Department of Child Healthhttp://ugspace.ug.edu.gh:8080/handle/123456789/35612024-03-28T22:14:47Z2024-03-28T22:14:47ZDiagnostic accuracy of Xpert MTB/RIF Ultra for childhood tuberculosis in West Africa – a multicenter pragmatic studyDiallo, A.B.Osman, K.A.Tolofoudie, M.et al.http://ugspace.ug.edu.gh:8080/handle/123456789/414062024-03-05T10:29:40Z2024-01-01T00:00:00ZDiagnostic accuracy of Xpert MTB/RIF Ultra for childhood tuberculosis in West Africa – a multicenter pragmatic study
Diallo, A.B.; Osman, K.A.; Tolofoudie, M.; et al.
Objective: To evaluate the performance of Xpert Mycobacterium Tuberculosis/rifampicin (MTB/RIF) Ultra
(Ultra) for diagnosis of childhood tuberculosis (TB) within public health systems.
Methods: In this cross-sectional study, children aged <15 years with presumptive pulmonary TB were
consecutively recruited and evaluated for TB at tertiary-level hospitals in Benin, Mali, and Ghana. Bivariate
random-effects models were used to determine the pooled sensitivity and specificity of Ultra against
culture. We also estimated its diagnostic yield against a composite microbiological reference standard
(cMRS) of positive culture or Ultra.
Results: Overall, 193 children were included in the analyses with a median (interquartile range) age of 4.0
(1.1-9.2) years, 88 (45.6%) were female, and 36 (18.7%) were HIV-positive. Thirty-one (16.1%) children had
confirmed TB, 39 (20.2%) had unconfirmed TB, and 123 (63.7%) had unlikely TB. The pooled sensitivity
and specificity of Ultra verified by culture were 55.0% (95% confidence interval [CI]: 28.0–79.0%) and
95.0% (95% CI: 88.0–98.0%), respectively. Against the cMRS, the diagnostic yield of Ultra and culture were
67.7% (95% CI: 48.6–83.3%) and 70.9% (95% CI: 51.9–85.8%), respectively.
Conclusion: Ultra has suboptimal sensitivity in children with TB that were investigated under routine
conditions in tertiary-level hospitals in three West African countries
Research Article
2024-01-01T00:00:00ZClinical and laboratory characteristics of children with sickle cell disease on hydroxyurea treated with artemether-lumefantrine for acute uncomplicated malariaSegbefia, C.Amponsah, S.K.Afrane, A.K.A.et al.http://ugspace.ug.edu.gh:8080/handle/123456789/413432024-02-20T14:08:58Z2023-01-01T00:00:00ZClinical and laboratory characteristics of children with sickle cell disease on hydroxyurea treated with artemether-lumefantrine for acute uncomplicated malaria
Segbefia, C.; Amponsah, S.K.; Afrane, A.K.A.; et al.
Introduction: Limited information exists on any interactions between hydroxyurea
(HU) and antimalarials in sickle cell disease (SCD). We evaluated changes in clinical
and laboratory parameters among children with SCD on HU therapy treated with
artemether-lumefantrine (AL) for acute uncomplicated malaria (UM).
Methods: A prospective, non-randomized, pilot study of 127 children with SCD
(23, UM; 104, steady state) were recruited from three hospitals in Accra. UM
participants were treated with standard doses of AL and followed up, on days 1,
2, 3, 7, 14, and 28. Venous blood was collected at baseline and follow-up days
in participants with UM for determination of malaria parasitaemia, full blood
count, reticulocytes, and clinical chemistry. Further, Plasmodium falciparum
identification of rapid diagnostic test (RDT) positive samples was done using
nested polymerase chain reaction (PCR).
Results: Among SCD participants with UM, admission temperature, neutrophils,
alanine-aminotransferase, gamma-glutamyl-transferase, and haemoglobin
significantly differed between HU recipients (HU+) and steady state, while
white blood cell, neutrophils, reticulocytes, bilirubin, urea, and temperature
differed significantly between non-HU recipients (no-HU), and steady state.
Mean parasitaemia (HU+, 2930.3 vs. no-HU, 1,060, p = 0.74) and adverse events
(HU+, 13.9% vs. no-HU, 14.3%), were comparable (p = 0.94). Day 28 reticulocyte
count was higher in the HU+ (0.24) (0.17 to 0.37) vs. no-HU, [0.15 (0.09 to 0.27),
p = 0.022]. Significant differences in lymphocyte [HU+ 2.74 95% CI (−5.38 to
58.57) vs. no-HU −0.34 (−3.19 to 4.44), p = 0.024]; bilirubin [HU+, −4.44 (−16.36
to 20.74) vs. no-HU −18.37 (−108.79 to −7.16)]; and alanine aminotransferase,
[HU+, −4.00 (−48.55 to 6.00) vs. no-HU, 7.00 (−22.00 to 22.00)] were observed
during follow up Conclusion: Parasite clearance and adverse event occurrence were comparable
between SCD children treated with AL irrespective of HU status. However, distinct
patterns of changes in laboratory indices suggest the need for larger, more
focused studies.
Research Article
2023-01-01T00:00:00ZPain Frequency and Health Care Utilization Patterns in Women with Sickle Cell Disease Experiencing Menstruation-Associated Pain CrisesSegbefia, C.Campbell, J.Tartaglione, I.et al.http://ugspace.ug.edu.gh:8080/handle/123456789/411242024-01-25T12:35:12Z2023-01-01T00:00:00ZPain Frequency and Health Care Utilization Patterns in Women with Sickle Cell Disease Experiencing Menstruation-Associated Pain Crises
Segbefia, C.; Campbell, J.; Tartaglione, I.; et al.
Background: Pain crises in sickle cell disease (SCD) lead to high rates of health care utilization. Historically,
women have reported higher pain burdens than men, with recent studies showing a temporal association between
pain crisis and menstruation. However, health care utilization patterns of SCD women with menstruation associated pain crises have not been reported. We studied the frequency, severity, and health care utilization of
menstruation-associated pain crises in SCD women.
Materials and Methods: A multinational, cross-sectional cohort study of the SCD phenotype was executed
using a validated questionnaire and medical chart review from the Consortium for the Advancement of Sickle Cell Research (CASiRe) cohort. Total number of pain crises, emergency room/day hospital visits,
and hospitalizations were collected from a subcohort of 178 SCD women within the past 6 months and
previous year.
Results: Thirty-nine percent of women reported menstruation-associated pain crises in their lifetime. These
women were significantly more likely to be hospitalized compared with those who did not (mean 1.70 vs. 0.67,
p = 0.0005). Women reporting menstruation-associated pain crises in the past 6 months also experienced
increased hospitalizations compared with those who did not (mean 1.71 vs. 0.75, p = 0.0016). Forty percent of
women reported at least four menstruation-associated pain crises in the past 6 months.
Conclusions: Nearly 40% of SCD women have menstruation-associated pain crises. Menstruation-associated
pain crises are associated with high pain burden and increased rates of hospitalization. Strategies are needed to
address health care disparities within gynecologic care in SCD.
Research Article
2023-01-01T00:00:00ZProspective identifcation of variables as outcomes for treatment (PIVOT): study protocol for a randomised, placebo-controlled trial of hydroxyurea for Ghanaian children and adults with haemoglobin SC diseaseSmart, L.R.Segbefa, C.I.Amissah‑Arthur, K.N.et al.http://ugspace.ug.edu.gh:8080/handle/123456789/402822023-10-09T10:54:07Z2023-01-01T00:00:00ZProspective identifcation of variables as outcomes for treatment (PIVOT): study protocol for a randomised, placebo-controlled trial of hydroxyurea for Ghanaian children and adults with haemoglobin SC disease
Smart, L.R.; Segbefa, C.I.; Amissah‑Arthur, K.N.; et al.
Background Haemoglobin SC (HbSC) is a common form of sickle cell disease (SCD), especially among individuals
of West African ancestry. Persons with HbSC disease sufer from the same clinical complications and reduced quality
of life that afect those with sickle cell anaemia (HbSS/Sβ0
). Retrospective anecdotal data suggest short-term safety
and benefts of hydroxyurea for treating HbSC, yet rigorous prospective data are lacking regarding optimal dosing,
clinical and laboratory efects, long-term safety and benefts, and appropriate endpoints to monitor. Prospective
Investigation of Variables as Outcomes for Treatment (PIVOT) was designed with three aims: (1) to measure the toxici‑
ties of hydroxyurea treatment on laboratory parameters, (2) to assess the efects of hydroxyurea treatment on sickle-related clinical and laboratory parameters, and (3) to identify study endpoints suitable for a future defnitive phase III
trial of hydroxyurea treatment of HbSC disease.
Methods PIVOT is a randomised, placebo-controlled, double blind clinical trial of hydroxyurea. Approximately 120
children and 120 adults ages 5–50 years with HbSC disease will be enrolled, screened for 2 months, and then ran‑
domised 1:1 to once-daily oral hydroxyurea or placebo. Study treatment will be prescribed initially at 20±5 mg/kg/
day with an opportunity to escalate the dose twice over the frst 6 months. After 12 months of blinded study treat‑
ment, all participants will be ofered open-label hydroxyurea for up to 4 years. Safety outcomes include treatment-related cytopenias, whole blood viscosity, and adverse events. Efcacy outcomes include a variety of laboratory
and clinical parameters over the frst 12 months of randomised treatment, including changes in haemoglobin
and fetal haemoglobin, intracranial arterial velocities measured by transcranial Doppler ultrasound, cerebral oxygena‑
tion using near infrared spectrometry, spleen volume and kidney size by ultrasound, proteinuria, and retinal imaging.
Exploratory outcomes include functional erythrocyte analyses with ektacytometry for red blood cell deformability
and point-of-sickling, patient-reported outcomes using the PROMIS questionnaire, and 6-min walk test.
Research Article
2023-01-01T00:00:00Z