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 Ocular injuries in a paediatric population at a child eye health tertiary facility, Ibadan, Nigeria(Elsevier, 2023) Ugalahi, M. O.; Adebusoye, S. O.; Olusanya, B. A.; Baiyeroju, A.Purpose: To determine the pattern, causes and risk factors for ocular injuries amongst children presenting to a tertiary facility in Ibadan, southwest Nigeria Methods: A retrospective review of clinical records of patients aged 16 years and below who presented with ocular injuries to the eye emergency unit between May 2010 and April 2016. Information extracted includes patient’s demography, location and circumstances of injury, clinical findings, and management. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0. Descriptive and inferential statis- tics were calculated. Odds ratio were derived from regression models adjusted for confounders. Significance was set at a P-value of 0.05. Results: A total of 109 children were studied. Majority were boys (male to female ratio = 2.9:1). The median age at presentation was 9 years. Injury occurred at home in 67 (61.5%) children, and at school in 30 (27.5%). More than half of the children were injured during play, 18 (16.5%) during corporal punishment, and 34 (31.2%) by accidents during domestic/schoolwork. Majority (73.4%) were closed globe injuries. The odds of injury with sharp objects and ocular trauma score of 4 or less was were 3.2 times (95% Confidence interval {CI}: 1.3–7.7) and 3.9 times (95% CI:1.4–11.4) higher in children aged 0–5 years respectively. The odds of open globe injury was 9.8 times (95% CI: 3.4–28.6) higher in injury from sharp objects. Wood/stick, cane, stone, broomstick and fist/palm/finger were the agents responsible for two- thirds of injuries. Conclusion: This study revealed that children predominantly sustain ocular injuries at home and younger children have greater odds of severe injuries with profound implications for visual disability. Health education, adult supervision and the application of appropriate measures necessary for reducing the incidence and severity of childhood ocular trauma are advocated.Item Management of primary childhood glaucoma: evaluation of practice, practice gaps, and needs in a low‑resource country(Wolters Kluwer - Medknow, 2024) Ugalahi, M.||||||||A. | ||; Sarimiye, T. F.; Obajolowo, T.; Nkanga, E. D.; Abdulrahman, A.; Olusanya, B.; Baiyeroju, A.Purpose: To evaluate the current practice, equipment availability, and training needs for managing childhood glaucoma in Nigeria. Materials and Methods: An online questionnaire (Google Forms) was distributed through E-mails and social media platforms of pediatric ophthalmologists and glaucoma specialists who practice in Nigeria and manage glaucoma in children aged 0–16years. Information concerning sociodemographic characteristics, type of practice, location of practice, years of practice, status, and preferred practices in the management of childhood glaucoma cataracts were obtained and analyzed with SPSS. Results: Thirty (23.3%) out of 129 eligible participants indicated they perform glaucoma surgeries in children. The majority (66.6%) had practiced as specialists for 10years or less, and 70% were pediatric ophthalmologists. A third of the respondents practiced in the country’s southwest region, with none in the Northeast region. The most common surgery performed for primary congenital glaucoma was combined trabeculotomy trabeculectomy, while trabeculectomy was the most common surgery performed for juvenile open-angle glaucoma. Two respondents reported performing glaucoma drainage device surgery and seven reported possessions of skills for goniotomy. All centers had trabeculectomy instrument sets, while three centers had facilities for endolaser cyclophotocoagulation, and only two centers had knives for goniotomy. Antimetabolites were routinely used for childhood glaucoma surgeries by 26(86.7%) respondents, and the most common antimetabolite used was mitomycin (21; 80.8%). Conclusion: There is a need for the development of in-country training programs and the exchange of skills through collaboration among those providing glaucoma services within Nigeria to improve the care of children with glaucoma.Item Management of childhood cataract: practice patterns among ophthalmologists in Nigeria(Springer, 2023-09) Ugalahi, M.; Adedira, O.; Olusanya, B.; Baiyeroju, A.OBJECTIVE: To describe the practice patterns for the management of paediatric cataracts among ophthalmologists practising in Nigeria. METHODS: A cross-sectional study of fully trained Nigerian ophthalmologists who perform cataract surgery in children aged 16 years and below. An online questionnaire was distributed via e-mail and social media platforms to respondents. Data on socio-demographic characteristics, type, location and years of practice, status and preferred approach to management of childhood cataracts were obtained and analysed. RESULTS: =A total of 41 ophthalmologists responded that they perform paediatric cataract surgery. Of these, 25 (61.0%) were paediatric ophthalmologists while 7(17.0%) were general ophthalmologists. Most respondents (92.7%) practise in urban settings and 30(73.2%) work in tertiary hospitals. Most respondents (90.2%) routinely insert intracular lenses (IOLs) in children aged 2 years and above while 32(78.0%) routinely under-correct the IOL power. Thirty-four (82.9%) have an anterior vitrectomy machine, 31 (75.6%) routinely perform posterior capsulotomy and anterior vitrectomy, and 17 (58.5%) routinely perform same-day sequential bilateral cataract surgery. Twenty-six respondents (63.4%) respondents routinely give near correction in aphakic children, while 24 (58.5%) respondents routinely give bifocals in pseudophakic children. Compared to other sub-specialists, paediatric opthalmologists were 24 times more likely to routinely under-correct IOL power (p=0.001) and 4 times more likely to routinely correct near vision in aphakic children (0.036) as well as prescribe bifocals for pseudophakic children respectively (0.029). CONCLUSION: The practice of paediatric cataract surgery in Nigeria is mainly in line with expected standards, but there is a need for the development of detailed practice guidelines.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 Intraocular pressure elevation following the use of topical dexamethasone ointment after Squint surgery(West African College of Surgeons, 2022-01) Ugalahi, M. O.; Ibukun, F. A.; Olusanya, B. A.; Baiyeroju, A. M.Purpose: To describe the pattern of intraocular pressure (IOP) changes after squint surgery in eyes of black Africans at the University College Hospital, Ibadan, Nigeria. Materials and Methods: This was a retrospective review of the clinical records of patients who underwent squint surgery between 2010 and 2019. Data on demographic characteristics, preoperative and postoperative intraocular pressure values, coexisting ocular pathology, type of strabismus, surgery performed, frequency and duration of postoperative topical steroid use and treatment received for elevated intraocular pressure were collected and descriptively summarised. Results: Thirty-six (39.1%) out of 92 patients who had squint surgery during the study period met study inclusion criteria. Mean age was 20.5 ± 13.6 years. All patients were administered Maxitrol® ointment postoperatively. Baseline, peak and net change in IOP were 12.9 ± 2.6 mmHg, 21.3 ± 6.8 mmHg and 8.39 ± 7.2 mmHg respectively. Thirty-one (86.1%) patients had elevation in IOP from baseline; 21 (67.7%) of these had significant IOP elevation. Topical steroid therapy was tailed off rapidly for all patients with significant IOP elevation. Twelve patients were commenced on topical IOP lowering medications, with normalization of intraocular pressure in majority of them by three months after surgery. Conclusion: Elevated intraocular pressure with the use of topical dexamethasone ointment after squint surgery was common in this study and majority of the patients had significant elevation in intraocular pressure. Close monitoring of the intraocular pressure of black patients, especially children, on topical steroid medication after squint surgery is strongly recommended.Item Indications for surgery amongst new patients presenting to the paediatric ophthalmology unit of the University College Hospital, Ibadan(Wolters Kluwer - Medknow, 2021-03) Ugalahi, M. O.; Monye, H. I.; Olusanya, B. A.; Baiyeroju, A. M.Objective: The objective of the study was to determine the proportion of children requiring ocular surgery amongst new patients presenting to the Paediatric Ophthalmology Unit of the University College Hospital, Ibadan, over a 2‑year period, to enhance planning and improve the efficiency of service delivery. Methods: The study was a retrospective review of records of all new patients aged 0–16 years who presented to the Paediatric Ophthalmology Unit of the University College Hospital, Ibadan, over a 2‑year period (May 2015–April 2017). Information on age and gender, clinical diagnosis and indications for surgery and type of surgery scheduled were retrieved from the diagnosis register of the unit, and a descriptive analysis was performed. Results: Of the 1240 children who presented to the clinic within the study period, 142 (11.5%) needed surgical interventions. Their ages ranged from 1 month to 16 years, with a mean age of 6.4 ± 4.7 years. Seventy‑nine (55.6%) of these were males. The most common indications for surgery were cataract and catara t‑related indications (n = 122, 85.9%), followed by glaucoma and strabismus. Other less common indications for surgery were nasolacrimal duct obstruction and epibulbar dermoid. Conclusion: Paediatric cataract, the leading cause of childhood blindness in this environment, presents the greatest surgical burden in our unit. It should, therefore, be a major focus of personnel training and equipment procurement for paediatric ophthalmology services in our environment.Item Frequency and determinants of postoperative fibrinous uveitis after paediatric cataract surgery at a tertiary hospital in southwest Nigeria(2019) Olusanya, B. A.; Baiyeroju, A. M.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.