FACULTY OF CLINICAL SCIENCES

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5-flourouracil vs. beta-aiiadiation in the prevention of pterygium recurrence
(Blackwell Publishing Limited, 2004) Bekibele, C. O.; Baiyeroju, A. M.; Ajayi, B. G. K
Aim: The aim of this study was to compare 5-fluorouracil (5-FU) with beta-irradiation in the prevention of pterygium recurrence. Materials and methods: A retrospective non-randomised review of cases of fleshy pterygium treated with bare sclera excision and adjuvant 5-FU were compared with similar morphologically appearing ptervgia, marched for age and sex, treated with bare seleral excision and adjuvant beta-irradiation. All surgeries were carried out at the university college hospital and Ojulowo eye hospital, Ibadan, Nigeria. Results: Twenty-seven eyes of 24 patients who had pterygium excision with adjuvant treatment with 5-FU were compared with 31 eyes of 24 patients who were treated with excision and beta-irradiation. The mean age for the 5-FU group was 46.1 years while that for the beta-irradiation group was 46.9 years. Both sexes were equally represented, 12 males and 12 females. There were seven (25.9%) initial recurrences in the 5-FU group but four of these became atrophic, and therefore, cosmetically acceptable leaving three eyes (11 %) with unacceptable recurrent pterygium. The beta-irradiation group, however, had seven (22.5) initial recurrence but five of these became atrophic and fell short of the cornea, leaving two (6.5%) with clinically unacceptable recurrence. The difference was, however, nor statistically significant (Zc = 0.74 and p > 0.1). The associated complications were mostly mild in both groups and included cornea opacitv of 10 (37%) complications, conjunctivitis of three (11 %) complications, sclera granuloma of three (11%) complications and conjunctiva necrosis of one (3.7%) complication for the 5-FU group, and while the beta-irradiation group had corneal opacity of one(3.7%) complication and conjunctivitis of three (11%) complications. Conclusion: The non-statistical significance of a lower pterygium recurrence rate with use of beta-irradiation for the treatment of fleshy pterygium compared with 5-FU may have been partly due to the small number of patients studied. A randomised-controlled study using a larger sample size is therefore proposed. However, the fact that over half of those with initial recurrence in the 5-FU group became atrophic (and therefore cosmetically acceptable) over rime as well as less cost implication in the purchase of 5-FU relative to Strontium-90 association with few and mild complications makes it a desirable adjuvant therapy in depressed economics. However, beta-irradiation still has a place when cost issue is not an inhibiting factor in view of its clinically superior outcome
Abdominal paraganglioma in a pediatric patient
(2008) Atalabi, O. M; Lee, E. Y.
Abdominal ultrasonography inHIV/AIDS patients in southwestern Nigeria.
(BioMEd Central Limited, 2008) Obajimi, M. O.; Atalabi, M. O.; Ogbole, G. I.; Adeniji-Sofoluwe, A. T.; Agunloye, A. M.; Adekanmi, A. J.
"Though the major target of the HIV-virus is the immune system, the frequency of abdominal disorders in HIV/AIDS patients has been reported to be second only to pulmonary disease. These abdominal manifestations may be on the increase as the use of antlretroviral therapy has increased life expectancy and improved quality of life. Ultrasonography is an easy to perform, non invasive, inexpensive and safe imaging technique that is invaluable in Africa where AIDS is most prevalent and where sophisticated diagnostic tools are not readily available. Purpose: To describe the findings and evaluate the clinical utility of abdominal uitrasonography in HIV?AIDS patients in Ibadan. Methods:A Prospective evaluation of the abdominal ultrasonography of 391 HIV-positive patients as well as 391 age and sex- matched HIV-negative patients were carried out at the University College Hospital, Ibadan.Results: Of the 391 cases studied, 260 (66.5%) were females; the mean age was 38.02 years, (range 15-66 years). The disease was most prevalent in the 4th decade with an incidence of 40.4%. Compared with the HIV-negative individual group of patients had a significantly higher proportion of splenomegaly (13.5% vs. 7.7%; p < 0.01), lymphadenopathy (2.0% vs. 1.3%; p < 0.70), and renal abnormalities (8.4% vs. 3.8%; p < 0.02). There were no differences in hepatic and pancreatic abnormalities between the HIV+ and HIV- groups. There were significantly fewer gallstones in the HIV+ group (1.4% vs. 5.1%; p < 0.01). Conclusion:AIDS is a multi-systemic disease and its demographic and clinical pattern remains the same globally. Ultrasond optimally suited for its clinical management especially in Africa. Its accuracy and sensitivity may be much improved with clinico-pathologic correlation which may not be readily available in developing countries; further studies may provide much needed diagnostic algorithms. "
Acceptability of counseling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria
(Makerere University, 2011-03) Bello, F.; Ogunbode, O. O.; Adesina, O. A.; Olayemi, O.; Awonuga, O. M.; Adewole, I. F.
Background: Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients. Objective: To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status presenting in labour. Methods: A cross-sectional study comprising counselling and obtaining consent for HIV testing among 104 unregistered patients who presented in labour over a 3-month period. Rapid and enzyme-linked immunosorbent assay screening was performed for 90 consenting respondents. Reactive results were confirmed by Western blot. Appropriate therapy was instituted. Results: Acceptance rate for HIV testing was 86.5%, prevalence of HIV was 6.7%. Women of lower educational status were more likely to accept testing in labour (OR: 0.3; 95% CI: 0.1-0.7; p=0.01); age, parity, occupation and knowledge of HIV had no influence. Most women (66.3%) had satisfactory knowledge of HIV. No one admitted to feeling coerced to test in fear of being denied care. Most refusals for screening were to avoid needle pricks (28.6%). Compared to ELISA screening test, specificity of the rapid test was 100%, sensitivity 85.7%, positive predictive value 100% and negative predictive value 98.8%. Attitude to testing was maintained on post-partum re-evaluation. Conclusion: The prevalence of HIV amongst unregistered parturients showed the importance of offering point-of-care HIV testing and intervention, especially in an environment where antenatal clinic attendance is poor. Rapid testing appeared to be acceptable and feasible in labour to prevent the mother-to-child transmission of HIV.
Accidental ingestion of a drawing pin a case of an unusal foreign body in the Oesphagus
(2001) Agunloye, A. M.; Atalabi, O. M.; Obajimi, M. O.
Adie's syndrome as a cause of amblyopia
(Slack Incorporated, Medical Publisher, New Jersey, 1987) Agbeja, A. M; Dutton, M. D.
Adie's syndrome comprises a tonic pupil, which may be associated with impairment of accommodation, in the presence of diminished or absent deep tendon reflexes. We report a case of a 4-year-old boy with Adie's syndrome in which latent hypermetropia was made manifest by accommodative paresis and resulted in reversible amblyopia
Advantages of simultaneous bilateral trabeculectomy over consecutive bilateral trabeculectomy in lbadan
(1996-09) Baiyeroju-Agbeja, A. M.; Ajewole, J. F.
A retrospective study of 26 patients who underwent simultaneous bilateral trabeculectomy over a 5year period was reviewed. Advantages of simultaneous bilateral trabeculectomy include a shorter stay in hospital compared to consecutive bilateral trabeculectomy, as well as a single general anaesthetic if required and this reduces the risk of exposure to anaesthetic agents within a short time. The turn-around time in theatre is also improved compared with separate operations. Preoperatively, 20 of the patients (77%) were on two or more antiglaucoma therapy. 69% of the patients (18patients) spent 7days in hospital, from admission to discharge, the normal duration of hospital stay for unilateral trabeculectomy. Only 31% spent over one week, none stayed in hospital beyond two weeks. Post operative complications occurred in 8 eyes (15.4%) but none led to blindness. Visual outcome was good in these patients as none had reduced vision postoperatively compared to preoperatively, 3eyes had an improvement in visual acuity postoperatively.
Anaesthesia considerations for the HIV positive parturient
(Association of Resident Doctors, University College Hospital, Ibadan, Nigeria, 2009-06) Adesina, O.; Oladokun, A.
The HIV epidemic in children parallels that among women on account of perinatal transmission. A combination of antiretroviral therapy and elective caesarean section reduces the rate of vertical transmission to <2%. Elective caesarean section independent of antiretroviral therapy decreases the risk of HIV vertical transmission from mother to baby. However, a caesarean section is a major surgical intervention that has well-reported complications. Women infected with HIV have been reported to be more susceptible to such complications. The multi-organ nature of HIV poses challenges at the time of surgery and anesthesia. Preoperative evaluation will allow a good prediction for the perioperative risk of the HIV-patient. The anesthesiologist should be aware of the possible toxic side effects or the possible interaction of antiretroviral drugs with the anesthetics. Some of these adverse effects may mimic signs and symptoms of the HIV disease itself. Regional anesthesia has been shown to be associated with reduced morbidity and mortality in a wide range of patients, including HIV positive parturients. Finally, the possibility of transmission in the health care setting highlights the need for anesthetists to enforce rigorous infection control policies to protect themselves, other health workers and their patients.
Anemia in pregnancy at two levels of health care in Ibadan, south west Nigeria
(Annals of African Medicine Society, 2011-12) Adesina, O.; Akinyemi, O.; Oladokun, A.
Background: In Africa, anemia in pregnancy contributes to non-attainment of the MDG goals 4 and 5. This study examined the prevalence and some risk factors for anemia at two levels of health care in the Ibadan metropolis. Methods: This was a retrospective study of the booking records of pregnant women at the University College Hospital (UCH, a profit-making tertiary institution) and Adeoyo Maternity Hospital (AMH, a secondary level institution offering free services) in Ibadan, September 1, 2008 to December 31, 2008. Eligible women had singleton pregnancies and no known chronic illnesses. Anemia was defined as packed cell volume (PCV) <30%, and degrees of anemia as mild (PCV 27–29%), moderate (PCV 19–26%), and severe (PCV below 19%). Statistical analysis was done by the Chi-square test, Fisher exact test, and t-test. A P value of <0.05 was considered significant. Results: Data from 2702 women (384 and 2318 from UCH and AMH, respectively) were available for analysis. About 30% of the women were anemic. The patients in UCH had higher mean PCV (33.03± 4.32 vs. 31. 04 ± 4.09, P = 0.00). A higher proportion of anemia was seen in patients presenting in Adeoyo (32.4% vs. 16.7%, P = 0.00). Factors associated with anemia included young age (P = 0.00), low parity (P = 0.00), and hospital type (P = 0.00). Parity and hospital type remained significant on logistic regression. Conclusion: Lower prevalence of anemia at the tertiary hospital maybe attributed to the higher socioeconomic status of the clientele. Short-term early antenatal management of anemia and long-term economic/educational empowerment is advocated.
AN ASSESSMENT OF THE TRAINING AND SERVICES OF COMMUNITY-BASED DISTRIBUTION (CBD) WORKERS IN OYO STATE
(1985-08) ADEDOYIN, E. O. O.
The study attempted to assess the effectiveness of the Community Based Distribution (CBD) programme of low-cost Family Planning, Maternal and Child Health Services. This was established in 1979 by the Fertility Research Unit of the Department of Obstetric and Gynaecology, University College Hospital, Ibadan in collaboration with Oyo State Ministry of Health the Pathfinder Fund of Boston; and the Centre for Population and Family, Columbia University both in the United States of America, The C.B.D., an innovative programme, consists of the training and utilization of Traditional Birth Attendants (TBAs) and Voluntary Health Workers (VHWs) to provide Primary Health Care to the door steps of the rural communities who live on the out-skirts of the main stream of sophisticated health technology. The pilot project site was Akinyele Local Government, a rural area, North of Ibadan with a population of 89,900. It was found that the programme was successful because within two years of its implementation, the population served increased from an initial 89,900 to 238,696 and the number of Zones from one to five. At the request of the Oyo State Ministry of Health officials, the project was extended to other Health Zones in Oyo State: Oyo, Oshun, Ife/ljesha Health Zones. The study assessed the training of the CBD workers with particular emphasis on the educational components of the training curriculum and also the educational activities of the CBD workers and their impact on their client community. The CBD training curriculum findings indicate that as designed presently, has enough contents which are relevant to the training objectives. However, it will be more useful, if it is developed into a standard training manual with clearly stated objectives, training methodologies and an evaluation instrument which will set an acceptable level of attainment for a trainee to qualify as a CBD worker. In relation to the application of the training, most of the CBD workers to a large extent were found to perform well on what they were taught to do - knowledge of educational tasks, performance of educational task and effectiveness of educational task. The response and support of the community members especially the clients, to the educational activities of the CBD workers was found to be positive. However, the CBD workers advocate that the government should re—introduce the monthly incentives because the CBD workers in carrying out their activities, incur tangible and intangible cost.
Assessment of tubal factor contribution to female infertility in a low resource setting (southwest Nigeria): hysterosalpingography vs laparoscopy
(2005) Okunlola, M. A.; Adebayo, O. J.; Odukogbe, A. A.; Morhason-Bello, I. O.; Owonikoko, K. M.
Astigmatism in post-operative cataract patients
(1994-12) Agbeja-Baiyeroju, A. M.; Oko, H. O.
The aim of the study was to find out the various degrees of post-operative refractive astigmatism in our cataract patients, causes of the astigmatism and ways of minimising this problem. The total number of post-operative refractive astigmatism was determined in patients following cataract surgery. 22% of the patients had an astigmatism of greater than 2 diopters although only 1.9% had the more intolerable astigmatism of greater than 4 diopters. Associated causes for the astigmatism included intraoperative vitreous loss, wound dehiscence, pterygium and corneal scars. With the advent of microsurgery and better magnification, suggestions are made as to how to minimise this condition which, if high proves very intolerable for the patient.
Asymptomatic bacteriuria among HIV positive pregnant women
(Taylor and Francis, 2010-06) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Mutiu, W. B.; Adewole, I. F.
The prognostic significance of asymptomatic bacteriuria resides in the observation that the prevalence is, relatively, high in persons with certain medical conditions, such as diabetes mellitus and pregnancy. This prevalence might, even, be higher in patients with human immunodeficiency virus infection. Hence, this study set out to determine the prevalence of asymptomatic bacteriuria among symptom free and newly enrolled HIV infected pregnant women attending PMTCT unit of Antiretroviral Clinic of University College Hospital, Ibadan, Nigeria between 1st May and 30th September 2007. Information was obtained on the socio-demographic characteristics of the subjects, CD4 count and viral load. Microbial culture was carried out on aseptically collected urines from the patients. Statistical analysis was done with SPSS 12 package. There were 161 analyzable samples from the participants. The mean age and gestational age at presentation of participants was 30.49 ± 4.3 years and 27.3 ± 3.2 weeks, respectively with modal parity of 2. Twenty-five (15.5%) of the urine samples significantly grew bacteria. The CD4 cells were significantly lower and the viral loads significantly higher (250.52 vs. 355.57 cells/mm3; 88,731 vs. 55,384 copies/ml; p = <0.0000) for the urine culture positive patients. Eshcherichia coli were isolated in 48%, Proteus in 16.0%, Klebsiella in 8.0% and Staphylococcus aureus in 28.0% of the urine positive cultures. The study showed that the prevalence of asymptomatic bacteriuria among PLWHAs is high. The microbial isolate from the urine samples were not different from those of HIV-negative patients.
Asymptomatic bacteriuria among HIV positive pregnant women
(2010) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Mutiu, W. B.; Adewole, I. F.
The prognostic significance of asymptomatic bacteriuria resides in the observation that the prevalence is, relatively, high in persons with certain medical conditions, such as diabetes mellitus and pregnancy. This prevalence might, even, be higher in patients with human immunodeficiency virus infection. Hence, this study set out to determine the prevalence of asymptomatic bacteriuria among symptom free and newly enrolled HIV infected pregnant women attending PMTCT unit of Antiretroviral Clinic of University College Hospital, Ibadan, Nigeria between 1st May and 30th September 2007. Information was obtained on the socio-demographic characteristics of the subjects, CD4 count and viral load. Microbial culture was carried out on aseptically collected urines from the patients. Statistical analysis was done with SPSS 12 package. There were 161 analyzable samples from the participants. The mean age and gestational age at presentation of participants was 30.49 ± 4.3 years and 27.3 ± 3.2 weeks, respectively with modal parity of 2. Twenty-five (15.5%) of the urine samples significantly grew bacteria. The CD4 cells were significantly lower and the viral loads significantly higher (250.52 vs. 355.57 cells/mm3; 88,731 vs. 55,384 copies/ml; p = <0.0000) for the urine culture positive patients. Eshcherichia coli were isolated in 48%, Proteus in 16.0%, Klebsiella in 8.0% and Staphylococcus aureus in 28.0% of the urine positive cultures. The study showed that the prevalence of asymptomatic bacteriuria among PLWHAs is high. The microbial isolate from the urine samples were not different from those of HIV-negative patients.
Asynchronous video-otoscopy with a telehealth facilitator
(Mary Ann Liebert , Inc, 2013-04) Biagio, L.; Swanepoel, D. W.; Adeyemo, A. A.; Hall, J. W.; Vinck, B.
Objective: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. Subjects and Methods: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. Results: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from videootoscopic images acquired by the otolaryngologist and facilitator (j = 0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. Conclusions: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings
Attitude and preferences of Nigerian antenatal women to social support during labour
(Cambridge University Press, 2007) Morhason-Bello, I. O.; Olayemi, O.; Ojengbede, O.A.; Adedokun, B. O.; Okuyemi, O. O.; Orji, B.
This was a hospital-based cross-sectional study of 224 randomly selected antenatal women receiving care at the University College Hospital, Ibadan, Nigeria. The study aimed to seek the attitude and preferences of respondents about social support during childbirth and also identify variables that may influence their decisions. Seventy-five per cent of respondents desired companionship in labour. Approximately 86% preferred their husband as companion while 7% and 5% wanted their mother and siblings as support person respectively. Reasons for their desire for social support were emotional (80•2%), spiritual (17•9%), errands (8•6%) and physical activity (6•8%). Socio-demographic variables found to be statistically significant on logistic regression analysis for the desire of a companion in labour were nulliparity (OR 3•57, 95% CI 1•49–8•52), professionals (OR 3•11, 95% CI 1•22–7•94) and women of other ethnic groups besides Yoruba (OR 2•90, 95% CI 1•02–8•26), which is the predominant ethnic group in the study area. Only those with post-secondary education were found to want their husbands as doula (OR 2•96, 95% CI 1•08–8•11). More than half of the respondents wanted information about labour prior to their experience. It is important that Nigerian women are allowed the benefit of social support during childbirth, particularly as there is a lack of one-to-one nursing care and other critical services, including epidural analgesia in labour, at many of the health care facilities in Nigeria. Men could play a pivotal role in the process of introducing support in labour so as to improve the outcome for both the mother and her newborn
Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia
(Routledge, 2015) Moore, A. M.; Bankole, A.; Awolude, O.; Audam, S.; Oladokun, A.; Adewole, I.
Fertility decisions among people living with HIV/AIDS (PLWHA) are complicated by disease progression, the health of their existing children and possible antiretroviral therapy (ART) use, among other factors. Using a sample of HIV-positive women (n = 353) and men (n = 299) from Nigeria and Zambia and their healthcare providers (n = 179), we examined attitudes towards childbearing and abortion by HIV-positive women. To measure childbearing and abortion attitudes, we used individual indicators and a composite measure (an index). Support for an HIV-positive woman to have a child was greatest if she was nulliparous or if her desire to have a child was not conditioned on parity and lowest if she already had an HIV-positive child. Such support was found to be lower among HIV-positive women than among HIV-positive men, both of which were lower than reported support from their healthcare providers. There was wider variation in support for abortion depending on the measure than there was for support for childbearing. Half of all respondents indicated no or low support for abortion on the index measure while between 2 and 4 in 10 respondents were supportive of HIV-positive women being able to terminate a pregnancy. The overall low levels of support for abortion indicate that most respondents did not see HIV as a medical condition which justifies abortion. Respondents in Nigeria and those who live in urban areas were more likely to support HIV-positive women’s childbearing. About a fifth of HIV-positive respondents reported being counselled to end childbearing after their diagnosis. In summary, respondents from both Nigeria and Zambia demonstrate tempered support of (continued) childbearing among HIV-positive women while anti-abortion attitudes remain strong. Access to ART did not impart a strong effect on these attitudes. Therefore, pronatalist attitudes remain in place in the face of HIV infection.
Audit of open pediatric tracheostomies at the university college hospital, Ibadan
(2020-06) Oyelakin, O.A.; Adeyemo, A. A.
Background: Tracheostomy is the creation of a communication between the trachea and the overlying skin, maintained by a tube. This is done either by an open or percutaneous technique. Anatomical and physiological variation of the paediatric trachea and adjoining structures necessitates finite skills and consistent competence in performing pediatric tracheostomies, lack of which may cause higher mortality and morbidity outcome in tracheostomies in the pediatric age group. Objectives: There are inadequate local data on the outcomes of pediatric tracheostomies; therefore, we conducted a local audit of pediatric tracheostomy to describe our experience. Methods: A retrospective study of pediatric patients who had tracheostomies from June 2011 to December 2017 was done. Results: Thirty‑four patients were identified, all of whom had an open tracheostomy. The age range was 3 weeks to 16 years; M: F ratio was 2.4:1. Indications for surgery were obstructive (88.2%) and prolonged‑assisted intubation (11.8%). Recurrent respiratory papillomatosis, retropharyngeal abscess, and foreign‑body aspiration were the main obstructive causes. Three patients (8.8%) had repeat procedures, and these patients were initially discharged on tracheostomy tube and instructions were given for home care. Conclusion: Despite the evolving local challenges peculiar to clinical practice in developing countries, the outcome of pediatric tracheostomy in our hospital is good
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 MTCT
An audit of the uptake of key PMTCT interventions in the pre and post WHO rapid advice periods at the University College Hospital, Ibadan
(Society of Gynaecology and Obstetrics of Nigeria, 2015-04) 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>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 MTCT.