Abiodun S ADENIRAN
@unilorin.edu.ng
Professor, Faculty of Clinical Sciences
University of Ilorin
EDUCATION
University of Ibadan
University of Ilorin
National Postgraduate Medical College of Nigeria
West Africa College of Surgeons
RESEARCH, TEACHING, or OTHER INTERESTS
Obstetrics and Gynecology, Reproductive Medicine
43
Scopus Publications
Scopus Publications
- Handling client financial insolvency in maternity services: An occurrence, experience and policy gap qualitative analysis among healthcare stakeholders in North-Central Nigeria
Abiodun S. Adeniran, Mojirola M. Fasiku, Maryam A. Jimoh, Omotayo O. Adesiyun, Oniyire Adetiloye, Ugo Okoli, Elizabeth Chukwu, Olusola S. Ayoola, Samuel Oyeniyi, Obinna Orjingene,et al.
Wiley
AbstractObjectiveTo assess the occurrence of client financial insolvency, experiences of key healthcare stakeholders, and policy gaps on handling the situation during maternity services.MethodsA qualitative study was conducted in North‐Central Nigeria. Participants were key healthcare stakeholders including healthcare workers from private, primary, secondary, and tertiary facilities, healthcare administrators/facility‐heads, program managers and policy makers at local and state government levels through In‐depth and Key Informant interviews. Identified themes were occurrence, experiences of stakeholders, and prevention of client financial insolvency. Data were analyzed with the Nvivo statistical package.ResultsParticipants confirmed the occurrence of client financial insolvency. Clients' inability to pay hospital bills was due to being indigent, awaiting support from relations, or clients who were uncommitted to the payment. Health facilities lack guiding policy documents; potential cases are referred from private to public or from primary to secondary/tertiary facilities. Methods of handling financial insolvency included healthcare worker‐related (staff scavenging for needed consumables, fund‐raising among facility staff), facility‐related (revolving fund, medical social welfare, welfare committee, discharge with re‐payment plan, fee‐waiver), community‐related (ward development committee, religious organizations/philanthropists) interventions, or hospital detention of insolvent clients. Although clients' bills did not increase during detention, many clients did not honor post‐discharge re‐payment agreements. Participants suggested a client‐friendly billing system, early initiation of birth preparedness, partner involvement, and a rapid scale‐up of health insurance for pregnant women to curb financial insolvency.ConclusionTackling client financial insolvency requires policy documents, support to private facilities, effective debt‐recovery mechanisms, and scale up of health insurance for pregnant women. - Impact of ‘decision-to-delivery’ interval on maternal and perinatal outcomes: a retrospective study of emergency caesarean section from 2017 to 2021 at a secondary health facility in Nigeria
Mariam Abdulbaki, Fullaila O Aliyu, Musa Ayinde, Amudalat Issa, Abiodun S Adeniran, and Olayinka R Ibrahim
Springer Science and Business Media LLC
Abstract Background The decision-to-delivery interval (DDI) for a caesarean section is among the factors that reflect the quality of care a pregnant woman receives and the impact on maternal and foetal outcomes and should not exceed 30 min especially for Category 1 National Institute for Health and Care Excellence (NICE) guidelines. Herein, we evaluated the effect of decision-to-delivery interval on the maternal and perinatal outcomes among emergency caesarean deliveries at a secondary health facility in north-central Nigeria. Methods We conducted a four-year retrospective descriptive analysis of all emergency caesarean sections at a secondary health facility in north-central Nigeria. We included pregnant mothers who had emergency caesarean delivery at the study site from February 10, 2017, to February 9, 2021. Results Out of 582 who underwent an emergency caesarean section, 550 (94.5%) had a delayed decision-to-delivery interval. The factors associated with delayed decision-to-delivery interval included educational levels (both parents), maternal occupation, and booking status. The delayed decision-to-delivery interval was associated with an increase in perinatal deaths with an odds ratio (OR) of 6.9 (95% CI, 3.166 to 15.040), and increased odds of Special Care Baby Unit (SCBU) admissions (OR 9.8, 95% CI 2.417 to 39.333). Among the maternal outcomes, delayed decision-to-delivery interval was associated with increased odds of sepsis (OR 4.2, 95% CI 1.960 to 8.933), hypotension (OR 3.8, 95% 1.626 TO 9.035), and cardiac arrest (OR 19.5, 95% CI 4.634 to 82.059). Conclusion This study shows a very low optimum DDI, which was associated with educational levels, maternal occupation, and booking status. The delayed DDI increased the odds of perinatal deaths, SCBU admission, and maternal-related complications. - Outcomes and quality of care for women and their babies after caesarean section in Nigeria
Abiodun S. Adeniran, Duum C. Nwachukwu, Amaka N. Ocheke, Salisu O Mohammed, Abdulkarim O. Musa, Silas Ochejele, Rais S. Ibraheem, Samuel Pam, Amsa B. Mairami, Aishatu A. Gobir,et al.
Wiley
AbstractObjectiveTo describe the outcomes and quality of care for women and their babies after caesarean section (CS) in Nigerian referral‐level hospitals.DesignSecondary analysis of a nationwide cross‐sectional study.SettingFifty‐four referral‐level hospitals.PopulationAll women giving birth in the participating facilities between 1 September 2019 and 31 August 2020.MethodsData for the women were extracted, including sociodemographic data, clinical information, mode of birth, and maternal and perinatal outcomes. A conceptual hierarchical framework was employed to explore the sociodemographic and clinical factors associated with maternal and perinatal death in women who had an emergency CS.Main Outcome MeasuresOverall CS rate, outcomes for women who had CS, and factors associated with maternal and perinatal mortality.ResultsThe overall CS rate was 33.3% (22 838/68 640). The majority of CS deliveries were emergency cases (62.8%) and 8.1% of CS deliveries had complications after delivery, which were more common after an emergency CS. There were 179 (0.8%) maternal deaths in women who had a CS and 29.6% resulted from complications of hypertensive disorders of pregnancy. The overall maternal mortality rate in women who delivered by CS was 778 per 100 000 live births, whereas the perinatal mortality at birth was 51 per 1000 live births. Factors associated with maternal mortality in women who had an emergency CS were being <20 or >35 years of age, having a lower level of education and being referred from another facility or informal setting.ConclusionsOne‐third of births were delivered via CS (mostly emergency), with almost one in ten women experiencing a complication after a CS. To improve outcomes, hospitals should invest in care and remove obstacles to accessible quality CS services. - Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
, Adewale Adisa, Michael Bahrami-Hessari, Aneel Bhangu, Christina George, Dhruv Ghosh, James Glasbey, Parvez Haque, J C Allen Ingabire, Sivesh Kathir Kamarajah,et al.
Oxford University Press (OUP)
Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries. - Endometriosis-associated massive ascites in a young Nigerian lady
Abiodun S. Adeniran, Munirdeen A. Ijaiya, Kazeem O.O. Ibrahim, Saidu Ibrahim, and Olaleke O Folaranmi
African Journals Online (AJOL)
Endometriosis-associated massive haemorrhagic ascites is rare and poses a diagnostic challenge to the gynaecologist due to its resemblance to malignancies, especially ovarian malignancy. We report a 31-year-old nulligravida with progressive abdominal swelling, worsening dysmenorrhea, weight loss and a family history of ovarian tumour. Pelvic ultrasonography and Computed Tomography scans suggested an ovarian mass suspected to be an ovarian malignancy. Exploratory laparotomy revealed massive haemorrhagic ascites (8.6 litre) and multiple nodular masses on the anterior abdominal wall, omentum, bowel and pelvic organs, which were biopsied and confirmed on histopathology to be endometriosis. She had drainage of ascites and hormonal suppression using progestogen (Medroxyprogesterone acetate) with no recurrence in 15 months. Endometriosis should be considered in young, nulligravid women with dysmenorrhea, weight loss and ascites. - Effect of inter-pregnancy interval on serum ferritin, haematocrit and pregnancy outcome in Ilorin, Nigeria
Callistus Elegbua, Hadijat Raji, Sikiru Biliaminu, Grace Ezeoke, and Abiodun Adeniran
African Journals Online (AJOL)
Background: Available information remains limited on inter-pregnancy interval (IPI) and its effect on maternal health and pregnancy outcome.
 Objectives: To determine the effect of IPI on maternal serum ferritin, haematocrit and pregnancy outcome.
 Materials and methods: A prospective cohort study of 316 women categorized into WHO recommended IPI of ≥24 months (group I) and IPI <24 months i.e. short IPI (SIPI) as group II after matching for gestational age and social status. Serum ferritin and haematocrit levels were assayed in first and second trimesters; primary outcome measures were maternal serum ferritin, haematocrit and pregnancy outcome gestational age at delivery, birth and placental weights, APGAR scores and neonatal intensive admission). Participants were followed up until six-week post-delivery. Data analysis was with SPSS version 21.0; p<0.05 wassignificant.
 Results: Women in group I had higher mean serum ferritin (37.40±3.15 vs. 32.61±2.68; P<0.001), booking haematocrit (33.24±3.59 vs. 27.92±2.67; P<0.001) and mean birth weight (3100±310 vs. 2700±350; P<0.001). Antenatal hospital admission (P0.002), preterm delivery (P<0.001) and neonatal intensive care admission (P<0.001) were higher for group II. There was no maternal mortality; perinatal mortality was zero (group I) and 95/1000 livebirth (group II).
 Conclusion: Low serum ferritin, haematocrit and adverse neonatal outcomes were associated with SIPI.
 Keywords: Inter-pregnancy interval; serum ferritin; haematocrit; pregnancy outcome. - Evaluation of obstetric outcomes for women in commuter versus non-commuter marriages: A comparative study
Abiodun S. Adeniran, Adegboyega A. Fawole, Stella T. Filani, Kikelomo T. Adesina, Bilqis W. Alatishe-Muhammad, and Abiodun P. Aboyeji
Elsevier BV - Delivery outcome and predictors of successful vaginal birth after primary cesarean delivery: A comparative study
Adebayo Adewole, Adegboyega Fawole, Munirdeen Ijaiya, Abiodun Adeniran, Adeshina Kikelomo, and Abiodun Aboyeji
Babcock Medical Society
Objectives: This study aimed to determine the rate and predictive factors for successful vaginal birth after cesarean delivery, and measure maternal and neonatal outcomes of VBAC following one previous cesarean delivery. Methods: In this hospital-based prospective study, sixty women with one previous CD (subjects) who attempted VBAC and another sixty without previous CD (controls) carrying singleton cephalic fetuses matched for maternal age, parity, and gestational age were compared. The primary outcome measures were successful vaginal delivery and its predictors. Data were analyzed using SPSS (version 22.0), and p<0.05 was significant. Results: Out of 1768 deliveries, 105 (5.9%) had one previous CD; 57.1% (60/105) attempted while 61.7% (37/60) had successful VBAC; 23 (38.3%) had failed VBAC and repeat CD, while 14 (23.3%) of the control group had CD. The significant predictors of successful VBAC were cervical dilatation ≥4cm on admission (p=0.003), maternal age >35 years (p=0.019); and augmentation of labor (p=0.020); while previous vaginal delivery (p=0.108), parity (p=0.706), BMI (0.240), and inter-delivery interval (p=0.265) were not statistically significant. The maternal and neonatal outcomes were not statistically different among women who had successful VBAC after one CD compared to women without previous CD. Important morbidities following VBAC included uterine rupture (3.3%) and primary postpartum hemorrhage (6.7%). There was no peripartum hysterectomy or maternal death; the perinatal mortality rate was 16.7/1,000 live births for women who attempted VBAC while no perinatal death was recorded among the controls. Conclusion: VBAC is safe, and its outcome is comparable to women without previous CD. - Evaluation of Knowledge and Attitude to Uptake of Vasectomy among Male Health Care Workers in a Tertiary Health Facility: A Cross-sectional Study
Abiodun Adeniran
Texila International Marketing Management
Vasectomy is a safe and effective permanent male contraceptive, although its acceptance remains low in low-income countries. A cross-sectional study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between 1st July and 31st August 2020. Participants were 247 consenting male health care workers recruited using systematic sampling based on their profession. Data collection was through a self-administered questionnaire, and analysis was performed using IBM-SSPS Version 23.0; p-value<0.05 was significant. The modal age group was 31-39 years (61.1%), 96.8% had tertiary education, 63.2% were Doctors, 21.5% were Laboratory Scientists, 12.1% Pharmacists, 1.6% Nurses, and 1.6% Physiotherapists; 68.0% had two or more children. Awareness about vasectomy was 93.5%, the commonest source of information was the health facility (55.3%), 76.5% supports the role of men in family planning while 84.0% were willing to share family planning responsibility with their partners 16.6% intend to undergo vasectomy on completion of their family size. The identified hindrances to the uptake of vasectomy were fear that it may lead to sexual dysfunction (87.0%), fear of other side effects (70.3%), irreversibility of the procedure (37.0%), cultural factors (25.0%), and concerns about possible infidelity (20.9%). Knowledge about vasectomy was negatively associated with its uptake (p<0.001). This study reports aversion to vasectomy among male health workers despite adequate awareness and Knowledge due to concerns about possible side effects, including the irreversibility of the procedure. Therefore, while advocacy for vasectomy continues, researchers should expedite actions to make reversible male contraceptives readily available. - Leiomyoma of the anterior vaginal wall: a rare case
Saheed Olanrewaju Jimoh, GRACE GWABACHI EZEOKE, OLAYINKA RABIU BALOGUN, ADEMOLA POPOOLA, ABIODUN SULEIMAN ADENIRAN, and IS'HAQ FUNSHO ABDUL
Babcock Medical Society
Background: Leiomyoma is a benign smooth muscle mesenchymal tumor, usually of uterine origin but may rarelydevelop in the vaginal walls. Case presentation: A case of 40-year-old para 5+0 woman with anterior vaginal wall leiomyoma is reported. Thepresentation mimics that of uterovaginal prolapse and hence presents a diagnostic challenge. The unusualappearance of the protrusion, failure to reduce at any time even while lying down, and complete absence of urinarysymptoms raised the suspicion of a rare case. The diagnosis was made through examination under anesthesia,cystoscopy, and biopsy. Histological examination of the biopsy specimen confirmed vaginal wall leiomyoma. Thepatient had complete excision of the mass without any complications. Discussion and Conclusion: Vaginal wall leiomyoma is a rare benign vaginal lesion that can easily bemisdiagnosed. Diagnosis involves critical clinical evaluation, especially during pelvic examinations. Any vaginalprotrusion should be approached with a high index of suspicion, especially in patients of reproductive age. - Impact of COVID-19 on vascular patients worldwide: Analysis of the COVIDSurg data
Louise HITCHMAN, Matthew MACHIN, and
Edizioni Minerva Medica
BACKGROUND The COVIDSurg collaborative was an international multicenter prospective analysis of perioperative data from 235 hospitals in 24 countries. It found that perioperative COVID-19 infection was associated with a mortality rate of 24%. At the same time, the COVER study demonstrated similarly high perioperative mortality rates in vascular surgical patients undergoing vascular interventions even without COVID-19, likely associated with the high burden of comorbidity associated with vascular patients. This is a vascular subgroup analysis of the COVIDSurg cohort. METHODS All patients with a suspected or confirmed diagnosis of COVID-19 in the 7 days prior to, or in the 30 days following a vascular procedure were included. The primary outcome was 30-day mortality. Secondary outcomes were pulmonary complications (adult respiratory distress syndrome, pulmonary embolism, pneumonia and respiratory failure). Logistic regression was undertaken for dichotomous outcomes. RESULTS Overall, 602 patients were included in this subgroup analysis, of which 88.4% were emergencies. The most common operations performed were for vascular-related dialysis access procedures (20.1%, N.=121). The combined 30-day mortality rate was 27.2%. Composite secondary pulmonary outcomes occurred in half of the vascular patients (N.=275, 45.7%). CONCLUSIONS Mortality following vascular surgery in COVID positive patients was significantly higher than levels reported pre-pandemic, and similar to that seen in other specialties in the COVIDSurg cohort. Initiatives and surgical pathways that ensure vascular patients are protected from exposure to COVID-19 in the peri-operative period are vital to protect against excess mortality. - Atherogenic and cardiovascular risks of women on combined oral contraceptives: A comparative study
OS Jimoh, IF Abdul, OR Balogun, SA Biliaminu, AS Adeniran, HO Jimoh-Abdulghaffaar, KT Adesina, A Ahmed, and WO Oladosu
Medknow
Background: Although combined oral contraceptive (COC) is commonly used in sub-Saharan Africa, data on its cardiovascular disease risk remains scanty. The study aimed to determine serial serum lipid profiles and cardiovascular disease risks among COC-users. Methods: This is a prospective, comparative multicentered study conducted at four health facilities in Nigeria. Participants were new users of contraceptives; 120 each of women initiating COCs (group I) and those initiating other forms of nonhormonal contraceptives (group II) were recruited and monitored over a 6-month period. Serial lipid profile, blood pressure, and atherogenic risk for cardiovascular diseases were measured at recruitment (start) and scheduled follow-up clinic visits at 3 months and 6 months for all participants. Statistical analysis was performed with SPSS (version 21.0) and P value < 0.05 was considered significant. Results: In all, 225 participants (111 COC-users, 114 nonCOC-users) that completed the study were aged 18 to 49 years. There was a statistically significant increase in the diastolic blood pressure (P = 0.001), Low Density Lipoprotein- Cholesterol (P = 0.038) and higher atherogenic risk (P = 0.001) among COC-users compared to nonCOC-users. The serial total serum cholesterol, triglyceride, High Density Lipoprotein, systolic blood pressure, and body mass index were higher among COC-users but were not statistically significant compared to nonCOC-users. Conclusion: Alterations in lipid profile and increased short-term atherogenic risk for cardiovascular disease were reported among the COC-users in this study. Serial lipid profile and atherogenic risk assessment for cardiovascular diseases are recommended for monitoring of COC-users. - Impact of Bacillus Calmette-Gue´rin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection
Covid Surg Collaborative
Oxford University Press (OUP)
There is little evidence around the potentially protective role of previous Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 vaccination. Prior BCG vaccination did not protect SARS-CoV-2 infected patients against postoperative pulmonary complications and 30-day mortality. - Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
James Glasbey, Adesoji Ademuyiwa, Adewale Adisa, Ehab AlAmeer, Alexis P Arnaud, Faris Ayasra, José Azevedo, Ana Minaya-Bravo, Ainhoa Costas-Chavarri, John Edwards,et al.
Elsevier BV
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. - Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study
Enoch Akowuah, Ruth A. Benson, Edward J. Caruana, Govind Chetty, John Edwards, Stefano Forlani, George Gradinariu, Gavin J. Murphy, Aung Ye Oo, Akshay J. Patel,et al.
Elsevier BV - Pre-and-post-operative aversion among men whose partners had caesarean delivery in a patriarchal setting.
Abiodun S. Adeniran, Olumuyiwa O. Ogunlaja, Idowu P. Ogunlaja, Shukurat B. Okesina, Adegboyega A. Fawole, Kikelomo T. Adesina, and Abiodun P. Aboyeji
African Journals Online (AJOL)
Objectives: The study evaluated pre and post-operative perception and aversion to caesarean delivery (CD) among men whose partners underwent the procedure.Design: A multicentre cross-sectional study.Setting: Two tertiary and two secondary health facilities.Participants: Men whose partners underwent CD at the study sites.Methods: Participants were recruited by purposive sampling, data collection was through interaction via an interviewer-administered questionnaire first immediately the decision for CD was made and thereafter on the third postoperative day. Men whose partners had vaginal delivery were excluded from the study and data management was with SPSS version 21.0 while p<0.05 was significant.Results: Awareness about CD was 84.0% mainly through the healthcare workers (42.1%) and the female partner (34.1%); 88.0% of participants recommended CD for medically-indicated reasons. The greatest influence on consent was the male partner (48.8%). The major pre-operative concerns were limitation of family size (34.7%) and fear of repeat CD (34.0%). Pre-operative perceptions of CD included being expensive (60.7%), fear of the procedure (48.0%), fear of complications (45.3%) and longer hospital stay (44.0%). Aversion to CD was 30.0% pre and 5.3% post-operation; predictors of aversion were history of previous surgery among male or female partner and awareness about CD. However, there were reductions in negative perception and aversion post-operation.Conclusion: The high negative perception and aversion to CD among male partners were reduced post-operation. Healthcare workers should address the concerns and negative perceptions about CD and prioritize patient-friendly experiences during surgical operations. - Female adolescents and the future of female genital mutilation/cutting: a report from an endemic area
Grace G Ezeoke, Abiodun S Adeniran, Kikelomo T Adesina, Adegboyega A Fawole, Munirdeen A Ijaiya, and Adebunmi O Olarinoye
African Journals Online (AJOL)
Background: Despite collaborative efforts aimed at its eradication, Female Genital Mutilation/Cutting (FGM/C) continuesin endemic areas.
 Objective: To evaluate the experience and preparedness of female adolescents to protect their future daughters from FGM/C.
 Methods: A cross-sectional survey involving adolescent secondary school girls in North Central Nigeria. Participants were secondary school students who completed the study’s self-administered questionnaire after informed parental or participant’s consent. Data management was with SPSS 20.0 (IBM, USA), P-value <0.05 was significant.
 Results: There were 2000 participants aged 13-19 years (mean 15.56±1.75), prevalence of FGM/C was 35.0%, awareness was 86.1%, mutilation was performed between infancy and eight years of age (mean 3.85±3.24 years), 644(32.2%) desire to mutilatetheir future daughters, 722(36.1%) expressed support for FGM/C and 63.1% of victims of FM/C reported adverse post-mutilation experiences. Support for FGM/C was associated with low social class (P0.0010), opinion that FGM/C has benefit (P0.001) and desire to mutilate future daughters (P0.001) while awareness of efforts to eradicate FMG/C was 813(40.7%).
 Conclusion: FGM/C remains prevalent with potential support for its continuation among female adolescents despite reported adverse post-mutilation experiences. The multi-pronged approach to eradicate FGM/C should prioritize re-orientation for adolescent girls, rehabilitation of mutilated girls and girl child formal education.
 Keywords: Female genital mutilation/cutting; female circumcision, harmful traditional practices, adverse childhood experiences. - Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: The COVIDSurg mortality score
, Laura Bravo, Dmitri Nepogodiev, James C Glasbey, Elizabeth Li, Joana FF Simoes, Sivesh K Kamarajah, Maria Picciochi, Tom EF Abbott, Adesoji O Ademuyiwa,et al.
Oxford University Press (OUP)
To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients. - Determinants of the decision-to-delivery interval and the effect on perinatal outcome after emergency caesarean delivery: A cross-sectional study
O. Ayeni, A. Aboyeji, M. Ijaiya, K. Adesina, A. Fawole and A. Adeniran
Background Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD. Methods A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time-motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant. Results The overall mean DDI was 233.99±132.61 minutes (range 44–725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes. Conclusion Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI. - Comparative analysis of caesarean delivery among out-of-pocket and health insurance clients in Ilorin, Nigeria
AbiodunS Adeniran, IsaacI Aun, AdegboyegaA Fawole, and AbiodunP Aboyeji
Medknow
Background: Although out-of-pocket (OOP) payment for health services is common, information on the experience in maternal health services especially caesarean delivery (CD) is limited. Aim: To compare the pregnancy events and financial transactions for CD among OOP and health-insured clients. Materials and Methods: A comparative (retrospective) study of 200 women who had CD as OOP (100 participants) or health-insured clients (100 participants) over 30 months at Anchormed Hospital, Ilorin, using multistage sampling was conducted. The data were analysed using Chi-square, t-test and regression analysis; P < 0.05 was considered statistically significant. Results: Of 1246 deliveries, 410 (32.9%) had CD; of these, 186 (45.4%) were health-insured and 224 (54.6%) were OOP payers. The health-insured were mostly civil servants (60.0% vs. 40.0%; P = 0.009) of high social class (48.0% vs. 29.0%; P = 0.001). The payment for CD was higher among OOP (P = 0.001), whereas duration from hospital discharge to payment of hospital bill was higher for the health-insured (P = 0.001). On regression, social class (odds ratio [OR]: 0.23, 95% confidence interval [CI]: −0.0891252–0.112799; P = 0.048), amount paid (OR: 48.52, 95% CI: −7.14–6.68; P = 0.001) and duration from discharge to payment (OR: 28.68, 95% CI: 51.7816–70.788; P = 0.001) were statistically significant among participants. The amount paid was lower (P = 0.001), whereas time interval before payment was longer (P = 0.001) for the public-insured compared to private-insured clients. Conclusion: OOP payers are prone to catastrophic spending on health. The waiting time before reimbursement to health-care providers was significantly prolonged; private insurers offered earlier and higher reimbursement compared to public insurers. The referral and transportation of health-insured clients during emergencies is suboptimal and deserve attention. - Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey
AS Adeniran, AN Ocheke, D Nwachukwu, N Adewole, B Ageda, T Onile, AC Umezulike, AP Aboyeji, OT Oladapo, and
Wiley
To evaluate the burden, causes and outcomes of severe non‐obstetric maternal complications in Nigerian public tertiary hospitals. - The burden of severe maternal outcomes and indicators of quality of maternal care in Nigerian hospitals: a secondary analysis comparing two large facility-based surveys
JP Vogel, B Fawole, AS Adeniran, O Adegbola, and OT Oladapo
Wiley
To compare severe maternal outcomes (SMOs) from two multi‐centre surveys in Nigerian hospitals, and to evaluate how the SMO burden affects quality of secondary and tertiary hospital care. - Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy: A randomized controlled trial
Muhibat A. Afolabi, Grace G. Ezeoke, Rakiya Saidu, Munirdeen A. Ijaiya, and Abiodun S. Adeniran
Galenos Yayinevi
Objective: To compare the effectiveness of perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy. Material and Methods: A randomized controlled trial involving women with uterine leiomyoma who underwent abdominal myomectomy was conducted at a tertiary facility in Nigeria. Participants were recruited after they gave informed consent and randomized into group I (single dose 400 μg vaginal misoprostol one-hour before surgery) and group II (intraoperative pericervical hemostatic tourniquet). Eighty participants (40 in each group) were recruited. Uterine size was measured in centimeters above the pubic symphysis, and blood loss estimation involved direct volume measurement and gravimetric methods. The main outcome measures were intraoperative blood loss, blood transfusion, and recourse to hysterectomy. Ethical approval and trial registration were obtained; the data were analyzed using the SPSS software version 21.0; p<0.05 was considered significant. Results: Participants in group I had higher mean intraoperative blood loss (931.89±602.13 vs 848.40±588.85 mL, p=0.532), intra-operative blood transfusion rates (60 vs 55%; p=0.651) and mean units of blood transfused (1.30±1.20 vs 1.20±1.30; p=0.722) compared with group II. The mean uterine size (19.50±6.93 vs 20.05±6.98 cm; p=0.725) and number of fibroid nodules (11.25±7.99 vs 11.45±8.22; p=0.912) were comparable. The change in post-operative hematocrit was 2.66±2.21% vs 3.24±2.85% (p=0.315) and post-operation blood transfusion was 2.5 vs 5% (p=0.556). There was no recourse to hysterectomy in either of the study groups. While adverse effects of misoprostol occurred in 5 (12.5%) participants of group I. Conclusion: The effectiveness of perioperative vaginal misoprostol is comparable to intra-operative hemostatic pericervical tourniquet in reducing blood loss during abdominal myomectomy. - An observation of umbilical coiling index in a low risk population in Nigeria
Kikelomo T. Adesina, Olumuyiwa A. Ogunlaja, Adebunmi O. Olarinoye, Abiodun P. Aboyeji, Halimat J. Akande, Adegboyega A. Fawole, and Abiodun S. Adeniran
Walter de Gruyter GmbH
Abstract Objectives: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. Methods: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. Results: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. Conclusion: The UCI was not associated with adverse perinatal outcome in this study.