Scholarly works in Obstetrics and Gynecology
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Item Partner’s profile and unmet need for child limiting among women living with HIV in Ibadan, Nigeria(Polish AIDS Research Society, 2021) Eniade, O. D.; Akinyemi, J. O.; Afolabi, R. F.; Awolude, O. A.Introduction: In many African countries, the success of secondary prevention among reproductive-age women living with HIV (WLH) is affected by unmet need for family planning and marital contexts. The influence of the latter has not received adequate attention, especially among WLH. This study describes the level of unmet need for child limiting and the effects of partner’s characteristics among childbearing WLH in Ibadan, South-West, Nigeria. Material and methods: A cross-sectional study was conducted among married women of childbearing age attending antiretroviral treatment clinic, University College Hospital, Ibadan between November and December 2015. Data were analyzed using descriptive statistics and generalized linear models. Results: Of 781 women, 171 (21.9%) had unmet need for child limiting, while 14.2% and 45.7% have partners who were unemployed and in unskilled occupation, respectively. Controlling for partner’s characteristics, socio-economic and demographic variables, having a partner who is unemployed (OR = 3.51; 95% CI: 1.71-7.21), and unknown HIV status (OR = 2.09; 95% CI: 1.20-3.62), significantly increased odds of unmet need. Age between 45 and 49 years (OR = 4.34; 95% CI: 1.36-13.90), Christianity (OR = 1.75; 95% CI: 1.06-2.87), earning <= minimum wage (OR = 1.72; 95% CI: 1.07-2.76), and having more than two children ever born were also significant factors associated with unmet need. Conclusions: HIV care and treatment programs require innovative approaches to promote partner’s testing and economic empowerment of WLH to reduce the level of unmet need for child limiting among reproductive-age women living with HIV.Item Demography of remarriage and fertility desire among women receiving antiretroviral therapy in South West Nigeria(Taylor & Francis, 2021) Akinyemi, J. O.; Afolabi, R. F.; Awolude, O. A.; Bamgboye, E. A.Background: In view of sociocultural norms surrounding marriage and childbearing in South West Nigeria, fertility desire may be stronger among remarried women living with HIV. This article describes the characteristics of remarriage and its relationship to fertility desire. Method: A cross-sectional study was conducted among HIV-positive women aged 18–49 years at the Antiretroviral Treatment (ART) clinic, College of Medicine/University College Hospital, Ibadan, Nigeria between November and December 2015. Data were analysed using descriptive statistics and generalised linear models. Results: Overall, 123 (17.3%) of 711 women had experienced remarriage. Significant factors among remarried women were a lack of formal education (ORadj = 3.35, CI: 1.46–7.72); polygamous family (ORadj = 2.65, CI: 1.71–4.12), and serodiscordant union (ORadj = 1.97, CI: 1.14–3.41). Fertility desire was expressed by 410 women (57.7%). After controlling for demographic, socio-economic, and HIV-care characteristics, remarried women were 2.5 times as likely to have fertility desire compared to their counterparts who never remarried (ORadj = 2.49, CI: 1.43–4.33). Younger age was significantly associated with higher odds of fertility desire. Other factors negatively associated with fertility desire were education (ORadj = 0.30, CI: 0.12–0.74) and number of surviving children (ORadj = 0.28, CI: 0.22–0.34). Conclusion: HIV-care and treatment programmes need to pay attention to reproductive concerns, especially among women in second and higher order marriages.Item Semi-parametric model for timing of first childbirth after HIV diagnosis among women of childbearing age in Ibadan, Nigeria(Public Library of Science (PLoS), 2020) Akinyemi, J. O.; Afolabi, R. F.; Awolude, O. A.Background HIV diagnosis is a watershed in women’s childbearing experience. It is usually accompanied by the fear of death and stigmatisation. Women diagnosed of HIV are often sceptical about pregnancy. Meanwhile, availability of antiretroviral treatments has impacted positively on childbearing experience among women living with HIV. We therefore investigated the timing of first childbirth after HIV diagnosis and its determinants among women in Ibadan, Nigeria. Methods We extracted and analysed data from a 2015 cross-sectional study on childbearing progression among 933 women living with HIV and receiving care at University College Hospital, Ibadan, Nigeria. Extended Cox proportional hazards regression, a semi-parametric event history model was used at 5% significance level. Results The women’s mean age was 38.1 (± SD = 6.1) years and the median time to first birth after HIV diagnosis (FBI_HIV) was 8 years. The likelihood of first birth after HIV diagnosis was lower among women who desired more children (HR = 0.63, CI: 0.51–0.78). Women whose partners had primary and secondary education respectively were about 2.3 times more likely to shorten FBI_HIV compared to those whose partners had no formal education. Knowledge of partner’s HIV-positive status (HR = 1.42, CI: 1.04,1.93) increased the likelihood of having a first birth after HIV diagnosis. Older age, longer duration on ART and a higher number of children at diagnosis were associated with a declined hazard of first birth after HIV diagnosis. Conclusions The median time to first childbirth after HIV diagnosis was long. Partner’s HIV-positive status and higher educational attainment were associated with early childbearing after HIV diagnosisItem Effect of Hepatitis C virus infection on selected laboratory values in pregnant women with Human Immunodeficiency virus infection(Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), 2016) Adesina, O. A.; Akinyemi, J. O.; Michael, O. S.; Fayemiwo, S. A.; Awolude, O. A.; Ogunbosi, B. O.; Kuti, M. A.; Adewole, I. F.Background and Objectives: Both hepatitis C and Human Immunodeficiency viruses affect laboratory indices. The objective of this study was to describe the impact of both viruses on laboratory indices among 1,821 HIV-positive pregnant women. Methods: This was a cross-sectional retrospective study at the University College Hospital, Ibadan Results: Twenty-six (1.7%) women were HCV positive, 139 (8.8%) were HBsAg positive and 1, 407 (89.3%) were negative for both viruses. Three patients (0.19%) were positive for both viruses. These patients, the HBsAg positive women and 246 with no result for either virus were excluded from analysis. The HCV positive women had lower hematocrit (27.3% + 4.5 vs. 28.4% + 4.6, p=0.29), lower WBC (5, 200 vs. 5, 500 cells/ml, p =0.766) but higher platelet count (209, 000 vs. 199, 000 cells / ml, p = 0.019). The coinfected group had higher CD4 (380 vs. 326 cells/ml, p = 0.319), higher urea (16.0vs.ll.0mg/ml, p =0.013) but comparable ALT (16.0 vs.15.0 iu/ml, p = 0.95), log viral load (4.08+1.22 vs. 4.08+1.11, p=0.97) and creatinine levels (0.6vs.0.6, p=0.329). Only the difference in urea level was statistically significant. Conclusion: While values were comparable between both groups, the synergistic effect of both viruses makes it necessary for health-care providers to closely monitor patients.Item 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.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 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 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.