FACULTY OF CLINICAL SCIENCES

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    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.
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    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.
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    A review of vulvar and vaginal cancers in Ibadan, Nigeria
    (2013) Okolo, C. A.; Odubanjo, M. O.; Awolude, O. A.; Akang, E. E. U.
    The objectives of this study are to give an update on the previous studies on vulvar and vaginal cancers from the University College Hospital (UCH), Ibadan, Nigeria, to elucidate any changes in pattern, and to enumerate some of the factors affecting the management of these cancers at the UCH today. All the cases of cancer of the vulva and vagina seen at the UCH between January 1981 and December 2008 were reviewed and re-classified according to the World Health Organization (WHO) histological classification of 2004. The results are as follows: Vaginal and vulvar cancers were the 4th (1.4%) and 5th (1.2%) most common of the 5913 gynecological cancers seen. The mean age was 49.7 years. Squamous cell carcinoma (SCC) was the most common histological type. Notably, vulvar cancer is more common than vaginal cancer in the US and the UK and this opposes our findings. We studied time periods before and after the year 2000, and found vaginal cancer to be more common before and vulvar cancer after the year 2000. We suggest that this may be related to the introduction of the FIGO guidelines in 2000. We conclude that it is important to strictly adhere to the FIGO guidelines in determining the primary site of origin of these cancers in patients with advanced local disease as this distinction has implications for clinical management. The objectives of this study are to give an update on the previous studies on vulvar and vaginal cancers from the University College Hospital (UCH), Ibadan, Nigeria, to elucidate any changes in pattern, and to enumerate some of the factors affecting the management of these cancers at the UCH today. All the cases of cancer of the vulva and vagina seen at the UCH between January 1981 and December 2008 were reviewed and re-classified according to the World Health Organization (WHO) histological classification of 2004. The results are as follows: Vaginal and vulvar cancers were the 4th (1.4%) and 5th (1.2%) most common of the 5913 gynecological cancers seen. The mean age was 49.7 years. Squamous cell carcinoma (SCC) was the most common histological type. Notably, vulvar cancer is more common than vaginal cancer in the US and the UK and this opposes our findings. We studied time periods before and after the year 2000, and found vaginal cancer to be more common before and vulvar cancer after the year 2000. We suggest that this may be related to the introduction of the FIGO guidelines in 2000. We conclude that it is important to strictly adhere to the FIGO guidelines in determining the primary site of origin of these cancers in patients with advanced local disease as this distinction has implications for clinical management.
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    Condom use among antiretroviral therapy patients in Ibadan, Nigeria
    (2010) Akinyemi, J. O.; Awolude, O. A.; Awolude, O. A.; Adewole, I. F.; Kanki, P. J.
    Background: While antiretroviral treatment (ART) has improved the health status of people living with HIV, new challenges to their sexual and reproductive health (SRH) needs and their ability to prevent secondary HIV infections have risen. This study aimed to determine the level and factors that affect condom use among ART-experienced patients at the premier teaching hospital in Nigeria. Methodology: This longitudinal study involved patients who initiated treatment at the University College Hospital, Ibadan, Nigeria, between January and December 2006. Sexually active patients who had received treatment for at least six months and had not defaulted on clinic follow-up schedules were studied. Data on socio-demographic characteristics and condom use were extracted from clinic records. Chi square test and logistic regression were employed to determine factors associated with condom use. Results: The study involved 866 patients, specifically, 306 (35.3%) men and 560 (64.7%) women aged 40.7 (SD 7.6) and 33.3 (SD 6.5) years respectively. Condoms usage before treatment and at last clinic visits was 14.0% and 43.3% respectively. Overall reports of condom use at specified periods were as follows: 1 – 6 months (33.0%); 7 – 12 months (37.3%) and above 12 months (53.8%). Patients in a marital union and those with higher education were more likely to use condoms. Conclusions: Condom use is significantly influenced by marital status and educational level. Although condom use increases together with follow-up time, the level can be improved. Primary and secondary prevention efforts targeting high-risk sexual behaviour among ART patients need to receive greater and continual attention.