 0.03) had higher odds of prolonged hospital stay. There was no significant difference in hospital stay among children admitted by the consultant as compared to other health personnel (P-value = 0.08). CONCLUSION: Prevention and proper management of Sickle cell disease and malaria reduces paediatric hospital stay in our environment. Paediatric emergency medicine should be re-organized to cater for high volume of off-hour admissions.

Knowledge and practice of contraception among pregnant women attending the antenatal clinic in Lagos University Teaching Hospital.

BACKGROUND: Preconception, prenatal and postnatal care forms a continuum. Family planning is one of the important aspects of the spectrum. Contraceptive options are available but the uptake has been poor. Ante natal clinic attendees represent a major target population for well designed /appropriate post partum contraceptive counseling and care. OBJECTIVES: The study examined the sociodemographic data of antenatal clinic attendees at the Lagos University Teaching Hospital (LUTH), their knowledge about contraceptive methods, previous contraceptive practice and anticipated pattern of post partum contraceptive uptake. METHOD: A Semi-structured questionnaire was administered to 151 pregnant women attending the antenatal clinic in LUTH to collect data on their sociodemographic characteristics, knowledge of family planning methods, pre-pregnancy contraceptive use and their anticipated post-partum contraceptive choices. RESULTS: The mean age of the women was 29.9 years and the mean Parity was 1.1. Majority (90.7%) of the women were married. Ten women (6.6%) felt that they had poor knowledge about contraception while the rest had fair to excellent knowledge. The prevalence of contraceptive use before current pregnancy was 57.6% and the male condom was the method used in 56 cases (64.4%). Their major (54%) source of contraceptive commodity was the chemist/pharmacy. Sixty (69%) women stopped using contraceptive because they wanted to get pregnant. Sixty-eight (45.0%) women planned to use contraceptives after delivery and the male condom (55.9%) was the most preferred method of post-partum contraception. There is no statistical association between age, religion, parity and educational attainment and desire for post-partum contraception. CONCLUSION: Antenatal women in LUTH appeared quite knowledgeable about contraception but majority had no plan for contraceptive use post delivery. Information dissemination about benefits of child spacing and provision of incentives for easy uptake of post partum contraception would help to correct this imbalance.

The profile of stroke in Nigeria's federal capital territory.

The pattern of stroke has been well characterized in many settings in Nigeria. The profile of stroke, has, however, not been previously reported from Nigeria's new federal capital. The aim of this study was to characterize the pattern of stroke in a specialist centre in Nigeria's federal capital territory over a 5-year period.