Institute of Child Health
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Item Pharyngo-cutaneous fistula post total-laryngectomy: a local experience(2020-03) Ogunkeyede, S. A.; Adeyemo, A. A.; Daniel, A.; Yaro, P. J.; Ogundoyin, O. ABackground: Pharyngo-cutaneous fistula is a major complication of total laryngectomy. Despite its significant impact on the patients' nutrition and management outcome, there is lack of consensus for recognising high-risk patients and factors associated with fistula formation. Hence, this study was aimed at determining the incidence of pharyngo-cutaneous fistula and factors associated with fistula formation. Methods: A retrospective collection of data on all cases of laryngeal cancer diagnosed histologically and had total laryngectomy, in the Otorhinolaryngology Department of a tertiary centre in Southwestern, Nigeria, from 2007 – 2016. The data collected include age, gender, tumour stage, tracheostomy, adjuvant therapy extent of laryngectomy procedure and factors for pharyngocutaneous fistula. Results: Forty-two patients had total laryngectomy, male to female ratio was 7.4:1 and mean age was 52.3 ± 2.1 years. All patients had pathological diagnosis of stage 3 (83.3%) and stage 4 (16.7%) laryngeal cancer, respectively. The incidence of pharyngo-cutaneous fistula was11.9% and the factors related to fistula formation were prior radiotherapy treatment and diabetes. Age, gender, neck dissection procedures, site of primary tumor and emergency tracheostomy did not contribute to fistula formation. Spontaneous fistula closure was achieved in all cases except one patient who had surgical closure. Conclusion: Pharyngo-cutaneous fistula formation post-surgery is related to the presence of co-morbidities. The high percentage of spontaneous closure underscores the need for a conservative management approachItem Pediatric hearing thresholds post-bacterial meningitis(2020-07) Jatto, M. E.; Adeyemo, A. A.; Ogunkeyede, S. A.; Lagunju, I. A.; Nwaorgu, O. G.Introduction: Disabling hearing loss as a sequela of bacterial meningitis results from damage to the auditory system. This study was designed to ascertain the hearing thresholds in survivors of bacterial meningitis and the risk factors of hearing loss in childhood bacterial meningitis. Methodology: One hundred and two children admitted and treated for bacterial meningitis were recruited prospectively along with 102 age- and sex-matched controls who had auditory evaluation using otoacoustic emission and auditory brain stem response tests 48 h prior to hospital discharge. This was also repeated at the follow-up clinic at 1 month after hospital discharge, irrespective of the initial hearing assessment results. Result: There were 57 (55.9%) males and 45 (44.1%) females among the cases (mean age, 5.34 ± 4.40 years) and 55 (53.9%) males and 47 (46.1%) females among the controls (mean age, 5.31 ± 3.15 years). The prevalence of hearing loss was 30.4% among the cases, while it was 6.9% among the controls. The risk factors of hearing impairment in this study were the presence of anemia, leukocytosis, and hypoglycorrhachia. Conclusion: Hearing impairment with varying degrees of severity is a frequent complication of bacterial meningitis in childrenItem Audit of open pediatric tracheostomies at the university college hospital, Ibadan(2020-06) Oyelakin, O.A.; Adeyemo, A. A.Background: Tracheostomy is the creation of a communication between the trachea and the overlying skin, maintained by a tube. This is done either by an open or percutaneous technique. Anatomical and physiological variation of the paediatric trachea and adjoining structures necessitates finite skills and consistent competence in performing pediatric tracheostomies, lack of which may cause higher mortality and morbidity outcome in tracheostomies in the pediatric age group. Objectives: There are inadequate local data on the outcomes of pediatric tracheostomies; therefore, we conducted a local audit of pediatric tracheostomy to describe our experience. Methods: A retrospective study of pediatric patients who had tracheostomies from June 2011 to December 2017 was done. Results: Thirty‑four patients were identified, all of whom had an open tracheostomy. The age range was 3 weeks to 16 years; M: F ratio was 2.4:1. Indications for surgery were obstructive (88.2%) and prolonged‑assisted intubation (11.8%). Recurrent respiratory papillomatosis, retropharyngeal abscess, and foreign‑body aspiration were the main obstructive causes. Three patients (8.8%) had repeat procedures, and these patients were initially discharged on tracheostomy tube and instructions were given for home care. Conclusion: Despite the evolving local challenges peculiar to clinical practice in developing countries, the outcome of pediatric tracheostomy in our hospital is goodItem Nasopharyngeal carcinoma in Ibadan, Nigeria: a clinicopathologic study(Pan African Medical Journal, 2020-06-20) Ogun, G. O.; Olusanya, A. A.; Akinmoladun, V. I.; Adeyemo, A. A.; Ogunkeyede, S. A.; Daniel, A.; Awosusi, B. L.; Fatunla, E. O.; Fasunla, A. J.; Onakoya, P. A.; Adeosun, A. A.; Nwaorgu, O. G.Introduction: nasopharyngeal carcinoma is relatively common in our environment. It is one of the most difficult malignancies to diagnose at an early stage. The aim of the study was to determine the clinical features, clinical disease stage of nasopharyngeal carcinoma at presentation and at diagnosis as well as the histologic types at the University College Hospital, Ibadan, Nigeria. Methods: this was a ten year retrospective study of all histologically confirmed nasopharyngeal carcinoma between January 2007 to December 2016 using clinical and pathology records and files. Results: there were 73 cases. The male: female ratio was 1.7. The age of patients ranged from 12 to 80 years with a mean age of 39 ± 16 years. The median age at diagnosis was 40 years. The peak age group of occurrence was 40-49 years. The most common symptoms were namely epistaxis in 67.1% of patients at presentation, neck mass/swelling (64.4%) and nasal mass/obstruction (63.0%). Majority (54.8%) of the patients presented late with stage 3 or 4 disease. Most (94.5%) of the tumours were of the non-keratinizing squamous cell carcinoma subtype. The keratinizing and basaloid variants accounted for 4.1% and 1.4% of the tumours respectively. Conclusion: vague, non-specific symptoms make patients present at late stages of the disease, making it almost impossible to attempt cure. The dominant histopathological type is non-keratinizing squamous cell carcinoma and resembles that seen in most parts of Nigeria and endemic areas of the worldItem Readiness of Nigerian health‑care workers to work during COVID‑19 pandemic(Wolters Kluwer - Medknow, 2021-06) Ogunkeyede, S. A. .; Adeyemo, A. A.; Ogundoyin, O. A.; Oyelakin, O. A.; Fawole, O. B.Introduction: Health‑care professionals of all cadres are the utmost valuable resource during pandemics and maintaining an adequate workforce of health professionals during an emergency is critical to ensure uninterrupted provision of services that are essential for patient care. Aim: Examine readiness of health‑care workers (HCWs) to provide service in the course of the COVID‑19 pandemic and the factors influencing their decision. Methodology: This was a cross‑sectional study of Nigerian health sector workers HCWs in the course of the COVID‑19 pandemic. The respondents were recruited using HCWs focus groups on WhatsApp and Telegram social medial platforms. Results: A total of 481 HCWs were recruited, consisting of 288 females and 193 males (M: F, 1:1.5), mean age = 30.71 ± 5.9 years. Most HCWs (97.3%) showed a willingness to provide service during the pandemic; 73.3% of the HCWs were willing to work if supplied with adequate personal protective equipment (PPE) although 5.8% were less willing to work without proper PPE. Factors supporting unwillingness to work during the pandemic were: concerns about the lack of adequate testing for COVID‑19 (48.9%), lack of disability insurance plan (40.1%), fear of being infected (47.2%), and the risk of infection in family members (24.5%). The readiness to work was related to the job cadres of the HCWs (P = 0.001), while the provision of additional incentives and a change in the working conditions would influence the readiness of the HCWs to work. Conclusion: HCWs were ready to provide service in the course of the COVID‑19 pandemic if there was a safe work environment, although the availability of PPE and other personal factors would influence their willingness to work, while improvement in working conditions would motivate HCWs to workItem Hearing healthcare gaps in LMICS: snapshot from a semi-urban community in Nigeria(2021-06) Adeyemo, A. A.; Ogunkeyede, S.; Dania, O.Background: Low and middle-income countries (LMICs) have high prevalence of hearing loss which are mainly due to preventable causes. While urban communities in LMICs are likely to have functional hearing healthcare delivery infrastructure, rural and semi-urban communities may have different reality. Objectives: This study aimed to provide: (i) a snapshot of the burden of ear diseases and (ii) a description of available hearing healthcare resources in a semi-urban Nigerian community. Methods: A cross-sectional study of households selected by multistage random sampling technique. Seventy-four participants: 39 males and 35 females with mean age of 34 years ± 5.24 were recruited and answered a structured questionnaire. In addition, the availability of hearing healthcare services in 15 health centers within the community were determined. Results: All participants reported recent occurrence of ear complaints or gave similar history in a household member. Common complaints were ear discharge, ear pain and hearing loss. Medical intervention was sought from patent medicine stores, hospitals and traditional healers. None of the assessed hospitals within the study site was manned by an ENT surgeon or ENT trained nurse. Conclusion: Despite the heavy burden of ear complaints there is inadequate hearing healthcare delivery in a typical LMIC community. This highlights the need for urgent improvement of hearing healthcareItem Evolving telemedicine practice: experiences of health care workers during covid-19 pandemic(2021) Adeyemo, A. A.; Ogunkeyede, S. A.; Ogundoyin, O. A.; Oyelakin, O. A.Background: Telemedicine is employed in patient care when direct physical contact is not possible or discouraged, as was seen during the COVID-19 pandemic. The use of smartphone technology could make telemedicine affordable and available in low and medium-income countries (LMICs). However, the evolution of telemedicine care depends on multiple factors. Aim: To explore the practice of telemedicine by Nigerian health care workers (HCWs) during the COVID-19 pandemic Methods: A cross-sectional study of the Nigerian HCWs on telemedicine practice in patient care during the COVID-19 pandemic period. Recruitment of respondents was done through dedicated WhatsApp and Telegram social media platforms for HCWs over a period of 40 days (May 1st and June 10th, 2020).Results: A total of 481 HCWs participated in the study consisting of 153(31.8%) doctors, 150(31.2%) nurses and 178(37%) other HCWs. Though 89.2% of the HCWs agreed that telemedicine is important, it was only 266 (55.3%) that practiced telemedicine, phone consultation was the form of telemedicine used in all the health institutions. Telemedicine was practiced more by doctors 91(18.9%), nurses 79(16.4%) and pharmacists 35(7.3%) than other groups of health care workers. Inadequate COVID-19 screening test and lack of personal protective equipment were strong motivators for the attending HCWs to practice telemedicine. Conclusion: There was widespread use of phone consultation by all cadres of health care workers during the pandemic. Hence there should be a health policy that will encourage greater use and acceptance of telemedicine in clinical practice and in the patients care beyond the pandemic period