FACULTY OF CLINICAL SCIENCES

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    Congenital anomalies in Ibadan, Nigeria
    (Spectrum Books. Publisher, Ibadan Nigeria, 2016) Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Ademola, A. D.; Olayemi, O.; Ogbole, G. I.; Akinmoladun, J. A.; Agunloye, A. M.; Akinrinoye, O. O.; Takure, A. O.; Oyewole, O. B.; Oluwatosin, O. M.; Omokhodion, S. I.
    Background: There is a need for a multidisciplinary database that can be used as a potential source for developing a protocol and a guideline for a possible nationwide prospective surveillance of congenital anomalies in Nigeria. Methods: This five-year cross-sectional retrospective survey of data from January 2009 to December 2013 was done at the University College Hospital, Ibadan. Data were collected from the admission records on the wards in 8 specialty units with the most workable documented clinical records of congenital anomalies in their care using a predesigned proforma. Proportions of congenital anomalies were determined based on systemic classification of the anomalies and the descriptive terms used were according to the ICD_10-chapter XVIII_RCPCH extension. Result: The total number of patients with congenital anomalies whose records were obtained from the ward registers was 1311, there were 75 (5.7%) missing case notes while information was obtained on 1236 (94.3%) patients. There were a total of 1479 anomalies with multiple anomalies seen in 16.1% of the patients. The male/female ratio was 2:1 and multiple births as well as positive family history of birth defects were seen in about 2.4% and 2.2% of cases respectively. Prenatal diagnosis of the anomalies was documented in only 11 cases (0.9%). Only about one in five cases presented within the neonatal period, and defects of the abdominal wall as well as the cranial-facial-orbital regions were the most prevalent. Next were those in the cardiovascular, spinal column, anorectal and genital, as well as musculoskeletal systems. Conclusion: The size and pan-systemic profiles of the birth defects documented in this study calls for further action on this all-important cause of childhood mortality and significant life-long morbidity in our country.
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    Mid-trimester maternal serum placental growth factor (PLGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) combined with fetal Doppler studies in prediction of preeclampsia.
    (2022) Bankole, A. O.; Oluwasola, T. A. O.; Olayemi, O.; Akinmoladun, J. A.; Suleiman, B. K.
    Background: There have been many studies on prediction of preeclampsia but there is no single test which has demonstrated sufficient predictive value. Combination of maternal biomarkers with fetal Doppler studies are the promising predictors. Objective: The purpose of this study was to evaluate midtrimester maternal serum PLGF, sFlt-1 and fetal Doppler studies in predicting preeclampsia. Methodology: This is a cohort study of 120 consenting pregnant women between the gestational ages of 18–24weeks had blood sample collected for PLGF and sFlt-1and Doppler obstetrics Ultrasound scan was performed at recruitment. The women were followed up longitudinally throughout pregnancy. Standard statistics methods were adopted as applicable. The level of statistical significance was set at 5% (P-value <0.05). Results: A total of 115 participants had complete data for analysis and 16 (13.9%) developed preeclampsia. There was a statistically significant difference in the serum level of sFlt-1 and the sFlt-1/PLGF in those that developed preeclampsia with P-values of 0.009 and 0.014 respectively. There was a significant statistical difference in those with abnormal uterine artery PI and RI, Umbilical artery PI and RI among those that developed preeclampsia. Combining sFlt-1 and sFlt-1/PLGF with uterine and umbilical arteries PI and RI on Receiver operating characteristics (ROC) curve yielded an Area under the curve (AUC) of 0.925 with a sensitivity of 93.8% at a specificity of 65.7%. Conclusion: The combination of the serum PLGF, sFlt-1 and fetal doppler in the midtrimester had highest sensitivity in predicting preeclampsia compared to when they are used singly, and this will form a valuable tool in predicting preeclampsia in those presenting late in second trimester.
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    Male involvement in maternal health care in Karonga District, Malawi.
    (2021) Soko, M.; Oluwasola, T. A. O.; Olayemi, O.
    Background: Male involvement in maternal health has been of interest since the Cairo International Conference on Population and Development (ICPD) programme of action in 1994 outlined the role of men in reproductive health. This study aimed to evaluate the level of male involvement in maternal health in Malawi. Methods: A cross sectional study, involving 408 men, was conducted in Karonga distuict of Malawi. Men whose spouses delivered a child within a period of 2 years preceding the study were selected using random sampling procedures. The study design adopted an explanatory mixed-method approach making use of questionnaires and focus group discussions for data collection. The quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 24 while the qualitative data analysis was guided by the thematic content analysis. Ethical approval was duly obtained before commencing the study. Results: Most of the participants had secondary education (54%), were businessmen (40.7%). had one or two children (53.7%) while 80% were aged between 21 and 40 years. Of the 408 participants, about three-fifths, 244 (59.8%) had accompanied their wives for antenatal care (ANC) during last pregnancy, 230 (56.4%) were present at delivery while 210 (51.5%) accompanied their wives for postnatal care services. Overall, only 185 (45.5%) of the patticipants had accompanied their wives for all the three services. Aside accompanying their wives for care, more than two-thirds of the participants, 284 (69.6%) planned ANC with their wives, about three-quarters. 304 (74.5%) helped with household chores and more than half, 223(54.7%) discussed their wives' health issues with health workers. Conclusion: There is a high level of male involvement in maternal health care services in Karonga district of Malawi, However, few men are involved in accompanying the wife to all the maternal health care services, There is need to improve male involvement in maternal health thereby warranting a need for clearly stated policies that address male involvement in maternal health care.
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    The woman trial: overview and progress
    (Onemedia Studios, Bodija, Ibadan., 2011) Bello, F. A.; Aimakhu, C. O.; Ogunbode, O. O.; Adeyemi, A. B.; Oluwasola, T. O. A.; Olayemi, O.; Fawole, A. O.
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    Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage
    (BioMed Central(BMC), 2018) Roberts, I.; Shakur, H.; Fawole, B.; Kuti, M.; Olayemi, O.; Bello, A.; Ogunbode, O.; Kotila, T..; Aimakhu, C. O.; Olutogun, T.; Hunt, B. J.; Huque, S
    Background: Early treatment with tranexamic acid reduces deaths due to bleeding after post-partum haemorrhage. We report the prevalence of haematological, coagulation and fibrinolytic abnormalities in Nigerian women with postpartum haemorrhage. Methods: We performed a secondary analysis of the WOMAN trial to assess laboratory data and rotational thromboelastometry (ROTEM) parameters in 167 women with postpartum haemorrhage treated at University College Hospital, Ibadan, Nigeria. We defined hyper-fibrinolysis as EXTEM maximum lysis (ML) > 15% on ROTEM. We defined coagulopathy as EXTEM clot amplitude at 5 min (A5) < 40 mm or prothrombin ratio > 1.5. Results: Among the study cohort, 53 (40%) women had severe anaemia (haemoglobin< 70 g/L) and 17 (13%) women had severe thrombocytopenia (platelet count < 50 × 109/L). Thirty-five women (23%) had ROTEM evidence of hyper-fibrinolysis. Based on prothrombin ratio criteria, 16 (12%) had coagulopathy. Based on EXTEM A5 criteria, 49 (34%) had coagulopathy. Conclusion: Our findings suggest that, based on a convenience sample of women from a large teaching hospital in Nigeria, hyper-fibrinolysis may commonly occur in postpartum haemorrhage. Further mechanistic studies are needed to examine hyper-fibrinolysis associated with postpartum haemorrhage. Findings from such studies may optimize treatment approaches for postpartum haemorrhage.
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    Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): protocol and statistical analysis plan for a randomized controlled trial
    (Wellcome Trust., 2016) Shakur, H.; Fawole, B.; Kuti, M.; Olayemi, O.; Bello, A.; Ogunbode, O.; Kotila, T.; Aimakhu, S. H.; Gregg, M.; Roberts, I.
    Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid has the potential to reduce bleeding and a large randomized controlled trial of its effect on maternal health outcomes in women with PPH (The WOMAN trial) is ongoing. We will examine the effect oftranexamic acid on fibrinolysis and coagulation in a subset of WOMAN trial participants. Methods: Adult women with clinically diagnosed primary PPH after vaginal or caesarean delivery are eligible for inclusion in the WOMAN trial. In a sub-group of trial participants, blood samples will be collected at baseline and 30 minutes after the first dose of tranexamic acid or matching placebo. Our primary objective is to evaluate the effect of tranexamic acid on fibrinolysis. Fibrinolysis will be assessed by measuring D-dimers and by rotational thromboelastometry (ROTEM). Secondary outcomes are international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, haemoglobin and platelets. We aim to include about 180 women from the University College Hospital, Ibadan in Nigeria. Discussion: This sub-study of WOMAN trial participants should provide information on the mechanism of action of tranexamic acid in women with postpartum haemorrhage. We present the trial protocol and statistical analysis plan. The trial protocol was registered prior to the start of patient recruitment. The statistical analysis plan was completed before un-blinding.
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    Acceptability of counselling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria
    (The Faculty of Medicine, Makerere University, 2011-03) Bello, F. A.; Ogunbode. O. O.; Adesinsa, 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.
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    Attitude to caesarean section amongst antenatal clients in Ibadan, Nigeria
    (College of Health Sciences, University of Ilorin, 2011-01) Bello, F. A.; Olayemi, O.; Ogunbode, O. O.; Adekunle, A. O.
    This was a cross-sectional study carried out on 372 clients receiving antenatal care at a rural, suburban and urban centres, in order to assess the acceptance of caesarean delivery amongst them and the factors influencing their attitude. Caesarean section was acceptable to 65.7%. Many respondents will refuse the surgery, because they do not think abdominal delivery is natural or necessary. However, if indicated by their health caregiver to be necessary to save life, 78.3% would comply. Others would leave for a religious healing home, another hospital, a traditional birth attendant or be delivered at home. The cultural reasons why some women decline include feeling that caesarean delivery is due to “spiritual attacks”, retribution for maternal infidelity and failure of a woman to fulfil her reproductive function. Respondents were more likely to accept the surgery if they had heard of it before or had a previous caesarean delivery. They were less likely to accept it if they were Christians or attended the rural health centre. Age, parity and educational level had no influence. Only 4% of the respondents would request a caesarean section for non-medical reasons. Health education needs to be carried out in the community, as well as during antenatal classes, to address the cultural beliefs. Means of involving religious bodies in enlightenment campaigns to improve women's attitude should be explored.
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    Plasma C-reactive protein and selected nutritional indices in elective caesarean section
    (Journalgurus, 2009-04) Adedapo, K. S.; Nwobi, L. N.; Olayemi, O.; Aimakhu, C. O.; Ogunbode, O. O.; Akinboade, A. F.; Adeniyi, F. A. A.
    Context: Caesarean Section (CS) is a major surgical procedure, often performed when a vaginal delivery is considered unsafe. Objective: This study was carried out to understand the interaction between acute phase proteins and nutritional factors consequent to caesarean section. The knowledge of this interaction is important for successful management of these patients. Methods: Plasma samples from fifty (50) pregnant women booked for elective caesarean section in Ibadan, Nigeria were collected on the day preceding surgery, one day and four days post-surgery to determine the levels of CRP, vitamin C, PCV, Total protein, albumin and globulin (Glb) levels. Results: The mean age of the patients studied was 32.29 + 3.66 years, range; 24 39 years. Significant elevations were observed in the levels of TP, Glb and CRP one day post-surgery (1DPS) compared with baseline (BS) (7.36 + 1.46) vs 6.56±1.30, (4.68 + 1.33) vs 2.70±1.51, (111.43 + 68.89) vs 6.00 ± 13.27 respectively, while albumin reduced significantly (2.68 + 1.08) vs 3.87±0 .63. Similar changes were observed on day 4. There was no significant change in the levels of Vitamin C. Conclusion: One of the positive predictive indicators of good outcome after caesarean delivery is adequate nutrition.
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    Perception and practice of emergency contraception among female Undergraduates of the University of Ibadan, Nigeria
    (Elsevier, 2009) Bello, F. A.; Olayemi, O.; Fawole, A. O.; Ogunbode, O. O.; Sobukunola, T.; Adesina, O. A.; Aimakhu, C.; Okunola, A.
    Objective To assess perception and level of proper utilization of emergency contraception (EC) among female undergraduates. Methods Cross-sectional questionnaire study was performed on 383 female undergraduates in Nigeria in June 2006. Data analysis was with χ-square test and logistic regressions (P<0.05). Results One hundred and five (48.2%) had been sexually exposed. Only 32 (30.5%) used regular contraception. Seventy-three (24.3%) female undergraduates were aware of EC. Only 29 (7.6%) had used EC before. Most would not use emergency contraceptive drugs in future due to lack of awareness (64.8%), and fear for future fertility and of drugs being injurious to health. Use of EC was associated with awareness of correct interval for use (OR=9.1; 95%CI: 2.1-39.9). Conclusion There is poor knowledge about EC and poor use, while significant need remains. Most knowledge was acquired from peers and inaccurate. Peer educators are important and professionals’ knowledge needs improvement.