Faculty of Clinical Sciences

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    Open Access
    22q11.2 deletion syndrome in diverse populations
    (Wiley Periodicals, Inc., 2017-04) Kruszka, P.; Addissie, Y.A.; McGinn, D.E.; Porras, A.R.; Biggs, E.; Share, M; Crowley, T.B.; Chung, B.H.; Mok, G.T.; Mak, C.C.; Muthukumarasamy, P.; Thong, M.K.; Sirisena, N.D.; Dissanayake, V.H.; Paththinige, C.S.; Prabodha, L.B.; Mishra, R.; Shotelersuk, V.; Ekure, E.N.; Sokunbi, O.J.; Kalu, N.; Ferreira, C.R.; Duncan, J.M.; Patil, S.J.; Jones, K.L.; Kaplan, J.D.; Abdul-Rahman, O.A.; Uwineza, A.; Mutesa, L.; Moresco, A.; Obregon, M.G.; Richieri-Costa, A.; Gil-da-Silva-Lopes, V.L.; Adeyemo, A.A.; Summar, M.; Zackai, E.H.; McDonald-McGinn, D.M.; Linguraru, M.G.; Muenke, M.
    22q11.2 deletion syndrome (22q11.2 DS) is the most common microdeletion syndrome and is underdiagnosed in diverse populations. This syndrome has a variable phenotype and affects multiple systems, making early recognition imperative. In this study, individuals from diverse populations with 22q11.2 DS were evaluated clinically and by facial analysis technology. Clinical information from 106 individuals and images from 101 were collected from individuals with 22q11.2 DS from 11 countries; average age was 11.7 and 47% were male. Individuals were grouped into categories of African descent (African), Asian, and Latin American. We found that the phenotype of 22q11.2 DS varied across population groups. Only two findings, congenital heart disease and learning problems, were found in greater than 50% of participants. When comparing the clinical features of 22q11.2 DS in each population, the proportion of individuals within each clinical category was statistically different except for learning problems and ear anomalies (P<0.05). However, when Africans were removed from analysis, six additional clinical features were found to be independent of ethnicity (P≥0.05). Using facial analysis technology, we compared 156 Caucasians, Africans, Asians, and Latin American individuals with 22q11.2 DS with 156 age and gender matched controls and found that sensitivity and specificity were greater than 96% for all populations. In summary, we present the varied findings from global populations with 22q11.2 DS and demonstrate how facial analysis technology can assist clinicians in making accurate 22q11.2 DS diagnoses. This work will assist in earlier detection and in increasing recognition of 22q11.2 DS throughout the world
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    Open Access
    3- year efficacy and safety for liraglitude 3.0mg in adults with obesity/overweight, prediabetes and baseline BMI <35 vs >/=35kg/m2 in the SCALE obesity and and pore diabetes, double-blind, placebo-controlled trial
    (Endocrine and Metabolism Society of Nigeria, 2007-09) Fasanmade, O; Greenway, F; Le Roux, C.W; McGowan, B; Pi-Sunyer, X; Cancino, A.P
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    Open Access
    A 3-year review of the pattern of contraceptive use among women attending the family planning clinic of a University Teaching Hospital in Lagos, Nigeria
    (2016) Okunade, KS; Daramola, E; Ajepe, A; Sekumade, A
    Background: Contraceptives are methods or devices used to prevent pregnancy. In Nigeria, the contraceptive prevalence was reported at 15% in 2013. Aims: This study aimed to determine the pattern of contraceptive use and sociodemographic characteristics of the users of family planning services in a teaching hospital in Lagos. Subjects and Methods: This was a descriptive, retrospective study of women who sought contraceptive services at the family planning clinic over a 3-year period. Relevant information was extracted from the case records of these women. Data were analyzed using Epi Info statistical package for Windows. Results: A total of 594 women opted to use a form of contraception in the study, within an age range of 15–52 years and with mean age of 34.3 ± 4.2 years. Fifty-four percent (54%) of the women users belonged to the Yoruba tribe and 89.4% were of the Christian faith. Married women accounted for 97.6% of the users, with the majority (68.9%) having parity of 2–4. Majority (77.6%) of the women had at least a tertiary level of education, with 46.1% of them involved in a form of skilled occupation. Nurses were the commonest source of referrals (42.9%). A larger proportion of the women (46.3%) preferred Jadelle implant while the least used method is Norplant (0.5%). Conclusion: Equipping medical personnel with the information and skills needed to meet the increasing demand for family planning services is necessary to avert the needless increase in the incidence of unwanted pregnancies, unsafe abortion, and their sequelae.
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    Open Access
    A 4-Year Clinical Review of Elective Hysterectomies at a University Teaching Hospital in Lagos, Nigeria
    (2017) Okunade, KS; Sekumade, A; Daramola, E; Oluwole, AA
    Objective: The aim of this research was to determine the types, indications, and operative outcomes of elective hysterectomies at the Lagos University Teaching Hospital (LUTH), in Lagos, South West, Nigeria. Design: This was a descriptive retrospective study of hysterectomies performed at LUTH from January 1, 2008, to December 3, 2012. Materials and Methods: Case notes of patients undergoing elective hysterectomy were retrieved from the hospital’s records department, and relevant information was extracted. Collation and analysis of data were performed, using the Epi Info statistical software package, version 7.2. Results: Hysterectomies accounted for 9.4% of all gynecologic surgical procedures. The mean age and parity of the studied women was 49.9 – 7.7 years and 3.74 – 1.57, respectively. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) was the most commonly performed (50.8%), and vaginal hysterectomy (VH) (14.5%) was the least performed. There was a rising trend in the number of TAH/BSOs (7%) and radical hysterectomies (RHs; 25%), with a 40% reduction in the number of VHs performed over the study period. General anesthesia was most commonly preferred anesthetic technique (66.7%), while uterine fibroids were the most common indication for hysterectomy. The mean units of blood transfused were 2.2 – 1.5 units, and the mean days of postoperative admission was 8.0 – 4.9 days. Conclusions: There is an urgent need to fortify postgraduate specialist training as a way to improve the skills of future gynecologists so they can perform procedures such as VH to improve the overall outcome for Nigerian women undergoing hysterectomy.
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    Open Access
    A 5‑Year Multidisciplinary Care Outcomes in Children with Wilms’ Tumour Managed at a Tertiary Centre: A Retrospective Observational Study
    (MedKnow, 2022) Alakaloko, FM; akinsete, AM; Seyi-Olajide, JO; Joseph, AO; Elebute, OO; Ladipo-Ajayi, AO; Odubanjo, MO; Olowoyeye, OA; Ademuyiwa, AO; Temiye, EO; Akinsulie, AA; Bode, CO
    Background: Over the last two decades, there has been significant improvement in the outcomes of children with Wilms' tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT. Methodology: This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients' case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant. Results: Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1-7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant. Conclusion: The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.
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    Open Access
    An 8-year review of major congenital abnormalities in a tertiary hospital in Lagos, Nigeria.
    (2016) Fajolu, I.B.; Ezenwa, B.; Akintan, P.; Ezeaka, V.C.
    Background: Congenital abnormalities are defects present at birth and are increasingly becoming an important cause of neonatal mortality. They can also result in disability in majority of the survivors. Objective: To describe the pattern and outcome of major congenital abnormalities (MCA) in a tertiary hospital in Lagos, Nigeria. Methods: The labour ward and labour ward theatre delivery records and admission records of the in-born ward of the neonatal unit of a tertiary hospital were reviewed retrospectively from January 2007 to December 2014. The MCA were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, (ICD-10). Multiple abnormalities were counted once by the system with the most major anomaly. Abnormalities were grouped according to organ systems, sex and yearly distribution. Statistical analysis was based on systemic type, and neonatal outcome. Results: Out of 14581 deliveries during the study period, 167 had MCA, giving an incidence of 11.5 per 1000 total births; 71 (42.5%) were females, 91 (54.5%) were male and 5(3.0%) had indeterminate sex. There was an increase in the yearly incidence from 2007-2014 The most frequent abnormalities were in the central nervous system (31.7%), musculoskeletal system (18.6%), complex congenital abnormalities group (15.5%) and urogenital system (11.4%). Fifty six (31.8%) infants died in the first week of life contributing 12.6% to the overall early neonatal mortality during the study period. Overall case fatality rate was 42.0%; case fatality was highest in the other abnormalities group, followed by chromosomal, cardiovascular and genitourinary system abnormalities respectively. Conclusion: The incidence of MCA in this study is high especially in the central nervous system. There was a steady increase in the yearly incidence during the study period. The overall case fatality rate was also very high with a high contribution to early neonatal deaths
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    Open Access
    A continuous quality improvement strategy to strengthen screening practices and facilitate the routine use of intravenous iron for treating anaemia in pregnant and postpartum women in Nigeria: a study protocol
    (2023) Eboreime, E.; Thomas, A.B; Obi-Cheff, C.; Adelabu, Y; Balogun, M; Aiyenigba, A.A; Oluwole, E.O.; Akinajo, O.R; Afolabi, B.B.
    Background Pregnancy-related anaemia is a public health challenge across Africa. Over 50% of pregnant women in Africa get diagnosed with this condition, and up to 75% of these are caused by iron deficiency. The condition is a significant contributor to the high maternal deaths across the continent and, in particular, Nigeria, which accounts for about 34% of global maternal deaths. Whereas oral iron is the mainstay treatment for pregnancy-related anaemia in Nigeria, this treatment is not very effective given the slow absorption of the medication, and its gastrointestinal adverse effects which lead to poor compliance by women. Intravenous iron is an alternative therapy which can rapidly replenish iron stores, but fears of anaphylactic reactions, as well as several misconceptions, have inhibited its routine use. Newer and safer intravenous iron formulations, such as ferric carboxymaltose, present an opportunity to overcome some concerns relating to adherence. Routine use of this formulation will, however, require addressing misconceptions and systemic barriers to adoption in the continuum of care of obstetric women from screening to treatment. This study aims to test the options to strengthen routine screening for anaemia during and immediately after pregnancy, as well as evaluate and improve conditions necessary to deliver ferric carboxymaltose to pregnant and postpartum women with moderate to severe anaemia. Methods This study will be conducted in a cluster of six health facilities in Lagos State, Nigeria. The study will employ continuous quality improvement through the Diagnose-Intervene-Verify-Adjust framework and Tanahashi’s model for health system evaluation to identify and improve systemic bottlenecks to the adoption and implementation of the intervention. Participatory Action Research will be employed to engage health system actors, health services users, and other stakeholders to facilitate change. Evaluation will be guided by the consolidated framework for implementation research and the normalisation process theory. Discussion We expect the study to evolve transferable knowledge on barriers and facilitators to the routine use of intravenous iron that will inform scale-up across Nigeria, as well as the adoption of the intervention and strategies inother countries across Africa.
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    Open Access
    A double-edged sword-telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers
    (BMJ Glob Health, 2021-02) Galle A.; Semaan A.; Huysmans E.; Audet C.; Asefa A.; Delvaux T.; Afolabi, B.B.; El Ayadi A.M.; Benova L.
    Introduction: The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally. Methods: The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level. Results: Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. Conclusions: Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.
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    Open Access
    A giant hydronephrotic pelvic kidney mimicking an ovarian cyst in a 34-week pregnancy
    (International Journal of Medicine and Biomedical Research, 2016-08) Okunade, K.S.; Sekumade A.; Sajo, E.A.; Daramola E.; Okojie O.E.; Ojewola R.W.; Balogun O.; Afolabi, B.B.; Anorlu R.I.
    Background: A giant hydronephrosis is defined as a dilated pelvi-calyceal system with an amount of urine exceeding one Litre in the urinary tract of an adult. It can mimic several other clinical conditions including a huge ovarian cyst. An ectopic pelvic kidney with hydronephrosis in pregnancy is a rare occurrence. Aim: This study documents a case of giant hydronephrosis that was wrongly diagnosed as an ovarian cyst. Findings: A 36-year old primiparous with a giant hydronephrosis which was initially diagnosed as an ovarian cyst. She was planned for a laparotomy with caesarean section and ovarian cystectomy at 34 weeks gestation. She was delivered of a live female neonate. Further exploration was done which revealed a left ectopic kidney. She had a left simple nephrectomy because the kidney appeared totally unhealthy. Conclusion: There is a need to be careful when dealing with cystic lesions of the abdomen. A high index of suspicion is required and further imaging other than ultrasound scan such as computerized tomography or magnetic resonance imaging may be necessary to make accurate diagnosis.
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    Open Access
    A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic
    (BMJ Glob Health, 2022-02) Banke-Thomas A.; Semaan A.; Amongin D.; Babah O. A.; Dioubate N.; Kikula A.; Nakubulwa S.; Ogein O.; Adroma M.; Anzo Adiga W.; Diallo A.; Diallo L.; Cellou Diallo M.; Maomou C.; Mtinangi N.; Sy T.; Delvaux T.; Afolabi, B.B.; Delamou A.; Nakimuli A.; Pembe A.B.; Benova L.
    Introduction: In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. Methods: Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019-February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020-February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. Results: Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. Conclusion: Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.
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    Open Access
    A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos
    (Ann Afr Med, 2022-06) Ogunsola F. T.; Odukoya O.O.; Banigbe B.; Caleb-Adepoju S.O.; Folarin O.; Afolabi, B.B.; Okubadejo N.U.; Adeyemo W.L.; Akanmu A.S.; Osuntoki A.; Okonkwo P.; Murphy R.; Kanki P.
    Background: A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia. Aims and objectives: This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health. Methods: Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked. Results: The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3-18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05). Conclusion: Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP.
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    Open Access
    A Review Of Eclampsia At The Lagos University Teaching Hospital (LUTH), Lagos, Nigeria: Have We Improved?.
    (IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 2014) Babah O.A.; Oluwole A.A.; Afolabi, B.B.; Odum C.U.
    A total of 12,234 patients were treated in the Lagos University Teaching Hospital (LUTH) for various obstetric conditions between January 1, 1996 and December 31, 2005. Of these, 165 (1.35%) were eclamptics. 148 (89.7%) of these were pre-delivery eclamptics and 17 (10.3%) were post-delivery eclamptics. Unbooked eclamptics remained a dominant group comprising 149 (90.3%) of all eclamptics. Mean maternal age was 26.59±0.44 years. Most of these patients were of low parity; primiparae constituting 76.8% and multiparae 23.2%. Mean gestational amenorrhoea at onset of eclampsia being 34.64±0.44 weeks. There were 22 maternal deaths due to eclampsia and its complications with a maternal mortality rate of 133.3 per 1000 eclamptics. The commonest causes of maternal deaths were septicaemia (13.64%), acute renal failure (9.09%) and respiratory failure (9.09%). There were 54 perinatal deaths, with a perinatal mortality rate of 346.2 per 1000. A comparison of the data obtained from this recent decade (1996 - 2005) to those of the previous three decades (1967 – 1976, 1977 – 1986 and 1986 – 1995) showed that there had been a progressive decline in the number of eclamptics managed in LUTH in the last three decades (572 eclamptics in 1977 – 1986, 299 eclamptics in 1986 – 1995, and 165 in 1996 – 2005). This study also showed a rise in the mean caesarean section rate for pre-delivery eclamptics and all eclamptics (55.41% and 49.70% respectively) compared to findings in the previous decades. There was a significant increase in the maternal mortality and perinatal mortality rates in recent decade. There was a decline in post mortem rate (40.9% in recent decade compared with 60% in previous decades).
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    Open Access
    A study of urinary prostacyclin products and some haematological parameters in pregnant women with sickle cell anaemia
    (Journal of Clinical Sciences, 2013) Akanmu A.S.; Afolabi, B.B.; Taiwo-Osunubi P. A.; Abudu O.O.
    ABSTRACT Objective: Normal gestation is associated with an increased plasma volume (PV) and vasodilation which plasma prostacyclin (PGI2) may account for. This study measured PGI2 levels in pregnant haemoglobin (Hb) SS patients as they have been reported to lack PV expansion. Methods: Urinary prostacyclin (UP) concentration and full blood count parameters were determined in pregnant Hb AA and Hb SS women, with non-pregnant controls. Results: Thirty-three Hb AA (19 non-pregnant and 14 pregnant) and 25 Hb SS (18 non-pregnant and 7 pregnant) were studied. UP did not rise in pregnant Hb SS women compared to non-pregnant (Geometric mean (GM) 614 ± 2.4 vs 248 ± 3.8, p=0.063), despite a very significant rise in Hb AA pregnancy (GM 1406 ± 2.1 vs 260 ± 2.9 pg/ml, p<0.0001). Conclusion: There is a lack of significant rise in plasma prostacyclin levels during pregnancy in Hb SS women, which could account for their reported lack of plasma volume expansion.
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    Open Access
    A Survey of Knowledge and Practices of Transfusion Medicine among Medical Doctors in Private Practice in Ibadan, Nigeria
    (Journal of Biomedical Research & Clinaical Practice, 2021) Ogbenna A.A; Salami I.O; Adewoyin A.S; Ajetunmobi I.A
    Comprehensive knowledge of blood transfusion practices among clinicians has an important role in provision of safe blood but continuous education and the academic rigor is not as versatile in private sector as in tertiary hospitals. The objective of this study is to evaluate the knowledge of clinicians in private practice in Ibadan on transfusion medicine. Eighty-one medical doctors from the 5 urban local government areas were enlisted in a multistage sampling technique. Self-administered questionnaires were employed and data analyzed using SPSS. Majority of clinicians were between the ages of 30-40 years (43.2%), had practiced for 0-5 years (42.0%) and prescribed blood transfusion at least once a month (44.4%). Male: female ratio was 4:1. The proportion of correct answers to the questions about age, minimum weight, Systolic Blood Pressure and Diastolic Blood pressure as criteria for selection of blood donor were as; 56.8%, 72.8 %, 71.6% and 81.5%, respectively. The proportion of correct answers to the questions on contraindications for the transfusion of platelet and cryoprecipitate were as; 54.3% and 9.9 %, respectively. The overall Knowledge score ranged from 22.0% to 93.0% (Mean= 49.0%; SD=37.7%). The mean knowledge score of indications and contraindications for transfusion of blood components are 79.2% and 34.2%, respectively. The study demonstrated significant gaps in knowledge of transfusion medicine. This can be closed by a more deliberate review of medical curricula, continuous medical education by professional groups and relevant stakeholders, as well as, a state-wide clinical audit of transfusion services
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    Open Access
    Absorbable suture materials for primary repair of episiotomy and second degree tears : RHL commentary . The WHO Reproductive Health Library; Geneva: World Health Organization.
    (WHO Reproductive Health Library, 2011) ADEGBOLA, O
    Repair of perineal trauma with synthetic absorbable sutures is associated with less short-term pain, reduction in the use of analgesia, less wound breakdown and reduced need for perineal re-suturing compared with catgut. However, the use of standard synthetic sutures was associated with greater frequency of removal of unabsorbed sutures compared with catgut. There was no significant difference between standard synthetic sutures and rapidly absorbed synthetic sutures, although with the latter fewer women required removal of unabsorbed suture up to 3 months post delivery, there was less analgesic use and more gaping wound edges.
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    Open Access
    Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study
    (2021) Hicks, JP; Allsop, MJ; Akaba, GO; Yalma, RM; Dirisu, O; Okusanya, B; et, al
    Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers’ knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders’ experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention’s acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. Conclusions: This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs’ workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. Trial Registration: ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372
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    Open Access
    Acceptability of child adoption in the management of infertility: A survey of women attending fertility clinics in the tertiary facilities in Lagos.
    (Journal of Clinical Sciences, 2014) Ezenwankwo, FC; Roberts, AA; Balogun, MR
    Introduction: Infertility is a major social problem with public health relevance in developing countries, with prevalence levels up to 30%. In contrast, the available treatment options for infertile couples are limited. Most times, the cost of this treatment is far beyond the reach of the common man and the success rates recorded with these treatments are minimal. This study was carried out to determine the knowledge, attitude, and practice of child adoption among infertile women attending fertility clinics in the public health facilities in Lagos, and to identify factors that may influence the willingness to adopt among these women. Materials and Methods: A descriptive cross‑sectional study was conducted in the three government‑owned tertiary fertility clinics in Lagos (namely the Lagos University Teaching Hospital (LUTH), the Lagos State University Teaching Hospital (LASUTH), and the Federal Medical Center (FMC) Ebute‑Metta) among 355 infertile women attending these clinics. Results: The majority of the respondents (90.1%) had heard of child adoption before and 28.7% of them had a good knowledge of the processes and legalities involved in child adoption. Almost two‑thirds (63.7%) expressed their willingness to adopt, while 58.6% of the respondents felt that an adopted child could never be compared to a biological child. Factors that were significantly associated with the attitude toward child adoption included the level of education of the respondent, their religion, marital status, knowledge of child adoption, and duration of infertility (P < 0.05). Discussion: The high level of willingness to adopt in contrast to the low level of practice among infertile women in Lagos indicates the scope for advocacy and public enlightenment to integrate adoption into the arsenal of management of infertility.
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    Open Access
    The Acceptance Rate of Intrauterine Contraceptive Device (IUCD) Amongst Family Planning Clinic Users in Lagos University Teaching Hospital
    (Lagos University Medical Society, 2008-10) Ogedengbe, O.K; Adegbola, O.
    BACKGROUND: Intrauterine Contraceptive Device is an effective reversible long-term contraceptive method that is popular and widely used in this environment. OBJECTIVES: To determine the characteristics of women using this mode of contraception, their main reasons for acceptance, complications arising from usage and the discontinuation rate as well as reasons for discontinuing the method. METHODS: A review of case records of all the new contraceptive acceptors attending the Department of Obstetrics and Gynaecology Family Planning Clinic of the Lagos University Teaching Hospital (LUTH) from 1st January 1990 to 31st December 1994 was examined and the clients that accepted the intrauterine contraceptive device, (IUCD) during this period were identified. The records of those that opted for IUCD were thoroughly reviewed to identify the follow up events through the subsequent ten years visits to determine outcome of the contraceptive usage. RESULTS: Amongst the 2754 new contraceptive acceptors during the study period, 1602 (58.17%) clients accepted the Intrauterine Contraceptive Device (IUCD). Of these IUCD acceptors, the mean age was 31.3 +/- 5.5 years, mean parity was 3.9 +/- 2 and mean number of children alive was 3.6 +/- 1.8. Seven hundred and forty nine (46.8%) of them had previously used contraceptives and 1175 (73.3%) of them still wanted more children, thus child spacing was the main reasons for accepting this method. By 12 months, the discontinuation rate was 13.9% with the cumulative discontinuation rate of 47% as at forty-eighth month. The commonest reason for discontinuation was planning to get pregnant in 426 (26.6%) of the clients. Menstrual disorders accounted for 108 (6.7%). The mean duration of IUCD was 25.4 +/- 18.8 months with an accidental pregnancy rate of 0.3%. CONCLUSION: Intrauterine Contraceptive Device is widely accepted amongst women in the study group. Devices that reduce menstrual loss and also have long duration of action like Levonorgestrel intrauterine system (LNG-IUS) qualifies to be considered.
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    Open Access
    Access to basic endocrine care where there's no endocrinologist
    (2019-03) Fasanmade, O.A
    There are few endocrinologists in many African countries including Nigeria when compared with the number in other regions of the world. There are many people with endocrine diseases and often these overwhelm the few endocrinologists. There is an urgent need to recruit other health care workers in the management of these patients to serve them better. The other healthcare providers need to be trained in basic endocrine care so that the endocrinologists can focus on the more serious or more technical endocrine problems. The shortage of endocrinologists should not reduce the quality/quantity of care for our patients with endocrine diseases and the endocrinologists need to think of innovative ways to cover this deficiency. Countries with one or 2 endocrinologists have explored and utilized other allied health workers to cover this gap, a lesson that Nigeria can learn from.
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    Open Access
    Access to information technology and willingness to receive text message reminders for childhood immunization among mothers attending a tertiary facility in Lagos, Nigeria
    (South African Journal of Child Health, 2012) Balogun, MR; Sekoni, AO; Okafor, IP; Odukoya, OO; Ezeiru, SS; Ogunnowo, BE; Campbell, PC
    Background. Effective communication is imperative for the delivery and receipt of adequate health care services. Aim. To determine access to information technology and willingness to receive short message service (SMS) text message reminders for childhood immunisation services among mothers in Lagos, Nigeria. Method. In this descriptive cross-sectional study, interviews using structured questionnaires were conducted with 399 mothers of children aged <5 years who brought their children to attend the immuno-prophylaxis and child welfare clinic of Lagos University Teaching Hospital during July and August 2011. Results. The age of the respondents ranged from 16 to 51 years with a mean of 31.1 4.7 years. Almost all (98%) were current owners of mobile phones, 68% had computer access, 66% were current users of the Internet though most used it occasionally and 65% had e-mail addresses. About three-quarters (77%) were willing to receive future SMS reminders about childhood immunisations although 67% preferred telephonic reminders to SMS and only 53% were willing to pay for the reminders. Respondents who were currently married and had at least a post-secondary education were more willing to receive SMS reminders. Conclusion. The mothers had better access to mobile phones than the Internet and were willing to receive SMS immunisation reminders. Future intervention strategies should explore payment mechanisms for SMS reminders, as there is an unwillingness to bear the cost by the respondents.