FACULTY OF CLINICAL SCIENCES
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Item Exploring differences between adolescents and adults with perinatal depression-data from the expanding care for perinatal women with depression trial in Nigeria(2019-10) Oladeji, B. D.; Bello, T.; Kola, L.; Araya, R.; Zelkowitz, P.; Gureje, O.Background: Depression is common among women in the perinatal period. Although pregnancy and motherhood among adolescents are global public health issues, little is known about how adolescents differ from adults in the occurrence and correlates of perinatal depression. Methods: Data were derived from a cluster randomized controlled trial of psychosocial interventions for perinatal depression in primary maternal care in Nigeria (the Expanding Care for Perinatal Women with Depression trial). Adolescents and adult participants recruited during pregnancy and followed up till 6-month postpartum were compared: proportions with depression [screening positive to depression on the Edinburgh Postnatal Depression Scale (score ≥ 12) and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria using the short form of the Composite International Diagnostic Interview]; adjustment and attitude to pregnancy and motherhood (using the Maternal Adjustment and Maternal Attitudes scale); and parenting skills (measured on Infant–Toddler version of the Home Inventory for Measurement of the Environment). Infant and fetal growth were assessed by measures of weight and head circumference at birth and upper mid-upper arm circumference (MUAC) at 6 months. Results: Of 8,580 adults screened, 6.9% had major depression compared with 17.7% of 772 screened adolescents (p < 0.001). Adolescents had significantly poorer adjustment and attitudes to pregnancy, lower mean fetal gestational age at birth, and a smaller mean baby’s birth weight. At 6-month postpartum, there were no significant differences in the rates of remission from depression between adolescent and adult women (Edinburgh Postnatal Depression Scale score <6). Adolescent mothers continued to have poorer maternal attitudes and parenting skills indicated by significantly lower scores on the Infant–Toddler version of the Home Inventory for Measurement of the Environment responsivity and involvement subscales. Infants of adolescent mothers had a higher rate of undernutrition (defined as MUAC < 12.5 cm) compared with those of adult mothers: 14.8 and 6.3%, respectively (p = 0.008), with the mean MUAC remaining significantly lower for infants of adolescent mothers after adjusting for their lower birth weight (p = 0.04). Conclusion: Perinatal depression is more common and is associated with poorer maternal attitudes and parenting skills in adolescents compared with those in adults. Evidence from this exploratory study suggests that in improving outcomes in infants of adolescent mothers with perinatal depression, depression treatment may need to be supplemented with specific approaches to improve parenting skills.Item Prevalence and correlates of major depressive disorder (MDD) among adolescent patients with epilepsy attending a Nigerian neuropsychiatric hospital(Elsevier, 2016) Fela-Thomas, A.; Akinhanmi, A.; Esan, O. B.Background: A high prevalence of mood disorders exists in patients with epilepsy. In most cases, this is not detected and, consequently, not treated. This study aimed to determine the prevalence and correlates of major depressive disorder (MDD) among adolescents with epilepsy attending a child and adolescent clinic in Nigeria. Methods: We recruited 156 participants consecutively for the study. Adherence was assessed using the 8 item Morisky Medication Adherence Questionnaire, while the K-SADS was used to assess the presence of major depressive disorder. Seizure control was evaluated by the frequency of seizures within a year. Results: Major depressive disorder (DSM-IV criteria) was diagnosed in 28.2% of the participants. The age of participants (p = 0.013), seizure control (p = 0.03), medication adherence (p = 0.045), frequency of seizures in the preceding 4 weeks (p b 0.001), and duration of illness (p b 0.001) were all significantly associated with the presence of MDD. Participants with seizures occurring more than once weekly in the preceding 4 weeks were 16 times more likely to have a MDD compared with those with no seizures in the preceding 4 weeks (p b 0.001, 95% C.I. [4.13, 65.43]), while participants with a duration of illness morethan10yearsweremorethanfourtimeslikelytohaveMDDcomparedwiththosewithanillnessdu ration of 5–10 years (p b 0.01, 95% C.I. [0.07, 0.70]). Conclusion: The prevalence of MDD among patients with epilepsy was high. Poor seizure control, poor medication adherence, and long duration of illness were associated with the presence of MDD among such patients. Intervention should focus on ensuring good seizure control and optimal adherence in order to mitigate the impact of MDD in patients with epilepsyItem Gender and rural-urban differences in the nutritional status of in-school adolescents in south-western Nigeria(Cambridge University Press, 2010) Omigbodun, O.O.; Adediran, K.I.; Akinyemi, J.O.; Omigbodun, A.O.; Adedokun, B.O.; Esan, O.B.This study assessed gender and rural/urban differences in height and weight, and the prevalence of stunting, underweight and overweight of school-going adolescents in south-west Nigeria, using 2007 WHO reference values for comparison. The influence of sexual maturity and the socio demographic correlates of growth performance were also examined. In this cross-sectional study, 924 male (51.4%) and 875 female (48.6%) students (1799 in total) aged 10–19 years from eighteen schools in Ibadan (five rural, nine urban public and four urban private) were interviewed and examined. Although males were significantly taller than females (p<0.05) stunting was more pronounced for males, who were 7.5 cm shorter than the 2007 WHO reference, compared with females who were 3.5 cm shorter. Body mass index (BMI) for girls was also greater than for boys (p<0.05) Rural adolescents had lower heights and BMIs compared with those in urban areas. The mean height of male adolescents in rural schools fell below 2 SDs of the 2007 WHO reference between 14 and 17 years, while heights of males and females in private schools were similar to the median 2007 WHO standard. Low height-for-age was observed in 282 adolescents (15.7%), which, after multivariate analysis, was significantly associated with school type, gender, number of mother’s children and puberty onset. Adolescents in rural schools were much more likely to be stunted than those in urban private schools (AOR 13.1; 95% CI 5.2–33.2) and males were three times more likely to be stunted compared with females (AOR 3.3; 95% CI 2.4–1.4). Low BMI-for-age was observed in 240 adolescents (18.9%), with correlates similar to stunting. Adolescents at the pre-puberty stage were twice as likely to have low BMI-for-age (OR 2.0; 95% CI 1.6–2.5) than those with signs of puberty. There were 2.3% overweight adolescents, who were significantly more likely to be female, in private school and post-pubertal. Innovative interventions for Nigerian adolescents, especially rural inhabitants and males, are needed to reduce the prevalence of stunting and underweightItem Prevalence and correlates of suicidal behaviour among adolescents in southwest Nigeria(Nigerian Medical Association, 2008) Omigbodun, O.; Dogra, N.; Esan, O.B.; Adedokun, B.Background: Despite being recognized by the World Health Organization as a significant social and health concern, information on suicidal behaviours in Nigerian adolescents is unknown. Aims: To establish the prevalence and associated psychosocial correlates of suicidal ideation and attempts in Nigerian youth. Methods: Stratified sampling was used to identify youth aged 10–17 years who completed the Nigeria version of the Global School Health Questionnaire (GSHQ) and the Diagnostic Predictive Scale (DPS) for youths (suicidal behaviour questions) in a classroom setting. Results: A total of 1429 youth completed the instruments. Over 20% reported suicidal ideation and approximately 12% reported that they had attempted suicide in the last year. Adolescents living in urban areas, from polygamous or disrupted families, had higher rates of suicidal behaviour. Multiple psychosocial factors such as sexual abuse, physical attack and involvement in physical fights were significant predictors of suicidal behaviour. Conclusion: Factors associated with suicidal ideation and behaviours are similar to those found in other studies but the rates of both suicidal ideation and attempts are towards the upper limit of rates for youth. This study suggests that there is an urgent need for Nigerian policymakers and health providers to review and address this issue.Item Comparison of Haematologic parameters among adolescents with and without asymptomatic malaria in Ibadan, Nigeria(Olad Resolution Print, 2022) Balogun F. M.; Ademola S. A.; Olutogun T.Background and Objectives: Asymptomatic malaria results from partial immunity resulting from recurrent exposure to the malaria parasite and it has been shown not to be benign as it was earlier believed. Adolescents are likely to have partial immunity to malaria which can predispose them to the asymptomatic form of malaria, but malaria is understudied in this age group. This study was conducted to compare the haematologic parameters among secondary school adolescents with and without asymptomatic malaria in Ibadan. Methods: A cross-sectional study was conducted and data regarding sociodemographic characteristics, presence or otherwise of malaria parasite (using microscopy) and haematological parameters (obtained using haematology auto- analyser and microscopy) were documented. Malaria parasite density was categorised as 1-100 and >100/μL. Other haematological parameters were classified as categorical variables. Associations were determined using Chi square test and level of significance was p<0.05. Results: A total of 103 students were recruited with a mean age of 15.6±2.02 years and 61(59.2%) were boys. Those from the low socioeconomic class were 86 (83.5%), 24 (23.3%) had asymptomatic malaria while 22 (21.4%) had parasite density of >100/μL. Haematological abnormalities detected were anaemia (11.7%), leucopenia (4.9%), thrombocytopenia (11.7%), reduced MCV and reduced MCH (88.3%). All participants had low MCHC. Abnormal peripheral blood film was found in 79.5% but this was not associated with the presence of malaria parasite. Older adolescence (age ≥ 15 years) was significantly associated with parasite density of>100/μL (p = 0.02) and a higher proportion of those from the low socioeconomic class had asymptomatic malaria (24.4% vs 17.6%). Conclusion: Although some haematologic parameters of the study participants were affected by asymptomatic malaria, there were other unexplained blood abnormalities. There is a need to address asymptomatic malaria among these adolescents and other causes of abnormal blood profile should be tackled.Item Facilitators and barriers of healthcare workers’ recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of theoretical domains framework(BioMed Central., 2022) Balogun F. M.; Omotade O. O.Background: The human Papillomavirus (HPV) vaccine has demonstrated efficacy in the prevention of cervical cancer when given in early adolescence. The recommendation of the vaccine by health care workers (HCW) is crucial to the uptake of the vaccine by adolescents and the process of this recommendation is important as it determines subsequent uptake of the vaccine. Understanding of the facilitators and barriers of recommendation of this vaccine can help in the development of strategies to improve its recommendation rates and uptake. This study therefore explored the facilitators and barriers for the recommendation of HPV vaccine for adolescents by HCW in Ibadan, Nigeria using the Theoretical Domain Framework (TDF). Methods: Key informant interviews were conducted with 14 purposively selected HCW who were in charge of vaccination. Content analysis was used after deductive coding of the data using the domains of the TDF. Relevant concepts for facilitators and barriers of HPV vaccine recommendation and quotes were then identified. Results: Mean age of the HCW was 47.7 ± 6.5 years and they consisted of eight nurses, four medical doctors, one medical social worker and one health visitor. Ten domains of the TDF were represented among the facilitators and barriers against the recommendation of HPV vaccination by the HCW, except the goals; memory, attention, decision process; emotion; and behavioral regulation domains. The domains with the highest frequency of concepts were: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, intention and environmental context and resources. Domains with conflicting statements in the concept were: environmental context and resources, and beliefs about consequences. While those with perceived strength of concept were: social influences, reinforcement and optimism. Conclusion: All the 10 identified domains of the TDF are potential areas of focus for strategies for improving the recommendation of HPV vaccine for adolescents by health care workers in Nigeria and other countries with similar sociocultural settings.Item She must have been sleeping around” Contextual interpretations of cervical cancer and views regarding HPV vaccination for adolescents in selected communities in Ibadan, Nigeria(PLoS ONE, 2018) Balogun F. M.; Omotade O. O.Background Human Papilloma virus (HPV) vaccines for adolescents are pivotal in the control of cervical cancer, the commonest women specific malignancy in sub-Saharan Africa. Knowledge about cervical cancer have been reported to be low in Africa but expressed acceptability for HPV vaccines have been high. The reason for this mismatch is not clear. An understanding of the interpretation of cervical cancer and views about HPV vaccine are important as they can affect actual decision making regarding adolescents' uptake of HPV vaccine. This study explored contextual interpretations of stakeholders regarding cervical cancer and HPV vaccines for adolescents in five selected communities in Ibadan, Nigeria. Methods Qualitative data were collected through twenty focus group discussions among parents of adolescents, religious and traditional leaders, school teachers and adolescents; and four key informant interviews with the identified traditional healers in the selected communities. Constant comparison analysis was done after transcription. Results Almost every group had at least one person who had seen a cervical cancer patient. Cervical cancer was widely viewed as being caused by promiscuity of women while older participants believed that the alteration of lifestyle by civilization was a major contributory factor. There was also a general notion that it was due to a curse. The role of HPV was generally not known. Most participants were favorable towards HPV immunization for adolescents, but traditional healers and some religious leaders were not. The high cost of the vaccines and possibility of side effects where the main concerns about the introduction of HPV vaccine. Decision to take the vaccine rest with the fathers whose views were heavily influenced by traditional and religious leaders. Conclusions Awareness about cervical cancer may not be as low as earlier reported and there were many misconceptions about cervical cancer in the study communities. It is important to address these misconceptions to ensure successful introduction of HPV vaccine for adolescents in future.Item Menstrual health of in-school adolescents in Ibadan: knowledge, attitudes and consequences(2009) Owonikoko, K. M.; Okunlola, M. A.; Ogunbode, O. O.|; Enabor, O. O.; Oluwasola, T. A. O.; Arowojolu, A. O."We evaluated the knowledge, attitudes to and consequences of menstrual morbidities among in –school Adolescents in Ibadan and determined their effect on school attendance. The pattern of drug use for menstrual symptoms was also assessed. Self-administered questionnaires were given to 1194 respondents in secondary schools chosen by randomization. The mean age of respondents was 15.7+ years while 86.1% were aged between 10-17 years. The most prevalent menstrual disorder was dysmenorrhea (87.3%). The commonest source of information about the menstrual cycle was from mothers (71%) while 0.5% of adolescents obtained information from health care givers. Menstrual symptoms were treated with non-pharmacological means in 53.1%. Of girls using pharmacologic agents 44% of them obtaining over the counter medications (OTC). Forty four percent of respondents missed school for 6-7 weeks per session following dysmenorrhea while 19% of them required hospital admission. It was concluded that there is insufficient knowledge of the menstrual cycle and its abnormalities among adolescents. Menstrual health should be introduced as part of reproductive health programs in school curricula in Nigeria. "Item Menstrual health of in-school adolescents in Ibadan: knowledge, attitudes and consequences(Lagos Society for Advancement of Medical Education (SAME) Ventures, 2009) Owonikoko, K. M.; Okunlola, M. A.; Ogunbode, O. O.; Enabor, O. O.; Oluwasola, T. A. O.; Arowojolu, A. O.We evaluated the knowledge, attitudes to and consequences of menstrual morbidities among in –school adolescents in Ibadan and determined their effect on school attendance. The pattern of drug use for menstrual symptoms was also assessed. Self-administered questionnaires were given to 1194 respondents in secondary schools chosen by randomization. The mean age of respondents was 15.7+ years while 86.1% were aged between 10-17 years. The most prevalent menstrual disorder was dysmenorrhea (87.3%). The commonest source of information about the menstrual cycle was from mothers (71%) while 0.5% of adolescents obtained information from health care givers. Menstrual symptoms were treated with non-pharmacological means in 53.1%. Of girls using pharmacologic agents 44% of them obtaining over the counter medications (OTC). Forty four percent of respondents missed school for 6-7 weeks per session following dysmenorrhea while 19% of them required hospital admission. It was concluded that there is insufficient knowledge of the menstrual cycle and its abnormalities among adolescents. Menstrual health should be introduced as part of reproductive health programs in school curricula in Nigeria.Item Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria(2008) Morhason-Bello, I. O.; Oladokun, A.; Enakpene, C. A.; Fabamwo, A .O.; Obisesan, K.A.; Ojengbede, O. A.This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15±2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p=0.00043). Majorities’ first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks