Institute of Child Health
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Item Perceived societal view about condom use and risky sexual behaviour of never-married in-school adolescents in Ibadan, Nigeria(Multifacism Institute of Child Health, 2019) Nwaiwu C.; Balogun F. M.There are social factors, within the adolescent environment, that hinder condom use, in HIV prevention. It is therefore important to understand the perception of never-married adolescents towards societal support for condom use, the effectiveness of condoms and access to them. This study assessed the relationship between perceived societal views on condom use and the risky sexual behaviours of adolescents in secondary schools in Nigeria. An interviewer-assisted questionnaire was used to collect information from 420 never-married adolescents, in selected secondary schools, in Ibadan North-East local government area. Perceived societal view about condom use was assessed under support, effectiveness, access. Chi-square and logistic regression were used for data analysis at p<0.05. Mean age of the respondents was 14±1.54 years while 43.3% were males and 19.3% were sexually experienced. Seventy-two (17.8%) perceived societal high support for condom use, 150 (37.3%) believed condom was highly effective and 67(16.5%) had good access to condom. Males were more likely to perceive high support for condom use (AOR=3.17; 95% CI: 1.843-5.433) and high condom effectiveness (AOR=1.57; 95% CI: 1.036-2.374). Perceived support for condom use was significantly associated with multiple sexual partners, sexual activity under the influence of drugs and alcohol (AOR=4.19; 95% CI: 1.752-10.044, AOR=3.67, 95% CI: 1.524-8.851 and AOR=3.91, 95% CI: 1.598-9.575). Sexually experienced adolescents perceive more social support for condom use but had low perception about their access to condom and its effectiveness. Behavioural change efforts promoting condom use as a means of preventing consequences of unprotected sex including HIV should encourage societal acceptance for condom use among adolescents and support access to it as well.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 Housing type and risk of malaria among under-five children in Nigeria: evidence from the malaria indicator survey(Springer Nature, 2018) Morakinyo O. M.; Balogun F. M.; Fagbamigbe A. F.Background: Malaria remains one of the major causes of morbidity and mortality among under-five (U5) children in Nigeria. Though different environmental factors have been assessed to influence the distribution and transmission of malaria vectors, there is a dearth of information on how housing type may influence malaria transmission among U5 children in Nigeria. This study assessed the relationship between housing type and malaria prevalence among U5s in Nigeria. Methods: A cross-sectional analysis of the nationally representative 2015 Nigeria malaria indicator survey data was done. A representative sample of 8148 households in 329 clusters was selected for the survey. Children aged 6–59 months in the selected households were tested for anaemia and malaria using the rapid diagnostic test (RDT) and the microscopy. Data were analysed using descriptive statistics, Pearson Chi square (χ2) and logistic regression models at 5% level of significance. Results: The odds of malaria infection was significantly higher among older children aged 24–59 months (aOR = 4.8, CI 2.13–10.99, p < 0.001), and children who lived in houses built completely with unimproved materials (aOR = 1.4, CI 1.08–1.80, p = 0.01). Other predictors of malaria infection include living in a rural area (aOR = 1.5, CI 1.25–1.91, p = 0.01), ever slept under a long-lasting insecticide-treated net (aOR = 1.1, CI 0.26–4.79, p = 0.89) and in a room not sprayed with insecticide (aOR = 1.2, CI 0.64–2.31, p = 0.56). Children who were malaria positive showed a higher prevalence of severe anaemia on RDT (87.6%) and Microscopy (67.4%) than those who were not anaemic (RDT = 31.6%, Microscopy = 12.9%). Conclusions: Non-improved housing predicted malaria infection among U5s in Nigeria. Improved housing is a promising means to support a more integrated and sustainable approach to malaria prevention. Education of the Nigerian people on the role of improved housing on malaria protection and empowerment of the public to adopt improved housing as well as overall enlightenment on ways to prevent malaria infection can help to augment the current malaria control measures among U5 children.Item Perception about the ‘opt out strategy’ for HIV testing and counselling among pregnant women attending antenatal clinic in Ibadan, Nigeria(African Journals Online, 2015) Balogun, F. M.; Owoaje, E. T.Background: Opt out strategy was designed to improve uptake of HIV testing and counselling (HTC) services but only a fifth of the population utilise this service in Nigeria. This study was conducted to determine perception about the opt out strategy for HIV screening among pregnant women attending antenatal clinic in a secondary health facility in Ibadan, Nigeria where the opt out strategy was used for HIV screening. Methodology: Cross sectional study was conducted and systematic random sampling was used to recruit 500 pregnant women. Data regarding sociodemographic characteristics, general knowledge about HIV transmission, assessment of HIV screening services in the hospital and attitude towards HIV screening was obtained. Results: Mean age of respondents was 27.4 (SD±6.1) years, 86.8% were married and 79.2% had at least secondary school education. Overall, 69.2% had good knowledge about routes of HIV transmission. More than 90% reported that information received during the HTC session was understood. Only 41.8% reported adequate privacy during screening process while 20.4% felt they were forced to participate. Positive attitude towards HTC was seen in 72.0%. Higher education was associated with better knowledge of routes of HIV transmission (OR=3.8; 95%CI= -4.3-3.3) Being married or cohabiting with a partner (OR=3.7; 95% CI=16.8-0.8), having more than one sexual partner (OR=3.3; 95%CI=-3.7-2.97) and being HIV negative (OR=3.9; 95%CI=39.0-0.39) was associated with a positive attitude towards HIV screening. Conclusion: Inadequate privacy and patient's voluntariness were major complaints about opt out strategy for HTC. Improving privacy and stressing that screening is optional may improve general uptake of HTC when using the opt out strategy.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 countries