FACULTY OF BASIC MEDICAL SCIENCES
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Item INCIDENCE OF HEPATITIS C VIRUS INFECTION IN A SEMI-URBAN COMMUNITY OF SOUTHWESTERN NIGERIA(2014-11) BAKAREY, A. S.Hepatitis C Virus (HCV) infection is an important cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Its epidemiology has been well described in developed countries. In Nigeria, previous studies on the virus were hospital-based or point prevalence from which the burden of HCV cannot be accurately determined. A population-based prospective study was therefore designed to assess the burden of HCV infection in a semi-urban community in southwestern Nigeria. A cohort of 490 purposively recruited consenting participants in Saki, a border town in Nigeria were enrolled and followed up for nine years (2003-2012). Blood samples were collected and tested for the presence of HCV antibodies using the ELISA technique from each participant at baseline, one year, 2 years and 9th year. The participants included 299 male and 191 female members of two occupational groups, auto-mechanics (n=236) and fashion designers (n=254) with age range of 15 to 65 years (median age=26years). A structured questionnaire was administered to capture information on awareness of HCV infection as well as predisposing factors including sharing of sharp objects, transfusion of blood and blood product, polygamy and multiple sexual partnership. The cohort was continuously provided education on prevention of sexually transmitted diseases and blood borne pathogens during the follow-up period. Data were analysed using descriptive statistics and ANOVA at p=0.05. Incidence of infection was reported as number of HCV cases/1000 person years. The rate of HCV infection at baseline was 8.4%. A total of 27 new cases of infection were identified in the cohort giving an overall incidence of 27.8 per 1000 person years. Incidence of HCV increased from first to the second (9.0 Vs 24.7 per 1000 person years) year but declined thereafter (11.3 per 1000 person years). Incidence of the infection increased with age and peaked among persons 45-54 years (34.5 and 38.5 per 1000 person years). The incidence was higher among male than female (21.2 Vs 14.5 per 1000 person years). Incidence in both male and female groups increased from first to second point but declined sharply thereafter. Incidence of HCV infection was higher among auto-mechanics (31.4 per 1000 person years), a male occupational group than fashion designers (23.9 per 1000 person years), a female dominated occupational group. Similarly, HCV incidence was higher in male (49.9 per 1000 person years) than female (14.6 per 1000 person years) members of the fashion designer group (Risk Ratio = 2.7, CI=1.32-5.87). The only significant risk factor identified was sharing of sharp objects (RR=2.4, CI=1.0-5.56, χ20.05:1=4.329, p=0.04). There was a substantial burden of HCV infection in the studied community. Sharing of sharp objects is a significant predisposing factor for HCV infection among the study populations. The high burden of the infection indicates the need for urgent implementation of measures to control HCV infection in Nigeria.Item Clinical and immunological profile of pediatric HIV infection in Ibadan, Nigeria(SAGE, 2011) Brown, B. J.; Oladokun, R. E.; Odaibo, G. N.; Olaleye, D. O.; Osinusi, K.; Kanki, P.In spite of the increasing number of children living with HIV in Nigeria, published data on their clinical profile are few. We describe the clinical profile at presentation of HIV-infected children at the University College Hospital, Ibadan, in a prospective study. Among 272 children studied (149 [54.8%] males; mean age 4.2 years [range 2 months to 15 years]), infection was acquired through vertical transmission in 252 (92.6%), blood transfusion in 5 (1.80%), and undetermined routes in 15 (5.5%) cases. Clinical features included weight loss (62.5%), prolonged fever (55.4%), generalized lymphadenopathy (48.6%), chronic cough (45.4%), and persistent diarrhea (28.3%). Tuberculosis was present in 45.3%, World Health Organization (WHO) clinical stages 3 and 4 disease in 70.6% and severe immunosuppression in 44.5% of cases. Pediatric HIV in Ibadan is acquired mainly vertically and most cases present with severe disease. Improved access to prevention services and early diagnosis are recommended.Item Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria(2010) Oladokun, R. E.; Awolude, O.; Brown, B. J.; Adesina, O.; Oladokun, A.; Roberts, A.; Odaibo, G.; Osinusi, K.; Olaleye, D.; Adewole, I. F.; Kanki, P.The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH), Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these, 51614 (99.5%) accepted HIV test and 49134 (95.2%) returned for their results. Out of the tested patients, 2152 (4.2%) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361 (16.7%) with 87 (18.6%) testing positive. There were a total of 942 deliveries out of which 39.2% of the mothers and 95.2% of the babies respectively received ARV prophylaxis. In all, 85.8% (788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing, 68.3% reported for the test and 17 (8.7%) tested positive. There has been progress in the programme, reflected in the increase in the number of new clients accessing the PMTCT service. However, partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention.Item Demographic factors in HIV infected patients seen at UCH, Ibadan, Nigeria.(2005) Ola, S. O.; Ladipo, M. M. A.; Otegbayo, J. A.; Odaibo, G. N.; Bamgboye, E. A.; Nwaorgu, O. G. B.; Shokunbi, W.; Olaleye, O. D."There is a rising rate of Human Immunodeficiency Virus (HIV) infection in Nigeria. Good knowledge of the demographic characteristics of the patients with HIV/AIDS may be of great importance in understanding its epidemiology in Nigeria and could facilitate efforts at curtailing the spread of the infection. The study was planned to determine the demographic factors in Nigerian patients with HIV infection. The study was conducted at the University College Hospital (U.C.H), Ibadan, located in the South West of Nigeria. It was a retrospective study of patients with HIV infection attending the U.C.H. from 1988 to 2002. The data collected from the clinical records of the patients with HIV infection included age, sex, marital status, number of spouses, tribe, occupation, education and their religious affiliation. A total of 460 patients aged 1-76 years with peak at 30-34 years were studied. The male/female ratio was 1.06 and the males were the older group. Traders accounted for 40% with female preponderance while the artisans (19.9%) and the military (2.9%) were mostly males. The patients were of Yoruba (70.6%), Igbo (20.0%) and Hausa (9.1%) races. Among the patients with marital status, majority (71.4%) were married while those separated and widowed accounted for 3.5% and 2.6% respectively. Also, a higher proportion of the female HIV patients were Christians whereas the majority of the males were of Islamic religion. Although, there was a low frequency of records on education, the males had better formal education. In conclusion, the study shows that HIV infection is presently an adult disease affecting the most productive segment of the Nigerian population regardless of the individual occupation, educational status, tribe and religious affiliation. Also, it shows that the infection could be associated with heterosexual intercourse."Item HIV infection among patients with pulmonary tuberculosis in Nigeria(2005) Odaibo, G. N.; Gboun, M. F.; Ekanem, E. E.; Gwarzo, S. N.; Saliu, I.; Egbewunmi, S. A.; Abebe, E. A.; Olaleye, D. O.Respiratory problems like Pneumocystic carinni and Pulmonary tuberculosis (PTB) are among the common opportunistic infections in patients with HIV/AIDS. The risk of acquiring Mycobacterium tuberculosis in a community becomes greater with increase in the number of HIV positive persons with active tuberculosis. This study was carried out to determine the magnitude of HIV infection among PTB patients in different parts of Nigeria as part of the year 2000 national HIV surveillance programme. Blood samples were collected on blotting paper from a total of 2826 individuals attending TB clinics between 1st of September and 1st November, 2000. Samples were collected from patients with confirmed PTB from 12 states in the 6 geopolitical/health zone (2 states/zone) of Nigeria as part of high risk sentinel population groups. Samples were tested for the presence of HIV antibodies using commercial ELISA (Genescreen HIV-1/2, Sanofi Pasteur, Paris). All initially reactive samples were retested with a rapid EIA (Gene II, Sanofi Pasteur, Paris) according to the WHO recommendations (option II). HIV Prevalence in the states varied from 4.2% in Oyo to 35.1% in Benue States with a median prevalence of 17.0%. HIV Prevalence increased with age to a peak of 23.9% among PTB patients 30-39 years and then declined progressively to 12.8% among those 60 years and above. A relatively high HIV infection rate (13.8%) was found among the young adolescent age group 10-19 years. There was no significant difference in the rate among male and female PTB patients tested. Comparison with results of previous HIV sero-surveys shows a steady increase in HIV prevalence among PTB patients over the years. The high prevalence of HIV among young PTB patients aged 10-19 years in this study is worrisome and must be noted for intervention.Item Serum Hepatitis C virus and hepatitis B surface antigenaemia patients with acute icteric hepatitis(2002) Ola, S. O.; Otegbayo, G. N.; Odiabo, G. N.; Olaleye, O. D.; Olubuyide, O. I.Acute hepatitis is common in Nigeria and hepatitis B virus (HBV) infection has been a major aetiological factor. However, the role of Hepatitis C virus (HCV) infection is yet undetermined. Forty-five consecutive Nigerian patients with Acute Icteric hepatitis (AIH) attending the medical clinic of the University College Hospital, Ibadan, Nigeria and 45 health adult Nigerians (controls) were studied for evidence of infection with both viruses. Questionnaire on risk procedures which predispose to acquisition of both HBV and HCV infections were administered to the patients. Blood samples were collected from all the subjects and tested for antibody to HCB (Anti-HCV) and Hepatitis B surface Antigen (HBsAg) using the second generation enzyme linked Immunoassay (Monosila-R, Sansofi, Pasteur;France). Anit-HCV was detected in 21(47%) and 17 (38%) of the patients and controls respectively. The corresponding prevalences of HBsAg were 38(84%) and 11(24%), p<0.001. Hepatitis B virus infection was found to occur more than the controls. Combined HBV and HCV infection occured more frequently among the patients(42.1%) than in the control (11%)(;<0.001). Although there was no significant difference in the HCV infection between the two groups, isolated HCV infection is commoner in the control than in the patients with AIH, (p<0.001). Similarly, single HCV infection is commoner than lone HBV infection among the control, p<0.05. In summary, this study shows that while both HBV and HCV infections are common in Nigeria, AIH may be more associated with HBV than HCV in the country.Item Human immunodeficiency seropositivity among mother-child pairs in South west Nigeria: a community-based survey.(2001) Omotunde, O. O.; Olaleye, D. O.; Saliu, I.; Odaibo, N. G.; Adeyemo, A. A.A community based survey to determine the prevelence of human immunodeficiency infection in Nigeira women and children in south western Nigeria is reported. A multi-stage cluster random sampling procedure was used to select mother-child pairs from 35 enumeration areas in south western Nigeria. The final study sample consisted of 460 mothers and 476 children (including 16 sets of twins). A commercially available recombinant antigen-based ELISA method was used to test for HIV-I and HIV-2 anti-body in sera and western blotting was used as a confirmatory test for initially reactive samples. Only one mother-child pair (out of 460 mother-child pairs) was found to the positive for HIV antibody giving a mother-child concordance for HIV infection of 0.22%. Antibody to either HIV-1 of HIV-2 was detected in 3.8% (18/476) of the children's sera and in 4.3% (20/460) of mothers sera. HIV-1 reactivity was commoner than HIV-2 reactivity (2.9% versus 0.8% among children and 2.8% versus 1.5% among mothers). There were many more positive samples in the rural than in urban areas among children (7.1% versus 1.1%) and also among mothers (6.8% versus 2.4%),(p<0.001). Ths, HIV infection appears to be a real problem in south western Nigeria. The lack of concordance between mother-child sera suggests that vertical transmission may not be a major route of tansmission of HIV infection in children in South western Nigeria. It suggested that certain high risk practices(such as the re-use of unsterillised hypodermic needles for injections and surgical knives in local scarfication) which are common practices, especially in rural areas, need to be investigated as potential major modes of transmission of the infection. Control programmes need to take note of these finidngs in order to adequatly paln comprhensive health education which will cover the whole population, invluding children.Item Prevalence of HIV-I subtypes in infected concordant and discordant couples in Nigera(Klober Academic Publishers, 2001-08) Odaibo, G. N.; Olaleye, O. D.; Ruppach, H.; Fasanmade, A. A.; Olubuyide, S. O.; Dietrich, U.The peptide binding immunoassay (PELISA) was used as previously described to determine HIV-I subtypes among 60 married HIV-I sero-positive individuals and their spouses identified at the University College Hospital, Ibadan in order to investigate the rate of heterosexual partners by different HIV-I subtypes in Nigeria. Out of the 60 couples whose blood samples were analyzed, 33 (55%) were both positive HIV while only one spouse of the couples was sero-positive among the other 27. Using the McNemer test for discordant paired samples, an insignificant (P=0.0636) differnce was obtained between male to female and female to male transmission. Subtypes A, B, C and E were dtected among these individuals. Most (82.3%) of the subtypes C and all of the subtype E(12) were detected among the tranmitters (couples with concordant sero-positive status). This study indicates that HIV-I subtypes C and E may be more efficiently transmitted heterosexually than the other subtypes.Item Multiple presence and heterogeneous distribution of HIV-I subtypes in Nigeria(Klober Academic Publishers, 2001) Odaibo, G. N.; Olaleye, O. D.; Ruppach, H.; Okafor, G. O.; Dietrich, U.Human immunodefiency virus types I(HIV) subtypes circulating in Nigeria was determined by using the Peptide based Enzymes Immuno-Assay (PELISA) to anlayze sera or plasma samples collected from 925 individuals in southeastern and nothern) of Nigeria. The synthetic peptides used as the capture antigens in the PELISA were design from the consensus sequence of the thrid hypervariable region. (V3 loop) of HIV-I subtypes A, B, C, D, E and O of HIV-I. The assay was initially validated using plasma samples from individuals infected with various genetically identified HIV-I subtypes in Europe and AFrica. Any serum or plasma samples that reacted with more than one peptide was re-tested using the same antigen panel in a limiting ELISA technique. The result co- circulation of multiple HIV-I subtypes including A, B, C, D, E and O in Nigeria. Varying prevalence of specific antibodies to the six HIV-I subtypes included in the PELISA panel were detected among infected individuals (74), B=2.5%(23) and group O, 2.4%(20). Thirty-six (3.9%) of the samples from the northen and southeastern regions reacted with HIV-I subtype O and B peptides respectively. As far as it can be ascertained, this is the first report of dtection of HIV-I subtypes B, D, and E in Nigeria. Furthermore, the result of this work indicated widespread circulation of multiple HIV-I subtypes in Nigeria. Therefore a polyvalent vaccine will be the best option for effective prophylactic immunization against HIV-I infection in Nigeria.