Tropical Medicine & International Health

Backgroundanaemia remains a major comorbidity among children living with HIV (CLHIV) in sub-Saharan Africa, yet sex-specific risk factors are poorly characterized. This study investigated the prevalence and sex-based determinants of anaemia among CLHIV in the Southern Province, Zambia. MethodsA retrospective cohort study was conducted using medical records from 321 CLHIV aged 0-14 years. Data on demographic, clinical, and anthropometric variables were analysed. Sex-stratified multivariable logistic regression identified factors associated with anaemia. ResultsOverall anaemia prevalence was 47.0% (151/321), with a higher, though not statistically significant, burden in males (52.6%) than females (41.9%). Younger age was a strong, independent risk factor across both sexes. Distinct sex-specific determinants were identified. In males, cotrimoxazole (CTX) use during treatment was associated with increased odds of anaemia (Adjusted Odds Ratio, AOR=3.04; 95% CI: 0.95-9.74). Conversely, among females, the type of caregiver was a significant factor; care provided by an aunt was associated with 90% lower odds of anaemia compared to other arrangements (AOR=0.10; 95% CI: 0.01-0.90). Poor anthropometric indices (height and weight) were significantly associated with anaemia in both sexes. ConclusionsThe study findings reveal a high prevalence of anaemia among CLHIV in Zambia, with nuanced sex-based differences in its determinants. The findings advocate for differentiated, gender-sensitive intervention strategies. For boys, careful review of CTX prophylaxis is warranted, while for girls, enhancing supportive caregiving environments may be protective. Integrating these sex-specific approaches into paediatric HIV programs is crucial for reducing the anaemia burden and improving clinical outcomes.

IntroductionAnaemia is a major cause of morbidity and mortality among children in sub-Saharan Africa. Anaemia has many aetiologies best addressed by different treatments, so regional studies of the aetiology of anaemia may be required. MethodsWe analysed data from Nigerias 2018 Demographic and Health Survey (DHS) to study predictors of anaemia among children ages 6-59m. We computed the fraction of anaemia at different degrees of severity attributable to malaria and sickle cell disease (SCD) using a regression model adjusting for demographic and socioeconomic risk factors. We also estimated the contribution of the risk factors to haemoglobin concentration. ResultsWe found that 63.7% (95% CI: 58.3-69.4) of semi-severe anaemia (<80 g/L) was attributable to malaria compared to 12.4% (95% CI: 11.1-13.7) of mild-to-severe (adjusted haemoglobin concentration <110 g/L) and 29.6% (95% CI: 29.6-31.8) of moderate-to-severe (<100 g/L) anaemia and that SCD contributed 0.6% (95%CI: 0.4-0.9), 1.3% (95% CI: 1.0-1.7), and 7.3% (95%CI: 5.3-9.4) mild-to-severe, moderate-to-severe, and semi-severe anaemia, respectively. Sickle trait was protective against anaemia and was associated with higher haemoglobin concentration compared to children with normal haemoglobin (HbAA) among malaria-positive but not malaria-negative children. ConclusionThis 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.

Anaemia is a common presentation feature in patients with visceral leishmaniasis (VL). Blood transfusion remains an important aspect of patient management in VL. However, triggers considered for making decisions on transfusion are poorly understood. This review is based on the Infectious Diseases Data Observatory (IDDO) VL clinical trials library, a database of all published efficacy studies since 1980 and has indexed 160 published trials (1980-2021). Description of blood transfusion was reported in 16 (10.1%) trials (n=3,459 patients). Transfusion was initiated solely based on haemoglobin (Hb) measurement in 9 studies, using a combination of Hb and other health conditions (epistaxis, poor health, or clinical instability) in 3 studies, and the criteria was unclear in 4 studies; Hb threshold ranged from 3-8 g/dL. Overall, the number of patients receiving transfusion was explicitly reported in 10 trials (n=2,421 patients enrolled). Of these, 217 patients underwent transfusion; 58 before treatment initiation and 46 during treatment or the follow-up phase, and the time of transfusion was unclear in 113. The median proportion of patients who received a transfusion in a study was 8.0% [Interquartile range (IQR): 4.7% to 47.2%; range: 0-100%; n=10 studies]. This review describes the variation in current clinical practice and is an important initial step in policy/guideline development, where both the patients haemoglobin concentration and clinical status must be considered.

BackgroundAnaemia during childhood adversely affects mental, physical and social development of the children, therefore morphological patterns of anaemia in under-five children are considered essential for classification, diagnosis and management. AimThis study aimed at assessing morphological patterns, the prevalence and associated factors of anaemia among under-five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu County, Kenya. MethodA cross-sectional health facility-based study was conducted among 175 children aged 6 to 59 months who attended clinic for the PMTCT programme for the period of January 2020 to December 2020. Pretested and structured questionnaires were used to collect socioeconomic and demographic characteristics of the family and child. Capillary blood sample was collected from each child for malaria parasite and Peripheral Blood Film (PBF) examination. ResultComplete blood counts indicate that microcytic pattern was the most common, representing 30 (42.3%) followed by microcytic hypochromic pattern 20 (28.2%), normocytic normochromic pattern with 11 (15.5%) and lastly dimorphic pattern with 10 (14.0%). High prevalence of anaemia was observed in children who were urban dwellers (50.0%), in children whose mothers aged 18-27 years (44.0%) and had no formal education (48.1%). Besides, the high prevalence rate of anaemia was found among children with a family monthly income of less than 500 Ksh. (46.9%), early (<6 months) introduction of complementary foods (71.4%) ConclusionThis study has revealed that the prevalence of anaemia in children less than five years is high and is a severe public health problem in the study area. Therefore, the policymakers should make a strategy that can reduce poverty and increase the awareness to women on breastfeeding, nutrition, and other associated factors to reduce anaemia.

Sickle cell disease is common in Sierra Leone, yet its long-term population burden is uncertain. We analyzed Global Burden of Disease 2023 estimates for sickle cell disorders in Sierra Leone from 1990 through 2023. We obtained prevalence, deaths, and disability adjusted life years (DALYs), calculated age standardized rates per 100 000, modeled temporal trends with log linear regression, decomposed mortality changes into effects of population growth and rate change, and assessed age specific and sex specific patterns in 2023. Sickle cell prevalent cases increased from 48 689 (95% UI, 42 588 to 56 140) in 1990 to 90 498 (95% UI, 78 126 to 105 815) in 2023, and deaths rose from 408 (95% UI, 288 to 579) to 635 (95% UI, 438 to 862). DALYs increased from 32 518 (95% UI, 23 446 to 45 336) to 50 608 (95% UI, 36 331 to 66 317). Over the same period, age standardized mortality declined from 10.2 to 7.9 per 100 000 (APC, -0.46%; 95% CI, -0.64 to -0.29) and age standardized DALYs from 811.5 to 631.5 per 100 000 (APC, -0.43%; 95% CI, -0.60 to -0.25). In 2023, children younger than 5 years accounted for 153 deaths (95% UI, 93 to 230; 24.1% of all deaths), and persons younger than 20 years for 314 deaths (95% UI, 203 to 446; 49.5%). Males and females had similar prevalence (45 442 vs. 45 056 cases), but males had 371 deaths and 28 855 DALYs versus 264 deaths and 21 753 DALYs in females. Decomposition indicated that population growth alone would have increased deaths by 179.5%, whereas rate reductions offset this by 79.5%. The burden of sickle cell disease in Sierra Leone has grown in absolute terms, driven mainly by rapid population expansion, while age standardized mortality and DALY rates have declined. Concentrated losses in children and young adults and persistent male excess mortality highlight the need to scale up newborn screening and early comprehensive care, expand access to hydroxyurea and infection prevention, and strengthen resilient sickle cell services.

Anaemia is a condition in which either the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking and pregnancy status. The global estimate of childhood anaemia indicates that 293.1 million children are anaemic, and 28.5% of these children reside in sub-Sahara Africa. Also, anaemia is a significant public health problem with a high age-standardised death rate of 11.18 per 100,000 in Zambia. We conducted a cross-sectional study involving 392 anaemic children aged one year to 14 years. The study was conducted at the Children Hospital, University Teaching Hospitals, which is a third-level referral Hospital in Lusaka, Zambia. The aim was to determine the most common type of anaemia, its severity, and the most affected age groups among children aged 1-14 years. Out of 392 participants, 219 (56%) were female. Maximum haemoglobin recorded was 10.9g/dl, a minimum of 2.0 g/dl, a mean of 7.8g/dl and a standard deviation of 1.86g/dl. 200 (51%) participants had severe anaemia, and 192 (49%) had moderate anaemia with none having mild anaemia. Microcytic hypochromic anaemia was the commonest (60%), followed by normochromic normocytic anaemia (26%) and the least was macrocytic anaemia in 14% of the participants. An analysis of variance (ANOVA) showed that the difference in mean haemoglobin concentration between age groups was not significant, F (7.94) = 0.83, p > 0.57. A Chi-squared test was used to determine the relationship between anaemia types (microcytic, hypochromic) and age groups. The interaction was not significant (Chi-Square (1) = 1.28, p-value = 0.73. Microcytic hypochromic anaemia was the most prevalent and all age groups were equally affected. We recommend the countrys National Food and Nutrition Commission to revisit the Zambian National Strategy and Plan of Action for the Prevention and Control of Vitamin A Deficiency and Anaemia of 1999 to 2004 and implement the measures stated in the strategic plan.

BackgroundSickle cell disease (SCD) is a genetic blood disorder characterized by abnormal hemoglobin S, leading to various complications. This study aimed to assess the spectrum of SCD-related complications and outcomes among pediatric patients at Mbeya Zonal Referral Hospital in Tanzania. MethodsA retrospective cross-sectional study was conducted, reviewing medical records of pediatric SCD patients admitted between June 2019 and June 2023. ResultsThe study found an inpatient prevalence of 7.7% for SCD. Vaso-occlusive pain events (68%), infections (55.3%), and severe anaemia (27.7%) were the leading causes of admission. Low rates of hydroxyurea (11.4%) and penicillin V (28.3%) use was observed. The median haemoglobin level was 6.5 g/dL, indicating significant anaemia. Newly diagnosed patients (50%) had an average age of 5.12 years at diagnosis, suggesting delayed identification. The mortality rate was 3%. ConclusionThese findings highlight the need of improved early diagnosis, management strategies, and access to essential medications for pediatric SCD patients in Tanzania. Implementation of newborn screening programs and increased awareness about SCD management could significantly improve patient outcomes.

IntroductionThe loss of splenic function is associated with an increased risk of infection in sickle cell disease (SCD); however, spleen function is rarely documented among SCD patients in Africa, due partly to the non-availability of sophisticated techniques such as scintigraphy. Methods of assessing splenic function which may be achievable in resource-poor settings include counting red blood cells (RBC) containing Howell Jolly Bodies (HJB) and RBC containing silver-staining (argyrophilic) inclusions (AI) using a light microscope. We evaluated the presence of HJB - and AI - containing RBC as markers of splenic dysfunction among SCD patients in Nigeria. MethodsWe prospectively enrolled children and adults with SCD in steady state attending outpatient clinics at a tertiary hospital in North-East Nigeria. The percentages of HJB- and AI-containing red cells were estimated from peripheral blood smears and compared to normal controls. ResultsThere were 182 SCD patients and 102 healthy controls. Both AI- and HJB-containing red cells could be easily identified in the participants blood smears. SCD patients had a significantly higher proportion of red cells containing HJB (1.5%; IQR 0.7% - 3.1%) compared to controls (0.3%; IQR 0.1% - 0.5%) (P = 0.0001). The AI red cell counts were also higher among the SCD patients (47.4%; IQR 34.5% - 66.0%) than the control group (7.1%; IQR 5.1% - 8.7%) (P = 0.0001). The intra-observer reliability for assessment of HJB-(R = 0.92; R2 = 0.86) and AI-containing red cells (R = 0.90; R2 = 0.82) was high. The estimated intra-observer agreement was better with the HJB count method (95% limits of agreement, -4.5 to 4.3; P = 0.579). ConclusionWe have demonstrated the utility of light microscopy in the assessment of red cells containing - HJB and AI inclusions as indices of splenic dysfunction in Nigerian SCD patients. These methods can be easily applied in the routine evaluation and care of patients with SCD to identify those at high risk of infection and initiate appropriate preventive measures.

BackgroundUltrasonography is an established and reliable method for assessing the spleen. Because of variation due to genetic and other environmental factors including malaria endemicity, interpretation of splenic sizes requires a knowledge of the normal reference range for a given population. The aim of this study was to determine spleen size in different age groups among healthy people in North-Eastern Nigeria and use this as a reference to determine spleen size amongst sickle cell disease (SCD) patients. MethodsUsing a cross-sectional study design, spleen size was measured in healthy people of different age groups, and steady-state SCD patients (children and adults) using abdominal ultrasonography. Using the age-group specific reference values obtained from the controls, spleens were classified into small, normal size, or enlarged among the SCD patients. ResultsAbdominal ultrasonography was performed for 313 participants, comprising 109 (34.8%) healthy controls and 204 (65.2%) steady-state SCD patients. The spleen was visualized in all the controls. However, 97(47.6%) of the SCD patients had no visible spleen. Small, normal, and enlarged spleens were observed in 16.7% (n=18/107), 63.6% (n=68/107) and 19.6% (n=21/107) SCD patients, respectively. Compared to the control group, splenic length was three-fold higher in the first two years of life in SCD patients, followed by a progressive age-related decline in size. Enlarged spleens were detected among 5(2.4%) SCD patients by manual palpation method compared to 21 (19.6%) using ultrasonography. ConclusionModel-based age-specific reference ranges and percentile curves for splenic dimensions based on ultrasonography among normal controls in North-Eastern Nigeria were established and may be of value in assessing spleen sizes among SCD patients living in malaria-endemic regions of Africa. Regular spleen scans to assess changes in size can help identify SCD patients at risk of splenomegaly complications including subclinical acute sequestration and hypersplenism, and those who are developing splenic atrophy.

BackgroundExtreme leukocytosis (EL), defined as an abnormally high white blood cell (WBC) count, is a critical clinical indicator associated with various underlying conditions, such as infections and malignancies. This study investigated the etiological factors and clinical profiles of patients presenting with EL at Mbeya Zonal Referral Hospital (MZRH). MethodsA retrospective cohort study was conducted among patients with WBC counts [&ge;]50x109/L who attended MZRH between January 2021 and December 2022. Data were retrieved from electronic health records and analyzed using Stata Version 16. ResultsA total of 178 patients with EL were included in the study. Malignant conditions accounted for 47.2% of cases, with haematological malignancies comprising 89.3%, predominantly chronic myeloid leukaemia (CML). Infections were the second most frequent cause (43.2%). Patients with malignancies had significantly higher median WBC counts (221 vs. 56 x 109/L, p<0.0001) and were more likely to present with symptoms such as bleeding, bone pain, B symptoms, splenomegaly, hepatomegaly, and lymphadenopathy. Severe thrombocytopenia (platelet count <50 x 109/L) was more common in the malignant group (p=0.0008). ConclusionMalignant etiologies, particularly haematological malignancies, are a leading cause of EL in patients with WBC counts [&ge;]50 x 109/L. Clinicians should maintain a high suspicion of malignancies in such patients and conduct thorough diagnostic evaluations to ensure optimal management.

Of the 500 000 children born with sickle cell disease annually, most cases occur in Africa, contributing to significant morbidity and mortality associated with limited sickle cell disease (SCD) health outcomes data and reduced access to therapeutic plus preventive care. We aim to develop and manage a standardized electronic SCD registry, establish consistent standards of care (SoC) for patients, improve the SCD research and biobanking capacity in Zimbabwe and Zambia. This five-year program employs mixed methods that include infrastructure and skilled manpower capacity building of SCD clinics, registry, biobanking, cohort and implementation science research studies to improve SCD treatment outcomes. We are collaborating with the SickleInAfrica consortium (Ghana, Mali, Nigeria, Tanzania, Uganda, and South Africa), the African Institute of Biomedical Sciences and Technology (AiBST) and St Judes Children Research Hospital. We established the SCD registry in Zimbabwe and Zambia for children and adult patients enrolling 1796/4000 (45%) participants to date. We are participating in SickleInAfrica consortium research activities, training health workers and educating SCD patient communities on SoC. This collaboration with African researchers, policymakers, health workers, and SCD patient communities will improve uptake of SCD SoC and increase our research capacity.

BackgroundVisceral leishmaniasis (VL) is a life-threatening parasitic disease endemic in Somalia, where its control is severely challenged by a fragile health system, ongoing conflict, and socioeconomic barriers. This study aimed to assess the availability, accessibility, and quality of VL services in Somalia and to develop evidence-based, context-specific strategies to improve service delivery. MethodsA qualitative study was conducted across five major VL treatment sites. Data were collected through in-depth interviews (n=57) with health managers and providers, focus group discussions (n=2) with patients and caregivers, and observational assessments using an adapted WHO Service Availability and Readiness Assessment (SARA) tool. The Consolidated Framework for Implementation Research (CFIR) guided data collection and thematic analysis to identify key determinants of implementation. The CFIR-ERIC Matching Tool was then employed to translate these findings into actionable strategies. ResultsFacility readiness assessments uncovered critical gaps and disparities in infrastructure, diagnostics, and essential medical supplies. CFIR analysis identified major barriers across multiple domains: the low adaptability and high complexity of VL protocols to the local context; unsustainable reliance on external funding; frequent service disruptions due to emergencies and outbreaks; and pervasive sociocultural misconceptions about the disease. Enablers included strong partnerships and committed local leadership. Based on this analysis, a set of tailored implementation strategies was developed, focusing on: creating flexible service delivery models (e.g., mobile clinics); securing sustainable financing; strengthening clinical and community referral networks; instituting continuous training and support for healthcare workers; and proactively engaging patients and communities. ConclusionThe effective delivery of VL services in Somalia is impeded by a complex array of intervention-specific, systemic, and contextual barriers. This study provides a comprehensive assessment of these challenges and, crucially, generates a set of targeted, practical strategies to address them. Implementing these evidence-based, context-specific recommendations is essential for strengthening VL care and advancing progress towards disease elimination in Somalia.

ObjectivesOur aims were to examine the geographic, socio-economic and behavioural factors associated with disease and antibiotic consumption in Nepal between 2006 and 2016 and to explore healthcare seeking patterns and the source of antibiotics. MethodsCross-sectional data from children under five in households in Nepal was extracted from the 2006, 2011 and 2016 Demographic Health Surveys (DHS). Univariate and multivariate analyses were carried out to assess the association of disease prevalence and antibiotic use with age, sex, ecological zone, urban/rural location, wealth index, maternal smoking, use of clean fuel, sanitation, nutrition, access to healthcare and vaccinations. ResultsPrevalence of fever, acute respiratory infection (ARI) and diarrhoea decreased between 2006 and 2016, while the proportion using antibiotics increased. Wealth, use of clean fuel, improved toilet sanitation, nutrition and access to healthcare were associated with reduced rates of disease. Those in the highest wealth index use less antibiotics and antibiotic consumption in rural areas surpassed urban regions over time. Health-seeking from the private sector has overtaken government facilities since 2006 with antibiotics mainly originating from pharmacies and private hospitals. Adherence to WHO recommended antibiotics has reduced over time. ConclusionsWith rising wealth, there has been a decline in disease prevalence but an increase in antibiotic use with more access to unregulated sources. Understanding antibiotic use and identifying associated behavioural and socio-economic factors may help to inform interventions to reduce inappropriate antibiotic use whilst ensuring access to those who need them.

The study aimed to assess the impact of the COVID-19 pandemic on Quality of Life (QoL) in persons living with Sickle Cell Disorder (SCD) in Lagos, Nigeria and to determine how they coped during the pandemic, particularly during the period of total lockdown with the additional "SHIELDING" measures to which they had to adhere. Data was collected using a standardized protocol PedsQL, Sickle Cell Disease Module version.3.0 designed for youth within the ages of (13-18) years, (19-35) years and their parents/Guardian if underage. The survey captured data on patients pain impact, hurts, management, treatments, communication with their caregivers and their Guardians perception. The survey was performed online, or Face-to-Face/telephone interview if online was not possible. Contacts of patients and parents were obtained from the database of Sickle Cell Foundation Nigeria. A total of 105 (80 patients and 25 parents) participants responded to the survey. The age distribution of respondents was highest at 56 % in the age bracket of 13 - 18 years old. Pain crisis were very common amongst patients. The survey revealed that the type of treatment or care received at these times determined whether or not the patients visited the hospital when they had pain crises. In addition, as patients reports an increase in ill-treatment they experienced in the hands of health care givers, so did the fear of accessing treatment during the COVID pandemic. It was observed that the frequency of pain crises experienced by SCD patients was proportional to the patients quality of life (the higher the frequency of pains, the worse the QoL). As a follow-up, a more detailed study would be required, as this study was limited in the capturing of the demographics, sex and number of participants; Considering the number of persons living with SCD that visit the Sickle Cell Foundation Nigeria, (about 3,000 patients), the number of responses in this study was low (105). It is believed that a higher number of responses would have given more information about the Sickle Cell burden and the QoL of persons living with SCD in Lagos during the COVID-19 pandemic. Lagos was the epicentre of the COVID-19 pandemic in Nigeria.

BackgroundGlobally, thrombocytopenia is one of the most common hematologic conditions seen in ill neonates. In countries with limited resources, like Ethiopia, it is a serious concern. Because the burden of thrombocytopenia is so great, generating updates evidence on predictors of mortality and survival status is vital to fight it. However, the problem is not well investigated in Addis Ababa. Therefore, this study aimed to assess survival and predictor of thrombocytopenic neonatal death in Public Hospitals, Addis Ababa, Ethiopia, 2024/2025. Methods and MaterialsA prospective follow-up study was done among a total of 350 neonates from March 20, 2025, to April 30, 2025, in Addis Ababa public hospitals. All thrombocytopenic neonates that meet the inclusion criteria were chosen as study participants. Data were collected using the Kobo Tool through direct observation and review of maternal and neonatal charts. After export to an Excel spreadsheet, data cleaning and recoding were performed using SPSS version 26, followed by statistical analysis using STATA version 17. The Kaplan-Meier failure curve was used to demonstrate the pattern of death, estimate the chance of death, and compare failure curves. Collinearity, Schoenfeld residual, and log-rank tests were performed. The Cox proportional hazards model was fitted with global test result of 0.7882. Finally, the findings were presented both descriptively and analytically. ResultsIn this study, the overall magnitude of thrombocytopenic neonatal death was 14.1% (95% CI: 10.4-18.1), with an incidence rate of 13.04/1000 (95% CI: 0.009-0.017) neonate-days. The restricted mean time to death in this study was 23.36 days (95% CI: 22.23-24.50). Being born to a mother with severe preeclampsia (AHR = 3.84; 95% CI: 1.78-8.26), very low birth weight (<1499g) (AHR = 3.67; 95% CI: 1.14-11.80), perinatal asphyxia (AHR = 2.76; 95% CI: 1.32-5.79), necrotizing enterocolitis (AHR = 2.45; 95% CI: 1.14-5.31), and delayed initiation of feeding (AHR = 3.37; 95% CI: 1.10-10.29) were the identified predictors of mortality. Conclusion and recommendationIn this study, a high burden of thrombocytopenic neonatal death. Early detection and treatment of high-risk conditions like severe preeclampsia, very low birth weight, perinatal asphyxia, and necrotizing enterocolitis should be the main goal of efforts to lower thrombocytopenic neonatal mortality. Furthermore, prompt neonatal feeding initiation ought to be given top priority.

ObjectiveThis study examined the laboratory results of COVID-19 patients from a hospital in the Peruvian Amazon and their clinical prognosis. MethodsAn analytical cross-sectional study was carried out whose purpose was to identify the laboratory tests of patients with COVID-19 and mortality in a hospital in Ucayali, Peru during the period from March 13 to May 9, 2020, selecting a total of 127 with Covid-19. Mean and the standard deviation was described for age, leukocytes, neutrophils, platelets, RDW-SD; median and interquartile range for the variables lymphocyte, RN / L, fibrinogen, CRP, D-dimer, DHL, hematocrit, monocytes, eosinophils. ResultsNo differences were observed in this population regarding death and sex (OR: 1.31; 95% CI 0.92 to 1.87), however, it was observed that, for each one-year increase, the probability of death increased by 4% (PR: 1.04, 95% CI 1.03 to 1.05). The IRR (Incidence Risk Ratio) analysis for the numerical variables showed results strongly associated with hematological values such as Leukocytes (scaled by 2500 units) (IRR: 1.08, 95% CI 1.03 to 1.13), neutrophils (scaled by 2500 units) (IRR: 1.08; 95% CI 1.03 to 1.13), on the contrary, it is observed that the increase of 1000 units in lymphocytes, the probability of dying decreased by 48% (IRR: 0.52; 95% CI 0.38 to 071). ConclusionParameters such as leukocytes and neutrophils were statistically much higher in patients who died.

ObjectivesTo determine how menorrhagia is managed in people with bleeding disorders. DesignA systematic review and thematic synthesis. Data sourcesPubMed, Medline, Scopus, Cochrane library, google scholar and CINAHL complete (via EBSCO). MethodsSearches were conducted on articles published from 1st January 2000 until 6th May 2024. Following deduplication, the titles and abstracts were screened for relevance. 244 primary studies were then assessed for eligibility based on inclusion and exclusion criteria. Studies were included if they were based on primary articles and focussed on people with inherited bleeding disorders and heavy menstrual bleeding. Included studies were appraised for risk of bias and quality assurance using the Newcastle Ottawa Scale, following which data was systematically coded to generate descriptive and analytical themes. ResultsWe identified 16 eligible articles of which 13 were included in a thematic synthesis. These included prospective and retrospective clinical studies, cross-sectional studies and randomised control trials encompassing over 893 participants. Thematic synthesis identified hormonal treatments, such as the levonorgestrel-releasing intrauterine system (LNG-IUS), to be largely effective in the symptom management of HMB in IBD and associated with improved quality of patient life. Treatment of HMB patients with LNG-IUS, followed by tranexamic acid (TA) or 1-deamino-8-d-arginine vasopressin (DDAVP), the trade name for desmopressin, commonly led to amenorrhea. Technological approaches to the management of HMB in IBD included the use of mobile technology to encourage treatment compliance. These management strategies led to an improvement in reported QoL by patients with IBD. This review had limitations including the exclusion of some articles that may have limited generalisability. The Medical Subject Heading (MeSH) terms used focussed on HMB as opposed to abnormal menstrual bleeding, potentially directing the identified recommendations for clinical practice. Based on the findings of this thematic review, the use of LNG-IUS as first line therapy for those with HMB, followed by the use of combination therapy such as TA and desmopressin, would be recommended. These measures should be adopted in both primary and secondary care settings. We identified the need to strengthen counselling and communication between specialists involved in the care of those with HMB and IBD, and the need to increase awareness of HMB in IBD through public and patient education. Data availability statementAll data presented is secondary to published studies and available within the public domain. RegistrationPROSPERO registration number: CRD42023452533 Key MessagesO_LIWhat is already known on this topic - Heavy menstrual bleeding (HMB) is often a symptom of inherited bleeding disorders (IBD) in females and can have a significant impact on the quality of life of an individual. C_LIO_LIWhat this study adds - A systematic review and thematic analysis of the currently available literature allowed the identification of best practise management options for patients with IBD and HMB. A thematic synthesis was used to identify best practice for IBD patient treatment and management of HMB, which will improve patient quality of life. C_LIO_LIHow this study might affect research, practice or policy - This study of existing literature and thematic synthesis has been used to provide recommendations to haematologists and gynaecologists to support evidence based best practise recommendations on how to treat patients with HMB consequent to IBDs. C_LI

Sickle cell disease (SCD) is associated with chronic systemic morbidity that extends beyond acute crises. However, data describing the clinical and laboratory adolescents and young adults with SCD at steady state in sub-Saharan Africa are limited. We described clinical and laboratory characteristics of adolescents and young adults with SCD at steady state in Uganda. We conducted a hospital-based cross-sectional study of 60 adolescents and young adults with SCD in steady state at Mulago National Referral Hospital. Descriptive statistics were used to summarize participant characteristics and medication use. The mean age was 16.5 {+/-} 3.3 years, and 34 (56.7%) participants were female. Mean hemoglobin was 9.1 {+/-} 2.2 g/dl. Mean systolic and diastolic blood pressures were 107.9 {+/-} 15.5 mmHg and 60.3 {+/-} 12.6 mmHg, respectively; mean heart rate was 89.5 {+/-} 15.5 beats/min. Fifty-two (86.7%) participants reported using hydroxyurea. These observations show that adolescents and young adults with SCD at steady state exhibit hematologic abnormalities and distinctive hemodynamic profiles that underscore substantial chronic subclinical abnormalities that extend beyond acute complications.

BackgroundPrimaquine is an 8-aminoquinoline antimalarial. It is the only widely available treatment to prevent relapses of Plasmodium vivax malaria. The 8-aminoquinolines cause dose dependent haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals. G6PDd is common in malaria endemic areas but testing is often not available. As a consequence primaquine is underused. MethodsWe conducted a pharmacometric study to characterise the relationship between primaquine dose and haemolysis in G6PDd. The aim was to explore shorter and safer primaquine radical cure regimens compared to the currently recommended 8-weekly regimen (0.75 mg/kg once weekly), potentially obviating the need for G6PD testing. Hemizygous G6PDd healthy adult Thai and Burmese male volunteers were admitted to the Hospital for Tropical Diseases in Bangkok. In Part 1, volunteers were given ascending dose primaquine regimens whereby daily doses were increased from 7.5 mg up to 45 mg over 15 to 20 days. In Part 2, a single primaquine 45 mg dose was given. Results24 volunteers were enrolled in Part 1, and 16 in Part 2 (13 participated in both studies). In three volunteers, the ascending dose regimen was stopped because of haemolysis (n=1) and asymptomatic increases in transaminases (n=2; one was hepatitis E positive). Otherwise the ascending regimens were well tolerated with no drug-related serious adverse events. In Part 1, the median haemoglobin concentration decline was 3.7 g/dL (range: 2.1 to 5.9; relative decline of 26% [range: 15 to 40%]). Primaquine doses up to 0.87 mg/kg/day were tolerated subsequently without clinically significant further falls in haemoglobin. In Part 2, the median haemoglobin concentration decline was 1.7 g/dL (range 0.9 to 4.1; relative fall of 12% [range: 7 to 30% decrease]). The ascending dose primaquine regimens gave 7 times more drug but resulted in only double the haemoglobin decline. Conclusions and InterpretationIn patients with Southeast Asian G6PDd variants full radical cure treatment can be given in under three weeks compared with the current 8 week regimen.

BackgroundFebrile neutropenia (FN), a life-threatening complication of chemotherapy, is a medical emergency requiring prompt antibiotic therapy. The epidemiology of causative pathogens is evolving with a shift towards multidrug-resistant (MDR) strains. This study aimed to evaluate the microbiologic spectrum and antimicrobial resistance patterns in FN patients at a hematology center in Eastern India. MethodsA retrospective study was conducted on FN patients admitted between July 2022 and July 2024. Clinical and demographic data, along with microbiological isolates and their antimicrobial susceptibility, were analyzed. Samples were evaluated from blood, respiratory, urinary, skin and mucocutaneous sites. Antimicrobial susceptibility testing was performed using Vitek 2. Statistical analyses, including multinominal logistic regression, were performed to identify factors associated with MDR infections. ResultsAmong the 1,604 FN episodes analyzed, the most common underlying hematologic malignancies were acute myeloid leukemia (46.2%) and acute lymphoblastic leukemia (34.3%). Blood culture positivity was 39%, with Gram-negative bacteria (GNB) (67.8%) predominating over Gram-positive bacteria (32.1%). The most frequently isolated GNB were Klebsiella oxytoca (12.4%), Klebsiella pneumoniae (8.5%), and Escherichia coli (7.3%). MDR isolates accounted for 30% of all pathogens, with significant resistance observed to fluoroquinolones (Ciprofloxacin: 57.8%) and carbapenems (Meropenem: 42.8%). MDR isolates of concern included carbapenem-resistant Acinetobacter baumannii (1.8%), carbapenem-resistant Enterobacterales (3.3%), and Candida auris (0.6%). ConclusionThis study necessitates ongoing surveillance and antimicrobial stewardship among FN patients in view of emerging MDR strains. The current predominance of Enterobacterales suggests a need to re-evaluate empirical antibiotic choices. Optimizing treatment strategies with newer {beta}-lactam/{beta}-lactamase inhibitors and targeted antimicrobial stewardship programs is essential in resource-limited settings.