Use of HIV and HSV-2 biomarkers in sub-saharan adolescent prevention research: a comparison of two approaches.

Self-report of sexual behavior among adolescents is notoriously inconsistent, yet such measures are commonly used as outcomes for human immunodeficiency virus (HIV) prevention intervention trials. There has been a growing interest in the use of HIV and other sexually transmitted disease biomarkers as more valid measures of intervention impact in high HIV prevalence areas, particularly in sub-Saharan Africa. We examine the challenges, benefits, and feasibility of including HIV and herpes simplex virus type 2 (HSV-2) biomarker data, with details about different data collection and disclosure methods from two adolescent prevention trials in Kenya and Zimbabwe. In Kenya, whole blood samples were collected using venipuncture; adult guardians were present during biomarker procedures and test results were disclosed to participants and their guardians. In contrast, in Zimbabwe, samples were collected using finger pricks for dried blood spots (DBS); guardians were not present during biomarker procedures, and results were not disclosed to participants and/or their guardians. In both countries, prevalence in the study samples was low. Although the standard of care for testing for HIV and other sexually transmitted infections includes disclosure in the presence of a guardian for adolescents under age 18, we conclude that more research about the risks and benefits of disclosure to adolescents in the context of a clinical trial is needed. Notably, current serological diagnosis for HSV-2 has a low positive predictive value when prevalence is low, resulting in an unacceptable proportion of false positives and serious concerns about disclosing test results to adolescents within a trial. We also conclude that the DBS approach is more convenient and efficient than venipuncture for field research, although both approaches are feasible. Manufacturer validation studies using DBS for HSV-2, however, are needed for widespread use.

Menstrual characteristics of sickle cell disease patients seen at a tertiary institution in North Western Nigeria.

Introduction: The burden of sickle cell disease (SCD) is high in Sub-Saharan Africa, including Nigeria, and with improved care and survival, reproductive health issues, including menstruation, have become increasingly important and may impact on long-term health and social wellbeing. Objectives: This study was carried out to characterize the menstrual characteristics of SCD patients. Methodology: Using a cross-sectional study design, a semi-structured questionnaire was administered and information collected on bio-demographic data, medical history of SCD, reproductive, and menstrual history. Results: One hundred and sixty female patients participated in the study. The mean age was 24.9 years (standard deviation [SD] ± 8.8). The mean age at menarche was 15.6 years (SD ± 2.7) for those menstruating. Most respondents had regular menstrual cycles 120 (82%); normal menstrual cycle lengths 120 (81%) significantly associated with respondent's age (P < 0.05); normal duration of flow 140 (97%); light menstrual flow 104 (71%) significantly associated with body mass index BMI (P < 0.05). Overall, however, 114 (78%) had abnormal menses and 32 (22%) had normal menses. Eighty-one respondents (56%) experienced menstrual pain, which was severe in only 28 cases (35%). The presence of menstrual pain did not significantly affect the annual frequency of crisis (P > 0.05). Conclusion: The mean age at menarche was high at 15.6 years. Most respondents had light menstrual flow and overall abnormal menstrual patterns. Menstrual pain was common but was not significantly associated with the frequency of crisis.

RésuméIntroduction: Le taux d'infection de la drépanocytose est élevé en Afrique Sub-Saharien, inclus le Nigéria. Avec les avancements en soin et survie, les problèmes de santé de reproductions, ci inclus le cycle menstruel, sont devenus très préoccupants et peuvent avoir un impact à longue terme sur la santé et le bien-être du patient. Objectifs: Cette étude a pour but de décrire les caractéristiques du cycle menstruel des drépanocytaires. Méthodologie: Utilisant la conception de l'étude transversale, un questionnaire semi-structuré a été administré pour collectionner les informations sur les données biodémographiques, les antécédents médicaux de la drépanocytose ainsi que l'histoire de reproduction et de menstruation des drépanocytaires. Résultats: Cent soixante (160) drépanocytaires de sexe féminin ont pris part à l'étude comme échantillons. La moyenne d'âge était de 24,9 ans (Écart-Type de ±8,8). La moyenne d'âge à ménarche était de 15,6 ans (Écart-Type de ±2,7) pour celles qui sont en cycle menstruel. La plupart des participantes avaient un cycle menstruel régulier (120 sur 160) donc un taux de 82% ; 120 avaient un cycle menstruel de durée normale (81%) qui correspondait significativement très bien à l'âge des participantes (P- Probabilité <0,05) ; 140 avaient une durée d'écoulement normal donc (97%) ; 104 avaient un écoulement léger c'est- à-dire 71% qui correspondait significativement à l'indice de masse corporelle (P<0,05). En totalité, 114 dont 78% ont eu des cycles menstruels anormaux et 32 (22%) ont eu des cycles menstruels douloureux avec 28 cas sévères donc 35%. La présence du cycle menstruel douloureux n'a pas eu d'effet significatif sur la fréquence de crises annuelles (P>0,05). Conclusion: La moyenne d'âge à ménarche était élevée à 15,6 ans. La plupart des participantes ont eu des écoulements légers et globalement, des cycles anormaux. Les cycles douloureux étaient fréquents, mais n'étaient significativement pas liés à la fréquence de crise. Mots-clés: Caractéristiques menstruelles, Menstruation (règles), Nord-Ouest du Nigéria, Drépanocytose.

Use and pattern of previous care received by infertile Nigerian women.

BACKGROUND: Prevalence of infertility in sub-Saharan Africa is high yet fertility care, its development and access is limited in resource-poor countries like Nigeria so infertile women resort to different forms of treatment. This study aimed to determine the use and pattern of previous treatments. METHODOLOGY: This was a descriptive Cross Sectional study conducted at a tertiary hospital in North-Western Nigeria. Interviewer administered pretested questionnaires were administered to 236 consenting clients seen at their first visit to the gynaecology clinic with complaints of inability to conceive, between January 2016 to March 2018. We collected information on demographic and reproductive characteristics, previous fertility treatment and other data relevant to infertility. Descriptive analysis was done using SPSS software version 22. RESULTS: Two hundred and thirty six clients participated in the study and majority were 20-29 years (44.5%), with a mean age of 31.5 ± 7.4, while the mean age of their husbands was 41 ± 8.0. More clients were educated up to secondary level or above (80.9%), with more Muslims (65%) than Christians. All clients were married except one, most clients had been married for 5 years or more, 18.2% were in their second order of marriage and 28% were in polygamous marriages. Many of the clients were homemakers (46.6%) and earned an average monthly income of less than fifty thousand naira. About 59.3% of clients presented with primary infertility, with 15.7% being infertile for duration of more than 10 years. One hundred and forty six respondents (61.9%) had received previous hospital treatments before presentation to our facility, 37% had visited more than three hospitals, 70% did not have adequate investigations done, treatment was successful in 15% while 40.7% received traditional treatments. Husbands of women receiving previous treatment were slightly older (p value < 0.05). CONCLUSION: Majority of woman have multiple and unnecessary visits to several hospitals for infertility care with little positive results despite time and resources spent. Quality of infertility care needs to be improved.