FACULTY OF CLINICAL SCIENCES
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Item Pregnancy outcomes in women with sickle cell disease at a tertiary hospital in Nigeria: a five-year retrospective study(Association of Resident Doctors (ARD), University College Hospital (UCH), Ibadan, 2024) Olukunle, T. A.; Ogunbode, O. O.; Abdus-salam, A. A.Background: Sickle cell disease (SCD) in pregnancy constitutes a high-risk pregnancy, associated with increased risk of adverse outcomes. Objective: To describe the outcome of pregnancy in SCD women managed at the University College Hospital, Ibadan, Nigeria. Materials and Methods: A retrospective review of the health records of sixty-three SCD pregnant women managed between January 1, 2016, and December 31, 2020. The information extracted included sociodemographic and obstetric characteristics, clinical presentations, mode of delivery, maternal and fetal outcomes. The data was analyzed using the IBM Statistical SPSS Statistics for Windows, version 23.0. The test of association was done using Chi-square and level of significance was p<0.05. Results: Prevalence of SCD in pregnant women was 0.65%. Mean age was 28.8±4.1years, 63.5% were haemoglobin SS while 36.5% were haemoglobin SC. Most of the women had tertiary education (61.8%) and booked for antenatal care (ANC) (60%). About 72.4% delivered at term while 46.1% had caesarean delivery. Most common complication was anaemia (79.4%) while vaso-occlusive crisis was the most common type of crisis (55.6%). Most of the women (92.5%) had live-birth with 15.2% of neonates requiring Neonatal Intensive Care Unit (NICU) admission. Maternal death rate was 6.3%. Good maternal and fetal outcomes occurred in 71.4% and 61.9% of participants respectively. Good maternal outcome was significantly associated with tertiary education(p=0.01). Good fetal outcome was associated with tertiary level of education(p=0.04) and multigravida status(p=0.03). Conclusion: SCD pregnant women have good fetal-maternal outcomes, however not receiving ANC and lower level of education were associated with poor pregnancy outcomes. Health education, access to ANC, prompt diagnosis, treatment of complications and multi-disciplinary team management will improve the pregnancy outcomes.Item Antenatal care utilisation among adolescent mothers in Ngozi Province, Burundi(Wolters Kluwer ‑ Medknow, 2024) Iradukunda, L. I.; Ogunbode, O. O.; Arulogun, O. S.Background: Globally pregnancy and childbirth complications are the leading cause of death among adolescents, with evidence showing that antenatal care (ANC) is a very effective preventive intervention. In Burundi, there is limited information on the extent to which pregnant adolescents utilise such services. Objective: To assess the ANC utilisation and factors associated with its use among adolescent mothers in Ngozi Province, Burundi. Materials and Methods: A cross-sectional, health facility-based study among 216 adolescent mothers who had given birth within two years preceding this study, using structured questionnaires and records from previous ANC booklets. A multistage random sampling technique was used to select respondents while the utilisation of ANC was determined by the frequency of ANC visits and the time when the women enrolled for the first ANC visit. Results: The majority (98.1%) of adolescent mothers in Ngozi Province used ANC services. Most respondents (64.8%) initiated ANC services within the first trimester while 57.8% attained the minimum of four recommended ANC visits. Marital status (P = 0.001), geographical location (P = 0.009), occupation of the partner (P = 0.002) and type of the last pregnancy (P = 0.012) were associated with ANC initiation within the first trimester while marital status (P < 0.001), respondent’s employment (P = 0.003) and type of last pregnancy (P < 0.001) were associated with appropriate ANC frequency. Conclusion: This study revealed a high use of ANC services among adolescent mothers, although more than one-third attended ANC late. There is therefore the need to put more effort into improving early booking for ANC.Item Serum copper, zinc an selenium levels in women with unexplained infertility in Ibadan Nigeria: a cross-sectional analytical study(Wolters Kluwer - Medknow, 2023) Adeniyi, A. A.; Ogunbode, O. O.; Adeyanju, A. S.; Oladokun, A.Background: Infertility is a global public health issue affecting couples. Trace metals have been implicated in effective reproductive functions in males but less studied in females. Objective: To compare the serum levels of copper (Cu), zinc (Zn), selenium (Se) and copper/zinc ratio in women with unexplained infertility and fertile women. Subjects and Methods: This was a cross-sectional analytical study that compared 75 consenting women who had unexplained infertility with 74 fertile women that were controls. Both groups were seen within 1 year of delivery and were recruited from the family planning unit, at the University College Hospital, Ibadan. Data were obtained through a semi-structured questionnaire, after which 10 mL of venous blood was collected. Analysis of selected trace elements were done by atomic absorption spectrophotometry. IBM SPSS version 23 was utilized for data analysis and the levels of statistical significance was set at <0.05. Results: The mean (±SD) serum concentrations of Cu (93.11 ± 16.55 μg/dL), Zn (72.04 ± 15.03 μg/dL) and Se (28.28±8.33 μg/dL) amongst the women with unexplained infertility were lower when compared to the control group (all with P<0.001). The serum Cu/Zn ratio was higher among the fertile women, though not statistically significant (P<0.62). Age of <35 years was associated with normal serum levels of Cu (P<0.01), while women with normal body mass index had low serum concentrations of Cu (P=0.04), amongst the fertile group. Conclusion: Serum copper, zinc and selenium concentrations are significantly lower in women with unexplained infertility, therefore diets or supplements containing these trace elements may be helpful in their management.Item Management and the prevention of anaemia in pregnancy(Tropical Journal of Obstetrics and Gynaecology (TJOG), 2023) Afolabi, B. B.; Ogunbode, O. O.; Ezechi, O. C.; Ogu, R. N; Agboghoroma, C. O; Aboyeji, A. P.; Tukur, J; Oyebode, T; Daru, P. H.; Oluwole. A. A.; Onyebuchi, A.; Audu, B.; Aimakhu, C.O.; Akinola, O. I; Ikpeze, O. C.; Sadauki, H. MAnaemia during pregnancy is a significant public health concern in this country. With 40% of the population living in poverty and 63% facing multidimensional poverty as reported by the National MPI 2022, it is not surprising that women often have poor diets, making them more prone to iron and folate deficiency anaemia, which are the leading causes of anaemia during pregnancy. Other factors contributing to anaemia during pregnancy include having multiple pregnancies in quick succession, giving birth to multiple babies, pre-pregnancy menorrhagia, worm infestation, severe and prolonged hyperemesis gravidarum, among others. Anaemia during pregnancy can cause serious complications for the fetus, such as preterm birth and low birth weight. It can also affect the mother's well-being, with severe anaemia increasing the risk of death or near misses. Recent evidence also suggests that anaemia during pregnancy significantly increases the risk of postpartum haemorrhage caused by uterine atony. It's crucial for healthcare providers to be aware of the issues associated with anaemia during pregnancy and the measures for preventing and detecting high-risk pregnancies early. Healthcare providers must understand the different types of anaemia, common symptoms, and treatment options to recognize the warning signs of anaemia and avoid complications. This clinical guideline is designed for obstetricians and midwives to help manage pregnant women with anaemia appropriately. The document's layout and practical step-by-step approach to managing anaemia during pregnancy are commendable, and the team of experts who produced this high-quality document under the chairmanship of Prof Abiodun Aboyeji deserves appreciation. All members of the committee deserve commendation for a job well done. Healthcare practitioners should use this guideline to manage anaemia during pregnancy effectively, reducing complications for both mother and foetus, and ultimately reducing the burden of high maternal and perinatal mortality and morbidity related to anaemia. This is one of four clinical guidelines to be produced by the SOGON Executive under my leadership. The other three will be rolled out shortly.Item Clinical audit of stillbirths at a faith-based Secondary health centre in Ibadan, Nigeria: a six- Year review(Zambia Medical Association, 2022) Ogunbode, O. O.; Poyeyiola, M. O.; Arowojo, A. O.Objective: The determine the prevalence of stillbirth and identify associated factors among parturients in a faith-based secondary health centre. Method: This was a retrospective audit of two hundred and twenty-five stillbirth deliveries at the Our Lady of Apostle Catholic Hospital at Oluyoro, Oke-Offa in Ibadan, Nigeria, between 1st January2010, and 31st December, 2015. Data was extracted from hospital records for sociodemographic characteristics, obstetric factors, complications, and outcomes of pregnancy. Data analysis was done using SPSS version 20 and the level of statistical significance was set at p < 0.05. Results: The stillbirth rate was 27.75 per 1000 births. More than half (129; 57.4%) were macerated. The ratio of still birth rate among the booked and unbooked parturients was 1:21. The common causes of stillbirths were hypertensive disorders in pregnancy (24.9%), anaemia in pregnancy (20.4%); while the least were congenital anomalies (1.0%) and gestational diabetes mellitus (1.0%). Conclusion: This study confirmed that most of the stillbirths were due to unsupervised or poorly supervised pregnancies. There is need to ensure quality antenatal care services for the early detection and management of risk factors in order to reduce the burden of stillbirths.Item Predictors of weight reduction in a Nigerian family practice setting(Ghana Medical Association, 2021) Ogunbode, A. M.; Owolabi, M. O.; Ogunbode, O. O.; Adebusoye, L. A.; Ogunniyi, A.Objectives: This study identified the predictors of weight reduction among adult obese patients in a Family Practice Setting and developed a statistical model to predict weight reduction. Design: A prospective cohort design. Setting: The Family Practice Clinic, University College Hospital, Ibadan, Nigeria Participants and study tools: Obese adults were recruited into a three-month weight reduction program. Patient Information Leaflets were used for counselling, while questionnaires were administered to obtain socio-demographic and lifestyle factors. Potential predictors were assessed using the Multidimensional Scale of Perceived Social Support, Zung Depression Scale, Rosenberg Self-Esteem scale, Garner’s Eating Attitude Test-26 (EAT-26), 24-hour dietary recall and International Physical Activity Questionnaire-short form. Anthropometric indices, blood pressure and Fast-ing Lipid Profile were assessed. Descriptive and inferential statistics were used for analysis with a significance set at α0.05. Results: Most 99(76.2%) of the 130 participants achieved weight reduction and had a median weight change of -2.3kg (IQR-4, -0.5), with 66 (66.7%) out of 99 attaining the weight reduction target of 10%. The regression model showed predictors of weight reduction to be Total Cholesterol [TC] (p=0.01) and Low-Density Lipoprotein Cholesterol [LDL-C] (p=0.03). The statistical model derived for Weight reduction = 0.0028 (LDL-C) -0.029 (TC)-0.053 (EAT-26) +0.041(High-Density Lipoprotein Cholesterol). The proportion of variance of the model tested was R2 = 0.3928 (ad-justed R2 = 0.2106). Conclusion: Predictors of weight reduction among patients were eating attitude score, Total Cholesterol, Low-Density Lipid and High-Density Lipoprotein Cholesterol levels. A statistical model was developed for managing obesity among patients.Item Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial(Elsevier, 2021) Vickery, N.; Stephens, T.; Toit, L. D.; Straaten, D. V.; Pearse, R.; Torborg, A.; Rolt, L.; Puchert, M.; Martin, G.; Biccard, B. B.; Osinaike, B. B.; Ogunbode, O. O.; Idowu, O.; Lawal, T. A.; Ogundiran, T. O.; Shittu, O. B.; Ayandipo, O. OBackground: The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods: Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results: The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n¼55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR¼3.0; 95% confidence interval [CI], 1.3e7.0); nursing management support of the trial (OR¼2.6; 95% CI, 1.1e6.5); performance of a dummy run (OR¼2.6; 95% CI, 1.1e6.1); nursing colleagues seeing the value of the intervention(s) (OR¼2.1; 95% CI, 0.9e5.7); and site investigators’ belief in the effectiveness of the intervention (OR¼3.2; 95% CI, 1.2e9.4). Conclusions: ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork.Item Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans(JohnWiley & Sons Ltd, 2020) Nepogodiev, D; Omar, O. M; Glasbey, J. C.; Li, E.; Simoes, J. F. F.; Abbott, T. E. F.; Ademuyiwa, A. O.; Biccard, B. M; Chaudhry, D.; Davidson, G. H; Saverio, S. D.; Gallo, G.; Ghosh, D.; Harrison, E. M.; Hutchinson, P. J.; Kamarajah, S. K.; Keller, D. S.; Ogunbode, O. O.Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12weeks of peak disruption. A Bayesian 𝛃-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12weeks of disruption due toCOVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90⋅2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72⋅3 per cent. Globally, 81⋅7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37⋅7 per cent of cancer operations (2 324 070 of 6 162 311) and 25⋅4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.Item Factors influencing the knowledge and practice of emergency contraception among Nigerian male undergraduates(Zambia Medical Association, 2020) Ogunbode, O. O.; Agboola, A.Background: Unwanted pregnancies among young women is a growing reproductive health concern. Correct and consistent use of contraception will stop this ugly trend while emergency contraception (EC) can also be viewed as a 'second chance method' in preventing unwanted pregnancies and unsafe abortions. The aim of this study is to assess the knowledge and practice of emergency contraception among Nigerian male undergraduates as they are known to have risky sexual behaviours. Methodology: This was a cross sectional study involving three hundred and thirty male undergraduates from three Tertiary institutions in Ibadan. A Multi-staged random sampling technique was used to recruit participants. Results: Knowledge about EC was poor among majority (74.5%) of male undergraduates. About 55.2% of the participants were sexually active and out of which 33.9% are currently using EC. The commonly (67.5%) used EC by their partners was levonorgestrel only pill (Postinor). Participants with higher levels of education, awareness of EC, previous use or having a partner who had previously used EC, participants who had sex within the past 6 months and those who were willing to recommend EC to others had a better knowledge of EC, which were all statistically significant. Conclusion: Providing accurate information to improve knowledge of EC among young men could lead to an increase in the uptake of EC.Item Assisted reproductive techniques and gamete donation; knowledge, attitude and willingness to participate among students in a Nigerian tertiary institution(Zambia Medical Association, 2020) Ogunbode, O. O.; Obajimi, G. O.Background: Infertility is a worldwide problem affecting about 10-15% of married couples and has social, economic and psychological implications1. A significant number of couples will require assisted reproduction following failure of common treatment options. Undergraduates form a rich source of potential gamete donors and it is imperative to assess their knowledge, attitude and willingness to participate in the expanding gamete donor programs in a developing country like Nigeria. Objectives: This study aimed to assess the knowledge and attitude of participants about assisted reproduction and to further evaluate their willingness to donate gametes for assisted conception or act as surrogates. Methodology: This was a cross-sectional descriptive study of 1150 participants consisting of 511 male students and 639 female students of the University of Ibadan. Participants were selected by simple random sampling technique. A semistructured, self-administered questionnaire was used to obtain information on sociodemographic characteristics, knowledge, attitude and willingness to participate in gamete donor programs. Participation was voluntary and data obtained was treated with utmost confidentiality. Data was analyzed using the Statistical Package for Social Sciences (IBM SPSS, New York) version 22. Descriptive statistics were generated, and the results summarized with the aid of a bar chart and frequency tables. Results: Eight seven percent of the respondents had good knowledge of Assisted Reproductive Techniques (ART) and the most common source of awareness was the media (63.3%). More respondents were aware of sperm donation (75.5%) compared to egg donation (61.9%). Ninety percent of the participants were correctly able to identify the places where ART could be practiced in Nigeria. Most of the respondents (81.5%) supported ART services and the most common reason for not supporting was due to ethical considerations (45.1%). Only about 54.9% were willing to participate in gamete donor programs. Nine (0.8%) female respondents had previously participated in egg (oocyte) donation while none of the male respondents had ever donated sperm. About threequarters of the respondents demonstrated good knowledge about the practice of surrogacy. Conclusion: Despite good knowledge about ART, only about half of the respondents were willing to participate in gamete donor programs. Religious and health concerns were primarily responsible for their reluctance. Providing Information, Education and Communication (IEC) materials about the safety of ART will increase the level of awareness and confidence in ART thereby increasing participation by potential donors particularly undergraduates in a developing country like Nigeria.