Browsing by Author "Oyerinde, S. O."

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Assessment of Infrastructural and Human Resource for Health Status and Readiness for HPV Vaccination in Rural Communities in Nigeria
(Fortune Journals, 2019) Awolude, O. A.; Oyerinde, S. O.
Introduction: Human papillomavirus vaccination remains an important primary preventive measure for cervical cancer. Its inclusion in preventive messages and service provision by first-line health care workers in low- and middle-income countries needs to be routine. However, there is paucity of data on willingness by health care workers (HCWs) working in rural communities, to counsel and/or provide service to beneficiaries of HPV vaccination programs. This study evaluated available facilities for cervical cancer prevention and willingness to vaccinate daughters for HPV by these HCWs. Materials and Methods: This was a descriptive, cross-sectional study among HCWs in all the primary and secondary health care facilities in the three local government areas of Ibarapa health zone of Oyo state, Nigeria. Descriptive statistics such as mean ± SD, frequency and proportion were used for socio-demographic data, awareness and willingness to vaccinate daughters by the study population. Results: We observed that despite good awareness about cervical cancer (79.1%), awareness about HPV vaccine (41.9%) and their availability in Nigeria (31.0%) were low. Also, the uptake of the vaccine was low (1.8%). However, the majority of the respondents (78.6%) were willing to vaccinate their daughters. This, we believe, can be leveraged on the opportunity of already existing structure for childhood immunization in 77.8% of the facilities where the respondents practise. Conclusion: It is important that narrowing of an existing gap between awareness of cervical cancer and practice of cervical cancer prevention should be initiated. Provision of more cervical cancer prevention educational programs and HPV vaccination opportunities will be key to achieving this.
Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: test-of-concept study in Ibadan, Nigeria
(African Field Epidemiology Network (AFENET), 2021) Awolude, O. A.; Oyerinde, S. O.; Ayeni, A. O.; Adewole, I. F.
Introduction: cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept. Methods: in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. Results: same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. Conclusion: triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.
Invasive cervical cancer in Ibadan: socio-sexual characteristic, clinical stages at presentation, histopathology distributions and HIV status
(2019) Awolude, O. A.; Oyerinde, S. O.
Background: Human Papillomavirus (HPV) infection persistence is the necessary but not sufficient cause of invasive cervical cancer (ICC). The effects of Human Immunodeficiency Virus (HIV) co-infection have been well documented. The purpose of this study was to describe our experience on the clinico-pathological characteristics of patients with cervical cancer and HIV status at a tertiary Hospital in Nigeria. Materials and Methods: This was a descriptive study among ICC patients presenting for clinical staging and biopsy for histological diagnosis at the Obstetrics and Gynaecology outpatient theatre of our hospital between January 2009 and February 2011. Results: Sixteen (6.8%) of the 248 patients with histologically confirmed ICC in this study were HIV positive. The mean age of all the participants was 55.4 (SD±10.2) years with the HIV positive patients’ younger than the HIV-negative and those that declined HIV testing. Coitarche was at lower age (18 [SD±4.4] vs 22[SD±3.4] years vs 24.5[SD±4.4], respectively). The modal lifetime sexual partners were four, one and two, respectively. Clinically, more HIV positive patients, presented at advanced stage of ≥ 2B. Also, the adenocarcinoma histological variant was slightly more among the HIV positive patients. Conclusion: HIV seemed relatively common among ICC patients and they presented at lower ages, at more advanced stages, earlier coitarche and more lifetime sexual partners. The proportion of adenocarcinoma histological types was slightly higher among the HIV positive patients compared with seronegative patients and those with unknown HIV status. Larger studies to substantiate these findings and ICC-HIV causal relationship are required.
Precancer Lesions of the Cervix among Treatment Experienced HIV Positive Women at University College Hospital, Ibadan, Nigeria
(Sciencedomain International, 2021) Awolude, O. A.; Oyerinde, S. O.
Background: Cervical precancer lesions, caused by persistence of human papilloma virus (HPV) infection, is common among women living with Human immunodeficiency virus (HIV) infection. However, there remains paucity of information on these dysplastic lesions especially in low- and middle-income countries of the world as there are few programmes that have incorporated routine screening as a standard of care. Aim: To determine the pattern of precancer lesions of the cervix among treatment experienced HIV positive women in a large antiretroviral therapy programme in South West Nigeria. Study Design: Retrospective review of clinical records. Place and Duration of Study: HIV Programme in College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria between January 2014 and December 2015. Methodology: A review of the Pap smear results of 468 women attending the antiretroviral therapy (ART) clinic at the University College Hospital (UCH) Ibadan over a 2-year period was done. The cytological results were analyzed with biosocial variables. Level of significance was set at 95% confidence level. Results: The mean age of the participants reviewed was 37.1+/- 8.7 years. The mean duration of ART among the participants was 19.5 (±14.0) months. The prevalence of any form of squamous Intraepithelial lesions (SIL) varied from 10.0% among those on ART for up to 12 months to 1.4% among those with more than 18 months of ART use (p=022) and polygamous relationship is significantly associated with dysplastic cervical lesions among this studied cohort (p=0.043) Conclusion: While ART appears to have anti-Human Papillomavirus (HPV) activities as observed in the pattern of cervical dysplastic lesions, polygamy, a common family setting in this environment seems to promote development of SIL among these WLHIV. These findings require further studies to corroborate in the light of limitations of difficulty in disaggregating the duration of HIV diagnosis from the onset of treatment as most were already on treatment before the screening and failure of baseline Pap smear test at the entry point to determine the rate of progression.
Screen and triage by community extension workers to facilitate screen and treat: task-sharing strategy to achieve universal coverage for cervical cancer screening in Nigeria
(2018) Awolude, O. A.; Oyerinde, S. O.; Akinyemi, J. O.
Purpose Universal coverage of cervical cancer screening remains elusive in most low- and middle income countries (LMICs), home to the greatest burden of this preventable disease. Implementation of a cytology-based screening strategy in these countries is challenging. Also, there is shortage of health care workers (HCWs) to implement the low-technology, cheaper, but equally effective, methods like visual inspection with acetic acid. However, the implementation of HIV programs in LMICs has introduced the innovation of task shifting and task sharing, using the community health extension workers (CHEWs) and community health officers (CHOs) to complement clinical HCWs, especially at the primary health care, level with good outcome. Hence, this study leveraged this strategy. Methods We piloted a study to improve knowledge and practice skills of CHEWs and CHOs in a rural community of Oyo state, Nigeria, through training and participatory supervision to screen for cervical cancer using visual inspection with acetic acid and link positive cases for treatment with cryotherapy. Results A total of 51 HCWs, including doctors, nurses, CHEWs, and CHOs, were trained during the study to provide cervical cancer screening services. After the training, cervical cancer and its prevention knowledge improved from 52.4% before training to 91.5% immediate after training. Over 12 months, 950 eligible women were screened, of whom 848 (89.3%) were screened by CHEWs and CHOs. Of the 63 rescreened by CHEWs and CHOs (data grouped), and nurses, 88.1% and 92.3%, respectively, agreed with expert team review, with κ statistics of 0.76 and 0.84, respectively. Conclusion This pilot project showed the ability of CHEWs and CHOs to identify cervical dysplasiawas good and that of nurses was very good with appropriate competency training to achieve universal coverage of cervical cancer screening in LMICs.
Suspected Ovarian Malignancy in HIV Positive Woman Might Just be Abdominal Tuberculosis: Reports of Two Cases
(Society of Obstetrics & Gynaecology of Nigeria, 2020) Awolude, O. A.; Oyerinde, S. O.; Ayeni, A. O.
Abdominal extrapulmonary tuberculosis (EPTB) responds well to medical treatment. The cases present with features which may be non-specific simulating other diseases like ovarian cancers leading to unnecessary surgery. The EPTB is common among HIV-TB co-infected population. We report cases of abdominal EPTB among 2 HIV positive women mimicking cancer of ovary. Case one was a 41-year-old multiparous HIV positive woman with painless abdominal swelling of a month. Abdomen was distended with ascites and palpable abdominopelvic mass of about 14 weeks size confirmed as a right ovarian 9.8cm x 8.2cm mass on ultrasonography. Investigations showed marked lymphocytosis and CA-125 value of 1095 U/ml. Intraoperatively, there was widespread peritoneal and omental military nodules with adhesion of the colon with the uterus. Histology of specimen showed caseating granulomatous lesion with necrotizing inflammation and cytology of ascitic fluid showed admixture of neutrophil polymorphs, lymphocytes, and macrophages with no malignant cells. She had antituberculosis and responded satisfactorily to the treatment. The second case was a 50-year-old grand-multiparous with recurrent abdominal swelling one month after surgery for suspected ovarian cancer in a private hospital. The histology of surgical specimen did not show malignant cells. The abdomen was distended with ascites and firm irregular 12-14 weeks suprapubic mass confirmed from ultrasonography as a left adnexal complex mass. The Mantoux test and HIV screening were positive. She was treated with antituberculotic and antiretroviral drugs with satisfactory improvement. Conclusion: With the high prevalence of HIV-TB co-infection in our environment, the possibility of abdominal tuberculosis should be considered in HIV positive patients with abdominal mass. This diagnosis should be high in our differentials and use of ancillary investigations can be helpful in resolving this diagnosis to avoid unnecessary surgical interventions.
Time of symptoms to health-seeking among cervical cancer patients in Ibadan, Nigeria
(2016-04) Awolude, O. A.; Akinyemi, J. O.; Oyerinde, S. O.; Adewole, I. F.
Background: Early cervical cancer presentation has an excellent prognosis following treatment. Unfortunately most patients present with late disease that requires radical treatment with considerable morbidity and mortality. Aim: This study examines factors associated with time of cervical cancer presentation to a tertiary treatment centre in Nigeria. Methodolgy: This is a descriptive study of one hundred and seventy-one patients managed for cervical cancer at the Obstetrics and Gynaecology Department of University College Hospital (UCH), Ibadan, Nigeria. The socio-demographic characteristics, presenting symptoms and number of visits to health care facilities before diagnosis were obtained. The data were analyzed by means of descriptive statistics, t-test and Chi square test. Results: The mean age of the patients was 56.5years. Of the patients, 60.7% had been to another health facility on the average of about 2 to 3 times prior to referral to UCH where final diagnoses were made. The average time interval between onset of symptoms and seeking of healthcare was 6.10 +/- 9.31 months, between seeking healthcare and referral to a UCH for eventual diagnosis was 9.35 +/-12.9 months. While 36.3% of the patients presented in early stages of I - Ha, 63.7% presented in late stages of lib - IV. Conclusions: Patients' delay in seeking healthcare and care providers' delay in ensuring proper final diagnosis are associated with late presentation in this study. Preventive and promotive health education to ensure early presentation, prompt and appropriate referral system, early and accurate diagnosis, when ensured, will reduce cervical cancer-related morbidity and mortality
Uterine Didelphys, an Uncommon Mullerian Duct Anomaly in a Multiparous Woman with Endometrial Carcinoma
(Science Publishing group, 2022) Awolude, O. A.; Kuboye, O. A.; Oyerinde, S. O.
Uterine didelphys is a rare deformity with most cases associated with favourable pregnancy outcomes. Uterine carcinoma in such uterine malformation is equally rare with many cases diagnosed late due to failed pre-surgery evaluation associated with routine endometrial biopsy. We report a case of incidental uterine didelphys found during surgery in a 62-year-old para 2 +3, woman with endometriod variant of endometrial carcinoma of the right uterus (grade II, and at least stage III). She, successful, had surgery and currently undergoing adjuvant chemoradiation with no complaint. This case demonstrates the possibility of uterine didelphys in a patient with endometrial cancer even when there has been successful pregnancies and deliveries. Clinicians should be aware of this rare possibility especially in a background of preceding repeated miscarriages. Diligently performed endometrial biopsy can still yield adequate specimen for pre-surgery histological diagnosis despite the documented high failure rate associated with the procedure. Where available, contrast-enhanced magnetic resonance imaging is a useful pre-surgery evaluation test with option of exploratory laparotomy performed to avoid delay in diagnosis and treatment of cancers where this is not available but with high index of suspicion.