Institute of Child Health
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Item Evaluation of histopathology examination of routine tonsillectomy and adenoidectomy specimens in developing countries(2011) Adeyemo, A. A.; Okolo, C.; Ogunkeyede, S. S.Objective: Healthcare costs are usually borne directly by patients or relations in developing countries; therefore reducing waste in the system is very important. This study aims to determine the necessity of full histopathology examination in routine tonsillectomy and adenoidectomy in children. Methods: A retrospective chart review of patients 18 years and younger who underwent tonsillectomy and/or adenoidectomy between January 1986 and December 2006 at the University College Hospital, Ibadan, Nigeria was done. The age, sex, surgical procedure and pathology results were recorded. Histology reports were broadly classified into: non-neoplastic and neoplastic pathologies. Charts of neoplastic pathologies were pulled and the medical history reviewed. Results: A total of 244 patients met the inclusion criteria with a mean age of 5.3 ±4.7 years. There were 150 males (61.5%) and 94 females (38.5%). Tonsillectomy and adenoidectomy were performed together on 74 patients (30.3%) while tonsillectomy and adenoidectomy alone were performed on 60 (24.6%) and 110 (44.7%) patients, respectively. Review of the pathology reports revealed two cases of malignancies with an incidence of 0.82%. Conclusion: Medico-legal factors will suggest the review of all surgical specimens. Therefore it is important to identify innovative approaches to reduce costs of histopathology examination in routine tonsillectomies and adenoidectomiesItem Metastatic cervical lymphadenopathy masquerading as extrapulmonary tuberculosis(2012) Adeyemo, A. A.Introduction: Cervical lymphadenopathy can be due to various pathologies especially in the young. A high index of suspicion is required in the management of cervical lymphadenopathy to prevent misdiagnosis and wrong treatment. Case report: Here present the diagnostic challenge in the case of a young lady with nasopharyngeal carcinoma who initially presented solely with cervical lymphadenopathy. Previous fine needle aspiration cytology had suggested tuberculosis (TB) and she was commenced on anti-TB drugs. However failure of improvement and worsening symptoms led to another review in ENT clinic. A subsequent nasopharyngeal biopsy confirmed nasopharyngeal carcinoma. She subsequently improved after commencement of appropriate treatment. Conclusion: In regions with a high prevalence rate of tuberculosis, care must be taken to exclude malignancy in patients with cervical lymphadenopathy even when cytology suggests a granulomatous infectionItem Knowledge of caregivers on the risk factor knowledge factors of otitis media(2012-10) Adeyemo, A. A.Introduction: Otitis media (OM) is common in children. In developing countries, it is the most common cause of hearing impairment. Many factors predispose to OM, some of which are modifiable through lifestyle changes. This study aimed to determine the knowledge of caregivers on the risk factors (RFs) associated with OM and their willingness to modify their lifestyle to reduce the risk of OM. The impact of socioeconomic status (SES) on the knowledge and willingness in lifestyle alteration was also assessed. Materials and Methods: This is a prospective study using a modifi ed Ear Infection Survey questionnaire. The SES of caregivers/mothers was determined, and they were interviewed to determine their knowledge of RFs for OM and their willingness to undergo lifestyle modifi cations. Results: One hundred caregivers (96 females) were interviewed, majority of whom (81%) were in the higher SES. There were signifi cant differences between low and high SES in day care attendance, siblings and parents with history of OM. Apart from daycare attendance and household smokers, all other RFs were higher among the lower SES. Individuals from low SES background had poorer knowledge of the RFs for OM. A strong willingness to modify behavior to avert a surgical procedure for OM is seen in both groups. Conclusion: Caregivers in both SES groups were willing to undergo behavioral modifi cations in reducing the risk of OM; utilizing this knowledge in educational programs will help to reduce the prevalence of OM in children. This must be coupled with training and encouragement of health workers to disseminate information on RFs of OMItem Pediatric head and neck malignancies in sub-Saharan Africa(2012) Adeyemo, A. A.; Okolo, C. A.Introduction: Cancers are relatively rare in children however recent reports suggest that malignancies are becoming a major source of pediatric deaths. Method: Using the database of the cancer registry of the University College Hospital, Ibadan we reviewed all newly diagnosed cases of head and neck cancers in children under 19years old at the hospital between 1981 and 2008. Results: A total of 1,021 cases of Head and Neck cancers were seen in children. The hospital based incidence of pediatric head and neck cancers is 36 cases per year. There were 627 males and 394 females [M:F ratio of 1.6:1] with mean ages of 8.21 and 7.70 years respectively. Boys were more affected than girls in all years of life while the peak age of onset for both sexes is the third year of life. The commonest anatomical site involved is the eye/orbit; other common sites were the nasopharynx, paranasal sinuses, nasal cavity and thyroid gland. Neural malignancies constitute the commonest malignancies seen (35.3%), other are lymphomas (33.1%), squamous cell carcinoma (9.1%) and soft tissue sarcoma (8.6%). Retinoblastoma is the commonest lesion seen among the patients with a slight male preponderance [M:F ratio of 1.2:1] Burkitt lymphoma (BL) is seen in all age groups but there is greater frequency in the older ages. The incidence of carcinomas is higher in the older age groups, relatively rare lesions like Hodgkins lymphoma and thyroid malignancies are almost exclusive to older children. Conclusion: The pattern of head and neck malignancies in children in sub-Saharan Africa is changing; dominant lesions like lymphomas are being gradually replaced by other malignancies such as neural malignancies, soft tissue sarcomas and squamous cell carcinomaItem Asynchronous video-otoscopy with a telehealth facilitator(Mary Ann Liebert , Inc, 2013-04) Biagio, L.; Swanepoel, D. W.; Adeyemo, A. A.; Hall, J. W.; Vinck, B.Objective: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. Subjects and Methods: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. Results: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from videootoscopic images acquired by the otolaryngologist and facilitator (j = 0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. Conclusions: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settingsItem Traumatic brain injuries in children: a hospital-based study in Nigeria(2013-06) Udoh, D. O.; Adeyemo, A. A.Background: Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality worldwide. Our previous studies showed a high frequency of motor vehicle accidents among neurosurgical patients. However, there is a dearth of data on head injuries in children in Nigeria. Aims: To determine the epidemiology of paediatric traumatic brain injuries. Setting and Design: This is a prospective analysis of paediatric head trauma at the University of Benin Teaching Hospital, a major referral centre for all traumatic brain injuries in Nigeria between October 2006 and September 2011. Materials and Methods: We studied the demographic, clinical and radiological data and treatment outcomes. Data was analysed using statistical package for the social sciences (SPSS) 16.0. Results: We managed 127 cases of paediatric head injuries, 65 boys and 62 girls representing 13% of all head injuries managed over the 5-year period. They were aged 3 months to 17 years. The mean age was 7.4 years (median 7 years) with peak incidence occurring at 6-8 years i.e. 31 (24.4%) cases. Motor vehicle accidents resulted in 67.7%, falls 14% and violence 7%. The most frequent computed tomography finding was intracerebral haemorrhage. Mean duration of hospitalization was 18 days (median 11 days). Eleven patients died, mortality correlating well with severity and the presence of intracerebral haematoma. Conclusion: Head injuries in children are due to motor vehicle and motor vehicle-related accidents. Hence, rational priorities for prevention of head injuries in children should include prevention of vehicular, especially pedestrian, accidents in developing countriesItem 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 Helminthiasis and chronic suppurative otitis media in Ijoun community in Ogun State, Nigeria(2018-02) Abdullahi, Z.. A.; Morenikeji, O. A.; Adeyemo, A. A.; Ogunleye, V. O.This study, carried out in a rural community in Ogun state Nigeria, aims to determine the prevalence of soil-transmitted helminths, bacteria causing Chronic Suppurative Otitis Media (CSOM), and their coinfection among school-aged participants. Formol-ether sedimentation technique was used to check for helminth eggs in stool samples. Ear swabs collected were cultured on chocolate, blood and MacConkey agar plates. CD4+T lymphocyte count was derived using a flow cytometre. Study participants were between 5 and 19 years old. Three hundred participants were sampled, 108 (36%) were infected with helminth parasites: Ascaris lumbricoides (28.7%), hookworm (6.7%) and Strongyloides stercoralis (0.7%). The prevalence of helminth infection between the sexes was not statistically significant (χ2 = 0.497; P= 0.390), but statistically significant between the age groups (χ2 = 10.10; P=0.016). Mixed helminthic infections were found in only 3.3% of the study population. Seventeen participants (5.7%) were found to have CSOM. Bacteria isolated in the ear swabs were Pseudomonas aeruginosa, Staphylococcus aureus, Klebiella pneumoniae, Proteus mirabilis and Haemophilus influenzae. Only two percent (2%) of study population were co-infected with helminth and bacteria. Heavy intensity of helminths and heavy growth of bacteria was found in the coinfected when compared with single infected children. This study showed the presence of otitis media in the study area, and that helminthiasis might have an effect on its presentation. Efforts to control CSOM in the study site may need to consider the inclusion of mass dewormingItem Mothers’ perspectives of newborn hearing screening programme(2018) Jatto1, M. E.; Ogunkeyede, S. A.; Adeyemo, A. A.; Adeagbo, K.; Saiki, O.Background: Newborn hearing screening programs identifies newborns with hearing loss. The early identification enables prompt intervention through hearing rehabilitation. Accurate knowledge of the program and its benefit will impact on the uptake of the program by the citizenry. We hypothesized that there is a gap in the knowledge of parents on hearing screening and rehabilitation measures in Nigeria. Aim: To determine the knowledge and perceptions of mothers of newborn children on hearing screening. Methods: A cross sectional observational study among mothers of newborn children at immunization clinics. Semi structured questionnaire on gestational duration, mode of delivery, birth asphyxia, knowledge on hearing loss and newborn hearing screening were administered. Results: Participants were 48 mothers with age range from 18 to 42 years. Awareness of newborn hearing screening was poor among the mothers; sources of information on newborn hearing screening were antenatal clinic, mass media and friends. The educational level of the participants had no association with awareness (p = 0.11), but the willingness to accept newborn hearing screening, was associated with socioeconomic status (p = 0.04) and the level of education (p = 0.02). The participants were not aware of factors responsible for hearing loss in childhood. Conclusion: There is inadequate knowledge about newborn hearing screening and risk factors for infant hearing loss among the mothers, though they demonstrate willingness to accept the newborn hearing screeningItem The Yoruba version of LittlEARS auditory questionnaire: evaluation of auditory development in children with normal hearing(Elsevier, 2018) Kayode, O.; Adeyemo, A. A.The goal of this study was to translate the LittlEARS Auditory Questionnaire into Yoruba language for use with Yoruba-speaking parents and to evaluate the psychometric properties of the Yoruba version of questionnaire. Translation of the LittlEARS Auditory Questionnaire into Yoruba language was done using a back-translation method. The study participants included 423 parents of normal hearing children aged 6e24 months. Psychometric analyses (scale analysis and item analysis) of the translated questionnaire was done. The scale characteristics in the dataset are: Internal consistency: Cronbach's alpha ¼ 0.907; reliability; Split-half ¼ 0.701; predictive accuracy; Guttman's lambda ¼ 0.583; correlation between total score and children's age¼ 0.783. The regression analysis showed that 75.3% of the variance in the total scores can be explained by age. The Yoruba version of the LittlEARS Auditory Questionnaire is a dependable and valid tool as evidenced by the results of psychometric analyses. The tool is useful for assessing auditory development in children between 6 and 24 months of age
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