Papers by Livingstone Dogara
Blood Advances
Sickle cell disease (SCD) is a common condition within sub-Saharan Africa and associated with hig... more Sickle cell disease (SCD) is a common condition within sub-Saharan Africa and associated with high under-5 mortality (U5M). The American Society of Hematology instituted the Consortium on Newborn Screening in Africa (CONSA) for SCD, a 7-country network of sites to implement standardized newborn hemoglobinopathy screening and early intervention for children with SCD in sub-Saharan Africa. CONSA’s overall hypothesis is that early infant SCD screening and entry into standardized, continuous care will reduce U5M compared with historical estimates in the region. Primary trial objectives are to determine the population-based birth incidence of SCD and effectiveness of early standardized care for preventing early mortality consortium-wide at each country’s site(s). Secondary objectives are to establish universal screening and early interventions for SCD within clinical networks of CONSA partners and assess trial implementation. Outcomes will be evaluated from data collected using a shared ...
Frontiers in Genetics
Background: Sickle cell disease (SCD) continues to pose physical and psychosocial burdens to pati... more Background: Sickle cell disease (SCD) continues to pose physical and psychosocial burdens to patients, caregivers and health workers. Stakeholder engagement in the processes of policy making and implementation is increasingly becoming the cornerstone of best practices in healthcare.Aim and Objectives: To engage stakeholders with a view to assessing the knowledge of SCD; ascertain the challenges associated with accessibility and affordability of healthcare services; improve the quality of care, and thereby effect behavioral change through increasing attendance and follow-up of patients in the clinics.Methodology: A Stakeholders’ Engagement meeting organized by the Sickle Pan Africa Research Consortium Nigeria Network (SPARC-NEt) was attended by patients, caregivers and members of patient support groups, healthcare providers and management/policymakers. The engagement was through PowerPoint presentations, structured questionnaires and an interactive session. The structured questionnai...
Italian Journal of Pediatrics
The impact of socio-economic status on the risk of allergy in African children is not clear.This ... more The impact of socio-economic status on the risk of allergy in African children is not clear.This was a cross sectional study including children aged 6–14 years from urban and rural settings in north-central Nigeria. Participants underwent skin prick tests to house dust mite (HDM) and an interview investigating socio-economic status through the Family Affluence Scale (FAS) based on a score of 0–6.A total of 346 children were enrolled (52.8% boys; mean age ± SD 9.6 ± 2.0 years), including 142 (41% of total) rural and 204 (59% of total) urban pupils. Prevalence of HDM sensitivity was 2.8% (4/142) in the rural setting and 15.6% (32/204) in the urban setting (P < 0.001). Among urban children, frequency of HDM sensitization was 8.6% (7/81) in the lowest socio-economic group (FAS 0–1), 13.1% (8/61) in the intermediate one (FAS 2–3) and 27.4% (17/62) in the highest one (FAS ≥ 4).Urbanization and increasing wealth are associated with a higher frequency of sensitization to HDM in Nigerian ...
American Journal of Respiratory and Critical Care Medicine
The Size and Lung Function in Children study was funded by the Wellcome Trust (WT094129MA). For d... more The Size and Lung Function in Children study was funded by the Wellcome Trust (WT094129MA). For data collection in Nigeria, the Sickle Cell Cohort Research Foundation (www.scorecharity.com) and Associazione Allergie Pneumopatie Infantile (https://www. alpiassociazione.it/) offered financial support to refund travel expenses to Nigeria for two investigators (M.A. and C.Z.).
Sub-Saharan African Journal of Medicine, 2018
Introduction The latest version of the American Society of Anesthesiologists (ASA) score approved... more Introduction The latest version of the American Society of Anesthesiologists (ASA) score approved by the ASA House of Delegates in 2014 is used preoperatively to assess patients’ physical status (PS) before administration of anaesthesia and surgery. The ASA score does not take into consideration the patients’ age, gender or results of laboratory investigations. This study was to determine any relationship between preoperative haemoglobin (Hb) concentration, age and ASA scores. Materials and Methods Clinical records of 205 patients who had elective surgeries in a tertiary hospital for more than a period of six months were analysed for patients’ ages, gender, Hb concentrations and ASA scores, retrospectively. Data were analysed using SPSS version 20.0 with level of significance set at P ≤ 0.05. Results There were 205 patients who had surgeries during the period under review with females making up 110 (53.7%). The mean Hb and ages were 12.0 ± 1.7 g/dl and 32.2 ± 19.0 years, respectivel...
Annals of Tropical Pathology, 2019
Background: Sickle cell disease (SCD) is the most common monogenetic disorder worldwide. With an ... more Background: Sickle cell disease (SCD) is the most common monogenetic disorder worldwide. With an annual birthrate of approximately 150,000 in Nigeria, the burden is expected to increase by 75% in 2050. With improved care, patients live longer but may have more complications. This study seeks to determine the prevalence of some complications of sickle cell anemia (SCA) and how age relates to these complications. Methods: This was a 2-year retrospective review of clinic records of patients with SCA attending the hematology clinic of Barau Dikko Teaching Hospital, Kaduna State, Nigeria. Data on sex, age at last birthday, age at diagnosis of SCA, number of crises in past 6 months, proteinuria, steady-state hemoglobin concentration, chest infections, stroke, and oxygen saturation (SPO2) were collated. Statistical Analysis: Data were analyzed using SPSS version 21 (IBM Corp., 2012, Armonk NY, USA). Continuous and categorical variables were assessed using the Shapiro–Wilk test and percenta...
Background: Decrease in Glomerular Filtration Rate occurs with advancing age. Average age of diag... more Background: Decrease in Glomerular Filtration Rate occurs with advancing age. Average age of diagnosis of CKD in Nigeria is below 45 years of age and male gender has been shown to be a risk factor for worsening CKD. . The influence of age and gender on prevalence of anaemia in CKD differs across the world, thus this study aims to determine the prevalence of anaemia and to evaluate associations between age, gender and anaemia in patients with CKD. Method: This was a cross-sectional descriptive study of patients with CKD. Age, gender, primary renal disease, stage of CKD and associated clinical conditions as well as blood samples of study subjects were analyzed for complete blood counts, creatinine, and Ferritin levels. Results: Mean age of the participants was 45.8±14.6 years with 59.3% diagnosed at or greater than 45 years of age, male-to-female ratio 1:1.2. Mean haemoglobin concentration (Hb) was 11.0±2.8g/dl, red cell indices were normal. Prevalence of anaemia was 61.5%, and it w...
Blood, 2021
Hemoglobinopathies, including sickle cell disease (SCD) and thalassemia syndromes, represent the ... more Hemoglobinopathies, including sickle cell disease (SCD) and thalassemia syndromes, represent the commonest monogenic diseases in the world. Although their pathogenicity is well established, the diverse clinical manifestations and the varying degree of severity are less understood and are thought to be governed, in part, by genetic modifiers. Despite the identification and characterization of a few genetic modifiers by previous studies, these are as yet insufficient to guide treatment recommendations or stratify patients reliably. Larger, multi-ethnic studies are needed to identify and validate further disease modifiers that can be used for patient stratification and personalized treatment. There is a growing need for deeper insight with the availability of novel targeted therapies and potentially curative options like gene therapy in both SCD and thalassemia. The International Hemoglobinopathy Research Network (INHERENT) is a recently established network with the aim of investigatin...
The Lancet Child & Adolescent Health, 2021
The emergence of the RNA virus SARS-CoV2, the causative agent of COVID-19 and its declaration by ... more The emergence of the RNA virus SARS-CoV2, the causative agent of COVID-19 and its declaration by the World Health Organization (WHO) as a pandemic has disrupted the delicate balance in health indices globally. Its attendant immune dysregulation and pathobiology is still evolving. Currently, real time PCR is the gold standard diagnostic test, however there are several invalidated antibody-based tests available for possible community screening. With ongoing community transmission in Nigeria, neither the true burden of COVID-19 nor the performance of these kits is presently known. This study therefore, compared the performance of the SARS CoV2 antibody test and the real time Polymerase Chain Reaction (Rt-PCR) in the diagnosis of COVID-19. For the purpose of this evaluation, we used the diagnostic test kit by Innovita® Biological Technology CO., LTD China, a total of 521 venous blood samples were collected from consenting patients for the SARS COVID-19 rapid diagnostic kit and Oral and ...
Blood Cells, Molecules, and Diseases, 2020
Blood Cells, Molecules, and Diseases, 2020
Background/Objective: Sickle cell disease (SCD) is a monogenic disease with multiple phenotypic e... more Background/Objective: Sickle cell disease (SCD) is a monogenic disease with multiple phenotypic expressions. Previous studies describing SCD clinical phenotypes in Nigeria were localized, with limited data, hence the need to understand how SCD varies across Nigeria. Method: The Sickle Pan African Research Consortium (SPARCO) with a hub in Tanzania and collaborative sites in Tanzania, Ghana and Nigeria, is establishing a single patient-consented electronic database with a target of 13,000 SCD patients. In collaboration with the Sickle Cell Support Society of Nigeria, 20 hospitals, with paediatric and adult SCD clinics, are participating in patient recruitment. Demographic and clinical information, collected with uniform case report forms, were entered into Excel spreadsheets and uploaded into Research Electronic Data Capture software by trained data clerks and frequency tables generated. Result: Data were available on 3,622 patients enrolled in the database, comprising 1,889 (52.9%) females and 1,434 (39.6%) children ≤15 years. The frequencies of Hb SS, Hb SC and Hb Sβ thalassemia in this data set were 97.5%, 2.5% and 0% respectively. Sixty percent, 23.8%, 5.9%, 4.8% and 2.5% have had bone pain crisis, dactylitis, acute chest syndrome, priapism and stroke respectively. The most frequent chronic complications were: leg ulcers (6.5%), avascular necrosis of bone (6.0%), renal (6.3%) and pulmonary hypertension (1.1%). Only 13.2% had been hospitalized while 67.5% had received blood transfusion. Conclusion: These data on the spectrum of clinical phenotypes of SCD are useful for planning, improving the management of SCD across Nigeria and provide a foundation for genomic research on SCD.
Blood Advances, 2019
Train professional nurses to increase outreach and nursing capacity in Africa, c Train physicians... more Train professional nurses to increase outreach and nursing capacity in Africa, c Train physicians to increase knowledge and skill in diagnosing and caring for people with IBDs, c Conduct knowledge and skill transfer workshops, and c Establish a care model for people with IBDs in Africa. Methods and materials c Individual and small group training sessions were conducted in Johannesburg to train technicians. The hands-on training focused on the resources trainees had at home. c Nurses were offered training fellowships by the WFH, Novo Nordisk Haemophilia Foundation, and the University of the Witwatersrand to go to train in Johannesburg. c Physicians were invited as fellows either sponsored externally by various organizations or supported by the University of the Witwatersrand to go to Johannesburg for training. c A Web site was established (http://coagulopatiasweb.datasus.gov.br) to demonstrate a model of care for people with IBDs. The site was constructed by taking into account the roles of various players who provide care for people with IBDs. The aim of the care model was to replicate the successes of other care models in other countries in Africa. Results The collaboration and capacity-building activities of the project from 2010 to 2018 resulted in: c Training 40 technicians from 12 countries in Africa (Figure 1), c Training 15 nurses from 10 countries in Africa (Figure 2),
Archives of International Surgery, 2017
Background: Preoperative anemia in surgical patients scheduled for major procedures results in po... more Background: Preoperative anemia in surgical patients scheduled for major procedures results in poor outcomes, hence the need for full optimization of packed cell volume (PCV) before surgery. This study aims to assess preoperative PCV and category of surgery as predictors of intraoperative blood transfusion in a tertiary healthcare facility in Zaria, Nigeria. Patients and Methods: This was a retrospective study where hospital records of patient's ≥13 years undergoing elective surgeries at a tertiary hospital in Zaria over a period of 6 months were reviewed. Patients' ages, gender, preoperative PCV, category of surgery, American Society of Anesthesiologists (ASA) scores, and number of units of blood transfused intraoperatively were analyzed using SPSS 20.0. Results: There were 164 surgeries conducted during the study period. Females constituted 96 (58.5%) of the patients. The mean age and preoperative PCV were 38.9 ± 14.9 years and 36.6 ± 4.9%, respectively. The median (interquartile range) units transfused intraoperatively and ASA scores were 0 (0) and 2 (0), respectively. Spearman's correlation to compare the number of units transfused as a reference point was significant for preoperative PCV (ρ = −0.222, P = 0.004). Regression analyses using category of surgery, ASA scores, age, and preoperative PCV predicted intraoperative transfusion; F(2, 161) = 5.120, P = 0.007, adjusted R2 = 0.048 with preoperative PCV and category of surgery predicting the number of units transfused (β =-0.176, P = 0.023) and (β = −0.158, P = 0.041), respectively. Conclusion: Preoperative PCV and category of surgery although important have a low ability to predict the number of blood units transfused intraoperatively.
Thorax, 2019
IntroductionLung function abnormalities are common in sickle cell anaemia (SCA) but data from sub... more IntroductionLung function abnormalities are common in sickle cell anaemia (SCA) but data from sub-Saharan Africa are limited. We hypothesised that children with SCA from West Africa had worse lung function than their counterparts from Europe.MethodsThis prospective cross-sectional study evaluated spirometry and anthropometry in black African individuals with SCA (haemoglobin phenotype SS) aged 6–18 years from Nigeria and the UK, when clinically stable. Age-matched controls were also included in Nigeria to validate the Global Lung Initiative spirometry reference values.ResultsNigerian SCA patients (n=154) had significant reductions in both FEV1 and FVC of ~1 z-score compared with local controls (n=364) and ~0.5 z-scores compared with the UK patients (n=101). Wasting (body mass index z-score<−2) had a prevalence of 27% in Nigerian patients and 7% in the UK ones (p<0.001). Among children with SCA, being resident in Nigeria (OR 2.4, 95% CI 1.1 to 4.9), wasting (OR 2.3, 95% CI 1.1 ...
Blood, 2018
Background: Factor V Leiden (FVL) mutation and Protein gene G20210A mutation (PGM) are the most c... more Background: Factor V Leiden (FVL) mutation and Protein gene G20210A mutation (PGM) are the most common inherited thrombophilias in the world. (Limdi NA et.al, Blood Cells Mol Dis. 2006 Sep-Oct;37(2):100-6) Both are inherited in an autosomal recessive fashion with individuals who are homozygous having higher risk of thrombosis compared to those who are heterozygous.(Rodger MA et.al, PLoS Med. 2010 Jun 15;7(6):e1000292.) The global prevalence of FVL and PGM is variable with Caucasians carrying the highest prevalence and Africans living in Africa, Asians and Native Americans having the lowest rate of these mutations; it is zero in West and Southern African countries, 2.4%-3.9% in North African countries including Morocco, Tunisia, and Algeria. (Limdi NA et.al, Blood Cells Mol Dis. 2006 Sep-Oct;37(2):100-6, Dziadosz M et. al, Blood Coagul Fibrinolysis. 2016 Jul;27(5):481-9) Pregnancy increases the risk of developing venous thromboembolism (VTE) by 0.05-1.8 %, (Eldor A, Thromb Haemost. 2...
Blood, 2018
Low hemoglobin (Hb) level at steady state in subjects with sickle cell anemia (SCA) may indicate ... more Low hemoglobin (Hb) level at steady state in subjects with sickle cell anemia (SCA) may indicate severe chronic hemolysis and might be related to a more severe course of disease. In this study we investigated the hypothesis that low hemoglobin at steady state may be associated with higher rate of lung function impairment in children and adolescents with SCA. Methods In this cross-sectional study black African subjects with SCA (Hb phenotype SS) aged 6 to 18 years followed at the Barau Dikko Teaching Hospital, Kaduna, Nigeria, underwent spirometry and anthropometry measures. A recent Hemoglobin level at steady state was recorded for each patient. Caregivers or patients were interviewed through a questionnaire investigating a history of asthma or acute chest syndrome (ACS) and frequency of pain crises in the last year that required analgesics for at least 24 hours. Exclusion criteria were: the lack of recorded complete blood count (CBC) performed in the last 6 months, respiratory symp...
F1000Research, 2018
The multiple clinical benefits of hydroxycarbamide in sickle cell disease are supported by a larg... more The multiple clinical benefits of hydroxycarbamide in sickle cell disease are supported by a large body of evidence. The maximum tolerated dose (MTD) is the regimen recommended by guidelines from a panel of National Heart, Lung, and Blood Institute (NHLBI) experts, but other dosage regimens have been used in babies (BABY-HUG) 9 to 18 months old (20 mg/kg per day) and developing countries such as India (10 mg/kg per day); however, there has been no direct comparison of the efficacy, effectiveness, or cost-effectiveness of these different regimens. The purpose of this review was to investigate the current situation with various hydroxycarbamide regimens with particular relevance to low-middle-income countries. In regard to methodology, a literature review was undertaken by using multiple databases in PubMed and Google and the search terms included sickle cell disease, hydroxyurea, hydroxycarbamide, sickle cell anaemia, low-middle-income countries, Sub-Saharan Africa, and India. Althou...
Paediatric Respiratory Epidemiology, 2017
Journal of tropical diseases & public health, 2018
Sickle Cell Disease (SCD) is among the most common single-gene diseases in the world but evidence... more Sickle Cell Disease (SCD) is among the most common single-gene diseases in the world but evidence-based comprehensive health care has not been implemented where the highest prevalence of SCD occurs, in sub-Saharan Africa (SSA). It represents an urgent health burden, both in terms of mortality and morbidity with an estimated mortality of 8-16% in children under 5 years in SSA. Addressing the high mortality of SCD in SSA and for effective management of SCD, newborn screening (NBS) should be incorporated with prevention of infections (including pneumococcal septicaemia and malaria), parental education and support at all levels of healthcare provision to enable timely recognition. The NBS working group of the Africa Sickle Cell Research Network (AfroSickleNet) collaboration surveyed current projects in NBS in SSA, and current conditions that hinder more widespread implementation of NBS for SCD. Solutions based on new point-of-care testing technology to disseminate education, and impleme...
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Papers by Livingstone Dogara