FACULTY OF CLINICAL SCIENCES
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Item Immunization of children in Africa: strides and challenges(Wolters Kluwer - Medknow, 2023-06) Olawuyi, D. A.; Esanju, D. O.; Olowolayemo, S. A.; Asogwa, C. S.; Salako, O. O.; Kolajo, A. E.; Akano, O. S.; Ibekwe, J. P.; Mbey, A. N.; Raji, A. H.Background: The African continent is behind by a wide margin in the childhood vaccination race which contributes significantly to the high childhood morbidity and mortality rate from vaccine-preventable diseases in the continent. Some African countries are still struggling to achieve routine immunization coverage for all recommended expanded program on immunization vaccines. Aim: In this study, we aimed to identify the barriers hindering childhood immunization in Africa and to identify the remarkable progress made so far. Materials and Methods: Peer-reviewed articles published in English that focused on the barriers to childhood immunization in Africa and the progress made so far was reviewed. This was achieved by searching relevant search terms in PubMed, Google Scholar, Wiley Online Library, and CINAHL databases dating back from January 2000 to June 2022. Result: A total of 30 papers were reviewed. The barriers include parents’ education status, economic status, and gender/age; place of birth and place of residence; cultural beliefs and religious affiliations; fear of contracting diseases and lack of trust in health public institutions; vaccine awareness and delivery; and dose-specific delays. The achievements include international support and oriented actions, plans for technological integration and its implementation, and domestic immunization-oriented actions and research work. Conclusion: Childhood immunization is still low in Africa with the majority of the countries yet to realize the global immunization targets. Technologies and immunization-related interventions have been implemented to support Africa but more concerted effort and aid are required to reduce vaccine-preventable deaths to the bare minimum.Item Ocular morbidity among orphans and vulnerable children living in shelters in Ibadan metropolis(Wolters Kluwer - Medknow, 2024) Ajetunmobi, B. S.; Ugalahi, M. O.; Uchendu, O. C.; Baiyeroju, A. M.Globally, orphans and vulnerable children (OVC) represent a significant population at risk of poor health as well as a high risk of developing ocular disorders. These ocular disorders could lead to childhood visual impairment or blindness if left undetected or untreated. This study therefore focuses on ocular morbidity among OVC living in shelter facilities to provide relevant data for planning eye care interventions. Methods: A descriptive, cross-sectional study was conducted among OVC ages 5–16 years living within shelter facilities in Ibadan, Oyo State. Sociodemographic characteristics were obtained. Ocular examinations, including visual acuity measurements, colour vision test, Hirschberg test, anterior and posterior segments assessment, and cycloplegic refraction were conducted. Descriptive and inferential analysis was done with IBM SPSS Statistics version 24. All analyses were at 5% level of statistical significance. Results: A total of 497 eligible OVC participated in the study. The mean age was 11 ± 3.4 years, and 263 (52.9%) were males. The prevalence of ocular morbidity was 18.1%. The most common types of ocular morbidity were refractive errors 47 (9.5%) and allergic conjunctivitis 18 (3.6%), with more females affected by both conditions, 28 (59%) and 11 (61%), respectively. Ocular morbidity was most common (28.3%) among the 14–16 years age group (P=0.001). Conclusion: Refractive errors and allergic conjunctivitis, which are treatable ocular conditions, were the most common ocular morbidities among these children. Regular eye screening as well as the provision of quality and affordable eye care services is advocated for this vulnerable population of children.Item Is couching rare in the pediatric age group? a report of bilateral couching in a child(Wolters Kluwer - Medknow, 2019-12) Ugalahi, M. O.; Ata, A. S.; Olusanya, B. A.; Baiyeroju, A. M.Background: Couching, an ancient procedure for cataract surgery, is unfortunately still being practiced in many developing countries. There are several reports of couching in adult populations; however, literature is sparse on its occurrence in children. Case report: We report a case of a 10-year-old boy who had bilateral couching on account of congenital cataracts due to presumed congenital rubella syndrome. The patient had initially presented to our clinic during neonatal period and was scheduled for surgery. Unfortunately, surgery was not performed due to various reasons which were either patient related or health system related. He represented to the eye clinic 6 years post-couching with complaints of poor vision. Conclusion: This report aims to highlight the fact that couching is, indeed, being performed on children’s eyes, especially as a consequence of inefficiencies in the eye healthcare delivery system.Item Familial cataracts: profile of patients and their families at a child eye care tertiary facility in a developing country(2023) Ugalahi, M. O.; Onebunne, E. O.; Olusanya, B. A.; Baiyeroju, A. M.Purpose: The aim of this study is to describe the clinical profile, pedigree charting, and management of children with familial cataracts at a child eye health tertiary facility in southwest Nigeria. Methods: The clinical records of children ≤16 years diagnosed with familial cataracts at the Pediatric Ophthalmology Clinic, University College Hospital Ibadan (Ibadan, Nigeria) from January 1, 2015, to December 31, 2019, were retrospectively reviewed. Information on demographic data, family history, visual acuity, mean refractive error (spherical equivalent), and surgical management was retrieved. Results: The study included 38 participants with familial cataract. The mean age at presentation was 6.30 ± 3.68 years, with a range of 7 months to 13 years. Twenty-five patients (65.8%) were male. All patients had bilateral involvement. The mean duration from onset of symptoms to presentation at the hospital was 3.71 ± 3.20 years, with a range of 3 months to 13 years. In 16 of the 17 pedigree charts obtained, at least one individual was affected in each generation. The most common cataract morphology was cerulean cataract, observed in 21 eyes (27.6%). The most common ocular comorbidity was nystagmus which was observed in seven patients (18.4%). Sixty-seven eyes of 35 children underwent surgery within the period of the study. The proportion of eyes that had best-corrected visual acuity ≥6 / 18 before surgery was 9.1%; this proportion had increased to 52.7% at the last postoperative visit. Conclusions: Autosomal dominant inheritance appears to be the major pattern among our patients with familial cataract. The most common morphological type found in this cohort was cerulean cataract. Genetic testing and counseling services are vital for the management of families with childhood cataract.Item Determinants of utilization of eye care services in a rural adult population of a developing country(Wolters Kluwer - Medknow, 2016-03) Olusanya, B. A.; Ashaye, A. O.; Owoaje, E. T.; Baiyeroju, A. M.; Ajayi, B. G.Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South‑Western Nigeria. Methods: A descriptive cross‑sectional survey using a multistage sampling technique was conducted. The main outcome measure was self‑reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of ≥70 years (odds ratio [OR] = 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community‑based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa.Item Pattern of congenital hand anomalies at a tertiary plastic surgery service in south-western Nigeria: a 10-year, cross-sectional retrospective review(2020) Michael, A.I.; Ademola, S.A.; Olawoye, O.A.; Iyun, A.O.; Oluwatosin, O.M.Context: Although congenital hand anomalies are among the more common musculoskeletal anomalies worldwide, we do not know its prevalence in our practice. Aims: The aim of the study was to determine the pattern of congenital hand anomalies presenting to our tertiary plastic surgery outpatient service in South-Western Nigeria. Materials and Methods: This is a cross-sectional retrospective analysis of outpatient cases of congenital hand anomalies presenting over a 10-year period. Descriptive and inferential statistics were performed using frequencies, Student’s t-test and Chi-square as appropriate. The data were analysed using IBM SPSS Statistics 23.0. The statistical significance value was set at P < 0.05. Results: One hundred and twenty-two cases were identified. The highest number of cases was seen in the year 2012, 23 patients (19.3%). There was a male preponderance of 66 patients (55.1%). Thirty-two patients (26.2%) presented as neonates and 36 (29.5%) as infants. Bilateral anomalies were seen in 67 patients (54.9%). The most common anomaly was failure of differentiation, 88 patients (72.1%) followed by duplication, 26 patients (21.3%). Syndactyly with 43 patients (35.2%) was the most common anomaly under failure of differentiation. No significant associations were found between the type of anomaly and gender or laterality. Conclusions: Syndactyly was the most common congenital hand anomaly in this study. There was a preponderance of bilateral involvement in both syndactyly and polydactyly.Item H3Africa partnerships to empower clinical research sites to generate high-quality biological samples(2020) Croxton, T.; Agala, N.; Jonathan, E.; Balogun, O.; Ozumba, P.J.; Onyemata, E.; Onyemata, E.; Lawal, S.; Mamven, M.; Ajayi, S.; Melikam, S.E.; Owolabi, M.; Ovbiagele, B.; Adu, D.; Ojo, A.; Beiswanger, C.M.; Abimiku, A.Background: The Institute of Human Virology Nigeria (IHVN) – Human Heredity and Health in Africa (H3Africa) Biorepository (I-HAB) seeks to provide high-quality biospecimens for research. This depends on the ability of clinical research sites (CRS) – who provide biospecimens – to operate according to well-established industry standards. Yet, standards are often neglected at CRSs located in Africa. Here, I-HAB reports on its four-pronged approach to empower CRSs to prepare high-quality biospecimens for research. Objectives: I-HAB sought (1) to assess a four-pronged approach to improve biobanking practices and sample quality among CRSs, and (2) to build human capacity. Methods: I-HAB partnered with two H3Africa principal investigators located in Nigeria and Ghana from August 2013 through to May 2017 to debut its four-pronged approach (needs assessment, training and mentorship, pilot, and continuous quality improvement) to empower CRSs to attain high-quality biospecimens. Results: Close collaborations were instrumental in establishing mutually beneficial and lasting relationships. Improvements during the 12 months of engagement with CRSs involved personnel, procedural, and supply upgrades. In total, 51 staff were trained in over 20 topics. During the pilot, CRSs extracted 50 DNA biospecimens from whole blood and performed quality control. The CRSs shipped extracted DNA to I-HAB and I-HAB that comparatively analysed the DNA. Remediation was achieved via recommendations, training, and mentorship. Preanalytical, analytical and post-analytical processes, standard operating procedures, and workflows were systematically developed. Conclusion: Partnerships between I-HAB and H3Africa CRSs enabled research sites to produce high-quality biospecimens through needsItem Study of streptomycin‑induced ototoxicity: protocol for a longitudinal study(2016) Adeyemo, A. A.; Oluwatosin, O.; Omotade, O. O.Hearing impairment is due to various causes including ototoxicity from aminoglycosides. The susceptibility to aminoglycosides increases in the presence of certain mitochondria gene mutations. There is unrestrained use of aminoglycosides in many developing nations which may worsen the burden of hearing impairment in these countries but there is lack of data to drive required policy changes. Streptomycin (an aminoglycoside) is part of the drug regimen in re-treatment of tuberculosis. Exploring the impact of streptomycin ototoxicity in tuberculosis patients provides a unique opportunity to study aminoglycoside ototoxicity within the population thus providing data that can inform policy. Also, since streptomycin ototoxicity could adversely affect treatment adherence in tuberculosis patients this study could enable better pre-treatment counseling with subsequent better treatment adherence. Patients on tuberculosis re-treatment will be recruited longitudinally from Direct Observation Therapy-Short course centers. A baseline full audiologic assessment will be done before commencement of treatment and after completion of treatment. Early detection of ototoxicity will be determined using the American Speech and Hearing Association criteria and genetic analysis to determine relevant mitochondria gene mutations will be done. The incidence of ototoxicity in the cohort will be analyzed. Both Kaplan–Meier survival curve and Cox proportional hazards tests will be utilized to determine factors associated with development of ototoxicity and to examine association between genotype status and ototoxicity. This study will provide data on the burden and associated predictors of developing aminoglycoside induced ototoxicity. This will inform public health strategies to regulate aminoglycoside usage and optimization of treatment adherence and the management of drug-induced ototoxicity among TB patients. Furthermore the study will describe mitochondrial gene mutations associated with ototoxicity in the African populationItem Consensus recommendations for the prevention of cervical cancer in Sub-Saharan Africa(2013) Adewole, I. F.; Abauleth, Y. R.; Adoubi, I.; Amorissani, F.; Anorlu, R. I.; Awolude, O. A.; Botha, H.; Byamugisha, J. K.; Cisse, L.; Diop, M.; Doh, S.; Fabamwo, A. O.; Gahouma, D.; Galadanci, H. S.; Githanga, D.; Magure, T. M.; Mabogunje, C.; Mbuthia, J.; Muchiri, L. W.; Ndiaye, O.; Nyakabau, A. M.; Ojwang, S. B. O.; Ramogola-Masire, D.; Sekyere, O.; Smith, T. H.; Taulo, F. O. G.; Wewege, A.; Wiredu, E.; Yarosh, O.Cervical cancer is the second most common cancer and the leading cause of cancer-related death in women in sub-Saharan Africa. It is estimated that more than 200 million females older than 15 years are at risk in this region. This paper highlights the current burden of cervical cancer in sub-Saharan Africa, reviews the latest clinical data on primary prevention, outlines challenges in the region, and offers potential solutions to these barriers. Based on these factors, clinical recommendations for the prevention of cervical cancer from the sub-Saharan African Cervical Cancer Working Group expert panel are presented.Item Community attitudes toward childbearing and abortion among HIV-positive women in Nigeria and Zambia(2013) Kavanaugh, M. L.; Moore, A. M.; Akinyemi, J.; Adewole, I.; Dzekedzeke, K.; Awolude, O.; Arulogun, O.Although stigma towards HIV-positive women for both continuing and terminating a pregnancy has been documented, to date few studies have examined relative stigma towards one outcome versus the other. This study seeks to describe community attitudes towards each of two possible elective outcome of an HIV-positive woman’s pregnancy – induced abortion or birth – to determine which garners more stigma and document characteristics of community members associated with stigmatising attitudes towards each outcome. Data come from community-based interviews with reproductive-aged men and women, 2401 in Zambia and 2452 in Nigeria. Bivariate and multivariate analyses revealed that respondents from both countries overwhelmingly favoured continued childbearing for HIV-positive pregnant women, but support for induced abortion was slightly higher in scenarios in which anti-retroviral therapy (ART) was unavailable. Zambian respondents held more stigmatising attitudes towards abortion for HIV-positive women than did Nigerian respondents. Women held more stigmatising attitudes towards abortion for HIV positive women than men, particularly in Zambia. From a sexual and reproductive health and rights perspective, efforts to assist HIV-positive women in preventing unintended pregnancy and to support them in their pregnancy decisions when they do become pregnant should be encouraged in order to combat the social stigma documented in this paper.