Browsing by Author "Akinyemi, J. O."

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Condom use among antiretroviral therapy patients in Ibadan, Nigeria
(2010) Akinyemi, J. O.; Awolude, O. A.; Awolude, O. A.; Adewole, I. F.; Kanki, P. J.
Background: While antiretroviral treatment (ART) has improved the health status of people living with HIV, new challenges to their sexual and reproductive health (SRH) needs and their ability to prevent secondary HIV infections have risen. This study aimed to determine the level and factors that affect condom use among ART-experienced patients at the premier teaching hospital in Nigeria. Methodology: This longitudinal study involved patients who initiated treatment at the University College Hospital, Ibadan, Nigeria, between January and December 2006. Sexually active patients who had received treatment for at least six months and had not defaulted on clinic follow-up schedules were studied. Data on socio-demographic characteristics and condom use were extracted from clinic records. Chi square test and logistic regression were employed to determine factors associated with condom use. Results: The study involved 866 patients, specifically, 306 (35.3%) men and 560 (64.7%) women aged 40.7 (SD 7.6) and 33.3 (SD 6.5) years respectively. Condoms usage before treatment and at last clinic visits was 14.0% and 43.3% respectively. Overall reports of condom use at specified periods were as follows: 1 – 6 months (33.0%); 7 – 12 months (37.3%) and above 12 months (53.8%). Patients in a marital union and those with higher education were more likely to use condoms. Conclusions: Condom use is significantly influenced by marital status and educational level. Although condom use increases together with follow-up time, the level can be improved. Primary and secondary prevention efforts targeting high-risk sexual behaviour among ART patients need to receive greater and continual attention.
Controlling malaria in pregnancy: how far from the Abuja targets?
(Dutch Malaria Foundation, 2016) Yusuf, O. B.; Akinyemi, J. O.; Fagbamigbe, A. F.; Ajayi, I. O.; Bamgboye, E. A.; Ngige, E.; Issa, K.; Abatta, E.; Ezire, O.; Amida, P.; Bashorun, A.
Background. The Roll Back Malaria (RBM) initiative recommended that all pregnant women receive Intermittent Preventive Treatment (IPTp) and that by 2010 at least 80% of people at risk of malaria (including pregnant women) use insecticide-treated bednets (ITN) in areas with stable transmission. We evaluated ITN/IPTp coverage, explored its associated factors, and estimated the number of pregnancies protected from malaria. Materials and methods. This analysis was based on data from the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus). To assess ITN coverage, we used the population of women that was pregnant (n=22,438) at the time of the survey. For IPTp coverage, we used women that had a live birth in the 5 years preceding the survey (n= 118,187) and extracted the population of pregnant women that, during their last pregnancy, received drugs for protection against malaria. We estimated the number of live births using the projected population of females in each state, population of women of child -bearing age and the total fertility rate. The estimated number of pregnancies covered/protected by ITN and IPTp was obtained from a product of the estimated live births and the reported coverage. Multivariate logistic regression was used to determine factors associated with ITN and IPTp use. Results. We estimated that there were 5,798,897 live births in Nigeria in 2012, of which 3,537,327 and 2,302,162 pregnancies were protected by ITN and IPTp, respectively. Four of 36 states achieved the 80% RBM target for ITN coverage. No state achieved the 100% target for IPTp. Education and socio-economic status were associated with IPTp use. Conclusion. ITN coverage was higher than in previous estimates even though it is still below the RBM targets. However, IPTp coverage remained low in 2012 and was not likely to increase to match the 2015 target coverage of 100%.
Demographic and epidemiological characteristics of HIV opportunistic Infections among older adults in Nigeria
(2017) Akinyemi, J. O.; Ogunbosi, B. O.; Fayemiwo, A. S.; Adesina, O. A.; Michael, O.; Kuti, M. A.; Awolude, O. A.; Olaleye, D. O.; Adewole, I. F.
Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.
Derivation and appraisal of maternal mortality estimates in Nigeria from the 2012 National HIV/AIDS and Reproductive Health Survey
(College of Medicine, University of Ibadan, 2017) Akinyemi, J. O.; Yusuf, O. B.; Fagbamigbe, A. F.; Bamgboye, E. A.; Kawu, I. B.; Ngige, E.; Amida, P.; Bashorun, A.
Background Despite the huge burden of in Nigeria, accurate and reliable data fur maternal mortality measurement arc locking The federal Ministry of Health in collaboration with development partners included questions that allow indirect estimation of maternal mortality m us 2012 National HIV/AIDS and Reproductive Health Survey (NARHS) The aim of this paper was to derive estimates of Maternal Mortality Ratio (MMR) and Lifetime Risk of maternal death (LTR) from the 2012 NARHS data Methods: This was a secondary analysis of data from the maternal mortality module of NARHS 2012. During the survey, respondents (men aged 15-59 years and women aged 15-49 years) were selected via a multi-stage cluster sampling technique and data collected by trained field workers. In this study, report on survival or otherwise of adult female siblings were analysed to derive estimates of life tune risk of maternal death using the indirect sisterhood method. Results: Data from 15,596 men and 15,639 women were analysed A total of 12.810 adult female siblings had been exposed to the risk of death out of which 377 (2.9*4) have died of the 377 adult female deaths. 70 (18 6%) were pregnancy related the estimates of LTR and MMR were I in 71 women and 256 (95% CT. 196 - 316) maternal deaths per 100,000 live births respectively. There were north-south and rural-urban differences. Conclusion: The high level of maternal mortality is worrisome, concerted efforts aimed at reduction and provision of routine data for its measurement should be intensified.
Differences in unintended pregnancy, contraceptive use and abortion by HIV status among women in Nigeria and Zambia
(2014) Bankole, A.; Keogh, S.; Akinyemi, J. O.; Dzekedzeke, K.; Awolude, O. A.; Adewole, I. F.
CONTEXT: Sub-Saharan Africa is burdened by high rates of unintended pregnancy and HIV. Yet little is known about the relationship between these two health risks in the region. Understanding the associations between HIV status and pregnancy decision making may benefit strategies to reduce unintended pregnancy. METHODS: In 2009–2010, household-based surveys of 1,256 women in Nigeria and 1,280 women in Zambia collected information on social and demographic characteristics, unintended pregnancy, contraceptive use, abortion and self-reported HIV status. Multivariate models were used to examine the association of reported HIV status with nintended pregnancy and abortion in the five years preceding the survey and with contraceptive use at the time of conception. RESULTS: HIV-positive and HIV-negative women did not differ in their odds of unintended pregnancy or of having an abortion. However, HIV-positive women were more likely than HIV-negative women to have been using a contraceptive at the time their unintended pregnancy was conceived (odds ratio, 3.2). Women who did not know their HIV status were less likely than HIV-negative women to report an unintended pregnancy (0.6). However, they were also less likely than HIV-negative women to have been using a contraceptive at the time of conception (0.5). CONCLUSION: HIV-positive women may be making greater efforts than HIV-negative women to prevent unintended pregnancy, but with less success. Efforts should be made to improve access to effective contraceptive methods and counseling for all women, and for HIV-positive women in particular.
Does knowledge about anti- retroviral therapy and mother-to- child transmission affect the relationship between HIV status and fertility preference and contraceptive use?
(Cambridge University Press, 2014) Bankole, A.; Biddlecom, A. E.; Dzekedzeke, K.; Akinyemi, J. O.; Awolude, O.; Adewole, I. F.
The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether women’s knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women’s HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.
Dynamics of poverty-related dissimilarities in fertility in Nigeria: 2003-2018
(Elsevier B.V, 2020) Adebowale, A. S.; Fagbamigbe, A. F.; Akinyemi, J. O.; Olowolafe, T.; Onwusaka, O.; Adewole, D.; Sadikue, S.; Palamuleni, M.
Nigeria is one of the high fertility countries worldwide. Little is known about the differences in fertility experience of women in poor and rich households in Nigeria. We ex amined the relationship between household wealth and fertility in Nigeria with focus on women from poor and rich households.This national representative and cross-sectional design study involved analysis of fourrounds (2003, 2008, 2013, 2018) of Nigeria Demographic Health and Survey data . Theoutcome variable was fertility measured from the full birth history information reported by women of reproductive age. Data were analyzed using descriptive statistics, direct and Gompertz-relational demographic methods, logistic regression and negative binomial re gression models (α=0.05). Across the survey years, the mean number of children ever born (CEB), the total fer tility rate and the percentage of women who had high fertility were consistently higher among the women from poor households than those from the rich households. From 2003 to 2018, declining pattern (slope = -0.87) in percentage of high fertility women was observed among rich unlike the poor women (slope = +0.31) where a slight increase was observed. In 2018 as for other survey rounds, about 18.7% and 38.4% of rich and poor women had high fertility (CEB≥5) respectively. The likelihood of high fertility (CEB≥5) was 2.74 (C.I=2.60-2.89, p<0.001) times higher among poor women than the rich women. In 2018,the fertility incidence risk ratio was about 8.0% higher among the women from the poo rhouseholds than their counterparts from the rich households and this pattern was observed when some other factors were included in the regression model across the survey years (2003-2018).
Dyslipidemia in ART-naive HIV-infected persons in Nigeria-implications for care
(Sage, 2014) Kuti, M. A.; Adesina, O. A.; Awolude, O. A.; Ogunbosi, B. O.; Fayemiwo, S. A.; Akinyemi, J. O.; Adetunji, A. A.; Irabor, A. E.; Odaibo, G. N.; Prosper, O.; Taiwo, B. O.; Olaleye, D.; Murphy, R. L.; Kanki, P.; Adewole, I. F.
Aims: This study aimed to describe the prevalence and pattern of lipid abnormalities among antiretroviral therapy (ART)- naive HIV patients, understand if there is any relationship to virologic and immunologic status, and discuss the implications for care. Methods: This was a cross-sectional study in which baseline demographic, clinical, and laboratory data of all ART-naive HIV-infected individuals recruited into the adult ARV clinic, University College Hospital, Ibadan, between January and December 2006, were analyzed. Results: In total, 1316 ART-naive HIV-infected persons were recruited in the period. Females subjects and participants aged 35 years accounted for 67.1% and 57.7% of all participants, respectively. At least 1 abnormal lipid fraction was seen in 73.3% of participants. It was observed that in 11.5% participants the total cholesterol (TC) was ≥5.2 mmol/L, in 2.7% the low-density lipoprotein cholesterol (LDL)-C was >4.1 mmol/L in 56.5% the high-density lipoprotein cholesterol (HDL)-C was <1.0 mmol/L, and in 27.6% the triglyceride (TG) was >1.7 mmol/L. The TC, LDL-C, and HDL-C were all significantly positively correlated with CD4 counts and negatively correlated with viral load. On the contrary, the TG levels were negatively correlated with CD4 counts and positively correlated with viral load. Multivariate linear analysis showed a significant relationship between all the lipid parameters and viral load. CD4 counts were only significantly associated with TC. Conclusions: A significant burden of dyslipidemia exists among ART-naive HIV-infected persons. Low HDL-C was the most frequently observed abnormality. The abnormalities related more with viral load levels than with CD4 counts. Dyslipidemia screening should be done in ART-naive HIV-infected persons. Simple healthy lifestyle changes should be emphasized, with other care given to those with the disorder.
Dyslipidemia in ART-naive infected Persons in Nigeria- implications for care
(Sage Publications, 2015) Kuti, M. A.; Adesina, O. A.; Awolude, O. A.; Ogunbosi, B. O.; Fayemiwo, S. A.; Akinyemi, J. O.; Adetunji, A. A.; Irabor, A. E.; Odaibo, G. N.; Okonkwo, P.; Taiwo, B. O.; Olaleye, D.; Murphy, R. L.; Kanki, P.; Adewole, I. F.
Aims: This study aimed to describe the prevalence and pattern of lipid abnormalities among antiretroviral therapy (ART)- naive HIV patients, understand if there is any relationship to virologic and immunologic status, and discuss the implications for care. Methods: This was a cross-sectional study in which baseline demographic, clinical, and laboratory data of all ART-naïve HIV-infected individuals recruited into the adult ARV clinic, University College Hospital, Ibadan, between January and December 2006, were analyzed. Results: In total, 1316 ART-naive HIV-infected persons were recruited in the period. Females subjects and participants aged ≤35 years accounted for 67.1% and 57.7% of all participants, respectively. At least 1 abnormal lipid fraction was seen in 73.3% of participants. It was observed that in 11.5% participants the total cholesterol (TC) was ≥5.2 mmol/L, in 2.7% the low-density lipoprotein cholesterol (LDL)-C was >4.1 mmol/L in 56.5% the high-density lipoprotein cholesterol (HDL)-C was <1.0 mmol/L, and in 27.6% the triglyceride (TG) was >1.7 mmol/L. The TC, LDL-C, and HDL-C were all significantly positively correlated with CD4 counts and negatively correlated with viral load. On the contrary, the TG levels were negatively correlated with CD4 counts and positively correlated with viral load. Multivariate linear analysis showed a significant relationship between all the lipid parameters and viral load. CD4 counts were only significantly associated with TC. Conclusions: A significant burden of dyslipidemia exists among ART-naive HIV-infected persons. Low HDL-C was the most frequently observed abnormality. The abnormalities related more with viral load levels than with CD4 counts. Dyslipidemia screening should be done in ART-naive HIV-infected persons. Simple healthy lifestyle changes should be emphasized, with other care given to those with the disorder.
Evaluation of paracheck - Pf™ rapid malaria diagnostic test for the diagnosis of malaria among HIV-positive patients in Ibadan, South-Western Nigeria
(Taylor and Francis, 2013) Falade, C. O.; Adesina-Adewole, B.; Dada-Adegbola, H. O.; Ajayi, I. O.; Akinyemi, J. O.; Ademowo, O. G.; Adewole, I. F.; Kanki, P.
Febrile illnesses occur frequently among HIV positive patients and these are often treated presumptively as malaria in endemic areas. Parasite-based diagnosis of malaria will eliminate unnecessary treatment, reduce drug–drug interactions and the chances for the emergence of drug resistant Plasmodium. We evaluated finger prick blood samples from 387 people living with HIV (PLWHIV) and suspected of having malaria by expert microscopy and Paracheck-Pf TM – a histidine-rich protein-II based malaria rapid diagnostic test. The study was conducted at the PEPFAR supported AIDS Prevention Initiative in Nigeria (APIN) Clinic of the University College Hospital Ibadan, southwest Nigeria. Outcome parameters were prevalence of malaria parasitemia, sensitivity and specificity of Paracheck-Pf as well as the positive and negative predictive values for Paracheck-Pf using microscopy of Giemsa-stained blood film as gold standard. Malaria parasites were detected in 19.1% (74/387) of enrollees by microscopy and 19.3% (74/383) by Paracheck-Pf. Geometric mean parasite density was 501/µl (range 39–749 202/µl). Sensitivity and specificity of Paracheck-Pf at all parasite densities were 55.4% and 89.3% while corresponding figures at parasite densities ≥200/µl were 90.9% and 90.3%. Sensitivity and specificity at parasite densities ≥500/µl was 97.6% and 90.3%. Positive and negative predictive values for parasite density ≥200/µl were 55.4% and 98.7%, respectively. Paracheck-pf was found to be a useful malaria diagnostic tool at parasite densities ≥200/µl facilitating appropriate clinical management.
External genital warts in HIV-infected patients with sexually transmitted infections in Ibadan, Nigeria
(2017) Fayemiwo, S. A.; Adesina, O. A.; Akinyemi, J. O.; Michael, O. S.; Adekanmbi, O. A.; Awolude, O. A.; Kuti, M. A.; Odaibo, G. N.; Adewole, I. F.
Background: Human Papilloma Virus (HPV) infection in the genital area is usually asymptomatic, and when symptomatic, manifests in cither benign or malignant forms. This study aims at providing information on the prevalence of external genital warts (EGWs) among people living with HIV (PLWHIVs) attending Antiretroviral Treatment (ART) clinic at the University College Hospital. Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of PLWHIVs attending ART clinic between January 2006 and December 2007. Diagnosis of genital warts was based on the findings of typical lesions on the external genitalia, vaginal, cervix or perianal region after clinical examination and informed consent from each participant. Antibodies against Herpes and HPV were measured using, Enzyme-linked immunosorbent Assay (ELISA). Results: A total of 5.207 patients, 3519 female and 1688 males attended the ART clinic during the period. The mean age of the patients was 34,67 yrs (± 9.16). Five hundred and forty-two (10.0%) had various sexually transmitted infections (STIs). The prevalence of anogenital warts was 3.65% among the HIV-infected patients and 35.0 % among the subset of HIV- infected patients with STIs. The prevalence of genital warts was 1.5 times higher in treatment experienced patients (OR =1.46; 95%CI: 1.02,2.10). Genital wart was found to be associated with low CD4 count, high viral load, treatment- experience and non-use of condom during sexual intercourse. (P = 0.002). Conclusions: External genital warts are common among people living with HIV infection. According to the appropriate guidelines, HPV vaccine should also be offered to HIV-infectcd adolescents that are non-rcactivc to the virus.
Gender variation in self-reported likelihood of HIV infection in comparison with HIV test results in rural and urban Nigeria
(Biomed Central, 2011) Fagbamigbe, A. F.; Akinyemi, J. O.; Adedokun, B. O.; Bamgboye, E. A.
Background: Behaviour change which is highly influenced by risk perception is a major challenge that HIV prevention efforts need to confront. In this study, we examined the validity of self-reported likelihood of HIV infection among rural and urban reproductive age group Nigerians. Methods: This is a cross-sectional study of a nationally representative sample of Nigerians. We investigated the concordance between self-reported likelihood of HIV and actual results of HIV test. Multivariate logistic regression analysis was used to assess whether selected respondents’ characteristics affect the validity of self-reports. Results: The HIV prevalence in the urban population was 3.8% (3.1% among males and 4.6% among females) and 3.5% in the rural areas (3.4% among males and 3.7% among females). Almost all the respondents who claimed they have high chances of being infected with HIV actually tested negative (91.6% in urban and 97.9% in rural areas). In contrast, only 8.5% in urban areas and 2.1% in rural areas, of those who claimed high chances of been HIV infected were actually HIV positive. About 2.9% and 4.3% from urban and rural areas respectively tested positive although they claimed very low chances of HIV infection. Age, gender, education and residence are factors associated with validity of respondents’ self-perceived risk of HIV infection. Conclusion: Self-perceived HIV risk is poorly sensitive and moderately specific in the prediction of HIV status. There are differences in the validity of self-perceived risk of HIV across rural and urban populations.
HCV co-infection is associated with metabolic abnormalities among HAART naïve HIV-infected persons
(2017) Kuti, M. A.; Akinyemi, J. O.; Ogunbosi, B. O.; Kuti, K. M.; Adesina, O. A.; Awolude, O. A.; Michael, O. S.; Adewole, I. F.
Objectives: To determine the metabolic abnormalities among Hepatitis C Virus (HCV) coinfected HAART naïve HIV infected persons within the adult ARV clinic of the University College Hospital/University of Ibadan, Ibadan, Nigeria Methods: This was a retrospective study involving the review of clinical records of newly recruited HIV-infected persons in the adult antiretroviral (ARV) clinic over a 12month period (January - December 2006). Baseline results for fasting plasma glucose (FPG) and fasting lipid profile were retrieved. Results: Out of the 1,260 HIV infected persons seen during the study period, HCV co-infection was found in 75 (6%) persons. The median values for total cholesterol, LDL-cholesterol and HDLcholesterol were lower in the HCV co-infected persons. HIV-HCV co–infection was associated with a 0.31 mmol/L depression in Total Cholesterol (TC). The median FPG concentration was significantly higher in HIV-HCV co–infected than HIV only infected persons (5.33mmol/L vs. 5.00mmol/L, p = 0.047). However, regression analysis showed there was no relationship between the HIV-HCV coinfected State and fasting glucose levels. Conclusion: HIV-HCV co-infection may be associated with a predictable decline in plasma cholesterol, but FPG may not be sufficient to demonstrate insulin resistance in these persons.
The incidence of abortion in Nigeria
(2015-12) Bankole, A.; Adewole, I. F.; Hussain, R.; Awolude, O.; Singh, S.; Akinyemi, J. O.
CONTEXT—Because of Nigeria’s low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country’s restrictive abortion law. Up-to-date estimates of abortion incidence are needed. METHODS—A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. RESULTS—An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15–49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15–49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. CONCLUSION—Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality.
Modelling the survivorship of Nigeria children in their first 10 years of life
(Nigerian Medical Association, Rivers State, Nigeria, 2016) Fagbamigbe, A. F.; Akinyemi, J. O.
Introduction: Several studies have attributed social demographic and environmental characteristics to differentials in children mortality rates worldwide but there is paucity of information on modelling of children survival in Nigeria. In this study we modelled children survival in Nigeria for first five years of life and predicted their chances of survival in their sixth to tenth years of life. Methods: We used the data from the 2013 Nigeria Demographic and Health Survey to carry out a retrospective analysis of children survival. We computed the probability of survival and mortality rates for the first five years and predicted survivals for 6th to 10th years of life using life table techniques and compared our estimates with those obtained using Brass indirect techniques. Results: The probability of a child surviving up to exact age 1 and 5 were 0.9212 (95% CI: 0.919-0.923) and 0.8583 (95% CI: 0.855-0.861), respectively. About 142 of every 1000 children would not make their tenth birthday in Nigeria. We found higher survivorship trend among female children than the males with higher rates in Southern Nigeria than in the Northern parts. The estimates of probabilities of survival from age 1 to 5 from the fitted curves agreed very closely with those obtained from Brass indirect techniques as the variability was less than 2%. Conclusion: Child mortality is high in Nigeria with fewer children deaths among females. Probability of not attaining age 10 in South West is lower than chances of not marking first birthday in North West zone. Efforts must be concentrated in reversing the worrisome survival trend in Nigeria especially in the Northern parts of the country.
Molluscum contagiosum virus infection among PLWHA In Ibadan, Nigeria
(African Journal of Clinical and Experimental Microbiology, 2014) Fayemiwo, S. A.; Adesina, O. A.; Akinyemi, J. O.; Odaibo, G. N.; Omikunle, T. O.; Adewole, I. F.
Background: Molluscum contagiosum (MC) infection is caused by a pox virus and the virus is probably passed on by direct skin-to- skin contact which may affect any part of the body. There is anecdotal evidence associating facial lesions with HIV-related immunodeficiency. This study was aimed to determine the prevalence and associated risk factors of Molluscum contagiosum infection among PLWHAs attending ART clinic at the University College Hospital, Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of 5,207 patients (3519 female and 1688 males) attending ART clinic between January 2006 and December 2007. Physicians performed complete physical and pelvic examinations. Diagnosis of Molluscum Contagiosum infection was based on the clinical findings of typical lesions on the external genitalia, perianal, trunk, abdominal and facial regions. Results: The mean age of the patients was 34.67 yrs. ± 9.16). About 10% (542) had various sexually transmitted infections (STIs). The male to female ratio was 1: 4.2. One hundred and twenty seven subjects (23.4%) had no formal or primary education with 247 (45.6 %) being treatment naive while 295 (54.4 %) were treatment experienced. Of the 542 PLWHAs with STIs, 3.3 % had undetectable viral load (< 200 copies/ ml) while 272 (50.1 %) had low CD4 count (< 200 cells / mm3.) and The Mean log10 viral load was 5.02 ± 0.94. Molluscum Contagiosum infection was diagnosed in 13 patients (0.024%; 8 females and 5 males). Vaginal Candidiasis was the commonest genital infection diagnosed in 223 (41.1%) of the patients with STIs. MC patients had higher viral load, lower CD4 count and more likely to be treatment experienced”. Conclusions: Molluscum Contagiosum infection is not uncommon among the HIV-infected patients, but underreported. Awareness of this cutaneous manifestation should be known to Physicians in AIDS care.
Obstetric and newborn outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women at the University College Hospital Ibadan
(Society of Gynaecology and Obstetrics of Nigeria, 2015-04) Adesina, O. A.; Michael, O. S.; Ogunbosi, B. O.; Akinyemi, J. O.; Kuti, M. A.; Awolude, O. A.; Fayemiwo, S. A.; Adewole, I. F.
There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HTV positive parturients were identified in the birth register. During the 30-month period, 318 of 6203 deliveries were HIV positive (5.1%) with 97.6% record retrieval. The mean age of the HTV positive parturients was 31.66 years (± 4.66); the mean gestational age at delivery was 38.02 weeks (± 2.75) and the mean birth weight 2.85kg (±0.59). There were 35.8% (109) preterm births, 2.9% stillbirths and 21.5% low birth weights. The regimen most commonly (198, 64.5%) used was a non-nucleoside reverse transcriptase (NNRTI) based HAART. Preterm births were similar following spontaneous vaginal delivery (31.5%) and elective section (31%) but higher (41.3%) with emergency section (p=0.4). On univariate analysis, the preterm infants had lower mean birth weights (2.46±0.61 vs 2.96±0.44; p=0.000). The proportion of preterm births was higher among Low birth weight infants (71.9% vs 28.1%; p=0.00). Variables with more preterm births were age >35 years (51.6%), ≤ 6years of schooling (51.5% vs 48.4%) and being on combination ARV (PI, 37.5% or non-PI, 36.2%). However, these differences did not attain statistical significance. Low birth weight infants had mothers who had higher mean ages (33.28 years ±4.59 vs 31.28 years ± 4.59,. p= 0.02), lower mean gestational age at delivery (35.72 weeks ± 3.16 vs 38.49 weeks ±2.1, p= 0.00). Variables with more low birth weight include <12years of schooling and being on mono/ dual therapy (31.8%). These differences were not statistically significant. On logistic regression, factors that retained an association with low birth weight were mean maternal age at delivery (p= 0.002; β- 0.904; 95% CI, 0.848 - 0.966) and being on mono/ dual therapy (p= 0.039; β= 3.042; 95% CI, 1.055 - 8.768). The only factor that retained an association with preterm birth was mean maternal age at delivery (p= 0.015; β= 0.935; 95% CI, 0.886-0.987). HIV positive (especially older) women, have high rates of preterm deliveries and low birth weights. The beneficial effects of HAART on mother-to-child transmission are indisputable but monitoring antiretroviral therapy in pregnancy remains a priority and antenatal surveillance should include fetal growth assessment.
Obstetric and newborn outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women at the University College Hospital, Ibadan
(2015-04) Adesina, O. A.; Obaro, S. M.; Ogunbosi, B. O.; Akinyemi, J. O.; Kuti, M. A.; Awolude, O. A.; Fayemiwo, S. A.; Adewole, I. F.
There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HIV positive parturients were identified in the birth register. During the 30-month period, 318 of 6203 deliveries were HIV positive (5.1%) with 97.6% record retrieval. The mean age of the HIV positive parturients was 31.66 years (± 4.66); the mean gestational age at delivery was 38.02 weeks (± 2.75) and the mean birth weight 2.85kg (±0.59). There were 35.8% (109) preterm births, 2.9% stillbirths and 21.5% low birth weights. The regimen most commonly (198, 64.5%) used was a non-nucleoside reverse transcriptase (NNRTI) based HAART. Preterm births were similar following spontaneous vaginal delivery (31.5%) and elective section (31%) but higher (41.3%) with emergency section (ƿ=0.4). On univariate analysis, the preterm infants had lower mean birth weights (2.46±0.61 vs 2.96±0.44; ƿ=0.000). The proportion of preterm births was higher among Low birth weight infants (71.9% vs 28.1%; ƿ=0.00). Variables with more preterm births were age >35 years (51.6%), ≤6years of schooling (51.5% vs 48.4%) and being on combination ARV (PI, 37.5% or non-PI, 36.2%). However, these differences did not attain statistical significance. Low birth weight infants had mothers who had higher mean ages (33.28 years ± 4.59 vs 31.28 years ± 4.59, ñ= 0.02), lower mean gestational age at delivery (35.72 weeks ± 3.16 vs 38.49 weeks ± 2.1, ƿ= 0.00). Variables with more low birth weight include <12years of schooling and being on mono/ dual therapy (31.8%). These differences were not statistically significant. On logistic regression, factors that retained an association with low birth weight were mean maternal age at delivery (ƿ= 0.002; β= 0.904; 95% CI, 0.848 –0.966) and being on mono/ dual therapy (ƿ= 0.039; β= 3.042; 95% CI, 1.055 – 8.768). The only factor that retained an association with preterm birth was mean maternal age at delivery (ƿ= 0.015; β= 0.935; 95% CI, 0.886 – 0.987). HIV positive (especially older) women, have high rates of preterm deliveries and low birth weights. The beneficial effects of HAART on mother-to-child transmission are indisputable but monitoring antiretroviral therapy in pregnancy remains a priority and antenatal surveillance should include fetal growth assessment.
Patterns and determinants of dropout from maternity care continuum in Nigeria
(2016) Akinyemi, J. O.; Afolabi, R. F.; Awolude, O. A.
Background: The maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits. Continuity of care is a challenge in sub-Saharan Africa. In this study, we investigate the patterns and factors associated with dropout in the continuum of maternity (antenatal, delivery and postnatal) care in Nigeria. Method: Using women recode file from the 2013 Nigeria Demographic and Health Survey, we analysed data on 20,467 women with an index birth within 5 years prior to data collection. Background characteristics and pattern of dropouts were summarised using descriptive statistics. The outcome variable was dropout which we explored in three stages: antenatal, antenatal-delivery, delivery-6 weeks postnatal visit. Multilevel logistic regression models were fitted to identify independent predictors of dropout at each stage. Measure of effect was expressed as Odds Ratio (OR) with 95 % confidence interval (CI). Results: Overall, 12,392 (60.6 %) of all women received antenatal care among whom 38.1 % dropout and never got skilled delivery assistance. Of those who received skilled delivery care, 50.8 % did not attend postnatal visit. The predictors of dropout between antenatal care and delivery include problem with getting money for treatment (OR = 1. 18, CI: 1.04–1.34), distance to health facility (OR = 1.31, CI: 1.13–1.52), lack of formal education, being in poor wealth quintile (OR = 2.22, CI: 1.85–2.67), residing in rural areas (OR = 1.98, CI: 1.63–2.41). Regional differences between North East, North West and South West were significant. Between delivery and postnatal visit, the same factors were also associated with dropout. Conclusion: The rate of dropout from maternity care continuum is high in Nigeria and driven by low or lack of formal education, poverty and healthcare access problems (distance to facility and difficulty with getting money for treatment). Unexpectedly, dropouts are high in South east and South south as well as in the Northern regions. Intervention programs focusing on community outreach about the benefits of continuum of maternal healthcare package should be introduced especially for women in rural areas and lower socio-economic strata.
Phenotyping stroke in Sub-Saharan Africa: stroke investigative research and education network (SIREN) phenomics protocol
(Karger Publishers, 2015) Akpalu, A.; Sarfo, F. S.; Ovbiagele, B.; Akinyemi, R.; Gebregziabher, M.; Obiako, R.; Owolabi, L.; Sagoe, K.; Jenkins, C.; Arulogun, O.; Adamu, S.; Appiah, L. T.; Adadey, M. A.; Agyekum, F.; Quansah, J. A.; Mensah, Y. B.; Adeoye, A. M.; Singh, A.; Tosin, A. O.; Ohifemen, O.; Sani, A. A.; Tabi-Ajayi, E.; Phillip, I. O.; Isah, S. Y.; Tabari, N. A.; Mande, A.; Agunloye, A. M.; Ogbole, G. I.; Akinyemi, J. O.; Akpa, O. M.; Laryea, R.; Melikam, S. E.; Adinku, D.; Uvere, E.; Burkett, N.-S.; Adekunle, G. F.; Kehinde, S. I.; Azuh, P. C.; Dambatta, A. H.; Ishaq, N. A.; Arnett, D.
Background: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research. Methods: SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patients with first stroke within 10 days of onset in whom neurovascular imaging will be performed. Etiological and topographical stroke sub types will be documented for all cases. Controls will be hospital- and community-based participants, matched to cases on the basis of gender, ethnicity, and age (±5 years). Information will be collected on known and proposed emerging risk factors for stroke. Study Significance: SIREN is the largest study of stroke in Africa to date. It is anticipated that it will shed light on the phenotypic characteristics and risk factors of stroke and ultimately provide evidence base for strategic interventions to curtail the burgeoning burden of stroke on the sub-continent.