FACULTY OF CLINICAL SCIENCES
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Item Paediatric peritoneal dialysis in a developing country: practice, challenges and opportunities(African Paediatric Nephrology Association, 2019) Asinobi, A. O.; Ademola, A. D.; Akuse, R. M.Background: The practice and challenges of peritoneal dialysis (PD) in a developing country may be uniquely different from what obtains in developed countries. Method: A review of the practice and challenges of PD in Nigeria as a case study and documentation of opportunities for improvement Review: There has been renewed interest in the provision of PD to children in acute kidney injury in Nigeria and this has led to adaptations such as use of nasogastric tubes as PD catheters and use of constituted PD fluid. The use of adaptations is lifesaving but complication rates may be higher than with the use of standard gadgets. Other challenges include limited availability and high cost of PD catheters and PD fluid. There are also challenges with the availability of expertise for the insertion of PD catheters and the PD procedure. Opportunities to advance paediatric PD include sustained efforts to provide PD with the use of adaptations, collection of data on outcomes of PD, advocacy for more support from government, non- governmental organisations and industry in the forms of insurance coverage, access to consumables and/or training in paediatric PD. Conclusion: Sustained provision of PD with adaptations, documentation of outcomes, and advocacy may lead to improvement in paediatric PD services.Item Prevalence and determinants of depression among patients with hypertension: A cross‑sectional comparison study in Ghana and Nigeria(Wolters Kluwer ‑ Medknow, 2020) Ademola, A. D.; Boima, V.; Odusola, A. O.; Agyekum, F.; Nwafor, C. E.; Salako, B. L.Background: Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension‑related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub‑Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. Subjects and Methods: Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ‑9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ‑9 score >4. Results: The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95–0.99)], concern about medications [OR 1.15 (1.03–1.30)], and poor BP control [OR 2.06 (1.09–3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. Conclusion: Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.Item Kidney disease in hepatitis B surface antigen-positive children: experience from a centre in south-west Nigeria and a review of the Nigerian literature(Taylor and Francis, 2017) Asinobi, A. O.; Ademola, A. D.; Okolo, C. A.; Adepoju, A. A.; Samuel, S. M.; Hoy, W. E.Background: Kidney disease is an important extra-hepatic manifestation of hepatitis B virus (HBV) infection. However, there is paucity of recent literature on kidney disease in children and adolescents with HBV infection from several parts of sub-Saharan Africa including Nigeria. Objective: To review the pattern of kidney disease in hepatitis B surface antigen (HBsAg)-positive children and adolescents seen at a tertiary hospital in south-west Nigeria. Methods: A retrospective study was undertaken of HBsAg-seropositive children with kidney disease managed at University College Hospital, Ibadan, from January 2004 to December 2015. Patients were identified from the paediatric nephrology unit admissions and the renal histology registers. Results: 24 children and adolescents were studied, 17 of whom were male (70.8%), and the median age was 10.0 years (range 3–15). Ten (41.7%) had nephrotic syndrome, five (20.8%) had non-nephrotic glomerulonephritis, five (20.8%) were in end-stage renal disease (ESRD), including a patient with posterior urethral valves, and four had acute kidney injury secondary to acute tubular necrosis. Renal histology was available for 10 patients: nine had nephrotic syndrome associated with minimal change disease in six, focal segmental glomerulosclerosis in two and one had membanoproliferative glomerulonephritis. The patient with non-nephrotic glomerulonephritis had diffuse global sclerosis. Conclusion: The pattern of kidney disease in HBV-positive children demonstrated a predominance of nephrotic syndrome, followed by non-nephrotic glomerulonephritis, ESRD and acute kidney injury. Better diagnostic facilities and treatment are required. Prevention of HBV infection by universal childhood immunisation is the ultimate goal.Item Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria(Oxford University Press, 2016) Asinobi, A. O.; Ademola, A. D.; Alao, M. A.Background: Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods: A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results: Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions: The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.Item Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria(Asian Pacific Society of Nephrology, 2014) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.; Mott S. A.Background: Children and adolescents with end-stage renal disease (ESRD) in sub-Saharan Africa may have the worst outcomes globally. Barriers to management include late presentation, poor socioeconomic conditions, absence of medical insurance, limited diagnostic facilities and non-availability of chronic renal replacement therapy (RRT). Our study was to determine the incidence, aetiology, management and outcomes of paediatric ESRD in a tertiary hospital in Nigeria. Methods: A retrospective case review of paediatric ESRD at the University College Hospital Ibadan, Nigeria, over 8 years, from January 2005 to December 2012. Results: 53 patients (56.6% male), median age 11 (inter quartile range 8.5-12) years were studied. Mean annual incidence of ESRD in Ibadan for children aged 14 years and below was 4 per million age related population (PMARP) while for those aged 5-14 years it was 6.0 PMARP. Glomerulonephritis was the cause in 41 (77.4%) patients amongst whom, 29 had chronic glomerulonephritis and 12 had nephrotic syndrome. Congenital anomalies of the kidneys and urinary tract (CAKUT) accounted for 11 (21.2%) cases, posterior urethral valves being the most common. Acute haemodialysis, acute peritoneal dialysis or a combination of these were performed in 33 (62.3%), 6 (11.3%) and 4 (7.5%) patients respectively. Median survival was 47 days and in-hospital mortality was 59%. Conclusions: Incidence of paediatric ESRD in Ibadan is higher than previous reports from sub-Saharan Africa. Glomerulonephritis, and then CAKUT are the most common causes. Mortality is high, primarily due to lack of resources. Preventive nephrology and chronic RRT programmes are urgently needed.Item Kidney disease in hospitalised HIV positive children in Ibadan, South West Nigeria(College of Medicine, University of Ibadan, 2012) Ademola, A. D.; Asinobi, O. O.; Oladokun, R. E.; Ogunkunle, O. O; Okolo, C. A; Ogbole. G. E.Background: There is a paucity of data on the clinicopathologic pattern of kidney disease in Human Immunodeficiency Virus (HIV) seropositive children from sub-Saharan Africa and non from South West Nigeria. Objective: To determine the clinical pattern and outcome of kidney disease among HIV positive children hospitalised at a tertiary hospital South West Nigeria Methodology: A retrospective study of all HIV positive children who were hospitalised and managed for kidney diseases over a period of 78 months at the University College Hospital Ibadan, South West Nigeria was reviewed. Patients were followed up over the duration of hospital admission. Results: Ten children (six males and four females) aged 4 -15(10.4±3.2) years were identified. Four presented in acute kidney injury, (AKI) three with nephrotic syndrome (NS) and two in chronic kidney failure (CKF). One patient had left renal artery stenosis. Renal biopsy performed in three children showed focal segmental glomerulosclerosis in two patients and membranous nephropathy in the third. Management included antiretroviral therapy, Angiotensin Converting Enzyme Inhibitors and acute haemodialysis. Mortality was 40%. Conclusion: AKI, NS and CKF were the predominant clinical patterns of kidney disease in hospitalised HIV positive children and the mortality is highItem Peritoneal dialysis in childhood acute kidney injury: experience in Southwest Nigeria(International Society for Peritoneal Dialysis, 2012) Ademola, A. D.; Asinobi, A. O.; Ogunkunle, O. O.; Yusuf, B. N.; Ojo, O. E.Background: The choices for renal replacement therapy (RRT) in childhood acute kidney injury (AKI) are lim¬ited in low-resource settings. Peritoneal dialysis (PD) appears to be the most practical modality for RRT in young children with AKI in such settings. Data from sub-Saharan Africa on the use of PD in childhood AKI are few. Methods: We performed a retrospective study of chil¬dren who underwent PD for AKI at a tertiary-care hospital in southwest Nigeria from February 2004 to March 2011 (85 months). Results: The study included 27 children (55.6% female). Mean age was 3.1 ± 2.6years, with the youngest being 7 days, and the oldest, 9 years. The causes of AKI were in¬travascular hemolysis (n = 11), septicemia (n = 8), acute glomerulonephritis (n = 3), gastroenteritis (n = 3), and hemolytic uremic syndrome (n = 2). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. Duration of PD ranged from 6 hours to 12 days (mean: 5.0 ± 3.3 days). The main complications were peri¬tonitis (n = 10), pericatheter leakage (n = 9), and catheter outflow obstruction (n = 5). Of the 27 patients, 19 (70%) survived till discharge. Conclusions: In low-resource settings, PD can be suc¬cessfully performed for the management of childhood AKI. In our hospital, the use of adapted catheters may have contributed to the high complication rates. Peritoneal di¬alysis should be promoted for the management of childhood AKI in low-resource settings, and access to percutaneous or Tenckhoff catheters, dialysis fluid, and automated PD should be increased.Item Factors associated with sexual dysfunction among female patients in a Nigerian ambulatory primary care setting(Association of Resident Doctors (ARD), University College Hospital (UCH), Ibadan, 2020) Adebusoye, L. A.; Ogunbode, O.; Owonokoko, K. M.; |Ogunbode, A. M.; Aimakhu, C.Background: Sexual dysfunction is a common but under-reported problem of public health importance among female adults in Nigeria. Empirical evidence on sexual dysfunction among female Nigerians is scarce. Objectives: To determine the prevalence and risk factors associated with sexual dysfunction among female patients presenting at the General Outpatient Clinic (GOPC), University College Hospital (UCH), Ibadan, Nigeria. Methods: This was a cross-sectional study of 480 married female patients who presented consecutively at the GOPC, UCH, Ibadan, Nigeria. The 28-item Sexual Function Questionnaire (SFQ-28) was used to determine sexual dysfunction. Information on their sociodemographic characteristics, obstetric and gynecological history were obtained. Bivariate and multivariate analyses were carried out and alpha was set at 0.05. Results: Point prevalence of sexual dysfunction was 80.0%. The most common sexual dysfunction was problems with sexual desire (99.4%), while the least common was problems with arousal cognition (5.8%). There was a significant association between the prevalence of sexual dysfunction and age, years of relationship, number of children alive, parity, level of education, age at coitarche and family dysfunction. Age (OR=0.893; 95% CI=0.821–0.972, p=0.008), parity (OR=3.093; 95% CI=1.174– 8.151, p=0.022), having family dysfunction (OR=2.096; 95% CI= 1.129–3.891, p=0.019) and having >10 years of formal education (OR=4.808; 95% CI= 2.604–8.928, p<0.0001) were found to be the predictors of sexual dysfunction. Conclusion: Sexual dysfunction among female married adults in our setting was high. We propose that modifiable factors such as socio-demographic and gynaecological variables should be evaluated during the consultation of female patients at first contactItem Sexual dysfunction among women in a Nigerian gynecological outpatients unit(Society of Gynaecology and Obstetrics of Nigeria (SOGON), 2019) Ogunbode, O. O.; Aimakhu, C. O.; Ogunbode, A. M.; Adebusoye, L. A.; Owonikiko, K. M.Background: Sexual dysfunction is an important public‑health problem, which is often less reported or explored through opportunistic evaluation during medical consultations. Objective: This study was designed to determine the prevalence and patterns of female sexual dysfunction (FSD) including the sexual quality of life among female patients attending a gynecological outpatients unit in Southwest Nigeria. Materials and Methods: This is a cross‑sectional descriptive study of 146 consenting women who attended the gynecological outpatients’ clinic of the University College Hospital, Ibadan, Nigeria, during the study period. Participants were selected using multistage sampling technique. The survey instruments were previously validated questionnaires such as Sexual Function Questionnaire (SFQ28), Sexual Quality of Life‑Female Questionnaire (SQOL‑F), and the Family Adaptation, Partnership, Growth, Affection and Resolve (APGAR) score. The results were analyzed using Statistical Package for Social Sciences version 17 and P value was set at 5%. Results: The mean age was 33.8 ± 5.7 years. Most (85.6%) respondents had at least one form of sexual dysfunction. The commonest dysfunction was arousal‑sensation (62.4%) while the least was pain (3.4%). The mean SFQ28 and SQOL‑F scores were 58.0 ± 12.57 and 28.0 ± 11.94, respectively. There were no statistically significant differences in the SFQ28 and SQOL‑F scores across sociodemographic factors. Women classified as belonging to dysfunctional family on Family APGAR score similarly had poorer scores for sexual dysfunction (100%, P = 0.016). Conclusion: FSD is common among women attending gynecological outpatients clinic. Managing clinicians should be aware of this condition and proffer appropriate care in addition to the main presenting complaint.Item Determinants and outcomes of preterm births in Nigerian tertiary facilities.(2024) Fajolu, I. B.; Dedeke, I. O. F.; Oluwasola, T. A.; Oyeneyin, L.; Imam, Z.; Ogundare, E.; Campbell, I.; Akinkunmi, B.; Ayegbusi, E. O.; Agelebe, E.; Adefemi, A. K.; Awonuga, D.; Jagun, O.; Salau, Q.; Kuti, B.; Tongo, O. O.; Adebayo, T.; Adebanjo-Aina, D.; Adenuga, E.; Adewumi, I.; Lavin, T.; Tukur, T.; Adesina, O.Objective: To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. Design: Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme. Setting: Data from births in 54 referral-level hospitals across Nigeria between 1 September 2019 and 31 August 2020. Population: A total of 69 698 births. Methods: Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. Outcome measures: Preterm birth and preterm perinatal mortality. Results: Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years – adjusted odds ratio [aOR] 1.52, 95% CI 1.36–1.71; >35 years – aOR 1.23, 95% CI 1.16–1.30), no formal education (aOR 1.68, 95% CI 1.54–1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61–2.34) and no antenatal care (aOR 2.62, 95% CI 2.42–2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20–1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02–1.83), no antenatal care (aOR 2.74, 95% CI 2.04–3.67), earlier gestation (28 to <32 weeks – aOR 2.94, 95% CI 2.15–4.10; 32 to <34 weeks – aOR 1.80, 95% CI 1.3–2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54–36.33) were associated with preterm perinatal mortality. Conclusions: Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio-economic status.