scholarly works
Permanent URI for this collectionhttps://repository.ui.edu.ng/handle/123456789/526
Browse
55 results
Search Results
Item 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.Item 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.Item 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.Item Multimoda hyperspectroscopy screening in women at risk of cervical cancer: results of a pilot study in a developing country(Wolters Kluwer - Medknow, 2017) Awolude, O. A.; Akinwunmi, B. O.; Adewole, I. F.Background: Screening and treatment of pre-cancerous lesions is important for prevention of cervical cancer. Currently, most available screening tests for cervical cancer are limited by low sensitivity, prohibitive costs, logistics and technical concerns. This study evaluates the role of multimodal hyperspectroscopy (MHS) as a cost-effective, sensitive and user-friendly point-of-care machine for early detection in women at risk of pre-cancer lesions. Materials and Methods: Multimodal hyperspectroscopy of the cervix using the LuViva® Advanced Cervical Scan was performed first in a 1-minute procedure among 100 previously screened for cervical cancer using either visual inspection after application of acetic acid (VIA) or cytology within the last 120 days. This was then followed by obtaining human papilloma virus (HPV) samples and biopsies from women for histology. Results: Of the 22 women with abnormal Pap tests of at least low‑grade squamous intraepithelial lesion, 3 had CIN2+, 6 had CIN1, 4 were free of dysplasia at histopathology while 9 had cervicitis. All 3 of the CIN2+ recorded high likelihood of CIN2+ by MHS. However, HPV was negative for all 3 women. The machine classified 1 of 1 CIN1s and 7 of the 13 women without dysplasia or cervicitis as low or moderate risk for CIN2+ (40% specificity); of the 37 women who were VIA+, 81% were classified as high risk, and 66% of 37 women with normal Pap tests and biopsy were either at moderate or low risk. Conclusions: The findings from this pilot study show that MHS reduced the percentage of unnecessary colposcopy and biopsy by 37.5%. It was also able to differentiate between VIA+ and Pap negative women suggesting its potential of being a point-of-care primary and objective screening test.Item Seroprevalence and factors associated with hepatitis C coinfection among HIV-positive pregnant women at the University College Hospital, Ibadan, Nigeria(Wolters Kluwer - Medknow, 2016) Adesina, O. A.; Akinyemi, J. O.; Ogunbosi, B. O.; Michael, O. S.; Awolude, O. A.; Adewole, I. F.Aim: This study estimated the hepatitis C virus (HCV) prevalence in a population of human immunodeficiency virus (HIV) infected pregnant women, compared women who were positive or negative for HCV and described risk factors associated with HCV infection. Materials and Methods: A retrospective, case control study was conducted at the University College Hospital, Ibadan among 1821 women. Twenty‑six (1.65%) women were HCV positive, 139 (8.83%) were HBsAg positive and 1407 (89.33%) were negative for both viruses. Three patients (0.19%) were positive for both viruses. These patients, i.e., the HBsAg positive women and 246 women with no result, for either virus were excluded from analysis. Data from 1433 pregnant women is presented. Chi square test and student’s t‑test examined associations, with level of significance set at P < 0.05. Results: Overall, the mean age of the HCV positive women was lower (26.77 ± 6.53 vs. 28. 95 years ± 5.33; P = 0.04), most women had attained primary (28.49%) or secondary (42.44%) education, over 90% were married and heterosexual sex (88.67%) was the most likely risk for HIV. HCV prevalence was higher in the lower age groups (5% in the ≤ 19 years group, P = 0.021). The coinfected had more unmarried women (3.6% vs. 1.7%; P = 0.164) and more likely to indicate blood transfusion as a risk factor for HIV (6.2%; P = 0.34). Conclusion: Only age showed any significant association with HCV infection. Lack of identifiable risk factors sum up challenges for developing screening strategies in sub‑Saharan Africa. Further studies will identify factors facilitating HCV transmission in the region.Item 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 mortalityItem Maternal near-miss due to unsafe abortion and associated short-term health and socio-economic consequences in Nigeria(2015) Prada, E.; Bankole, A.; Oladapo, O. T.; Awolude, O. A.; Adewole, I. F.; Adewole, I. F.; Onda, T.Little is known about maternal near-miss (MNM) due to unsafe abortion in Nigeria. We used the WHO criteria to identify near-miss events and the proportion due to unsafe abortion among women of childbearing age in eight large secondary and tertiary hospitals across the six geo-political zones. We also explored the characteristics of women with these events, delays in seeking care and the short-term socioeconomic and health impacts on women and their families. Between July 2011 and January 2012, 137 MNM cases were identified of which 13 or 9.5% were due to unsafe abortions. Severe bleeding, pain and fever were the most common immediate abortion complications. On average, treatment of MNM due to abortion costs six times more than induced abortion procedures. Unsafe abortion and delays in care seeking are important contributors to MNM. Programs to prevent unsafe abortion and delays in seeking postabortion care are urgently needed to reduce abortion related MNM in Nigeria.Item 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.Item An audit of the uptake of key PMTCT interventions in the pre and post WHO rapid advice periods at the University College Hospital, Ibadan(2015-05) Adesina, O. A.; Kuti, M. A.; Ogunbosi, B.; Akinyemi, O. J.; Fayemiwo, A.; Awolude, O. A.; Adewole, I. F.Prevention of vertical transmission of HIV may require the uptake of the culturally unacceptable options of cesarean delivery and formula feeding. The successful use of HAART, as enumerated by the WHO 2009 rapid advice, has the potential for facilitating the uptake of the more culturally acceptable vaginal delivery and breast feeding. These recommendations became operational at the PMTCT unit, University College Hospital, Ibadan. This retrospective study describes the impact of these recommendations on the uptake of PMTCT interventions at our center. The pre-rapid advice period was June 2009 to April 2011 and the post rapid period May 2011 till December 2012. Pre-rapid advise, antiretrovirals administered was zidovudine or Combivir for women with CD4 The new WHO guidelines appear to have facilitated a shift in uptake of the more culturally acceptable options of vaginal delivery and breast feeding. A follow-up evaluation of the infant HIV status will ascertain the ultimate impact on MTCT. >200cells / ml and Combivir/nevirapine for CD4 <200 Cells/ ml. Post-rapid, all were eligible for HAART (mostly efavirenz/ truvada or efavirenz/ Combivir). Six weeks post-natally, the options adopted were documented and are presented here. Information from 1165 women was available. Thirty three (2.8%) did not have adequate information and were excluded. There were 711 women pre-rapid advise and 421 women post rapid. The women's characteristics were not significantly different over both periods, 69.0% had >6 years of education, 97.0% were married and slightly over half (56.9%) were involved with traders. Overall, more women were delivered by the vaginal route than Caesarean Delivery (70.5% vs. 29.5%), while more breastfed compared to formula feeding (67.2% vs. 32.8%). In the post rapid period (compared to the pre- rapid) advise, more women had vaginal delivery (73.5% vs. 64.8%, p = 0.54), more women breast-fed (77.0% vs. 50.1%, p= 0.00) and fewer women used contraception (21.5% vs. 27.3%, p= 0.023). The commonest method was the condom (83.4%). The new WHO guidelines appear to have facilitated a shift in uptake of the more culturally acceptable options of vaginal delivery and breast feeding. A follow-up evaluation of the infant HIV status will ascertain the ultimate impact on MTCTItem 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.