Browsing by Author "Lawal, T. A."

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Awareness and knowledge of birth defects among antenatal Clinic attendees at the University College Hospital Ibadan, South-West, Nigeria.
(2021) Akinmoladun, J. A.; Uchendu, O.; Lawal, T. A.; Oluwasola, T. A. O.
OBJECTIVES: This study assessed the knowledge of risk factors and prevention of birth defects among ante-natal clinic attendees at the University College Hospital, Ibadan, Oyo State, Nigeria METHODS: This was a cross sectional study among 415 mothers who presented at the antenatal clinic, A semi-structured questionnaire was used to obtain information on respondents socio-demographic profile, pregnancy, birth history, knowledge on prevention and risk factors for birth defects. Descriptive statistics was used to present results, independent t-test and ANOVA were used to determine the factors associated with mean of overall knowledge of birth defects. Test statistics was done at a 5% level of statistical significance. RESULTS: The mean age of the women was 31.7 + 4.8 years Overall, 93 (22.4%) of the women were above 35 years, 118 (29.9%%) were skilled workers and 343 (84.9%) had tertiary education. More than half (219, 52.8%) of the respondents had good knowledge of birth defects (56.4%a had good knowledge of prevention and 66.0% had good knowledge of risk factors) Antenatal clinic attendees in their first trimester had higher mean overall knowledge score (8.3 t 4.9) compared to those in second (7.9 + 4.5) and third (7,9 + 4,9) trimesters but this was not statistically significant (p=0.873). However, respondents in skilled/ semi-skilled occupation (8_62) had a significantly higher mean knowledge score compared with those in unskilled occupation/ unemployed (7,33) (p=0.005) CONCLUSION: Knowledge of birth defects is relatively low among women. To reduce the occurrence and severity of birth defects, there is a need to educate mothers on the knowledge, prevention and importance of screening for birth defects.
Awareness and knowledge of birth defects among antenatal clinic attendees at thè University College Hospital, Ibadan, South-West, Nigeria
(West African College of Physicians and the West African College of Surgeons, 2021) Akinmoladun, J. A.; Uchendu, O. C.; Lawal, T. A.; Oluwasola, T. A. O.
BACKGROUND: The burden of birth defects is disproportionately higher in developing countries. OBJECTIVES: This study assessed the knowledge of risk factors and prevention of birth defects among ante-natal clinic attendees at the University College Hospital, Ibadan, Oyo State, Nigeria. METHODS: This was a cross-sectional study among 415 mothers who presented at the antenatal clinic. A semi-structured questionnaire was used to obtain information on respondents' socio-demographic profile, pregnancy, birth history, knowledge on prevention and risk factors for birth defects. Descriptive statistics was used to present results, independent t-test and ANOVA were used to determine the factors associated with mean of overall knowledge of birth defects. Test statistics was done at a 5% level of statistical significance. RESULTS: The mean age of the women was 31.7 ± 4.8 years. Overall, 93 (22.4%) of the women were above 35 years, 118 (29.9%) were skilled workers and 343 (84,9%) had tertiary education. More than half (219, 52.8%) of the respondents had good knowledge of birth defects (56.4% bad good knowledge of prevention and 66.0% had good knowledge of risk factors). Antenatal clinic attendees in their first trimester had higher. mean overall knowledge score (8.3 4.9) compared to those in second (7.9 4.5) and third (7.9 4.9) trimesters but this was not statistically significant (p=0.873). However, respondents in skilled semi-skilled occupation (8.62) had a significantly higher mean knowledge score compared with those in unskilled occupation/ unemployed (7.33) (p=0,005), CONCLUSION: Knowledge of birth defects is relatively low among women. To reduce the occurrence and severity of birth defects, there is a need to educate mothers on the knowledge, prevention and importance of screening for birth defects.
Experience with sonogram-guided hydrostatic reduction of intussusception children in South-West Nigeria
(The West African College of Surgeons, 2013) Ogundoyin, O. O.; Atalabi, O. M.; Lawal, T. A.; Olulana, D. I.
"Background Intussusception is a common cause of intestinal obstruction in young children. The diagnosis and treatment of intussusception has evolved over the years with ultrasound being the first choice imaging technique and a major player in the non-operative reduction of intussusception owing to its advantage of reduced morbidity and non-exposure to ionizing radiation when compared to other modalities of treatment.Aim & Objectives: The aim of this study was to evaluate the efficiency of ultrasound guided hydrostatic reduction in the management of intussusception in children and assess the predictors of reducibility.Methods: A prospective study of all infants and children who presented with uncomplicated intussusception was conducted between January, 2005 and September, 2013. The diagnosis of intussusception was made clinically and this was confirmed by an abdominal ultrasonography. Ultrasound guided hydrostatic reduction of intussusception was performed on the selected patients after they were adequately resuscitated. Failed was abandoned in favour of operative reduction in some patients. Data collected included the age of the patient, duration of symptoms and the outcomes of the procedure and these were analyzed. Results: Eighty-four patients with intussusception were treated over this period, 36(42,9%) patients were found suitable for hydrostatic reduction of intussusception. Twenty-four(66.7%) patients presented within 48 hours of onset of symptoms. Twenty-one(58.3%) patients had successful hydrostatic reduction of intussusceptions while 15 (41.7%) patients had failed reduction. The procedure was successful in majority (58%) of the patients age of 1 year and one of the three (33%) patients older than one year. Hydrostatic reduction of intussusceptions was successful in 14 out of 24 patients (58.3%) who presented within 48 hours of onset of symptoms. Conclusion: Hydrostatic reduction of intussusception under ultrasound guidance is an effective and use conservative method of management in carefidly selected children with intussusception. Overall, this modality treatment is cost effective and could readily be used for patients in resource poor environment. It also monitors the reduction process and visualizes the components of the intussusception including the lead points. "
Factors influencing the pratcie of hydrostatic reduction of intussusception amongst radiologists in a developing country
(2009) Lawal, T. A.; Atalabi, O. M.; Adekanmi, A. J.; Ogundoyin, O. O
Background: Intussesception is a mojor cuase of intestinal obstruction in children and can be treated operatively or non-operatively. Surgery is associated with mortality rates, in dveloping countries of 8.5% to 18%. Hydrostatic reduction is a cost effective treatment that can lower the mortality rate in resource poor settings. However, the teachnique is not widely performed inspite of the advantages. Objectives: We reviewed factors influencing the current practice of hydrostatic reduction of intussusception by radiologists in Nigeria. Materials and Methods: A survey of radiologists was conducted using structured self adminsitered questionnaires. Strenght of assocition between the practice of hydrostatic reduction and variables related to the workforce was evaluated using Fisher's exact test. Result: Fifty-one participants were studied. Three (18.8%) hospitals have at least one consultant radiologist focusing on pediatric surgeon or more. Hydrostatic reduction is practiced in hospitals with a radiologist with interest in pediatric radiology, (p=0.002). Lack of expertise was given as the main reason why hte other hospitals have not commenced the procedure.
Hydrostatic reduction of intussusception under ultrasound guidance: an initial experience in a developing country
(2007-07) Atalabi, O. M; Ogundoyin, O. O,; Ogunlana, D. I,; Onasanya, O. M.; Lawal, T. A.; Olarinoye, A. S.
Background: Intussusception is one of the most common causes of acute intestinal obstruction in children. Hydrostatic reduction with barium enema is the widely accepted and preferred mode of treatment of uncomplicated intussuception. The aim of this study was to report our initial experience with hydrostatic reduction of intussusception. Patients and methods: We present our initial experience in which 8 patients had ultrasound guided hydrostatic reduction of intussusception over a period of 2 years. All patients that presented within 48hours of onset of symptoms were recruited into the study. Clinical diagnosis of intussusceptions was made in all of them while abdominal ultrasound was used to confirm the diagnosis. Results: Half of the patients presented after 24 hours of onset of symptoms. Five patients (62.5%) had a successful reduction of thier instussusception while was completed by surgery. There was only one (12.5%) recurrence and there was no peritonitis. Conclusion: Ultrasound guided hydrostatic reduction of intussusceptions in this environment is possible when patients present early with low risk of complication and low recurrence rate.
Involvement of oxidative stress in municipal landfill leachate-induced toxicity in boar sperm
(Elsevier B.V., 2013) Adedara, I. A. || || || ||; Oyebiyi, O. O.; Lawal, T. A.; Adesina, A. A.; Farombi, E. O.
Exposure to leachates generated from an improperly managed hazardous waste dump sites is detrimental to human health and the ecosystem. The present study investigated the effect of Olushosun municipal landfill leachate (OMLL) on sperm characteristics and antioxidant systems in boar sperm cells. The sperm cells were incubated with the leachate at final concentrations of 0, 1, 2, 4 and 8% for 3 h at 37◦C. Sperm characteristics were monitored hourly during the incubation period whereas amino transferases activities and oxidative stress indices were determined after the incubation period. Results revealed a time- and dose-dependent decline in sperm progressive motility from 1 h post-treatment with 2, 4 and 8% OMLL whereas decreased sperm viability with elevated abnormalities were observed from2 h post-treatment with 4 and 8% OMLL when compared with control. Exposure to OMLL caused a significant increase in aminotransferases, catalase and glutathione-S-transferase activities whereas it markedly decreased superoxide dismutase and glutathione peroxidase activities without affecting glutathione level in the treated sperm cells. Co-incubation of sperm with OMLL increased the levels of hydrogen peroxide and malondialdehyde levels. In conclusion, OMLL elicited spermatotoxicity via induction of oxidative stress possibly generated through an enhanced intracellular reactive oxygen species.
Municipal landfill Leachate-induced testicular oxidative damage is associated with biometal accumulation and endocrine disruption in rats
(Springer Science+Business Media, 2015) Adedara, I. A.; Awogbindin, I. O.; Adesina, A. A.; Oyebiyi, O. O.; Lawal, T. A.; Farombi, E. O.
Improper management of hazardous wastes adversely impacts the environment and the public health. The present study was aimed at investigating the influence of Olushosun municipal landfill leachate (OMLL) from Ojota in the Lagos State of Nigeria on testicular function by assessing the plasma concentrations of reproductive hormones, testicular biometal levels, and antioxidant levels as well as observing the histological alterations in testes and epididymides of rats after exposure to 0, 12.5, and 25 % OMLL in drinking water for 7 days. Exposure to OMLL significantly decreased the daily fluid intake, but it resulted in testicular biometal accumulation as follows: lead [cadmium[nickel[iron[copper. Acute exposure to OMLL induced oxidative stress and increased the activities of marker enzymes of testicular function but markedly decreased the circulatory concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, thyroid-stimulating hormone, triiodothyronine, and thyroxine. Testicular and epididymal degeneration with significant decrease in sperm quality and quantity were observed in OMLL-exposed rats. Collectively, the data presented herein indicate that exposure to OMLL-induced testicular dysfunction associated with biometal accumulation and endocrine disruption in rats. If the effects can be extrapolated to humans, OMLL may present significant health implications for individuals exposed to OMLL-contaminated substances.
Ophthalmic congenital anomalies: spectrum and systemic associations in a Nigerian tertiary hospital
(2017) Olusanya, B. A.; Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Lawal, T. A.; Baiyeroju, A. M.; Ogunkunle, O. O.; Joel-Medewase, V. I.; Adebayo, B. E.; Akinrinoye, O. O.; Ashubu, O. F.; Omokhodion, S. I.
Background: To document the pattern of ophthalmic congenital anomalies and their associated systemic anomalies in Nigeria’s foremost university teaching hospital. Methods: Retrospective cross-sectional study conducted at the University College Hospital, Ibadan from January 2009 to December 2013. Clinic and ward registers of various departments and units in the hospital were reviewed to identify children with any structural abnormality, present at birth, which involved the eye and/or its adnexae. Results: Two hundred and forty eight children with 259 ophthalmic congenital anomalies were studied. The median age was 1.2 years with an interquartile range of 4.6 years. The male to female ratio was 1.27:1. Congenital cataract was found in 109 (44%) patients; 40 (15.4%) children had congenital glaucoma, and whole globe anomalies were observed in 18 (6.9%) children. Eighteen (7.9%) children had a family history of congenital anomalies. Associated systemic congenital anomalies were seen in 32 (12.9%) patients with the most common being cardiovascular anomalies in 13 (5.2%) patients. Children who had congenital cataracts were more likely to have multiple associated systemic anomalies (p<0.005). All the children who had associated cardiovascular anomalies had congenital cataracts (p= 0.001). Conclusion: The commonest ophthalmic congenital anomaly presenting for tertiary care in Ibadan is congenital cataract. Cardiovascular anomalies are the commonest systemic association of ophthalmic congenital anomalies. There is an urgent need for the establishment of a registry for congenital anomalies with effective screening and active surveillance within the Nigerian health system.
Ophthalmic congenital anomalies: spectrum and systemic associations in a Nigerian tertiary hospital
(2017) Olusanya, B. A.; Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Lawal, T. A.; Baiyeroju, A. M.; Ogunkunle, O. O.; Joel-Medewase, V. I.; Adebayo, B. E.; Akinrinoye, O. O.; Ashubu, O. F.; Omokhodion, S. I.
Background: To document the pattern of ophthalmic congenital anomalies and their associated systemic anomalies in Nigeria’s foremost university teaching hospital. Methods: Retrospective cross-sectional study conducted at the University College Hospital, Ibadan from January 2009 to December 2013. Clinic and ward registers of various departments and units in the hospital were reviewed to identify children with any structural abnormality, present at birth, which involved the eye and/or its adnexae. Results: Two hundred and forty eight children with 259 ophthalmic congenital anomalies were studied. The median age was 1.2 years with an interquartile range of 4.6 years. The male to female ratio was 1.27:1. Congenital cataract was found in 109 (44%) patients; 40 (15.4%) children had congenital glaucoma, and whole globe anomalies were observed in 18 (6.9%) children. Eighteen (7.9%) children had a family history of congenital anomalies. Associated systemic congenital anomalies were seen in 32 (12.9%) patients with the most common being cardiovascular anomalies in 13 (5.2%) patients. Children who had congenital cataracts were more likely to have multiple associated systemic anomalies (p<0.005). All the children who had associated cardiovascular anomalies had congenital cataracts (p= 0.001). Conclusion: The commonest ophthalmic congenital anomaly presenting for tertiary care in Ibadan is congenital cataract. Cardiovascular anomalies are the commonest systemic association of ophthalmic congenital anomalies. There is an urgent need for the establishment of a registry for congenital anomalies with effective screening and active surveillance within the Nigerian health system.
Pattern and outcome of childhood intestinal obstruction at a Tertiary Hospital in Nigeria
(Faculty of Medicine, Makerere University, 2009) Ogundoyin, O. O.; Afolabi, A. O.; Ogunlana, D. I.; Lawal, T. A.; Yifieyeh, A. C.
Background: Intestinal obstruction is a common cause of pediatric surgical emergency with a high morbidity and mortality in Africa. Methods: A retrospective review of cases managed from January 1996 to December 2005 at a teaching hospital in Southwestern, Nigeria was done to examine the pattern of causes of intestinal obstruction in children and the management outcome. Results: One hundred and thirty cases were seen over the study period with an age range of 2 hours to 14 years. Majority (61.24%) were infants, while 18.46% were neonates. Fifty-five cases (42.31%) were due to congenital causes while the rest were of acquired causes. The major causes of intestinal obstruction in the study were intussusception (29.23%), anorectal malformations (22.31%), obstructed inguinoscrotal hernia (16.92%) and Hirschsprungís disease (13.85%). Surgical site infection and sepsis were the commonest complications observed with an overall complication rate of 60.78%. The mortality rate was 3.08% and most (75%) occurred in neonates. Conclusion: While mortality as an outcome of management is low, the morbidity was very high in this study.
Pediatric intussusception in Ibadan, South Western Nigeria
(Wolters Kluwer - Medknow, 2008) Ogundoyin, O. O.; Afolabi, A. O.; Lawal, T. A.
Background: Intussusception is the most common cause of acquired intestinal obstruction in children presenting commonly as a surgical emergency between the fifth and ninth months of life. Method: A retrospective review of cases seen over eight years in our hospital was done to study the pattern of presentation and factors influencing management in our environment. Results: Thirty four patients were managed with age ranging from one week to six years. Thirty patients (88.2%) were infants. Majority were boys (58.8%) and the most common symptoms were vomiting (94.1%), passage of red currant jelly stool (91.2%), excessive crying (58.8%) and fever (52.9%). All the patients had exploratory laparotomy done with half of them undergoing simple reduction of the intussusception. There were three mortalities, two of which presented very late after two weeks of onset of illness with septicemia. There was no recurrence. Conclusion: Late presentation is a major cause of morbidity and mortality in developing countries. Early presentation, aggressive resuscitation and non- operative treatment will help in reducing the high mortality associated with late presentation.
Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery
(Springer Science+Business Media, 2019) Lawal, T. A.; Raji, Y. R.; Ajayi, S. O.; Ademola, A. D.; Ademola, A. F.; Ayandipo, O. O.; Adigun, T.; Ogundoyin, O. O.; Olulana, D. I.; Asinobi, A. O.; Salako, B. L.
Background: It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods: This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results: A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion: Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI.
Routine prenatal ultrasound anomaly screening program in a Nigerian university hospital: redefining obstetrics practice in a developing African country
(2015-08) Akinmoladun, J. A.; Ogbole, G. I.; Lawal, T. A.; Adesina, O. A.
Background: Congenital anomalies are among the leading causes of fetal and infant morbidity and mortality worldwide. Prenatal ultrasound (US) screening has become an essential part of antenatal care in the developed world. Such practice is just evolving in die developing countries such as Nigeria. The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country. Materials and Methods: This was a prospective evaluation of the prenatal .US screenings conducted at a major referral hospital in Southwestern Nigeria All pregnant women referred to the antenatal clinic for mid-trimester screening during the period of study were assessed. Results: Two hundred and eighty-seven pregnant women (5 with twin gestations) were presented for fetal anomaly scan during the study period. Twenty-nine anomalies (9.9%) were detected among the scanned population. Sixteen of the anomalies were followed to delivery/termination with a specificity of 93.5%. The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%). Six (20.6%) of the anomalies were lethal. Five of the anomalies were surgically collectable. Conclusion: Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.
Spectrum of childhood obstructive uropathy in Ibadan, Nigeria
(MedPrime, 2019) Asinobi, A. O.; Ademola, A. D.; Lawal, T. A.; Takure, A. O.; Shittu, O. B.
Background and Objectives: Obstructive uropathy (OU) is an important cause of morbidity and mortality in childhood with congenital OU being among the top three aetiologies of paediatric end-stage kidney disease (ESKD). With paucity of data on the impact of childhood OU in a setting of largely unaffordable facilities for ESKD management, further studies are needed. The aim of the study was to appraise the aetiological pattern and short- term outcome of childhood OU. Methods: A descriptive cross-sectional study was conducted on consecutively presenting children aged 15 years and below with features of urinary tract obstruction at the University College Hospital, Ibadan between January 2009 and December 2012. Their biodata, clinical presentation, aetiology, treatment, and short- term outcome were analysed in addition to the prevalence of OU in relation to other childhood renal disorders. Results: Eighty-six children aged one day to 15 years with a median age of 2.5 years and a modal age of 6 years were recruited over a 4-year period. The male to female ratio was 4.7:1. Congenital OU occurred in 81% of cases, with the lower urinary tract more frequently affected (78%). Posterior urethral valves (PUV) was the most common cause of OU (59.3%) followed by pelvi-ureteric junction (PUJ) obstruction in 17.4%; 73.3% of all PUJ obstructions occurred in females. Only 3.5% of cases were detected prenatally. Of all incident admissions into the Paediatric Nephrology Unit, OU accounted for 20.7%. An in-hospital mortality rate of 5% occurred. Conclusion: Childhood OU is a significant cause of renal disease in Ibadan accounting for one-fifth of new paediatric renal admissions. It was majorly congenital with a male preponderance and PUV was the most common cause. Contrary to expectations, PUJ obstruction occurred more often in females. Prenatal diagnosis rate was very low.
Sperm functional parameters and erythrocytes oxidant–antioxidant imbalance during municipal landfill leachate treatment withdrawal in rats
(Elsevier B.V., 2014) Adedara, I. A.; Lawal, T. A.; Adesina, A. A.; Oyebiyi, O. O.; Ebokaiwe, A. P.; Farombi, E. O.
Adequate information on how leachates affect hematological and reproductive functions is necessary to help in linking causality with predictable response. The present study investigated the effects of Olushosun municipal landfill leachate (OMLL) exposure and withdrawal on sperm characteristics and erythrocytes oxidant–antioxidant balance in rats. Adult male Wistar rats were exposed to 0%, 12.5% and 25% OMLL in drinking water for 28 days. One half of the rats in each group were sacrificed on day 29 while the remaining one-half stayed an additional 28 days without treatment. OMLL exposure significantly decreased sperm functional parameters, disrupted antioxidant systems with concomitant elevation in hydrogen peroxide and malondial dehyde levels in erythrocytes and sperm. Following withdrawal of treatment, OMLL-mediated decrease in sperm count and daily sperm production were reversed to near control. However, erythrocytes and sperm oxidative damage, increased sperm abnormalities, decreased epididymis weight, sperm progressive motility and testicular sperm number persisted and were consistent with results obtained from rats sacrificed immediately after OMLL treatment. Collectively, OMLL-induced irreversible oxidative damage to erythrocytes and sperm in rats within the time course of investigation. These findings highlight potential adverse effects of OMLL on individuals unduly exposed to leachates contaminated substances.
Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial
(Elsevier, 2021) Vickery, N.; Stephens, T.; Toit, L. D.; Straaten, D. V.; Pearse, R.; Torborg, A.; Rolt, L.; Puchert, M.; Martin, G.; Biccard, B. B.; Osinaike, B. B.; Ogunbode, O. O.; Idowu, O.; Lawal, T. A.; Ogundiran, T. O.; Shittu, O. B.; Ayandipo, O. O
Background: The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods: Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results: The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n¼55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR¼3.0; 95% confidence interval [CI], 1.3e7.0); nursing management support of the trial (OR¼2.6; 95% CI, 1.1e6.5); performance of a dummy run (OR¼2.6; 95% CI, 1.1e6.1); nursing colleagues seeing the value of the intervention(s) (OR¼2.1; 95% CI, 0.9e5.7); and site investigators’ belief in the effectiveness of the intervention (OR¼3.2; 95% CI, 1.2e9.4). Conclusions: ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork.