Scholarly works in Obstetrics and Gynecology
Permanent URI for this collectionhttps://repository.ui.edu.ng/handle/123456789/526
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Item WHO Recommendations for the Prevention of Postpartum Haemorrhage(The WHO Reproductive Health Library, 2010) Fawole, B.; Awolude, O. A.; Adeniji, A. O.; Onafowokan, O.Item Sleep disturbance and associated factors among Nigerian adults living with HIV in the dolutegravir era(Frontiers Media S.A., 2022) Osiyemi, A. O.; Owoaje, E.; Mundt, J. M.; Oladeji, B.; Awolude, O.; Ogunniyi, A.; Okonkwo, P.; Berzins, B.; Taiwo, B. O.Sleep disturbance is common among persons living with HIV (PLWH) causing significant health impacts. Nigeria recently switched from efavirenz to dolutegravir (DTG) for first-line antiretroviral therapy (ART). This study aimed to assess the prevalence of sleep disturbance and to determine factors associated with sleep disturbance among treatment-experienced PLWH. Using a cross-sectional study design and systematic random sampling, 300 participants were recruited from the Infectious Diseases Institute, Ibadan, Nigeria (IDI). Interviewer administered questionnaire was used to collect data regarding sociodemographic, sleep disturbance (Pittsburgh Sleep Quality Index; PSQI), depression (Patient Health Questionnaire; PHQ-9), anxiety (Generalized Anxiety Disorder-7; GAD-7), and psychoactive substance use. HIV-specific data were retrieved from IDI’s medical records. The relationship between the PSQI score and the scores on the PHQ-9 and GAD-7 were explored with the Pearson correlation coeffcient. Chi-square global tests of independence were used to assess factors associated with sleep disturbance and a multivariable binary logistic model was used to determine independent predictors of sleep disturbance. The mean age of the sample was 44.5 ± 11.4 (years), the average duration of HIV diagnosis was 8.13 ± 5.33 (years) and the majority were on DTG-based regimens (95%). Depression and anxiety were present in 14 and 17.3%, respectively. Prevalence of sleep disturbance (PSQI score of 6 ormore) was 21.7%. Higher PSQI scores were associated with higher PHQ-9 scores (r = 0.526; p < 0.001) and higher GAD-7 scores (r = 0.529; p < 0.001). Sleep disturbance was associated with age ($ 2 = 4.483, p = 0.038), marital status ($ 2 = 7.187, p < 0.01), depression ($ 2 = 46.589, p < 0.001), and anxiety ($ 2 = 38.379, p < 0.001). There was no significant association between sleep disturbance and HIV clinical stage at diagnosis, virological suppression status, and ART regimen type (p > 0.05), whereas tea intake was associated with an absence of sleep disturbance ($ 2 = 6.334, p < 0.014). Age (>45 years), depression and anxiety were associated with higher odds of sleep disturbance among PLWH. Sleep disturbance remains common among PLWH in the DTG era. Depression and anxiety are significant factors associated with sleep disturbance. Assessing these factors in future studies may improve the sleep health of PLWH.Item Knowledge and Attitude of Pregnant Women Attending Antenatal Clinic to Cervical Cancer Screening in Pregnancy in Ibadan, Nigeria(Science Publishing group, 2022) Ifebude, J. E.; Idowu, O. C.; Awolude, O. A.Intensive global efforts are currently on-going to ensure the elimination of cervical cancer by 2030. To achieve this, identification of populations and settings to optimize implementation is important. Pregnant women in antenatal setting provide one of such opportunities. This cross-sectional study conducted among pregnant women in a tertiary health facility evaluates the knowledge and attitude of cervical cancer screening in pregnancy. A total of 372 of the 380 (97.9%) women responded to the survey. The knowledge about cervical cancer among the respondents was 16.0%, 27.0% with good knowledge about cervical cancer screening and 21.0% had been previously screened for cervical cancer. If offered in the index pregnancy, about 74.2% were willing to undergo the screening. The age of respondents (p < 0.001) and the knowledge about cervical cancer screening (p = 0.034) were statistically significant factors associated with the respondents’ attitude to screening in pregnancy. Fear of the screening affecting their pregnancies was the reason in about half of the 26.8% of the respondents unwilling to undertake cervical cancer screening in pregnancy. The knowledge about risk factors for cervical cancer among our participants was poor. However, the attitude of participants towards cervical cancer screening in pregnancy was good. While policy makers might find this encouraging to incorporate routine cervical cancer screening into maternity services, there is urgent need for more awareness creation among our pregnant women, adequate counselling to correct misconceptions and education on the benefits of cervical cancer screening among our parturient.Item 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.Item Oncology Training Needs Assessment Among Health Care Professionals in Nigeria..Journal of Global Oncology(American Society of Clinical Oncology (ASCO), 2022) Adejumo, P. O.; Oluwasanu, M. M.; Ntekim, A.; Awolude, O. A.; Kotila, O. A.; Aniagwu, T.; Brown, B. J.; Dzekem, B. S.; Duncan, S.; Ilori, M. T.; Ajani, O.; Lee, S. M.; Babalola, C. P.; Ojengbede, O.; Huo, D.; Hammad, N.; Olopade, O. I.PURPOSE This study investigated the status of training and preparedness for oncology practice and research and degree of interprofessional collaboration among health care professionals in the six geopolitical regions of Nigeria. METHODS A convergent parallel mixed methods design was used. Three hundred seventeen respondents completed a three-part, online questionnaire. Self-rated competencies in oncology research (26 items), oncology practice (16 items), and interprofessional collaboration (nine items) were assessed with a one- to fivepoint Likert scale. Six key informant and 24 in-depth interviews were conducted. Descriptive statistics, analysis of variance, and pairwise t-test were used to analyze the quantitative data, whereas thematic analysis was used for the qualitative data. RESULTS Respondents were mostly female (65.6%) with a mean age of 40.5 6 8.3 years. Respondents include 178 nurses (56.2%), 93 medical doctors (29.3%), and 46 pharmacists (14.5%). Self-assessed competencies in oncology practice differed significantly across the three groups of health care professionals (F = 4.789, P = .009). However, there was no significant difference across professions for competency in oncology research (F = 1.256, P = .286) and interprofessional collaboration (F = 1.120, P = .327). The majority of respondents (267, 82.4%) felt that educational opportunities in oncology associated research in the country are inadequate and that this has implications for practice. Key training gaps reported include poor preparedness in data analysis and bioinformatics (138, 43.5%), writing clinical trials (119, 37.5%), and writing grant/research proposals (105, 33.1%). Challenges contributing to gaps in cancer research include few trained oncology specialists, low funding for research, and inadequate interprofessional collaboration. CONCLUSION This study highlights gaps in oncology training and practice and an urgent need for interventions to enhance interprofessional training to improve quality of cancer care in Nigeria. These would accelerate progress toward strengthening the health care system and reducing global disparities in cancer outcomes.Item Use of intermittent preventive therapy and incidence of acute malaria in pregnancy among postpartum women at University College Hospital, Ibadan, Nigeria(Wolters Kluwer - Medknow, 2021) Ifebude, J. E.; Idowu, C. O.; Awolude, O. A.Background: Malaria in pregnancy remains a significant cause of feto‑maternal morbidity and mortality especially in regions of high prevalence like Nigeria. Intermittent preventive therapy (IPT) for malaria is an important measure to abate this menace. Aim: The aim is to determine the uptake and effectiveness of IPT in relation to the occurrence of malaria, despite the use of IPT in pregnancy. Patients, Materials and Methods: This was a cross‑sectional study conducted in UCH, Ibadan from October 1, to December 31, 2020. A total of 150 postpartum women were selected using the total sampling technique of all consenting participants. Structured questionnaires were used for data collection. Results: About 87.7% of the respondents took IPT in the index pregnancy. Of these, 15.4%, 50.8%, and 33.8% of participants took one, two, and three doses, respectively. The factors that determined intermittent preventive treatment for malaria in pregnancy (IPTp) uptake include occupation (P = 0.001), booking status (P = 0.002), antenatal care attendance (P = 0.001), and level of IPTp awareness (P = 0.002). About 48.0% of respondents indicated that they were treated for malaria in the index pregnancy. Meanwhile, only about 15.3% of those who took IPT were treated for malaria in pregnancy. It was found that the use of IPT (P = 0.03) and an increasing number of IPT doses used (P = 0.03) were associated with a reduction in the prevalence of malaria in pregnancy. Conclusion: The uptake of the current recommendation for IPT‑SP that stipulates the use of monthly doses of IPT till delivery with a target of a minimum of three doses was quite poor. There is therefore an urgent need for widespread awareness and implementation of the World Health Organization and national guidelines on prevention of malaria. The prevalence of malaria declined with the number of doses of IPT‑SP used by the respondents. This emphasizes the need for adequate dosing of IPT.Item Relationship between CD4+ count, serum inflammatory cytokines, and oral melanotic hyperpigmentation in newly diagnosed HIV-seropositive patients: a nested casecontrol study(Elsevier Inc, 2022) Abe, E. O.; Adisa, A. O.; Adeyemi, B. F.; Awolude, O. A.; Owotade, F. J.Objective. Oral melanotic hyperpigmentation (OMH) in patients with human immunodeficiency virus (HIV) infection has been attributed to the use of antifungal or antiretroviral drugs, as well as HIV-induced cytokine dysregulation. This research aimed to determine the relationship between immunosuppression and cytokine dysregulation in newly diagnosed HIV-seropositive subjects with OMH. Study Design. The study was conducted among newly diagnosed HIV-seropositive patients at the Infectious Disease Clinic, Ibadan, Nigeria. The cases were patients with OMH matched for age and sex with control subjects without OMH. CD4+ count and cytokine levels (interleukin-6 and tumor necrosis factor-a) were compared between the cases and control subjects. SPSS version 21 software was used for data analysis. Results. Seventy newly diagnosed HIV-seropositive patients were studied, which comprised of 35 cases and 35 control subjects. The median CD4+ counts for cases and control subjects were 174 cells/mm3 (interquartile range [IQR], 57-250) and 324 cells/ mm3 (IQR, 107-424), respectively. Severe immunosuppression (CD4+ count, 200 cells/mm3) was found in over half of the study participants, being more prevalent among the cases than among the control group (P = .019). Serum cytokine levels did not significantly vary between the cases and control subjects. Conclusions. There was a significant association between HIV-OMH and severe immunosuppression in the newly diagnosed HIV-seropositive patients.Item Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth(Public Library of Science (PLoS), 2021) Kuhns, L. M.; Johnson, A. K.; Adetunji, A.; Kuti, K. M.; Garofalo, R.; Omigbodun, O.; Awolude, O. A.; Oladeji, B. D.; Berzins, B.; Okonkwor, O.; Amoo, O. P.; Olomola, O.; Taiwo, B.Background Nigeria has the second highest number of people living with HIV (PLWH) globally, and evi- dence-based approaches are needed to achieve national goals to identify, treat, and reduce new infections. Youth between the ages of 15–24, including young men who have sex with men (YMSM), are disproportionately impacted by the Nigerian HIV epidemic. The purpose of this study was to inform adaptation of evidence-based peer navigation and mHealth approaches (social media outreach to promote HIV testing; short messaging service text message reminders to promote HIV treatment engagement) to the local context within iCARE Nigeria, a multi-phase study designed to investigate combination interventions to promote HIV testing and care engagement among youth in Nigeria. Methods To elicit expert and community perspectives, a local group of advisors from academia, com- munity, and governmental sectors provided feedback on intervention adaptation, which then informed a series of focus groups with stakeholders in Ibadan, Nigeria. Focus group data were collected over a period of three days in December of 2018. Participants in focus groups included YMSM and HIV-positive youth in care ages 16–24, and HIV service providers from local AIDS service organizations (ASO). Groups were stratified by HIV serostatus, gender, and stakeholder type. Focus group sessions were conducted using a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using a content analy- sis approach. Results Local experts recommended intervention adaptations specific to the status of peer naviga- tors as volunteers, peer characteristics (slightly older age, high maturity level, HIV/YMSM status), and intervention characteristics and resources (low navigator to peer ratio; flexible matching by demographic and social characteristics; social media platforms and content). Five focus group discussions with stakeholders, including 27 participants were conducted to elicit feedback on these and other potential adaptations. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive, 76% men and 48% MSM. Service providers (n = 6) represented both HIV prevention and care services. Participants across stratified subgroups reported largely positive perceptions and high perceived acceptability of both mHealth and peer navigation strategies, and echoed the recommendations of the advisory group for volunteer-based navigators to promote altruism, with a low navigator- peer ratio (1:5). Participants emphasized the need to incorporate minimal mobile data use strategies and popular social media platforms among YMSM (e.g., Facebook, Grindr) for widespread access and reach of the interventions. Conclusions In Ibadan, Nigeria, stakeholders support the adaptation of combined mHealth and peer navi- gation strategies to promote HIV testing and care engagement among high-risk youth. Rec- ommended adaptations for the local context reflect concerns about the feasibility and sustainability of the intervention and are expected to improve accessibility and acceptability.Item Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa(Wiley, 2021) Khalil, A. I.; Mpunga, T.; Wei, F.; Baussano, I.; de Martel, C.; Bray, F.; Stelzle, D.; Dryden-Peterson, S.; Jaquet, A.; Horner, M. J.; Awolude, O. A.; Trejo, M. J.; Mudini, W.; Soliman, A. S.; Sengayi-Muchengeti, M.; Coghill, A. E.; van Aardt, M. C.; DeVuyst, H.; Hawes, S. E.; Broutet, N.; Dalal, S.; Clifford, G. M.HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in subSaharan Africa (SSA). We estimated HIV- and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age- specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women <34 years to only 12% in women >55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.Item 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.