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Although there are several indirect methods that can be used to verify reference limits, they have a common weakness in that they assume a low proportion of pathological values. This paper investigates whether a Gaussian decomposition algorithm can identify the non-pathological fraction even if it is not the main subset of mixed data. All investigations are carried out in the R programming environment. The mclust package is used for Gaussian mixture modelling via the expectation maximization (EM) algorithm. For right-skewed distributions, logarithms of the original values are taken to approximate the Gaussian model. We use the Bayesian information criterion (BIC) for evaluation of the results. The reflimR and refineR packages serve as comparison procedures. We generate synthetic data mixtures with known normal distributions to demonstrate the feasibility and reliability of our approach. Application of the algorithm to real data from a Nigerian and a German population produces results, which help to interpret reference intervals of reflimR and refineR that are obviously too wide. In the first example, the mclust analysis of hemoglobin in Nigerian women supports the medical hypothesis that an anemia rate of more than 50 % leads to falsely low reference limits. Our algorithm proposes various scenarios based on the BIC values, one of which suggests reference limits that are close to published data for Nigeria but significantly lower than those established for the Caucasian population. In the second example, the standard statistical analysis of creatine kinase in German patients with predominantly cardiac diseases yields a reference interval that is clearly too wide. With mclust we identify overlapping fractions that explain this false result. Gaussian mixture modelling does not replace standard methods for reference interval estimation but is a valuable adjunct when these methods produce discrepant or implausible results. [ABSTRACT FROM AUTHOR]

Copyright of Sanamed is the property of Sanamed and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Micronutrients are required by the body in minute quantities, and their absence can have highly negative effects. A food-based approach is needed to increase the consumption of an adequate amount of underutilized micronutrient-rich foods. Objectives: This study assessed the effect of consuming Sourdough excluded pearl millet snacks on the nutritional status of school-age children in Odeda Local Government Area of Ogun State. Materials and Methods: One hundred primary school age children were grouped into three study groups (sourdough pearl millet extruded snacks group, pearl millet extruded snack group, and ferrous supplement group) and monitored for eight weeks as part of the study's randomized block single-blind trial design. Blood samples from the subjects were taken at the start and end of the study, and hematological factors were examined (hemoglobin, packed cell volume, serum zinc). ANCOVA was used for statistical analysis. P<0.05 was considered significant. Results: Results revealed the average age of the children was 105.9± 27.2 months with 49.0% being female and 51.0% male. 54.9% of respondents were anaemic, while 11.4% tested low in zinc. Haemoglobin and packed cell volume at the endpoint had significantly improved in the three groups (p<0.05). Only the sourdough pearl millet extruded snacks, though, made a 10% improvement in the zinc status. Conclusion: Sourdough pearl millet extruded snacks improved the hemoglobin status of anemic children and zinc status of children with low zinc levels. This study has demonstrated that sourdough pearl millet extruded snacks is a safe option for the treatment of anaemia in children, particularly those who do not enjoy taking medications. [ABSTRACT FROM AUTHOR]

Background: Iron-deficiency anemia is an important limiting factor to a sustainable supply of blood units, especially in low- and middle-income countries. Blood transfusion practice in Nigeria is poorly developed and structured with paucity of voluntary nonremunerated blood donors and high rate of donor deferrals resulting from low hemoglobin (Hb) levels. Aims: This study aimed to assess the effect of daily supplementation of iron using Ranferon-12 on Hb level, red blood cell (RBC) indices, iron level, ferritin level, and Hb recovery in blood donors in Nigeria. Methodology: This longitudinal study was conducted at a tertiary hospital blood transfusion center from March to July 2020. Blood samples of regular donors were collected at three points in the study for the measurement of Hb and hematocrit (HCT); RBC indices including mean cell volume (MCV), mean cell hemoglobin (MCH), and Mean cell haemoglobin concentration (MCHC); and iron stores including serum iron, serum ferritin, and serum transferrin. The first point was at recruitment before donation of one unit of blood; the second point after the blood donation; and the third point at 6 weeks post blood donation. Following donation, participants were placed on Ranferon capsules (iron fumarate - 100 mg elemental iron) and 100 mg of tablet Vitamin C, for 6 weeks. Results: There was a moderate significant positive correlation between administration of Ranferon and change in the values of HCT, MCV, MCH, red cell distribution width, ferritin, and transferring (P < 0.05). Percentage recovery of Hb, red cell indices, and iron stores parameters after 6 weeks of daily Ranferon ranged between 89% and 100%. Conclusion: Iron supplementation using Ranferon capsule daily for 6 weeks enhances recovery of Hb, red cell indices, and iron stores with attainment of benchmark Hb levels for donation. [ABSTRACT FROM AUTHOR]

Background: Anaemia disproportionately affects women of reproductive age in sub-Saharan Africa including Nigeria. Yet, community-based studies on the prevalence and determinants of anaemia among women of reproductive age are scarce in Nigeria. Design: A cross-sectional community-based survey using a nationally representative sample. Objectives: This study described anaemia prevalence and its associated factors among women of reproductive age, pregnant women, and non-pregnant women in Nigeria. Methods: We analysed data from the 2018 Nigeria Demographic and Health Survey. Pregnant women with a haemoglobin level less than 11 g/dL and non-pregnant women with a haemoglobin level less than 12 g/dL were considered anaemic. Anaemia was also categorized as mild, moderate, and severe. Pearson's chi-square test was used to evaluate the association between anaemia status and independent variables. All variables with ρ ⩽ 0.25 in bivariate analyses were further analysed using complex sample logistic regression. Results: Anaemia prevalence was 57.8%, 57.4%, and 61.1% for women of reproductive age, non-pregnant women, and pregnant women, respectively. The prevalence of severe anaemia was 1.6%, 1.5%, and 2.3% for overall women of reproductive age, non-pregnant women, and pregnant women, correspondingly. The southern regions, rural residence, low education, unemployment, low wealth index, and non-use of modern contraceptives significantly increased the likelihood of anaemia and severe anaemia among women of reproductive age and non-pregnant women. The likelihood of being anaemic was significantly increased by large family size among women of reproductive age and by being underweight among non-pregnant women. The South-East region, rural residence, low education, and unemployment were significantly associated with anaemia among pregnant women. The South-South region and unemployment increased the likelihood of severe anaemia among pregnant women. Short stature significantly reduced the odds of being anaemic and severely anaemic among pregnant women. Conclusions: Anaemia prevalence among all categories of women of reproductive age is high in Nigeria. Predictors of anaemia prevalence and severity should be considered in policies intended to reduce anaemia among women of reproductive age in Nigeria. [ABSTRACT FROM AUTHOR]

The burden of Sickle cell anaemia (SCA) is huge in Sub Sahara Africa as it affects 1–2% of the population. HbSS impacts negatively on the quality of life of the sufferers. The clinical manifestations start between 3 and 5 months of life as a result of reduction in foetal hemoglobin. This study describes the clinical and laboratory characteristics of HbSS patients at presentation in steady state, vaso-occlusive and hemolytic crises states. This was a cross sectional, analytical study. Ninety HbSS participants were divided into three groups; steady state, hemolytic and vaso-occlusive crises with 30 individuals in each group. The survey contained sections on bio-data and past medical history obtained from the patients' notes and results of laboratory tests. Data were analysed using SPSS version 23.0. Results were considered statistically significant if p < 0.05. Ninety participants were analysed in this study. The mean age of the participants was 29.4 ± 8.9 years. Only one-third of the participants were diagnosed within the first year of age. Forty-seven (52.2%) participants have steady state haematocrit in the range of 21–25%. All the participants experienced bone pain in a year, about 25% of these participants had more than three episodes of pain per year. There was a statistically significant difference in the mean values of PCV (p <.001), WBC (p <.001), platelet (p =.008), ANC (p <.001), ALC (p <.001), AMC (p <.001), reticulocyte count and ISC % among the different categories. This study established the fact that only a minority of the SCD patients are diagnosed in the first year of life and vaso-occlusive crisis is the most frequent reason for hospital presentation. We therefore recommend the institutionalisation by government policy, neonatal screening programme in Nigeria. The study highlight delay in early diagnosis of SCA due to unavailability of neonatal diagnosis program in our setting. Bone pain remains the major cause of presentation for SCA and most patients presented after a day of onset of pain to the hospital. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Sickle cell disease is the most common genetic hematologic disorder especially in Sub-Saharan Africa. Newborn screening (NBS) for sickle cell disease is a tool for early disease detection and treatment. Objective: To report the outcome of newborn screening for sickle cell disease at Abakaliki, Ebonyi state. Setting: Alex Ekwueme Federal University Teaching Hospital (AEFUTHA), Ebonyi State. Design: Retrospective study. Methods: A two- year period data on sociodemographic characteristics, haemoglobin phenotype of 1,165 babies and parents were obtained from the laboratory register. Main Outcome measures: Prevalence of haemoglobin (Hb) phenotypes in newborns, couples’ Hb phenotype compatibility. Statistical analysis: Data were summarized using proportion, mean, median and standard deviation. Chi-square and Fisher’s exact tests were used where appropriate. Results: A total of 1,165 newborns were screened for hemoglobin phenotype consisting of 589 (50.4%) males and 572 (47.1%) females. Majority, 856 (73.9%) had haemoglobin (Hb) phenotype AA, 283 (24.4%) had AS, 12 (1.0%) and 6 (0.5%) had SS and AD; respectively while SC and AC were (0.1%) each. Nine (0.9%) of the parents who reported a compatible Hb phenotype had newborns with SS. There was a significant difference in Hb phenotype of the newborns of parents with compatible and those with incompatible Hb phenotypes (p <0.001). Conclusions: The prevalence of SCD (HbSS 1.0% and HbSC 0.1%) is 1.1% among newborns in Ebonyi state. There is a high level of Hb phenotype incompatibility between couples in the state. Public awareness, premarital education and screening of couples are needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and performance of self-collected vaginal swab samples for HPV screening among women in Lagos, Nigeria.Methods: A cross-sectional study was implemented from March to August 2020 among sexually active women. Study participants provided same-day paired vaginal swab samples. Medic-sampling and poster-directed self-sampling methods were used to collect the two samples per participant. A real-time PCR assay detected HPV 16, HPV 18, other-high-risk (OHR) HPV, and the human β-globin gene. The self-collected samples' sensitivity, specificity, and accuracy were determined against the medic-collected samples using the MedCalc Online Diagnostic Calculator.Results: Of the 213 women aged 16 ~ 63-year-old recruited, 187 (88%) participants had concordant results, while 26 (12%) participants had discordant results. Among the 187 concordant results, 35 (19%) were HPV positive, 150 (80%) participants were HPV negative, and two (1%) were invalid. 18 (69%) out of the 26 discordant samples were invalid. The self-collected sample was invalid for 14 (54%) participants. Two (8%) medic-collected samples were invalid. Compared to the medic-collected sample, the self-collected sample was 89.80% (95% CI: 77.77 ~ 96.60%) sensitive and 98.21% (95% CI: 94.87 ~ 99.63%) specific, with an accuracy of 96.31% (95% CI: 92.87 ~ 98.40%). The mean age for HPV positive and negative participants were 39 and 40, respectively, with an ANOVA p-value of 0.3932. The stratification of HPV infection by the age group was not statistically significant (P > 0.05).Conclusions: With high accuracy of 96%, self-collected sampling is adequate when tested with real-time PCR and may increase the uptake of HPV testing. Though more self-collected samples were invalid than medic-collected samples, most likely due to poor collection, they could be identified for repeat testing. Future implementation can avoid this error with improved guidance and awareness. [ABSTRACT FROM AUTHOR]

Pastoralists in Nigeria mix Garcinia kola seed (GK), Khaya senegalensis stem bark (KS) , and Vernonia amygdalina leaves (VA) to treat leptospirosis. To determine the in vitro and in vivo effect on single and combination therapy on Leptospira interrogans -infected mice. Evaluation of in vitro assay for anti-leptospiral motility of the extracts was carried out in triplicates. For the in vivo assessment, 40 adult male mice inoculated with Leptospira were randomly allocated into 8 groups of 5 mice each. Groups IV-IX were treated with 800 mg/kg b.w. of KS, GK, VA, KS + GK, KS + VA, GK + VA for 5 days. Group I was negative control, II was model control, and III was treated with penicillin (3.7 mg/kg b.w.) intramuscularly. In vitro , at 90 min, all the extracts at 800, 400, and 200 mg/ml showed complete cessation of motility which was significantly (p < 0.05) different when compared to the negative control. A significant (p < 0.05) IC 50 of 0.18 mg/ml was recorded with GK when compared to KS (0.40 mg/ml), VA (0.25 mg/ml), and procaine penicillin (0.31 mg/ml). Mean packed cell volume, haemoglobin concentration, and mean corpuscular haemoglobin concentration decreased significantly (p < 0.05) in all infected groups and returned to almost pre-infection values. However, significant leucocytosis (p < 0.05) was observed in group II. AST and ALP showed a significant increase (p < 0.001). Histopathological evaluation showed the extracts to prevent the distortion of normal architecture of the selected organs. This study demonstrates the significant potential of Garcinia kola , Khaya senegalensis , and Vernonia amygdalina extracts singly and in combination to combat leptospirosis. [Display omitted] • All extracts showed concentration-dependent cessation of leptospiral motility in vitro. • IC 50 of Garcinia kola (0.18 mg/ml) was significant when compared to procaine penicillin (0.31 mg/ml). • In vivo , a significant increase to almost pre-infection values was observed in the treated groups. • Aspartate amino transferase showed a significant increase in the infected untreated group. • Extracts prevented distortion of normal architecture of the selected organs for histopathology. [ABSTRACT FROM AUTHOR]

Background Uptake of iron – folate supplementation for at least 90 days during pregnancy is recommended as a cost-effective way of reducing iron deficiency anemia, the commonest form of anemia among women of childbearing ages. The paper examines the level of compliance in Nigeria. Methods We analysed a sample of 14 740 married women aged 15–49 years from the 2018 Nigerian Demographic and Health Survey with available data on hemoglobin and anemia. Multinomial logistic regression models were used to establish associations between socio-demographic characteristics, compliance with recommended uptake of micronutrients and anemia status of the mothers. Results A number of socio-demographic factors, namely maternal age, type of residence, education, wealth, among others correlated with incidence of maternal anemia as well as compliance with recommended uptake of micronutrient to protect against anemia. For instance, whereas 46.3% of mothers from rural backgrounds were not anemic, 39.0% of those with urban background were not anemic (P  < 0.001). More than half (56.2%) of mothers in the richest households were anemic compared with about a third (34.6%) of mothers in the poorest household who were not anemic (P  < 0.001). The urban dwellers, richer and more educated mothers complied more with the uptake of iron–folate supplements to protect against anemia during pregnancy (P  < 0.001). The younger mothers (15–29 years) were more likely to comply with iron intake (odds ratio: 1.150 (1.060–1.247)). [ABSTRACT FROM AUTHOR]

BACKGROUND: Vitamin D supplementation has been shown to improve hemoglobin levels in patients with sickle cell anemia (SCA). However, very little is known about the prevalence of its deficiency, its role in hemolysis, and its effects on transfusion requirements in SCA, hence this study. PATIENTS AND METHODS: Serum level of vitamin D was determined in 50 SCA patients in steady state, 50 SCA patients in hemolytic crises, and 50 in normal HbAA individuals. All were 18 years or older and were age- and sex-matched. In addition, PCV and hemoglobin (Hb) concentration, absolute reticulocyte count, uric acid, total and conjugated bilirubin, creatinine, lactate dehydrogenase (LDH), and estimated glomerular filtration rate (eGFR) were also assessed in all subjects and controls. Baseline sociodemographic, clinical, and anthropometric data were also recorded. RESULTS: The prevalence of vitamin D insufficiency and deficiency was found to be 18% and 79%, respectively. The mean serum levels of vitamin D were 18.84 ± 6.86 ng/mL and 17.58 ± 6.23 ng/mL in the steady-state and the hemolytic crises SCA groups, respectively. Transfusion requirements were found to be higher in SCA patients with lower vitamin D levels. Unlike those in crisis who received one or more units of blood transfusion, 42% of those in the steady state did not receive blood transfusion over the same period of 12 months. Hemoglobin levels were, however, found to predict reduced vitamin D levels. CONCLUSION: Vitamin D deficiency (VDD) is highly prevalent among adults with SCA and those with lower vitamin D levels are more anemic and hence may require more blood transfusions. [ABSTRACT FROM AUTHOR]

The current research focused on the impact of dietary diversity on serum micronutrient levels and anthropometric values in 100 adolescent schoolgirls in Enugu, South east Nigeria. Data was collected using a 24-hour food consumption questionnaire that consisted of the demographic and the diet recall parts which were used in calculating the dietary diversity score. Weights (kg) and height (meters) and blood samples were collected from the participating schoolgirls for the determination the blood micronutrient (iron and zinc) and hemoglobin (Hb) levels. The result showed that 90% of the schoolgirls consumed cereal and consumption of other food groups was below 50% especially fruits and milk/dairy products. There was no case of iron deficiency among the adolescent schoolgirls while serum iron of 77% of the schoolgirls were above the recommended level and were at the risk of iron overload. About 89% of the adolescent girls had zinc level below the normal range and are thus zinc deficient. While 41% of the adolescent schoolgirls recorded a body mass index (BMI) within the normal range, more than 50% of the girls were under weighted. Poor dietary diversity was observed among the schoolgirls as was reflected in the high number of zinc deficient and underweight adolescent schoolgirls observed in this study. Diversification of diets with fruits, vegetables and animal products and education of the general public on good eating habits is hereby advocated for in order to ensure adequate intake of nutrients. [ABSTRACT FROM AUTHOR]

Aim: Nigeria has the highest number of children with sickle cell disease (SCD) with a consistent prevalence of 2 to 3% despite increased awareness and widespread premarital screening. In our practice, we observed that complaints of haemoglobin phenotype misdiagnosis are common among parents of children living with SCD. The present study was thus carried out to identify the prevalence, determinants, as well as the perceived impacts of haemoglobin phenotype misdiagnosis in Lagos, Nigeria. Materials and Methods: This study included the parents of children with SCD aged below 18 years. Interviewer administered questionnaires were used to obtain relevant biodata, sociodemographic data and an assessment of the perceived impact from both caregivers and their children, between May and July 2019. Results: Fifty-nine (32.4%) out of the 182 parents recruited had a previous haemoglobin phenotype misdiagnosis. Misdiagnosis was significantly more in individuals in the upper social class and those that had their tests performed in private laboratories. Clinical, psychosocial and economic impacts of having an affected child with SCD were reported. Conclusion: The frequency of wrong haemoglobin phenotype diagnosis is alarmingly rampant amongst the parents of children with SCD. This is potentially devastating to these families and to society; hence, the government needs to act by auditing and enforcing regulatory oversight of laboratories as well as instituting a nationwide new-born screening programme to replace the existing widespread use of haemoglobin electrophoresis for the diagnosis of SCD. [ABSTRACT FROM AUTHOR]

Background: Plasmodium falciparum is the leading cause of malaria morbidity and mortality in Nigeria with varied symptoms and haematological consequences. The objective of this study is to assess the differences in haematological parameters and haemoglobin phenotypes in symptomatic P. falciparum infected and apparently healthy asymptomatic individuals in parts of Kaduna metropolis. Methodology: A total of 1000 subjects; 500 symptomatic and 500 apparently healthy subjects asymptomatic for malaria, were recruited from selected hospitals and National Blood Bank in Kaduna metropolis. Blood samples were collected for thick and thin film microscopy to determine malaria parasitaemia and parasite species identification respectively. Haematological parameters were determined using automated blood analyser (KX-21N, Sysmex, Japan) and haemoglobin phenotypes by alkaline cellulose acetate electrophoresis. Results: Of the 1000 subjects recruited, 347 (34.7%) were positive for P. falciparum on blood film, which included 226 (45.2%) of 500 symptomatic and 121 (24.2%) of 500 asymptomatic subjects (p<0.00001). Of the 347 P. falciparum infected subjects, 275 (79.3%) had HbAA, 61 (17.6%) had HbAS, 1 (0.3%) had HbAC, 8 (2.3%) had HbSS, and 2 (0.6%) had HbSSf phenotypes. One hundred and sixty-three (72.1%) of the 226 symptomatic subjects had HbAA while 112 (92.6%) of the 121 asymptomatic subjects had HbAA, which indicated a significantly higher frequency of asymptomatic malaria in subjects with HbAA (p<0.00001). Conversely, 53 (23.5%) of the 226 symptomatic subjects had HbAS while 8 (6.6%) of 121 asymptomatic subjects had HbAS, indicating a significantly higher frequency of symptomatic malaria in subjects with HbAS (p=0.000086). The frequency of parasitaemia > 3,000 parasites/μL of blood was 100% for HbSSf, 25% for HbSS, 8.2% for HbAS and 2.2% for HbAA, which showed significantly higher frequency in subjects with HbSS (X²=7.5989, p=0.0054) and HbAS (X²=3.9627, p=0.046519) compared to HbAA. In symptomatic subjects, only MCHC value was significantly higher in subjects with HbAS (33.21±2.430) compared to those with HbAA (32.09 ±2.315) (p=0.003), while all other haematological parameters were not significantly different (p>0.05). In asymptomatic subjects, none of the haematological parameters was significantly different between subjects with HbAS and HbAA (p>0.05). Conclusion: Although the frequency of P. falciparum infection in this study is generally higher in subjects with HbAA, symptomatic infection and higher parasite density are associated with HbAS, HbSS and HbSSf. Effective utilisation of personal preventive measures by inhabitants, in addition to current malaria control and intervention strategies should be adequately implemented in Kaduna metropolis. [ABSTRACT FROM AUTHOR]

Background: Gestational Diabetes Mellitus (GDM) is a common metabolic complication in pregnancy with a broad range of adverse foetal and maternal outcomes if not properly managed. Due to the difficult nature of the Oral glucose tolerance test (OGTT), the utilization of the Glycatedhaemoglobin (HbAlc) test as a simpler and acceptable alternative has been suggested. The aims were to determine the GDM prevalence, the diagnostic accuracy, the optimal cut-off point and the validity of the HbAlc in diagnosing GDM using OGTT as the gold standard in the University of Port Harcourt Teaching Hospital (UPTH). Methodology: This was a prospective cross-sectional study involving a cohort of 250 antenatal attendees at 24-28 weeks of pregnancy in the UPTH from 151 February 2018 - 30,h April 2018. Socio-dcmographic data and results of the OGTT and HbAlc tests were analysed using SPSS 21.0 for windows' statistical software. The area under the Receiver Operating Characteristics (ROC) curve was used to determine the diagnostic accuracy of HbAlc. The Youden index was used to get the optimal cut-off point for HbAlc. The validity of the HbAlc was determined using sensitivity, specificity, positive predictive value and negative predictive value. The P-value at p<0.05 was set as the level of significance. Results: Out of the 250 women, 36 (14.4%) had GDM hence in this study, the GDM prevalence was 14.4%. Area under the curve (AUC) = 0.649; 95% confidence interval: 0.550 - 0.748; p-value = 0.004. The optimal cut-off point for HbAlc was 5.18% with a sensitivity of 63.9%, a specificity of 59.3%, a positive predictive value of 20.9% and a negative predictive value of 90.7%. Conclusion: The HbA 1 c at the Optimal cut-off point of 5.18% in our environment cannot replace the OGTT in the diagnosis of GDM because of its low sensitivity and specificity but will be useful in the screening for GDM because of its high negative predictive value at 24-28 weeks gestation. This will reduce the count of gravidae who undergo the cumbersome OGTT. [ABSTRACT FROM AUTHOR]

Background and Objectives: Human parvovirus B19 (B19V) has singular tropism to erythropoietic cells and causes a wide range of complications in some fetuses of infected pregnant women, especially those with hemoglobinopathies. This study aimed to determine association of hemoglobin electrophoretic patterns and other risk factors of B19V in pregnant women attending University of Abuja Teaching Hospital (UATH), Abuja, Nigeria. Methods: Blood samples were collected from 200 pregnant women and screened for anti- B19V Immunoglobulin-M (IgM), Immunoglobulin-G (IgG) and hemoglobin phenotypic pattern using enzyme immunosorbent assay and Minicap Flex Piercing Electrophoresis, respectively. Structured questionnaires were used to collate sociodemographic variables and associated risks for B19V. Results: Of the 200 participants, 12 (6.0%) were positive for B19V IgM, 45 (22.5%) positive for IgG, 2 (1.0%) were positive for both antibody classes while 145 (72.5%) had no detectable B19V antibodies. Twenty-six (28.3%) of subjects with Hemoglobin AA (HbAA) electrophoretic pattern had B19V IgG, 9 (12.5%) in those with HbAS and 11 (30.6%) in those with HbSS electrophoretic pattern. There was significant association between prevalence of anti-B19V IgG and hemoglobin electrophoretic pattern of participants (p value = 0.037). However, no association between B19V IgM and hemoglobin electrophoretic pattern, age and parity of pregnant women (p value >0.05). Conclusion: Findings from this study revealed a high prevalence of B19V infection. Recent B19V infection was associated with hemoglobin electrophoretic profile of pregnant women. It is recommended to follow all pregnant women with anti-B19V IgM positive results and their fetuses. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage remains a leading cause of maternal mortality especially in developing countries. The majority of previous trials on the effectiveness of tranexamic acid in reducing blood loss were performed in low-risk women for postpartum hemorrhage. A recent Cochrane Systematic Review recommended that further research was needed to determine the effects of prophylactic tranexamic acid for preventing intraoperative blood loss in women at high risk of postpartum hemorrhage., Objective: This study aimed to evaluate the effectiveness and safety of tranexamic acid in reducing intraoperative blood loss when given prior to cesarean delivery in women at high risk of postpartum hemorrhage., Study Design: The study is a double-blind randomized controlled trial., Methods: The study consisted of 200 term pregnant women and high-risk preterm pregnancies scheduled for lower-segment cesarean delivery at Enugu State University of Science and Technology, Teaching Hospital, Parklane, Enugu, Nigeria. The participants were randomized into two arms (intravenous 1 g of tranexamic acid or placebo) in a ratio of 1:1. The participants received either 1 g of tranexamic acid or placebo (20 mL of normal saline) intravenously at least 10 min prior to commencement of the surgery. The primary outcome measures were the mean intraoperative blood loss and hematocrit change 48 h postoperatively., Results: The baseline sociodemographic characteristics were similar in both groups. The tranexamic acid group when compared to the placebo group showed significantly lower mean blood loss (442.94 ± 200.97 versus 801.28 ± 258.68 mL; p = 0.001), higher mean postoperative hemoglobin (10.39 + 0.96 versus 9.67 ± 0.86 g/dL; p = 0.001), lower incidence of postpartum hemorrhage (1.0% versus 19.0%; p = 0.001), and lower need for use of additional uterotonic agents after routine management of the third stage of labor (39.0% versus 68.0%; p = 0.001), respectively. However, there was no significant difference in the mean preoperative hemoglobin (11.24 ± 0.88 versus 11.15 ± 0.90 g/dL; p = 0.457), need for other surgical intervention for postpartum hemorrhage (p > 0.05), and reported side effect, respectively, between the two groups., Conclusion: Prophylactic administration of tranexamic acid significantly decreases postpartum blood loss, improves postpartum hemoglobin, decreases the need for additional uterotonics, and prevents postpartum hemorrhage following cesarean section in pregnant women at high risk of postpartum hemorrhage. Its routine use during cesarean section in high-risk women may be encouraged.The trial was registered in the Pan-African Clinical Trial Registry with approval number PACTR202107872851363 .

Background: Malaria has remained a major issue of public health concern. Protozoan parasites of the genus Plasmodium are the causative agents of malaria and an infected Anopheles mosquito transmits the parasite. Hb genotype and ABO blood groups have been implicated as part of the host innate features that may confer protection against the infection. Methods: This study was a retrospective study which involved the use of laboratory data of students who reported for malaria test in 2017/2018 with the corresponding Hb genotype and ABO/Rhesus blood groups identified. Results: A total of 2294 subjects participated in the study comprising 1039 (45.3%) males and 1255 (54.7%) females. From the study, 921 (40.1%) subjects were malaria positive giving a prevalence of 40.1% among the participants. Blood group O (60.5%) had the highest distribution followed by group B (19.9%), A (17.5%) and AB (2.1%). This same pattern of distribution was repeated for malaria positive and negative participants. The ABO/Rhesus blood group revealed the following pattern of distribution for malaria positive subjects: ORh+ > BRh+ > ARh+ > ORh- > ARh- >ABRh- > BRh- > ABRh+ {58.3%, 17.9%, 16.5%, 2.8%, 2.1%, 0.9%, 0.8% and 0.8%} and ORh+ > BRh+ > ARh+ > ORh- > ABRh+ >ARh- > BRh- > ABRh- {56.7%, 20.5%, 16.2%, 3.4%, 2.1%, 0.7%, 0.3% and 0.2%} for malaria negative subjects. Meanwhile, 2127 (94.7%) were Rhesus positive while 122 (5.3%) were Rhesus negative, out of the 921 malaria positive subjects, 861 (93.5%) were Rhesus positive while 60 (6.5%) were Rhesus negative. HbAA (66.7%) had the highest distribution among the study participants followed by HbAS (23.8%), HbSS (4.8%), HbAC (2.9%), HbSC (1.8%) and HbCC (0.04%), this was the same pattern observed among malaria positive and negative subjects. Conclusion: The high prevalence of malaria in this study is a pointer to the high level of endemicity and asymptomatic nature of malaria in this part of the world. [ABSTRACT FROM AUTHOR]

Background: In this study, the hematological and antioxidant potential as well as the osmotic fragility effects of a Nigerian polyherbal formulation were evaluated. Materials and methods: A total of 40 fats were divided into four groups of 10 rats each. Group 1 served as the control group, and the rest were assigned increasing daily oral administration of the extract for 28 days. At the end of treatment, blood was collected for hematological and osmotic fragility studies. The free radical scavenging effect of the extract was investigated via different in vitro models as well. Results: Results showed that the nitric oxide scavenging and 2,2-diphenyl-1-picrylhydrazyl (DPPH) activities of the extract were significant (p < 0.05) and compared favorably with that of vitamin C. At 200 and 400 μg/mL, the nitric oxide scavenging activities for Ajumbise Polyherbal Extract (APE) were 60.71 ± 0.25% and 59.49 ± 0.98%, respectively, whereas for the same concentrations of vitamin C, 74.60 ± 0.25% and 85.24 ± 0.14 scavenging activities were obtained. The (DPPH) activity at 100 μg/mL was 81.24 ± 0.02% for the extract and 96.22 ± 0.18% for vitamin C. However, at all concentrations, the extract had significantly lower Ferric Reducing Antioxidant Power (FRAP) activity than vitamin C. Red blood cell counts (RBCC), hemoglobin and packed cell volume values (PCV) were significantly lowered only in groups treated with 400 and 800 mg/kg of the extract (p < 0.05), whereas other RBCC parameters and white blood cell counts (WBCC) were not significantly affected (p < 0.05). Platelet (PLT) count was also significantly lowered in all extract-treated groups. The extract also significantly reduced RBCC percentage hemolysis (p < 0.05). Conclusions: Ajumbise polyherbal may be free of hematoxicity and may improve the integrity of the RBC membrane due to its appreciable antioxidant activity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hemoglobin (Hb) and iron are prooxidants in nature and sources of free radicals in the biological system of all Hb phenotypes. Recent evidence linked abnormal hemoglobin S and C (HbSC) in sickle cell disease (SCD) to various complications in multiple oxidative processes. However, similar studies in relation to abnormal Hb traits are sparse. Besides, reports on activities of antioxidant enzymes and iron status in SCDs are still contradictory. This study assessed the interplay between lipid peroxidation and antioxidant defense capacity in various Hb variants. We enrolled 193 participants with different Hb phenotypes. They were consecutive patients with sickle cell anemia (HbSS, n = 32) and hemoglobin SC (HbSC) disease (n = 28) regularly followed up in a steady state. Other participants were subjects with abnormal Hb traits (HbAS, n = 50; HbAC, n = 33) and normal controls (HbAA, n = 50). The hematocrit (Hct) level, hemoglobin (Hb) concentration, iron status, and biochemical parameters including malondialdehyde (MDA), total antioxidant status (TAS), superoxide dismutase (SOD), and glutathione peroxidase (GPx) enzymes were investigated simultaneously. The MDA and SOD levels were significantly higher (P < 0.05) in Hb variants in order of HbSS>HbSC>HbAC>HbAS when compared with controls. Conversely, GPx and TAS levels showed significant reductions (P < 0.05). Similarly, Hct, Hb, and iron concentrations showed significant reductions (P < 0.05) sequentially following HbAC > HbAS > HbSC > HbSS compared with controls. The results suggest that both SCDs and the carriers were relatively more vulnerable to systemic oxidative stress against normal phenotype, and may be owing to ineffective antioxidant mechanisms needed for keeping spontaneous generations of free radicals in control without necessarily iron‐mediated. [ABSTRACT FROM AUTHOR]

Introduction: dry eye is a fairly common ocular surface disorder which significantly affects the quality of life of patients. This study aimed to determine the prevalence, and relationship between dry eye and glycosylated haemoglobin (HbA1c) among patients with diabetes mellitus. Methods: this was a descriptive hospital-based study conducted among patients diagnosed with diabetes mellitus and attending the Diabetic Clinic at a tertiary health facility in Ibadan, south-western Nigeria. Dry eye was assessed using the standardized Ocular Surface Disease Index Questionnaire administered to the eligible respondents on dry eye symptoms. Detailed ocular examination including the tear break-up time (TBUT) and Schirmer I test were carried out and a recent glycosylated haemoglobin value was also obtained. Results: one hundred and eighty-nine Type 2 diabetic patients were studied, with 68.8% female and a mean age of 60.2 ± 10.3 years. The frequency of dry eye among patients was 21.7% (95% CI, 15.8-27.6). The most commonly reported symptoms of dry eye were "feeling of gritty sensation" (78%, 95% CI, 65.4-90.7) and "blurred vision" (73.2%, 95% CI, 59.6-86.7) while "discomfort in windy areas" (61%, 95% CI, 46.0-75.9) was the most common environmental trigger. No statistically significant correlation was noted between dry eye and HbA1c (r = 0.086, p= 0.239), and age (r = 0.096, p = 0.1) Conclusion: dry eye is fairly common among patients with diabetes mellitus with most frequent symptoms being gritty sensation and blurred vision. No significant correlation was noted between dry eye and glycosylated haemoglobin (HbA1c). [ABSTRACT FROM AUTHOR]

Malaria is a life threatening disease and one of the leading causes of death in Africa especially in children. This study aimed to assess the impact of malaria on levels of hepcidin and iron status (haemoglobin, serum iron and total iron binding capacity) based on the severity of malaria infection. A total of ninety three subjects between the ages of 6 months-15 years were investigated for malaria infection using microscopic method. Thirty three subjects had severe malaria; thirty subjects had non-severe malaria and thirty apparently healthy subjects served as control. Hepcidin was estimated using enzyme linked immunosorbent assay (ELISA), serum iron and haemoglobin were estimated spectrophotometrically. The results obtained showed that there were increased levels of hepcidin and decreased levels of haemoglobin, serum iron and total iron binding capacity in severe and non-severe malaria compared with apparently healthy subjects (P<0.05). Hepicidin also showed inverse correlation with serum iron, TIBC and haemoglobin in both severe and non-severe malaria. The study concluded that severe malaria may cause the upregulation of hepcidin and the increased hepcidin could put the subject at risk of iron deficiency anemia. The study suggests that hepcidin could help in the evaluation of severe and non-severe malaria and also be used to monitor the progression of malaria infection. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence, pattern and risk factors of Diabetic Retinopathy (DR) among patients with Diabetes Mellitus (DM) in a tertiary hospital in north-central Nigeria. Settings and Design: This was a hospital-based cross-sectional study conducted in Jos, north-central Nigeria. Materials and Methods: Consecutive adult patients with DM attending the endocrinology clinic who consented to the study were examined over a six-month period. Demographic data, duration of diabetes and history of any systemic disorder were obtained for each patient. A detailed ocular examination and fundus photography were performed and results of blood investigations such as Fasting Blood Glucose (FBG), Glycosylated Haemoglobin (HbA1c) and serum lipid profile were analysed. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0 software. Results: Three hundred and fifty-six patients were examined comprising of 120 (33.7%) males and 236 (66.3%) females giving a male to female ratio of 1:2. The mean age of the study population was 56.6 ± 12.3 years. Diabetic retinopathy and macular oedema were present in 66 (18.5%) and 51 (14.3%) patients respectively. Diabetes diagnosis of 10 years and above, FBG and HbA1c all had a statistically significant association with DR with p values <0.001. Conclusion: The prevalence of DR was 18.5% in a hospital cohort of diabetic patients in north-central Nigeria with long duration of diabetes and poor glycaemic control being the major risk factors for retinopathy. These findings highlight the need for regular eye screening and good glycaemic control in individuals with diabetes in our environment. [ABSTRACT FROM AUTHOR]

Background: Transcranial Doppler ultrasound (TCD) scan, which measures blood flow velocity through the time-averaged mean of maximum velocities (TAMMVs) in the internal carotid arteries and middle cerebral arteries, is a useful screening tool for predicting stroke risk in children with sickle cell anaemia (SCA). Aim: To investigate which clinical and laboratory indices predict abnormal TCD velocity in children with SCA. Methods: Fifty-four SCA patients with normal TCD (TAMMV < 170 cm/s), classified as negative TCD (NTCD), and 93 patients with conditional and abnormal TCD velocities (TAMMV ≥ 170 cm/s) classified as positive TCD were recruited. The haemoglobin oxygen saturation, haematological variables, nitric oxide metabolites and lactate dehydrogenase activity of the patients were analysed. Results: The mean (SD) age was 7.16 (3.84) years (range 2–16). The median SpO2of the patients in the positive TCD group was significantly lower than that of the negative TCD group (p = 0.002). Multivariate logistic regression analysis indicated that the MCV [odds ratio (OR) 1.12, 95% confidence interval (CI) 1.04–1.22,p = 0.01)], MCH (OR 1.34, 95% CI 1.02–1.77,p = 0.04), leucocyte count (OR 1.26, 95% CI 1.07–1.49,p = 0.01) and lactate dehydrogenase (LDH) level (OR 1.00, 95% CI 1.00–1.01,p = 0.01) were independent predictors of high cerebral blood flow velocities. Conclusions: These clinical and laboratory indices are characteristic of chronic hypoxia and severe anaemia and are predictors of abnormal cerebral blood flow velocity. They can be used to predict stroke risk in children with SCA when access to TCD screening is limited. [ABSTRACT FROM AUTHOR]

Blood transfusion is an important treatment modality for severe anaemia. Monitoring post-transfusion haemoglobin (Hb) concentration helps the clinician in assessing the success of blood transfusion. Previous authors have reported different timings for post-transfusion equilibration using varied time intervals for post-transfusion Hb concentration assessment. This study was therefore aimed at determining the appropriate time to assess Hb concentration after packed red blood cell (pRBC) transfusion in children using 5 different time intervals. It was a longitudinal observational study carried out in a tertiary care hospital in Southeast, Nigeria and involved 108 children aged 1–10 years without active bleeding or significant haemolysis that were transfused with pRBC. The Hb concentration was measured using a portable haemoglobinometer just before the blood transfusion and after the blood transfusion at 1, 6, 12, 24, and 48th-hour. The 1-hour (6.8 ± 1.5 g/dl) post-transfusion Hb concentration was significantly different (p 0.001) from the 6th-hour (10.2 ± 1.5 g/dl), but no further significant (p > 0.05) changes occurred after the 6th-hour till the 48th-hour. This finding suggests that equilibration of Hb concentration had occurred by the 6th hour after blood transfusion. This study, therefore, recommends that Hb concentration assessment in children without ongoing bleeding or haemolysis can be done at the 6th hour after pRBC transfusion. [ABSTRACT FROM AUTHOR]

Objectives: Because of lack of data on the prevalence of sulfadoxine antibody, this study was conducted to determine the prevalence of sulfadoxine antibodies and its possible risk factors. Methods: Blood specimens were collected from 500 patients undergoing treatment for malaria at Central Hospital, Benin City, Nigeria. A structured questionnaire was used to collect information and sociodemographic data. Sulfadoxine antibodies were detected by drug absorption (DAT) and immune complex (IMC) methods. ABO, rhesus blood group, and hemoglobin (Hb) phenotype were determined by using standard technique. Results: DAT method had a significantly higher rate of detecting sulfadoxine antibodies compared to IMC method (p = 0.019). Age, gender, and level of education did not affect the prevalence of sulfadoxine antibodies (p > 0.050). Patients that were an artisan (p < 0.001), married (p = 0.025), living in a two-room apartment (p = 0.003), had history of drug reaction, consumed antimalarial drug (maloxine), and consumed sulfadoxine-containing drug within the last month (p < 0.001 each), and significantly affected the prevalence of sulfadoxine antibodies. Individuals with Hb phenotype AA had significantly higher prevalence of sulfadoxine antibodies (p < 0.001), and presence of rhesus D antigen was associated with sulfadoxine antibodies. Conclusions: An overall prevalence of 22.0% among the tested individuals had sulfadoxine antibodies. Prudent use of sulfadoxine containing drugs is advocated. [ABSTRACT FROM AUTHOR]

Background: Maternal anaemia results in morbidity and mortality in both the mother and the unborn child., Introduction: Several factors have been found to determine anaemia among pregnant women but vary from place to place depending on the population and setting of the study. We thus set out to determine predictors of anaemia among pregnant women at booking in FMC, Bida., Methods: This is a descriptive cross-sectional study carried out over a period of three (3) months among 248 pregnant women booking for Antenatal Care (ANC) at the ANC Clinic of the Federal Medical Centre (FMC), Bida, Niger state., Results: The mean haemoglobin concentration was 10.2 ±1.0g/dl and 72.6% of all the women were anaemic (haemoglobin concentration < 11g/dl). Anaemia was significantly related to Religion (Islam) (p <0.001), Ethnicity (Yoruba) (p <0.001), the Gestational age (second trimester) at booking (p= 0.013), Interpregnancy interval (< 2 years) (p <0.001), microcytic red blood cell (p <0.001) and hypochromic red blood cell (p <0.001) morphology and absence of fever (p = 0.043) in index pregnancy. In the final analysis at the multivariate level hypochromic red blood cells (OR = 0.049, p = 0.001, CI = 0.008-0.307), Gestational age (second trimester) at booking (OR = 3.465, p = 0.011, CI = 1.323-9.077) and Religion (Islam) (OR = 4.309, p = 0.006, CI = 1.520-12.215) remained significant independent predictors of anaemia., Conclusion: Anaemia in pregnancy is still a frequent finding, and it's linked to diets poor in iron and folate, booking in the second trimester, and religion. The prevalence and severity of anaemia in pregnancy will be considerably reduced by early booking, and iron/folate nutritional interventions., Competing Interests: The authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Background: The mother-to-child transmission of HIV, which accounts for 90% of infections in children, has been reduced markedly through the use of antiretroviral drugs by pregnant women and their newborns. Changes to the World Health Organization guidelines support further extension of the prevention of mother-to-child transmission programs with increased risk of toxicity on the fetuses.Aim: To determine the hematological indices at birth of infants exposed in utero to maternal antiretroviral drugs.Method: A comparative analytical study of 126 neonates whose blood samples were analyzed to determine their hematological indices.Result: The hemoglobin, hematocrit, the total white blood cell (WBC) count and absolute neutrophil count (ANC) were significantly lower in infants of HIV-positive mothers. The total WBC and ANC were also significantly lower in the highly active antiretroviral therapy. HAART group and those exposed to maternal drugs for <1 year.Conclusion: There are significant changes in the hematological indices of infants of HIV-positive mothers at birth. [ABSTRACT FROM AUTHOR]

Late patronage of antenatal care by women in low-resource areas makes timely intervention at correcting anaemia difficult. This study aimed to identify modifiable sociodemographic factors that predict anaemia before commencing antenatal care and make appropriate recommendation. A survey of sociodemographic features and haemoglobin concentrations of 232 women booking for antenatal care was conducted. Anaemia was diagnosed in 119 (51.3%), of which 87 (37.5%) had mild anaemia and 32 (13.8%) were moderately anaemic. There was no severe anaemia. Anaemia was highest among respondents who were ≥ 35 years of age, Muslims, of Igbo ethnicity (64.3%), single (55.0%), student/unemployed (58.8%), nulliparous (57.3%) and those who registered at ≥ 21 weeks’ gestation (54.2%). Only occupation of the woman showed association with anaemia before antenatal care (p= 0.007). A personal source of income may reduce anaemia in pregnancy; and it is advisable to have a social welfare package for unemployed pregnant women. [ABSTRACT FROM PUBLISHER]

Background: Malaria is preventable but has contributed significantly to maternal morbidity and mortality in our environment. Malaria parasitaemia during pregnancy is mostly asymptomatic, untreated but with complications. Aim: A follow-up study aimed at determining plasmodium falciparum parasitaemia and associated complications among booked parturient who had intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) compared with another study among unbooked parturients who did not take SP for intermittent preventive treatment in pregnancy (IPTp). Materials and Methods: This study was conducted in the labour ward complex of Federal Teaching Hospital, Abakaliki from March to May 2012. Five hundred booked parturients at term that received two doses of SP were consecutively recruited. A structured data collection sheet was administered to each parturient. Thick and thin blood films were prepared for quantification and speciation of parasitaemia, respectively. The haemoglobin concentration and birth weights were determined. Analysis was done with the Statistical Package for the Social Sciences (SPSS) software with level of significance at P value < 0.05. Results: The prevalence of malaria parasitaemia in the study was 59.6%. The mean age of parturients was 28.7 (5.5). The highest prevalence of malaria parasitaemia, 92% was found among the parturients aged ≤19 years. The association between age and parasitaemia was significant (x2 = 16.496, P = 0.000). The median parity was 1.0 (3.0). The highest prevalence of asymptomatic parasitaemia, 65.5% was noted among the nulliparous parturients. The association between parity and parasitaemia was significant (x2 = 11.551, P = 0.003). Majority of the parturients were of high social class. Those of the lowest social class (class 5) had the highest prevalence (80%) of parasitaemia. The association between social class and parasitaemia was significant (x2 = 9.131, P = 0.003). Prevalence of anaemia in the study was 14%. The non-parasitaemic and parasitaemic parturients had mean haemoglobin concentrations of 12.7 g/dl and 10.4 g/dl, respectively. There was significant association between haemoglobin concentration and parasitaemia (x2 = 39.143, P = 0.000). The prevalence of low birth weight was 3.0%. The relationship between birth weight and parasitaemia was significant (x2 = 2.535, P = 0.000). Conclusion: The was reduction in asymptomatic malaria parasitaemia compared to parturients who had no SP though the prevalence was still high showing possibly increasing resistance to SP but the treatment was still very effective in reducing anaemia and low birth weight associated with malaria in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Schoolchildren are vulnerable to anaemia because of their higher iron need to meet the demands of puberty and adolescence. Objective: The survey determined the haemoglobin levels of schoolchildren aged 6-15 years and the factors affecting their haemoglobin status. Design: Data were obtained through a cross sectional survey of 450 randomly selected schoolchildren in Ede-Oballa, Nsukka, Enugu State, Nigeria. Ninety were selected for clinical examination, biochemical tests, and nutrient intake study. Haemoglobin, malaria, and stool analysis were carried out by the cyanmethaemoglobin, thin blood film, and wet mount direct methods, respectively. Iron intake was determined by a three-day weighed food intake. Results: Results showed that the schoolchildren had pallor (35.6%), brittle hair (31.1%), koilonychia (2.2%), oedema (4.4%) and sore/smooth tongue (7.8%). The children also had malaria (58.9%) and Entamoeba histolytica (42.2%), hookworm (36.7%), tapeworm (35.6%), whipworm (34.5%), and roundworm (27.9%) infestations. Iron intake was inadequate (<100% of recommended nutrient intake) for most of the children. The mean haemoglobin levels of the schoolchildren were low. The 6-9, 10-12, and 13-15 year olds had 9.0, 9.1, and 9.3 g/dl, respectively. Most (85.5%) of them had anaemia. Moderate anaemia was prevalent in 62.2%. Severe anaemia affected the 6-9 year olds more. Malaria (P<0.001), Entamoeba histolytica (P<0.01), hookworm (P<0.05), tapeworm (P<0.01), and whipworm (P<0.001) caused significant reduction in haemoglobin level. Age (b=1.284, P<0.05), birth order (b=0.629, P<0.01), frequency of illness attack (b=1.372, P<0.01), household size (b=0.526, P<0.05), and frequency of skipping breakfast (b=1.542, P<0.001) were factors that influenced the haemoglobin status of the children. Conclusion: The schoolchildren had poor iron status as a result of consumption of plant sources of iron with low bioavailability, parasitic infections, birth order, skipping of breakfast, large household size, and frequent bouts of illnesses. [ABSTRACT FROM AUTHOR]

In developing countries such as Nigeria, anaemia in pregnancy is thought to be one of the most common complications of pregnancy accounting for a significant level of maternal morbidity and mortality. The aim of this study was to determine the prevalence of anaemia in pregnancy among women attending the booking Antenatal Clinic (ANC) in Benue State University Teaching Hospital (BSUTH), North-Central, Nigeria. A cross-sectional descriptive study was conducted from May 2019 to January, 2020 on 299 women. A structured interviewer administered questionnaire was used to obtain socio-demographic, clinical, and nutritional information from pregnant women attending the clinic who consented to participate in the study. Haematocrit levels were stratified according to the World Health Organisation's (WHO) classification as follows: <7mg/dL - severe, 7-8.99mg/dL - moderate, 9-10.99mg/dL - mild anaemia and ≧ 11mg/dL - non-anaemic. Data were analysed using SPSS version 25.0. Chi-square test was conducted to determine relationships. Multivariate logistic regression model was used to identify the risk factors for anaemia among pregnant women. P-value <0.05 and odds ratio with a 95% confidence interval were used to assess the association. The mean age of respondents was 29.9, ranging from 18 - 40 years. One hundred and twenty-three (41.1%) women were anaemic (haemoglobin [Hb] < 11.0 g/dL). The majority (95.1%) of these anaemic patients were mildly anaemic, whereas 4.9% were moderately anaemic. There was no case of severe anaemia (Hb < 7.0 g/dL). The prevalence of anaemia was significantly higher in those within the age group of 20-24 years and those with lower levels of education (P < 0.05). The patient's gestational age, number of miscarriages and birth interval had no significant relationship with the haemoglobin concentration among the pregnant women in this study (P > 0.05). However, parity, clinical features such as fever, and practices like use of haematinics and non-consumption of meat, poultry and fish were significantly related to anaemia (P < 0.05). The pregnant women who did not take haematinics were 5.8 times likely to develop anaemia (OR=5.8, 95%CI [2.3, 14.5]) while pregnant women who did not eat meat, poultry or fish were 9 times more likely to become anaemic than pregnant women who ate (OR=9.0, 95%CI [1.0, 79.5]). The prevalence of anaemia in pregnancy is high among women attending booking antenatal clinic at BSUTH, North-Central, Nigeria, and requires specific intervention that address the identified risk factors.

Abstract: Ethnopharmacological relevance: Different parts of the plant Diospyros mespiliformis have been used traditionally for the treatment of ailments in Nigeria particularly among the Kamwe people of Michika local government area of Adamawa State where the root has been used as an anti-malarial for ages. Most of the uses have been without any scientific evidence and toxicological assessment. The present study aimed to determine acute toxicity profile as well as the effect of prolonged administration of the extract on clinical, haematological and biochemical parameters of albino rats. Materials and methods: Thirty and twenty-five Wistar rats of both sexes and of varying weights were, respectively, used for acute toxicity study and prolonged administration study of crude ethanolic root extract of Diospyros mespiliformis. The rats used for both studies were each administered graded concentrations of the extract (100, 200, 400, 800 and 1600mg/kg) for acute toxicity testing and (50, 100, 200 and 400mg/kg) for the study of the effect of prolonged administration. The rats used for acute toxicity study were observed for a period of 24h for signs of toxicity and eventual death while parameters for prolonged study were recorded at weekly interval starting from day zero up to day 28 post administration. Results: The extract produced an intraperitoneal LD50 of 570mg/kg. Body weight changes were not statistically significant (p>0.05) while haematological parameters (packed cell volume (PCV)), haemoglobin concentration (Hb), red blood cells (RBC), white blood cells (WBC) and differential leucocyte counts (DLC) were significantly modulated (p>0.05) after administration. Haematological indices (mean corpuscular volume (MCV)), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentrations (MCHC) were similarly modulated significantly (p>0.05). Conclusions: The extract appeared to be moderately toxic while prolonged administration improved the blood parameters of rats, suggesting that the plant׳s extract at lower doses can be used for a prolonged period, without deleterious effect on the haematological profile and serum enzymes. [Copyright &y& Elsevier]

We conducted a study to assess trends in haemoglobin recovery among HIV-infected patients initiated on zidovudine-based combination antiretroviral therapy (cART) stratified by baseline haemoglobin level. Haemoglobin data from non-pregnant adult patients initiating cART in rural north-central Nigeria between June 2009 and May 2011 were analysed using a linear mixed effects model to assess the interaction between time, zidovudine-containing regimen and baseline haemoglobin level on the outcome of subsequent haemoglobin level. Best-fit curves were created for baseline haemoglobin in the 10th, 25th, 75th and 90th percentiles. We included 313 patients with 736 measures of haemoglobin in the analysis (239 on zidovudine and 74 on non-zidovudine-containing regimens). Median haemoglobin increased over time in both groups, with differences in haemoglobin response over time related to baseline haemoglobin levels and zidovudine use (p = 0.003). The groups of patients on zidovudine at the 10th and 90th percentiles had downward sloping curves while all other groups had upward trending haemoglobin levels. Although haemoglobin levels increased overall for patients on zidovudine-containing regimens, for those in the 10th and 90th percentiles haemoglobin levels trended downward over time. These results have implications for decisions regarding when to initiate, switch from or avoid the use of zidovudine. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterize the genetic pool of the West African Dwarf (WAD) goats using haemoglobin (Hb) polymorphism, as well as the association of some morphological traits with the Hb variants. Blood samples were collected from a total of 104 mature goats of both sexes belonging to the WAD breed in north central Nigeria. The red cell lysates were subjected to cellulose acetate electrophoresis and specific staining procedure to reveal the band patterns of haemoglobin. Three co-dominant alleles, causing the presence of three genotypes (AA, AB and AC) were detected among individual goats. The frequencies of the A, B and C alleles were 0.69, 0.30 and 0.01, respec- tively. The corresponding genotype frequencies for AA, AB and AC in the goat population were 0.37, 0.61 and 0.02, respectively. The discrepancy between the observed and the expected genotype number was significant (P<0.05) thereby violating the Hardy-Weinberg frequencies. The expected heterozygosity (H), which is a measure of gene diversity in the population, was 0.57; while the local inbreeding coefficient (F) was -0.055 indicating disassortative mating. Apart from body weight and heart girth which were higher (P<0.05) in individuals with Hb AA genotype, other body parameters were not significantly influenced (P>0.05) by Hb variants. There is a need for further study encom- passing more number of goats covering larger areas, use of DNA markers and their relationship with economic traits as well as performance study for detailed understanding of breed characteristics, conservation and genetic improvement of WAD goats in north central Nigeria. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate a traditional herbal preparation, Jobelyn,® for its effects on anemia and CD4+ T-cell counts in human immunodeficiency virus-positive (HIV+) patients in Nigeria. Design: An open-label pilot study involving 10 confirmed (HIV+) patients who were not receiving antiretroviral therapy (ARVT) was performed, in which the patients consumed Jobelyn for 8 weeks, at a dose of 500 mg twice daily. The pilot study was followed by a controlled trial involving 51 patients, all confirmed HIV+, where the patients with CD4+ T-cell counts below 350 cells/μL were receiving ARVT. The eight patients with baseline CD4+ T-cell counts above 350 cells/μL received Jobelyn. The remaining patients who all received ARVT were randomized to ARVT alone versus ARVT+Jobelyn for 12 weeks. Results: Patients receiving ARVT showed a statistically significant improvement in their CD4+ T-cell counts across the 12-week study period ( p<0.01). Patients receiving ARVT+Jobelyn showed a faster improvement, reaching a high level of statistical significance compared to baseline already at 6 weeks ( p<0.001), and remained highly significant at 12 weeks ( p<0.001). Conclusions: This is the first controlled study conducted to evaluate efficacy of Jobelyn on immune status in HIV+ patients. The data suggest that consumption of Jobelyn contributed to improved hemoglobin levels and increased CD4+ T-cell counts in Nigerian HIV+ patients. Further studies are needed to examine similar effects in other populations, and to elaborate on the underlying mechanisms, specifically, whether the consumption of Jobelyn supported multiple aspects of bone marrow function. [ABSTRACT FROM AUTHOR]

Introduction. Hypertransfusion refers to chronic blood transfusion therapy aimed at ameliorating disease complications in various haemopathies particularly the haemoglobinopathies. In sickle cell disease, hypertransfusion is aimed at maintaining patient's haemoglobin level at 10 to 11 g/dL using haemoglobin AA blood and its resultant dilutional effect on sickle haemoglobin is sustained by intermittent long-term transfusions. Aim and Objective. This paper highlights hypertransfusion and its privileged position as a secondary measure in prevention and treatment of sickle cell disease, especially in the Nigerian context. Materials and Methods. Relevant literatures were searched on PubMed, Google Scholar and standard texts in haematology and transfusion medicine. Keywords used in the search are hypertransfusion, sickle cell disease, chronic transfusion, and Nigeria. Literatures gathered were reviewed, summarized, and presented in this paper. Result. Immense clinical benefit is associated with hypertransfusion therapy including prevention of stroke and amelioration of severe sickle cell disease especially in transplant ineligible patients. Careful patient selections, appropriate blood component, and prevention of transfusion hazards as well as oversight function of an experienced haematologist are pertinent to a successful hypertransfusion therapy. Conclusion. Improved knowledge of the benefits and practice of hypertransfusion will effectively translate into improved health status even among Nigerian sickle cell disease patients. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the fraction of anaemia attributable to malaria and sickle cell disease (SCD) among children aged 6-59 months in Nigeria., Design: Cross-sectional analysis of data from Nigeria's 2018 Demographic and Health Survey (DHS)., Setting: Nigeria., Participants: 11 536 children aged 6-59 months from randomly selected households were eligible for participation, of whom 11 142 had complete and valid biomarker data required for this analysis. Maternal education data were available from 10 305 of these children., Primary Outcome Measure: Haemoglobin concentration., Results: We found that 70.6% (95% CI: 62.7% to 78.5%) of severe anaemia was attributable to malaria compared with 12.4% (95% CI: 11.1% to 13.7%) of mild-to-severe and 29.6% (95% CI: 29.6% to 31.8%) of moderate-to-severe anaemia and that SCD contributed 0.6% (95% CI: 0.4% to 0.9%), 1.3% (95% CI: 1.0% to 1.7%) and 10.6% (95% CI: 6.7% to 14.9%) mild-to-severe, moderate-to-severe and severe anaemia, respectively. Sickle trait was protective against anaemia and was associated with higher haemoglobin concentration compared with children with normal haemoglobin (HbAA) among malaria-positive but not malaria-negative children., Conclusions: This approach used offers a new tool to estimate the contribution of malaria to anaemia in many settings using widely available DHS data. The fraction of anaemia among young children in Nigeria attributable to malaria and SCD is higher at more severe levels of anaemia. Prevention of malaria and SCD and timely treatment of affected individuals would reduce cases of severe anaemia., Competing Interests: Competing interests: FBP received fees from Bluebird Bio, Novartis, and Analytics Group for work unrelated to this study., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: Androgenetic alopecia (AGA) is the most common form of alopecia, affecting 50% of the adult population world-wide. The exact mechanisms of this common hair disorder are yet to be fully elucidated. It is believed to be related to high circulating androgen levels in the blood and it is genetically determined. Deficiencies of micronutrients such as iron in the development of AGA have been a subject of debate., Objective: This study sought to determine the association between serum ferritin levels and androgenetic alopecia among patients attending the Dermatology clinic at a tertiary health facility in South-Western Nigeria., Methods: This was a hospital based cross sectional study with a total of 114 participants, which consisted of 57 subjects with AGA and 57 age and sex-matched healthy adults without AGAwho met the inclusion criteria. The diagnosis of AGA was made clinically and with the aid of a Dermatoscope (Wi-Fi Digital Microscope RoHS YPC&#95;X03 V2018, HD Colour CMOS sensor with 50X-1000X magnification and HD resolution 1920x1080P)., Results: The mean age of the study participants was 41.68 ± 12.86 years with age ranging from 24 to 80 years. The mean serum ferritin levels among the subjects and control group were 188.65 ±97.92ng/ml and 194.49 ± 76.67ng/ml respectively but this difference was not statistically significant (p = 0.724). However, subjects with premature AGA had a significantly lower serum ferritin level compared to those with adult-onset AGA (p = 0.020)., Conclusion: Iron deficiency is known to cause quantitative defect in haemoglobin production, limiting the amount of oxygen transported for hair growth and this, in addition to genetic factors, may explain why individuals with premature AGA have a significantly low serum ferritin levels., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2022 by West African Journal of Medicine.)

Abstract: Ethnopharmacological relevance: Aframomum melegueta is a popular medicinal plant in Nigeria believed to have many agents acting in different ways to bring about human health benefits. This study aimed to determine the acute toxicity, identify some phytochemicals known to be present in this plant and the possible effects on lipid profile, haematological indices and biomarker of prostate and cardiac dysfunction. Materials and methods: Twenty four Wistar rats (284–326g) were used in four groups of six animals. Group 1 (control) received normal saline; groups 2, 3 and 4, received intraperitoneal injection of 27.39, 54.77 and 82.16mg/kg body weight of the extract respectively for 7 days. Haematological and biochemical parameters were measured. Results: Alkaloids, flavonoids, saponins, tannins, cardiac glycosides, terpenoids and steroids were identified in this plant extract. The LD50 was 273.86mg/kg body weight. Prostate Specific Antigen (PSA) decreased significantly in group 2. Testosterone increased significantly in all the test groups compared to the control. Cardiac troponin I (0ng/dl) was recorded for the test groups while the control had 1.69±0.12ng/dl. Lipid profile results showed increase in HDL and decrease in total cholesterol and LDL-cholesterol. Haemoglobin (Hb) and Red Blood Cells count (RBC) decreased significantly in group 4. White Blood Cells count (WBC), Mean Cell Volume (MCV), Mean Cell Haemoglobin (MCH) and Mean Cell Haemoglobin Concentration (MCHC) did not change significantly. Conclusion: Aframomum melegueta seed oil has the potential of ameliorating benign prostatic hyperplasia (BPH) and cardiac dysfunction as indicated by testosterone, PSA, lipid profile and troponin I levels. The LD50 of 273.86mg/kg body weight is indicative of mild toxicity. The lower than normal Hb, RBC confirms the possibility of toxicity. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: The sclerotia of Pleurotus tuberregium are used in Southern Nigeria for the management of diabetes and hypertension, yet there is scarcity of information in the literature regarding the evaluation of the biochemical basis of its antihypertensive property, as well as the biochemical impact of its administration to the hypertensive. Thus, in this study, the ability of an aqueous extract of the sclerotia of Pleurotus tuberregium to moderate biochemical and hematological indices was investigated in normal and sub-chronic salt-loaded rats. Materials and methods: The normal and treatment control groups received a diet consisting 100% of the commercial feed, while the test control, reference and test treatment groups received an 8% salt-loaded diet. The extract was orally administered daily at 100 and 200mg/kg body weight; while the moduretics was administered at 1mg/kg. The normal and test control groups received appropriate volumes of water by the same route. Results: On gas chromatographic analysis of the crude aqueous extract, 29 known flavonoids (mainly 47.71% kaempferol and 37.36% quercetin), four saponins (mainly 72.93% avenacin B1 and 26.80% avenacin A1), six hydroxycinnamic acid derivatives (mainly 57.57% p-coumaric and 42.10% caffeic acid), ten carotenoids (mainly 58.44% carotene and 28.16% lycopene) and seven phytosterols (mainly 98.16% sitosterol) were detected. Also detected were nine benzoic acid derivatives (mainly 44.19% ferulic acid and 25.92% rosmarinic acid), six lignans (mainly 70.88% galgravin and 22.69% retusin), three allicins (mainly 71.92% diallyl thiosulphinate and 23.68% methyl allyl thiosulphinate), seven glycosides (mainly 84.86% arbutin and 12.01% ouabain), 31 alkaloids (mainly 48.82% lupanine, 32.26% augustamine) and 24 terpenes (mainly 60.66% limonene and 6.52% geranyl acetate). Compared to test control, the treatment significantly, dose-dependently lowered (P<0.05) the mean cell volume, atherogenic indices (cardiac risk ratio, atherogenic coefficient and atherogenic index of plasma), plasma alanine and aspartate transaminase activities, mean cell hemoglobin, sodium, bicarbonate, urea, blood urea nitrogen, triglyceride, total-, non-high density lipoprotein-, low density lipoprotein- and very low density lipoprotein cholesterol concentrations, and neutrophils, monocytes and platelets counts of the treated animals. However, it significantly, dose-dependently increased (P<0.05) the hemoglobin concentration, mean cell hemoglobin, red cells and lymphocytes counts, plasma high density lipoprotein cholesterol, calcium, potassium, chloride, creatinine, albumin and total protein concentrations of the treated animals. Conclusions: All these results support the use of the plant in traditional health care, for the management of hypertension, and highlight the cardio-protective potential of the sclerotia, whilst suggesting that its antihypertensive activity may be mediated through alteration of plasma levels of sodium and potassium, or increases in muscle tone brought about by changes in plasma calcium levels. [Copyright &y& Elsevier]

Aim: Malaria is prevalent in the tropical and subtropical regions of the world and has been associated with some haematological changes. This study determined the effect of malaria infection on haematological values amongst children in north-western Nigeria. Materials and methods: Fifty-eight malaria-infected children, aged 1-12 years, and 58 age-matched uninfected children were studied between September and December 2011 at Aminu Kano Teaching Hospital, Kano. Blood samples collected were analysed for full blood count using a Swelab Alfa 3-part analyser and malaria parasite test using the field staining technique. Results: There were significantly lower values of haematocrit, haemoglobin concentration, and platelet count of 29.0 ± 4.7%, 10.0 ± 1.7 g/L, and 195.9 ± 111.9 x 109/L in malaria-infected children compared to 32.3 ± 2.8%, 11.1 ± 1.1 g/L, and (287.4 ± 92.6) x 109/L, respectively, in uninfected control subjects (P < 0.05), while the values of total white blood cell count, granulocyte count, lymphocyte count, and mid-cell count in malaria-infected and noninfected children showed no significant differences (P > 0.05). Parasite densities had no significant influences on haematocrit, haemoglobin, or white blood cell counts (P > 0.05), but showed influence on platelet count (P < 0.05). Conclusion: Changes in haematological values in malaria-infected children are associated with anaemia and thrombocytopaenia irrespective of their sex. It is recommended that platelet count be determined as it could assist in the diagnosis of malaria infection. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to study some hematologic parameters, here, the packed cell volume (PCV), the red blood cell (RBC) count, hemoglobin concentration (HC) and white blood cell (WBC) count in residents of Offa in Kwara state, Nigeria Methods: Blood samples of healthy male and female Offa indigenes were analyzed for RBC count, PCV, HC and WBC count. Results: The mean HC was 14.6 and 13.71 g/dl of blood, for both males and females respectively, while the mean PCV was 43.1% and 40.4% for both males and females, respectively. The mean RBC count for males was 5.45 × 166 cells per mm³ while that of females was 4.55 × 106 / mm³. Conclusion: All values investigated were lower than that for Caucasians. The probable causes of the differences between the above values as compared to those of the western world were also discussed. [ABSTRACT FROM AUTHOR]

Background: Sickle cell anaemia is the most common genetic disorder worldwide as well as in Nigeria. Delay in the diagnosis of the condition constitutes an important cause of concern for caretakers of affected children. Objective: To determine the age at diagnosis in a population of children with sickle cell anaemia in Lagos, Nigeria Methodology: The study was conducted between October and December 2009 at the sickle cell clinic of the Department of Paediatrics of Lagos State University Teaching Hospital, Ikeja, Lagos in South west Nigeria. By convenience sampling, a total of 192 children with sickle cell anaemia aged six months to 15 years were interviewed with the aid of a structured questionnaire. Results: Overall, the mean age at confirmation of haemoglobin genotype was 27.33 months (± 26. 36 months). The mean age at diagnosis was significantly lower among males than females (25.59 ± 27.74 Vs. 29.14 ± 24.85, p = 0.04). A quarter of the children were diagnosed before infancy and three-quarters before three years of age. Upper social stratum and small family size were significantly associated with earlier diagnosis of sickle cell anaemia. Conclusion: Too few subjects are diagnosed in infancy. Routine screening should ideally be done at birth and neonatal period or at the latest, between six and nine months. [ABSTRACT FROM AUTHOR]

Background: Low hemoglobin (Hb) and iron deficiency among child bearing females have been linked to decreased immune system function, impaired cognitive functioning and complications in pregnancy. Methods: A total of 106 blood samples from apparently healthy nulliparous female students were assayed for Hb and serum iron concentrations using the cyanmethemoglobin and bathophenanthroline methods, respectively, to evaluate changes that may occur in these parameters at different phases of the reproductive cycle. Results: The mean (SD) Hb values during the ovulatory, menstrual, and follicular phases were 13.27 (1.14) g/dL, 12.05 (1.31) g/dL, and 12.23 (1. 56) g/dL, respectively. The prevalence of anemia (Hb<12 g/dL) was reported among 21 (19.8%) subjects, and 31 subjects declined to complete their samples collection. The mean serum iron concentrations during the 3 phases were 92.98 (18.25) μg/dL, 79.90 (13.14) μg/dL and 70.85 (18.65) μg/dL, respectively. A total of 28 (26.4%) study participants showed iron deficiency (serum level, <65 μg/dL). These variations in the values of Hb and serum iron concentrations were statistically significant in the 3 phases. However, no significant difference was observed in Hb concentrations between the menstrual and follicular phases. Of interest, a positive correlation was observed between the hemoglobin and serum iron concentrations within the phases, with the exception of a few cases that showed negative correlations. Conclusion: Menstruation has been shown to be the major cause of anemia and iron deficiency in nulliparous women. A prophylactic dose of iron and folate supplements may be indicated for menstruating females to cushion the adverse effects of menstruation on ematologic status. [ABSTRACT FROM AUTHOR]

This study was designed to validate or refute the reliability of total lymphocyte count (TLC) and other hematological parameters as a substitute for CD4 cell counts. Participants consisted of two groups, including 416 antiretroviral naive (G1) and 328 antiretroviral experienced (G2) patients. CD4+ T cell counts were performed using a Cyflow machine. Hematological parameters were analyzed using a hematology analyzer. The median ± SEM CD4 count (range) of participants in G1 was 199 ± 10.9 (5-1840 cells/μL) and the median ± SEM TLC (range) was 1. 61 ± 0.05 (0.07-6.63 × 103/μL). The corresponding values among G2 were 421 ± 15.8 (13-1801) and 2.13 ± 0.04 (0.06-5.58), respectively. Using a threshold value of 1.2 × 103/μL for TLC alone, the sensitivity of G1 was 88.4% (specificity (SP) 67.4%, the positive predictive value (PPV) 53.5% and negative predictive value (NPV) of 93.2% for CD4 , 200 cells/μL, the sensitivity for G2 was 83.3%, SP 85.3%, PPV 23.8%, and NPV of 93.2%. Using multiple parameters, including TLC , 1.2 × 103/μL, hemoglobin , 10 g/dL, and platelets , 150 × 103/L, the sensitivity increased to 96.0% (SP, 82.7%; PPV, 80%; NPV, 96.7%) among G1, while no change was observed in the G2 cohort. TLC , 1.2 × 103/μL alone is an insensitive predictor of CD4 count of , 200 cells/μL. Incorporating hemoglobin , 10 g/dL, and platelets , 150 × 103/L enhances the ability of TLC , 1.2 × 103/μL to predict CD4 count , 200 cells/μL among the antiretroviral-naïve cohort. We recommend the use of multiple, inexpensively measured hematological parameters in the form of an algorithm for predicting CD4 count level. [ABSTRACT FROM AUTHOR]