Prevalence and risk factors for pulmonary artery systolic hypertension among sickle cell disease patients in Nigeria.

Pulmonary artery systolic hypertension is common and associated with increased mortality among adult sickle cell disease (SCD) patients in the United States. Although the prevalence of SCD is highest in sub-Saharan Africa, the frequency of pulmonary artery systolic hypertension and the risk factors for the development of pulmonary hypertension have not been reported from Africa. We studied 208 hydroxyurea naïve Nigerian SCD patients at steady state and 94 healthy controls. Pulmonary artery systolic hypertension was defined prospectively as tricuspid regurgitant jet velocity > or =2.5 m/sec. Results were compared with a previously published US prospective SCD cohort. Only 7% of Nigerians compared with 46% of US adults with SCD were >35 years. Tricuspid regurgitant jet velocity was > or =2.5 m/sec in 25% of Nigerian SCD patients. Higher jet velocity was associated with greater serum globulin (P = 0.002), blood urea nitrogen (P = 0.019) and lactate dehydrogenase concentrations (P = 0.026) and with inability to walk >300 m in 6 min (P = 0.042). Compared with the US cohort, Nigerian patients had more hemolysis as indicated by lower hemoglobin and higher lactate dehydrogenase concentrations (P < or = 0.003). Pulmonary hypertension is common among Nigerian SCD patients. The public health implication of this finding is significant considering the potential number of individuals at risk for this complication. Better understanding of the long term outcome of pulmonary hypertension and causes of death in SCD and the institution of preventive measures are major public health challenges for Africa. The inclusion of African sites in sickle cell pulmonary hypertension clinical trials should be encouraged.

Trends in female circumcision between 1933 and 2003 in Osun and Ogun States, Nigeria (a cohort analysis).

The international movement against female circumcision gained momentum in the past two decades. Although recent studies report decline in the practice none has studied the cohort effect or provided plausible explanation for such decline. Changes in female circumcision occurring in two southwestern States of Nigeria between 1933 and 2003 were tracked in a cross-sectional survey using cohort analysis. 1174 female live births to 413 women were included in the analysis. About fifty-three percent of all females were circumcised. The prevalence dropped from 64.9% during the period 1933-60 to 25.7% for the period 2000-2003. For first order births, the corresponding rates were 58.8% and 25.0%. The decline for first-born females comes a decade before other birth orders. Age and education of mother are two main factors of the decline. Global consensus or legal enforcement plays secondary roles. Understanding how modernisation affects the decline in female circumcision should receive greater attention.