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Item Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study(Elsevier Ltd., 2019) Bishop, D.; Dyer, R. A.; Maswime, S.; Rodseth, R. N.; Van Dyk, D.; Kluyts, H.-L.; Tumukunde, J. T.; Madzimbamuto, F. D.; Elkhogia, A. M.; Ndonga, A. K. N.; Ngumi, Z. W. W.; Omigbodun, A. O.; Amanor-Boadu, S. D.; Zoumenou, E.; Basenero, A.; Munlemvo, D. M.; Youssouf, C.; Ndayisaba, G.; Antwi-Kusi, A. A. K.; Gobin, V.; Forget, P.; Mbwele, B.; Ndasi, H.; Rakotoarison, S. R.; Samateh, A. L.; Mehyaoui, R.; Patel-Mujajati, U.|; Sani, C. M.; Esterhuizen, T. M; Madiba, T. E.; Pearse, R. M.; Biccard, B. M.Background Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0•7 per 100 000 population (IQR 0•2–2•0). Maternal mortality was 20 (0•5%) of 3684 patients (95% CI 0•3–0•8). Complications occurred in 633 (17•4%) of 3636 mothers (16•2–18•6), which were predominantly severe intraoperative and postoperative bleeding (136 [3•8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4•47 [95% CI 1•46–13•65]), and perioperative severe obstetric haemorrhage (5•87 [1•99–17•34]) or anaesthesia complications (11•47 (1•20–109•20]). Neonatal mortality was 153 (4•4%) of 3506 infants (95% CI 3•7–5•0). Interpretation Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. Funding Medical Research Council of South Africa.Item Nigerian surgical outcomes – Report of a 7-day prospective cohort study and external validation of the African surgical outcomes study surgical risk calculator(Elsevier Ltd., 2019) Osinaike, B.; Ayandipo, O.; Onyeka, T.; Alagbe-Briggs, O.; Mohammed, A.; Oyedepo, O.; Nuhu, A.; Asudoh, F.; Akanmu, O.; Nwokorie, C.; Mohammed, A.; Edubiol, M.; Izuoram, K.; Mohammed, R.; Nweze, O.; Efu, M.; Eguma, S.; Jasper, A.; Ewah, R.; Akhideno, I.; Nnaji, C.; Adov, S.; Ogboli-Nwasor, E.; Atiku, M.; Salisu, I.; Adinoyi, Y.|; Aguz, E.; Desalu, I.; Samuel, L.; Olorode, Y.; Fatungase, O.; Akinwonmia, O.; Faponle, F.; Idowu, O.; Isamade, E.; Aliyu, A.; Buba, S.; Hamza, G.; Onajin-Obembe, B.; Amanor-Boadu, S.Background: Surgical outcomes study for individual nations remains important because of international differences in patterns of surgical disease. We aimed to contribute to data on post-operative complications, critical care admissions and mortality following elective surgery in Nigeria and also validate the African Surgical Outcomes Study (ASOS) surgical risk calculator in our adult patient cohort. Materials and methods: We conducted a 7-day, national prospective observational cohort study in consented consecutive patients undergoing elective surgery with a planned overnight hospital stay following elective surgery during a seven-day study period. The outcome measures were in-hospital postoperative complications, critical care admissions and in-hospital mortality censored at 30 days. Also, we identified variables which significantly contributed to higher ASOS surgical risk score. External validation was performed using area under the receiver operating characteristic curve (ROC) for discrimination assessment and Hosmer–Lemeshow test for calibration. Results: A total of 1,425 patients from 79 hospitals participated in the study. Postoperative complications occurred in 264(18.5%, 95% CI 16.6–20.6), 20(7.6%) of whom were admitted into the ICU and 16(6.0%) did not survive. Total ICU admission was 57 (4%), with mortality rate of 23.5% following planned admission and overall in-hospital death was 22(1.5%, 95% CI 0.9–2.2). All prognostic factors in the ASOS risk calculator were significantly associated with higher ASOS score and the scoring system showed moderate discrimination (0⋅73, 95% CI 0.62–0.83). Hosmer–Lemeshow χ2 test revealed scale was well calibrated in the validation cohort. Conclusion: NiSOS validates the findings of ASOS and the ability of the ASOS surgical risk calculator to predict risk of developing severe postoperative complications and mortality. We identified failure-to-rescue as a problem in Nigeria. Furthermore, this study has provided policy makers with benchmarks that can be used to monitor programmes aimed at reducing the morbidity and mortality after elective surgery. We recommend the adoption of the ASOS surgical risk calculator as a tool for risk stratification preoperatively for elective surgery.Item Sexual dysfunction among women in a Nigerian gynecological outpatients unit(Society of Gynaecology and Obstetrics of Nigeria (SOGON), 2019) Ogunbode, O. O.; Aimakhu, C. O.; Ogunbode, A. M.; Adebusoye, L. A.; Owonikiko, K. M.Background: Sexual dysfunction is an important public‑health problem, which is often less reported or explored through opportunistic evaluation during medical consultations. Objective: This study was designed to determine the prevalence and patterns of female sexual dysfunction (FSD) including the sexual quality of life among female patients attending a gynecological outpatients unit in Southwest Nigeria. Materials and Methods: This is a cross‑sectional descriptive study of 146 consenting women who attended the gynecological outpatients’ clinic of the University College Hospital, Ibadan, Nigeria, during the study period. Participants were selected using multistage sampling technique. The survey instruments were previously validated questionnaires such as Sexual Function Questionnaire (SFQ28), Sexual Quality of Life‑Female Questionnaire (SQOL‑F), and the Family Adaptation, Partnership, Growth, Affection and Resolve (APGAR) score. The results were analyzed using Statistical Package for Social Sciences version 17 and P value was set at 5%. Results: The mean age was 33.8 ± 5.7 years. Most (85.6%) respondents had at least one form of sexual dysfunction. The commonest dysfunction was arousal‑sensation (62.4%) while the least was pain (3.4%). The mean SFQ28 and SQOL‑F scores were 58.0 ± 12.57 and 28.0 ± 11.94, respectively. There were no statistically significant differences in the SFQ28 and SQOL‑F scores across sociodemographic factors. Women classified as belonging to dysfunctional family on Family APGAR score similarly had poorer scores for sexual dysfunction (100%, P = 0.016). Conclusion: FSD is common among women attending gynecological outpatients clinic. Managing clinicians should be aware of this condition and proffer appropriate care in addition to the main presenting complaint.Item Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial(The Wellcome Trust, 2018) Shakur-Still, H.; Roberts, I.; Fawole, B.; Kuti, M.; Olayemi, O. O.; Bello, A.; Huque, S.; Ogunbode, O.; Kotila, T.|; Aimakhu, C.; Okunade, O. A.; Olutogun, T.; Adetayo, C. O.; Dallaku, K.; Mansmann, U.; Hunt, B. J.; Pepple, T.; Balogun, E.Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants. Methods: Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study). We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements. Results: Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67). There were no significant effects of TXA on any other parameters. Conclusion: TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests.Item Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study(Elsevier Ltd., 2018) Biccard, B. M.; Madiba, T. E.; Kluyts, H. L.; Munlemvo, D. M.; Madzimbamuto, F. D.; Basenero, A.; Gordon, C. S.; Youssouf, C.; Rakotoarison, S. R.; Gobin, V.; Samateh, A. L.; Sani, C. M.; Omigbodun, A. O; Amanor-Boadu, S. D.; Tumukunde, J. T.; Esterhuizen, T. M.; Manach, Y. L.; Forget, P.; Elkhogia, A. M.; Mehyaoui, R. M.; Zoumeno, E.; Ndayisaba, G.; Ndasi, H.; Ndonga, A. K. N.; Ngumi, Z. W. W.; Patel, U. P.; Ashebir, D. Z.; Antwi-Kusi, A. A. K.; Mbwele, B.; Sama, H. D.; Elfiky, M.; Fawzy, M. A.; Pearse, R. M.Background There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). Findings We recruited 11 422 patients (median 29 [IQR 10–70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0•7 (0•2–1•9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38•5 years [SD 16•1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1–2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18•2%, 95% CI 17•4–18•9]) of 10 885 patients. 239 (2•1%) of 11 193 patients died, 225 (94•1%) after the day of surgery. Infection was the most common complication (1156 [10•2%] of 10 970 patients), of whom 112 (9•7%) died. Interpretation Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. Funding Medical Research Council of South Africa.Item The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications.(Elsevier Ltd., 2018) Kluyts, H. L.; Le Manach, Y.; Munlemvo, D. M.; Madzimbamuto, F.; Basenero, A.; Coulibaly, Y.; Rakotoarison, S.; Gobin, V.; Samateh, A. L.; Chaibou, M. S.; Omigbodun, A. O.; Amanor-Boadu, S. D.; Tumukunde, J.; Madiba, T. E.; Pearse, R. M.; Biccard, B. M.Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high6income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799(4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.Item Guidelines and standard of care manual for managing gynaecological cancers.(Ibadan University Press, 2014) Odukogbe, A. A.; Awolude, O. A.; Oluwasola, T. A. O.; Adewole, I. F.; Omigbodun, A. O.Item What’s in your hands? A systematic review of dietary assessment methods and estimation of food sizes in a Primary Care Clinic(Wolters Kluwer - Medknow, 2018) Ogunbode, A. M.; Owolabi, M. O.; Ogunbode, O. O.; Ogunniyi, A.Introduction: Many patients with noncommunicable diseases such as obesity are attended to in Family Practice Clinics where quick dietary assessment along with estimation of food sizes as part of lifestyle modification and appropriate intervention could be offered. We performed a systematic review to determine the dietary assessment methods with the best evidence that can be employed in a Family Practice Clinic. Methods: Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines were used to conduct a systematic review of PubMed, Google, and Google Scholar databases from 1992 to 2017. Results: We found 730 original research articles, case–control studies, review articles, proceedings, transactions, and textbooks. Thirty-seven articles were selected out of which two were secondary data, 12 were review articles, 10 were descriptive surveys, and one was a prospective cohort study. There were two randomized controlled trials, two mixed study designs, one working paper, and seven guides. Food portion size estimation using household objects and the hand guide, then the food pyramid guide along with the food-sized plate intervention was documented. Conclusion: In view of the busy nature of Family Practice Clinics in several countries, in performing dietary assessment, food portions can be estimated using household measures and the hand portion guide. The pyramid guide and the portion-sized plate can then be used for intervention.Item Assessment of serological markers of genital chlamydia trachomatis infection among the gynaecology patients attending Babcock University teaching hospital, Ilishan-Remo, Ogun state, Nigeria.(2019) Ajani, T. A.; Elikwu, C. J.; Nwadike, V.; Babatunde, T.; Anaedobe, C. G.; Opeoluwa S.; Okangba, C.; Oluwasola, T. A. O.; Omeonu, A.; Faluyi, B.; Thompson, T. E.; Ebeigbe, E.; Ajani, M. A.; Joshua, A. K.; Kolawole, T.; Kristilere, H.; Meremikwu, C. M.; Mgbemena, L.; Nwaejike, C. S.; Salami, A.; Tantua, A.; Timothy, M.; Akagbusum, T.; Coker, A. O.Genital Chlamydia trachomatis infection causes significant morbidity and mortality in women. A number of epidemiologic studies have suggested that Polymerase Chain Reaction (PCR) is more accurate as a diagnostic tool for Chlamydia trachomatis.However, the use of serological markers may be cost effective and practical in diagnosing and estimating the burden of the disease in resource limited countries.This study was aimed at determining the serological markers (IgG, IgM and IgA) of Chlamydia trachomatis, evaluate the association between Chlamydia trachomatis infection and the sociodemographic characteristics and clinical diagnosis of the participants. This was a cross sectional hospital-based study in which blood samples from 145 consenting participants were tested for IgG, IgM and IgA antibodies against Chlamydia trachomatis using enzyme linked immunosorbent assay and their clinical diagnosis, retrieved from their case notes. The cumulative prevalence of seropositivity for Chlamydia trachomatis (IgG, IgM, IgA) was 112 (77.2%) while 33 (22.8%) were seronegative. The overall predominant seromarker was IgG 91(62.8%) while IgM and IgA accounted for 85(58.6%) and 54(37.2%) respectively. A statistically significant association was found between Chlamydia trachomatis infection and PID (p value = 0.031), primary infertility (p value 0.011) and level of income (p value= (0,045).Item Prevalence and associated risk factors of chlamydia trachomatis among gynecology clinic attendees in a tertiary institution in Ogun State, Nigeria.(2019) Ajani, T. A.; Elikwu, C. J.; Anaedobe, C. G.; Oluwasola, T. A. O.; Ajani, M. A.Chlamydia trachomatis is one of the most prevalent bacterial causing urogenital infections in men and women worldwide. There have been increasing reports of the prevalence of C. trachomatis in Nigeria. Aims: This study aimed to detect the prevalence of C. trachomatis seromarkers immunoglobulin G (IgG) and immunoglobulin A (IgA) and also to determine their associated risk factors among gynecology clinic attendees in the Babcock University Teaching Hospital, Ilishan Remo, Ogun State of Nigeria. Materials and Methods: This was a cross sectional study involving 145 consenting attendees of gynecology clinic of the hospital. Blood samples were collected and tested for =C. trachomatis IgG and IgA using the enzyme linked immunosorbent assay technique. Sociodemographic and sex behavioral factors were obtained by the interviewer based questionnaires, whereas statistical analysis was done using SPSS version 23. Results: Overall prevalence of combined IgG and IgA was 46 (31.7%). Among the infected, 30 (65.2%) were young women aged 15–25 years and majority, 109 (75%), had never used condom while 83 (57.2%) had only one sex partner in the preceding 3 months. Twenty three (15.9%) had a positive history of sexually transmitted infection (STIs), whereas 75 (51.7%) had ≥2 lifetime sex partners. Factors associated with the occurrence of both seromarkers on bivariate analysis included the previous history of STI and number of lifetime sex partners (P < 0.05), but with further analysis, only lifetime sex partners remained statistically significant (odds ratio = 5.63, confidence interval = 1.09–29.05, P = 0.007). Conclusion: There was a high prevalence of active, chronic, and persistent C. trachomatis infection with number of lifetime sex partner being a significant risk factor among our clinic attendees in Ogun State. Appropriate sex education should be encouraged among young people to reduce the burden of the infection and its attendant sequelae in our community.