Publications by authors named "Oladosu Ojengbede"

82 Publications

Whole-genome analysis of Nigerian patients with breast cancer reveals ethnic-driven somatic evolution and distinct genomic subtypes.

Nat Commun 2021 11 26;12(1):6946. Epub 2021 Nov 26.

Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA.

Black women across the African diaspora experience more aggressive breast cancer with higher mortality rates than white women of European ancestry. Although inter-ethnic germline variation is known, differential somatic evolution has not been investigated in detail. Analysis of deep whole genomes of 97 breast cancers, with RNA-seq in a subset, from women in Nigeria in comparison with The Cancer Genome Atlas (n = 76) reveal a higher rate of genomic instability and increased intra-tumoral heterogeneity as well as a unique genomic subtype defined by early clonal GATA3 mutations with a 10.5-year younger age at diagnosis. We also find non-coding mutations in bona fide drivers (ZNF217 and SYPL1) and a previously unreported INDEL signature strongly associated with African ancestry proportion, underscoring the need to expand inclusion of diverse populations in biomedical research. Finally, we demonstrate that characterizing tumors for homologous recombination deficiency has significant clinical relevance in stratifying patients for potentially life-saving therapies.
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http://dx.doi.org/10.1038/s41467-021-27079-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626467PMC
November 2021

Associations between age of menarche and genetic variation in women of African descent: genome-wide association study and polygenic score analysis.

J Epidemiol Community Health 2021 Oct 27. Epub 2021 Oct 27.

Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA

Introduction: Many diseases of adulthood are associated with a woman's age at menarche. Genetic variation affects age at menarche, but it remains unclear whether in women of African ancestry the timing of menarche is regulated by genetic variants that were identified in predominantly European and East Asian populations.

Methods: We explored the genetic architecture of age at menarche in 3145 women of African ancestry who live in the USA, Barbados and Nigeria. We undertook a genome-wide association study, and evaluated the performance of previously identified variants.

Results: One variant was associated with age at menarche, a deletion at chromosome 2 (chr2:207216165) (p=1.14×10). 349 genotyped variants overlapped with these identified in populations of non-African ancestry; these replicated weakly, with 51.9% having concordant directions of effect. However, collectively, a polygenic score constructed of those previous variants was suggestively associated with age at menarche (beta=0.288 years; p=0.041). Further, this association was strong in women enrolled in the USA and Barbados (beta=0.445 years, p=0.008), but not in Nigerian women (beta=0.052 years; p=0.83).

Discussion: This study suggests that in women of African ancestry the genetic drivers of age at menarche may differ from those identified in populations of non-African ancestry, and that these differences are more pronounced in women living in Nigeria, although some associated trait loci may be shared across populations. This highlights the need for well-powered ancestry-specific genetic studies to fully characterise the genetic influences of age at menarche.
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http://dx.doi.org/10.1136/jech-2020-216000DOI Listing
October 2021

Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria.

J Obstet Gynaecol 2021 Oct 27:1-6. Epub 2021 Oct 27.

Center for Population and Reproductive Health, Ibadan, Nigeria.

A 16-year review of causes, clinical presentation and management outcomes of Acquired gynatresia (AG) at University College Hospital, Ibadan, Nigeria. Information was obtained using a proforma and data analysed using SPSS version 20.0. The mean age of the 31 women with AG was 35.6 ± 6.2 years. The majority (90.3%) were married and had a tertiary level of education. The mean parity was 0.74 ± 1.1 and 54.8% were nulliparous while 29.0% were primiparous women. The commonest cause of AG was the insertion of caustic substances into the vagina and this was mainly for the treatment of uterine fibroid (68.2%) and infertility (54.5%). Over three-quarters presented with dyspareunia while 54.8% had infertility. A majority (87.1%) had one-stage surgery with dissection/excision of fibrotic tissue being the commonest (45.2%) and sigmoid vaginoplasty the least performed. Postoperative complications were seen in 29.0% of cases. Acquired gynatresia remains a condition of public health interest despite an increase in female education and relatively improved health care in Nigeria.Impact statement Acquired gynatresia (AG) could be of chemical and non-chemical origin and result from certain cultural beliefs and practices. Irrespective of the women's level of education, there is inadequate awarene of the implications of inserting caustic materials into the vagina. However, there is a high success rate of treatment of AG. There is a need to increase health education and awareness of the populace on the causes of AG and its associated complications.
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http://dx.doi.org/10.1080/01443615.2021.1959530DOI Listing
October 2021

Intimate partner violence among pregnant women attending antenatal care services in the rural Gambia.

PLoS One 2021 5;16(8):e0255723. Epub 2021 Aug 5.

Institute of Life and Earth Science (Including Health and Agriculture), Pan African University, Ibadan, Nigeria.

Background: Intimate partner violence (IPV) refers to any behavior by either a current or ex-intimate partner or would-be rejected lover that causes physical, sexual, or psychological harm. It is the most common form of violence in women's lives. According to a World Health Organization report, about 1 in 3 women worldwide experience at least one form of IPV from an intimate partner at some point in her life. In the Gambia, about 62% of pregnant women experience at least one form of violence from an intimate partner. IPV has severe physical and mental health consequences on a woman ranging from minor bodily injury to death. It also increases the risk of low birth weight, premature delivery, and neonatal death.

Methods: A health facility-based cross-sectional study design was carried out to assess the magnitude and factors associated with intimate partner violence among pregnant women seeking antenatal care in the rural Gambia. The study enrolled 373 pregnant women, and a multi-stage sampling technique was used to select the respondents. An interviewer-administered structured questionnaire was used to obtain information from the study participants. The collected data were analyzed using SPSS Ver.22. Bivariate and multivariate logistic regression were used to determine the association between dependent and independent variables. Odds ratio with 95% confidence interval (CI) was computed to determine the presence and strength of associated factors with IPV.

Result: The study reveals that the prevalence of IPV in The Gambia is 67%, with psychological violence (43%) being the most common form of IPV reported by the respondents. The multivariate logistic regression result reveals that being aged 35 years or older [AOR 5.1(95% CI 1.5-17.8)], the experience of parents quarreling during childhood [AOR 1.7(95% CI 1.0-2.75)], and having cigarette smoking partners [AOR 2.3 (95% CI 1.10-4.6)] were significantly associated with IPV during pregnancy.

Conclusion: This study has demonstrated that all forms of IPV in rural Gambia are frequent. Women older than 35 years, had experienced parents quarreling, had a partner who smoked, and a partner who fight with others were more likely report IPV compared to other pregnant women in the study. We recommend that IPV screening should be included as an integral part of routine antenatal care services in The Gambia. Community-based interventions that include indigenous leaders, religious leaders, and other key stakeholders are crucial to create awareness on all forms of IPV and address the risk factors found to influence the occurrence of IPV in rural Gambia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255723PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341542PMC
December 2021

Cross-ancestry GWAS meta-analysis identifies six breast cancer loci in African and European ancestry women.

Nat Commun 2021 07 7;12(1):4198. Epub 2021 Jul 7.

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.

Our study describes breast cancer risk loci using a cross-ancestry GWAS approach. We first identify variants that are associated with breast cancer at P < 0.05 from African ancestry GWAS meta-analysis (9241 cases and 10193 controls), then meta-analyze with European ancestry GWAS data (122977 cases and 105974 controls) from the Breast Cancer Association Consortium. The approach identifies four loci for overall breast cancer risk [1p13.3, 5q31.1, 15q24 (two independent signals), and 15q26.3] and two loci for estrogen receptor-negative disease (1q41 and 7q11.23) at genome-wide significance. Four of the index single nucleotide polymorphisms (SNPs) lie within introns of genes (KCNK2, C5orf56, SCAMP2, and SIN3A) and the other index SNPs are located close to GSTM4, AMPD2, CASTOR2, and RP11-168G16.2. Here we present risk loci with consistent direction of associations in African and European descendants. The study suggests that replication across multiple ancestry populations can help improve the understanding of breast cancer genetics and identify causal variants.
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http://dx.doi.org/10.1038/s41467-021-24327-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263739PMC
July 2021

Household air pollution, ultrasound measurement, fetal biometric parameters and intrauterine growth restriction.

Environ Health 2021 06 23;20(1):74. Epub 2021 Jun 23.

Department of Medicine and Center for Global Health, University of Chicago, Chicago, USA.

Background: Low birthweight, intrauterine growth restriction (IUGR) and perinatal mortality have been associated with air pollution. However, intervention studies that use ultrasound measurements to assess the effects of household air pollution (HAP) on fetal biometric parameters (FBP) are rare. We investigated the effect of a cookstove intervention on FBP and IUGR in a randomized controlled trial (RCT) cohort of HAP-exposed pregnant Nigerian women.

Methods: We recruited 324 women early in the second trimester of pregnancy. Between 16 and 18 weeks, we randomized them to either continue cooking with firewood/kerosene (control group) or receive a CleanCook stove and ethanol fuel (intervention group). We measured fetal biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and ultrasound-estimated fetal weight (U-EFW) in the second and third trimesters. The women were clinically followed up at six regular time points during their pregnancies. Once during the women's second trimester and once during the third, we made 72-h continuous measurements of their personal exposures to particulate matter having aerodynamic diameter < 2.5 μm (PM). We adopted a modified intent-to-treat approach for the analysis. Differences between the intervention and control groups on impact of HAP on fetal growth trajectories were analyzed using mixed effects regression models.

Results: There were no significant differences in fetal growth trajectories between the intervention and control groups.

Conclusions: Larger studies in a setting of low ambient air pollution are required to further investigate the effect of transitioning to a cleaner fuel such as ethanol on intrauterine growth.

Trial Registration: ClinicalTrials.gov NCT02394574 ; September 2012.
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http://dx.doi.org/10.1186/s12940-021-00756-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243629PMC
June 2021

Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry.

Am J Hum Genet 2021 04 12;108(4):564-582. Epub 2021 Mar 12.

The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.

Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained ≤20 variants in the credible sets that jointly account for 99% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.
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http://dx.doi.org/10.1016/j.ajhg.2021.02.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059339PMC
April 2021

Incidence of postpartum urinary retention in a tertiary hospital in Ibadan, Nigeria.

Int J Gynaecol Obstet 2022 Jan 21;156(1):42-47. Epub 2021 Apr 21.

Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine/University College Hospital Ibadan, University of Ibadan, Ibadan, Oyo, Nigeria.

Objective: To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and associated risk factors.

Methods: A total of 250 women were recruited following vaginal delivery at the UCH, Ibadan. Sociodemographic and obstetrical data were collected using a pro forma. Transabdominal ultrasound scan of the urinary bladder was performed 6 hours after delivery to estimate the post-void residual bladder volume (PVRBV) of participants. PVRBV was compared with obstetrical characteristics and labor events. Data collected were analyzed using SPSS 17.0. The level of statistical significance was set at P value less than 0.05.

Results: The incidence of PUR was 17.6%. Women with PUR, had longer duration of first stage (591 versus 501 minutes; P = 0.001), and second stage (50 versus 32 minute; P < 0.001) of labor compared with those without PUR. There was evidence that augmentation of labor (P < 0.01), catheterization during labor (P < 0.01), perineal injury (P < 0.01), and episiotomy (P < 0.01) were associated with developing PUR. Also, women with PUR were more likely to experience storage and obstructive urinary symptoms than those without PUR. Resolution of PUR occurred within 24 hours.

Conclusion: This study showed that postpartum urinary retention is relatively common following vaginal delivery. Awareness of risk factors will increase index of suspicion especially in women with storage and obstructive symptoms.
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http://dx.doi.org/10.1002/ijgo.13659DOI Listing
January 2022

Impact of prenatal and postnatal household air pollution exposure on lung function of 2-year old Nigerian children by oscillometry.

Sci Total Environ 2021 Feb 5;755(Pt 2):143419. Epub 2020 Nov 5.

Department of Medicine and Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021, Chicago, IL 60637, USA; Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 6076, Chicago, IL 60637, USA. Electronic address:

Rationale: Lung function is adversely affected by exposure to household air pollution (HAP). Studies investigating the impact of prenatal and postnatal HAP exposure on early childhood lung development are limited, especially from Sub-Saharan Africa.

Objective: We used oscillometry to investigate the impact on lung function of prenatal and postnatal HAP exposure of children born to Nigerian women who participated in a randomized controlled cookstove intervention trial.

Methods: We performed oscillometric measurements (R: airway resistance; X: airway reactance; Fres: resonant frequency; AX: reactance area) in 223 children starting at age of 2 years (ethanol stove, n = 113; firewood/kerosene, n = 110). Personal exposure monitoring assessed mothers' prenatal exposure to particulate matter less than 2.5 μm in aerodynamic diameter (PM). Postnatal HAP exposure was measured by determining household PM levels. We employed linear regression analysis to examine the association of prenatal and postnatal HAP exposures with children's lung function. Models were adjusted for age, gender, weight, height, group (intervention or control), birthweight and gestational age.

Results: Mean age of the children was 2.9 years (standard deviation = 0.3); 120 were boys (53.8%) and 103 were girls (46.2%). Higher postnatal PM exposures were significantly associated with higher airway reactance at 5 Hz (X5 Hz; p = 0.04) in adjusted models. There were no significant associations between prenatal or postnatal PM exposure levels and other oscillometry parameters in adjusted regression analysis.

Conclusions: This is the first study to use oscillometry to explore the relationship between HAP exposure and lung function in children as young as 2 years. The findings provide some evidence that increased postnatal HAP exposure may result in poorer lung function in children, although larger studies are needed to confirm observed results. This study indicates that oscillometry is a low-cost and effective method to determine lung function in early childhood.
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http://dx.doi.org/10.1016/j.scitotenv.2020.143419DOI Listing
February 2021

Factors associated with the awareness of vaginal fistula among women of reproductive age: findings from the 2018 Nigerian demographic health cross-sectional survey.

BMJ Open 2020 11 12;10(11):e040078. Epub 2020 Nov 12.

Centre for Population and Reproductive Health, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria.

Introduction: Involuntary leakage of urine and or stool per vaginam (vaginal fistula) after childbirth remains a public health challenge in Africa and South East Asia. To the best of our knowledge, there is no previous national data that examined the awareness of vaginal fistula among women in Nigeria.

Aim: To determine the prevalence of awareness of urinary/faecal incontinence due to vaginal fistula, and the associated risk factors among women with no previous experience of incontinence.

Methods: We used a cross-sectional study, the 2018 Nigerian Demographic Health Survey, to analyse awareness of vaginal fistula among women with no previous leakage of urine or stool. The primary outcome was childbirth experience, and other variables were demographics, access to information and reproductive or sexual history. The descriptive, univariate and multivariable models were presented.

Results: Of 26 585 women interviewed, 50 (0.2%) who had experienced fistula were excluded from the risk factor analysis. The mean age of women with childbirth experience was 32.8±8.6 years, while that of women without childbirth experience was 20.3±6.2 years. The prevalence of vaginal fistula awareness was 52.0%. Factors associated with the awareness include the following: childbirth experience (adjusted OR (AOR)=1.14; 95% CI, 1.01 to 1.30); age of 20-24 years (AOR=1.36; 95% CI, 1.18 to 1.56) and older; currently working (AOR=1.35; 95% CI, 1.22 to 1.49) and ownership of a mobile phone (AOR=1.16; 95% CI, 1.05 to 1.27). Other associated factors include the following: having at least secondary education; wealth quintiles, ethnicity, regional location, religion, access to radio, newspaper and internet; age up to 17 years at first sex; history of previous termination of pregnancy and use of contraception.

Conclusion: A significant number of young women with no childbirth experience had low level of awareness. We recommend vaginal fistula awareness programmes that will target women at risk of vaginal fistula and the inclusion of other useful questions to improve the quality of information in future surveys.
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http://dx.doi.org/10.1136/bmjopen-2020-040078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662540PMC
November 2020

Factors promoting sustainability of NURHI programme activities in Ilorin and Kaduna, Nigeria: findings from a qualitative study among health facility staff.

BMJ Open 2020 10 29;10(10):e034482. Epub 2020 Oct 29.

Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.

Objectives: The Nigerian Urban Reproductive Health Initiative (NURHI) was implemented in six urban sites in Nigeria from 2009 to early 2015. Under a second phase (NURHI-2), activities ceased operations in four of the original six sites in 2015 (Ilorin, Abuja, Benin City and Zaria), and continued in two sites (Kaduna and Ibadan). This paper examines the sustainability of facility-based intervention activities implemented under NURHI-1 in Ilorin and Kaduna.

Methods: A qualitative study that used in-depth interviews was conducted with 31 service providers purposively selected from 10 of the NURHI-1 intervention facilities in Ilorin and six in Kaduna. Interviews were digitally recorded and transcripts uploaded into ATLAS.ti for analysis. Structured observations to document renovations implemented during the NURHI-1 interventions were also conducted in the health facilities.

Results: Family planning (FP) awareness creation within the facilities and integration of FP into existing maternal and child health and HIV services, were sustained in both cities. The majority of the equipment supplied as part of the NURHI 72-hour clinic makeover were still functional in both cities. Respondents in both cities reported that FP awareness and demand were sustained. On the whole, challenges with sustaining activities were reported more among respondents in Ilorin than Kaduna. In Ilorin, NURHI outreach activities and trainings, had discontinued while in Kaduna, they were no longer being implemented to the same degree as occurred during NURHI-1. Inadequate funds was a major reason for discontinued activities in both cities while integration of FP into existing services enhanced sustainability.

Conclusions: Many activities were not sustained in Ilorin compared with Kaduna although FP awareness and demand remained high in both cities. Integration of FP into existing services promoted sustainability in Ilorin and Kaduna. A gradual closeout of donor projects with concomitant input from government and indigenous institutions could be useful in sustaining donor activities.
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http://dx.doi.org/10.1136/bmjopen-2019-034482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597523PMC
October 2020

Factors associated with induced abortion among women of reproductive age attending selected health facilities in Addis Ababa, Ethiopia: a case control study.

BMC Womens Health 2020 09 3;20(1):188. Epub 2020 Sep 3.

Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Background: There has been a significant reduction of abortion rates in high-income countries, while the rates remain unchanged in low- and middle-income countries. In Ethiopia, for example, the number of women of reproductive age seeking an induced abortion is increasing. However, there is limited information concerning the reasons why the occurrence of this procedure is increasing. Thus, this study aimed to identify factors associated with having induced abortion in Addis Ababa, Ethiopia.

Methods: An unmatched case-control study was conducted using a semi-structured, interviewer-administered questionnaire from October to December 2017. The cases were 147 women of reproductive age who underwent abortion in a health facility or presented with complications due to induced abortion conducted outside the health facility. The controls were 295 women who came for antenatal care and who reported never having had an induced abortion. The cases were selected by consecutive sampling from nine health facilities, whereas the controls were selected by systematic sampling from the same health facilities. Bivariate and multivariate logistic regression models were employed using STATA version 14 to identify factors associated with induced abortion.

Results: The mean age of cases was 26.5 ± 5.7 years, while for the controls it was 28.1 ± 4.8 years. Being unmarried (AOR = 9.6; 95% CI: 1.5-61.7), having primary (AOR = 5.3; 95% CI: 1.5-18.3) and tertiary (AOR = 5.7; 95% CI: 1.6-21.1) education, earning monthly income 100-300 USD (AOR = 0.2; 95% CI: 0.1-0.4) and >  300 USD (AOR = 0.1; 95% CI: 0.0-0.2), initiating first intercourse between ages of 15 and 19 (AOR = 4.7; 95% CI: 1.4-15.6), marrying before the age of 18 (AOR = 2.9; 95% CI: 1.3-6.7), and having two children (AOR = 4.7; 95% CI: 1.8-12.7) were independent predictors of induced abortion.

Conclusion: Family planning programs hoping to reduce the occurrence of induced abortion should specifically target unmarried women, low income, and those who have two children. The government should also work on preventing early marriage and providing sexual and reproductive health education to help adolescents delay age at first sexual experience.
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http://dx.doi.org/10.1186/s12905-020-01023-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469090PMC
September 2020

Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers.

Pan Afr Med J 2020 18;36:22. Epub 2020 May 18.

Centre for Population and Reproductive Health, Ibadan, Nigeria.

Obstetric fistula (OF) remain a source of public health concern and one of the most devastating maternal morbidities afflicting about two million women, mostly in developing countries. It is still prevalent in Nigeria due to the existence of socio-cultural beliefs/practices, socio-economic state and poor health facilities. The country's estimated annual 40,000 pregnancy-related deaths account for about 14% of the global maternal mortality, placing it among the top 10 most dangerous countries in the world for a woman to give birth. However, maternal morbidities including OF account for 20 to 30 times the number of maternal mortalities. This review substantiates why OF is yet to be eliminated in Nigeria as one of the countries with the largest burden of obstetric fistula. There is need for coordinated response to prevent and eliminate this morbidity via political commitment, implementation of evidence-based policy and execution of prevention programs.
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http://dx.doi.org/10.11604/pamj.2020.36.22.22204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388624PMC
December 2020

Implementing oncology clinical trials in Nigeria: a model for capacity building.

BMC Health Serv Res 2020 Aug 3;20(1):713. Epub 2020 Aug 3.

Section of Hematology Oncology, University of Chicago, Chicago, USA.

Background: There is both higher mortality and morbidity from cancer in low and medium income countries (LMICs) compared with high income countries (HICs). Clinical trial activities and development of more effective and less toxic therapies have led to significant improvements in morbidity and mortality from cancer in HICs. Unfortunately, clinical trials remain low in LMICs due to poor infrastructure and paucity of experienced personnel to execute clinical trials. There is an urgent need to build local capacity for evidence-based treatment for cancer patients in LMICs.

Methods: We conducted a survey at facilities in four Teaching Hospitals in South West Nigeria using a checklist of information on various aspects of clinical trial activities. The gaps identified were addressed using resources sourced in partnership with investigators at HIC institutions.

Results: Deficits in infrastructure were in areas of patient care such as availability of oncology pharmacists, standard laboratories and diagnostic facilities, clinical equipment maintenance and regular calibrations, trained personnel for clinical trial activities, investigational products handling and disposals and lack of standard operating procedures for clinical activities. There were two GCP trained personnel, two study coordinators and one research pharmacist across the four sites. Interventions were instituted to address the observed deficits in all four sites which are now well positioned to undertake clinical trials in oncology. Training on all aspects of clinical trial was also provided.

Conclusions: Partnerships with institutions in HICs can successfully identify, address, and improve deficits in infrastructure for clinical trial in LMICs. The HICs should lead in providing funds, mentorship, and training for LMIC institutions to improve and expand clinical trials in LMIC countries.
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http://dx.doi.org/10.1186/s12913-020-05561-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397583PMC
August 2020

Miscarriage, stillbirth, and infant death in an oil-polluted region of the Niger Delta, Nigeria: A retrospective cohort study.

Int J Gynaecol Obstet 2020 Sep 25;150(3):361-367. Epub 2020 Jun 25.

Department of Obstetrics and Gynecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria.

Objective: To determine the association between oil pollution and miscarriage, stillbirth, and infant death in the Niger Delta region of Nigeria.

Methods: A retrospective cohort study was undertaken of pregnant women (aged 18-45 years) who attended selected health facilities in regions with high and low exposure to oil pollution from May 14, 2018, to September 27, 2018. A multistage sampling technique was used to randomly select a representative of women with high and low exposure to oil pollution. An interviewer-administered questionnaire was used for data collection. Bivariate and multivariable logistic regression analyses were employed to adjust for confounding factors of miscarriage, stillbirth, and infant death.

Results: In total, 1564 pregnant women were included in the study. Women with high exposure to oil pollution were more likely to experience stillbirth (odds ratio [OR] 1.806; 95% confidence interval [CI] 1.177-2.770) and infant death (OR 2.162; 95% CI 1.409-3.317). However, after adjusting for potential confounders, only infant death was associated with high exposure (adjusted OR 1.843; 95% CI 1.146-2.962). No association was found between miscarriage and high exposure to oil pollution.

Conclusion: Women with high exposure to oil pollution are at higher risk of infant death.
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http://dx.doi.org/10.1002/ijgo.13259DOI Listing
September 2020

A Social Media-Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial.

J Med Internet Res 2020 06 2;22(6):e18343. Epub 2020 Jun 2.

FHI 360, Durham, NC, United States.

Background: Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with younger children or adults. Despite poorer health outcomes, few interventions target youth specifically. Expanding access to mobile phone technology, in low- and middle-income countries (LMICs) in particular, has increased interest in using this technology to improve health outcomes. mHealth interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMICs.

Objective: This study aimed to test the effectiveness of a structured support group intervention, Social Media to promote Adherence and Retention in Treatment (SMART) Connections, delivered through a social media platform, on HIV treatment retention among YLHIV aged 15 to 24 years and on secondary outcomes of antiretroviral therapy (ART) adherence, HIV knowledge, and social support.

Methods: We conducted a parallel, unblinded randomized controlled trial. YLHIV enrolled in HIV treatment for less than 12 months were randomized in a 1:1 ratio to receive SMART Connections (intervention) or standard of care alone (control). We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews with subsets of intervention group participants. The primary outcome was retention in HIV treatment. We conducted a time-to-event analysis examining time retained in treatment from study enrollment to the date the participant was no longer classified as active-on-treatment.

Results: A total of 349 YLHIV enrolled in the study and were randomly allocated to the intervention group (n=177) or control group (n=172). Our primary analysis included data from 324 participants at endline. The probability of being retained in treatment did not differ significantly between the 2 study arms during the study. Retention was high at endline, with 75.7% (112/163) of intervention group participants and 83.4% (126/161) of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant differences were found for ART adherence or social support. Intervention group participants overwhelmingly reported that the intervention was useful, that they enjoyed taking part, and that they would recommend it to other YLHIV.

Conclusions: Our findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Retention was greater than anticipated in both groups, likely a result of external efforts that began partway through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence, and social support in ways that were not captured quantitatively. Web-based delivery of support group interventions can permit people to access information and other group members privately, when convenient, and without travel. Such digital health interventions may help fill critical gaps in services available for YLHIV.

Trial Registration: ClinicalTrials.gov NCT03516318; https://clinicaltrials.gov/ct2/show/NCT03516318.
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http://dx.doi.org/10.2196/18343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298637PMC
June 2020

Economic status, a salient motivator for medicalisation of FGM in sub-Saharan Africa: Myth or reality from 13 national demographic health surveys.

SSM Popul Health 2020 Aug 20;11:100602. Epub 2020 May 20.

Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Female Genital Mutilation or Cutting (FGM) and its medicalisation remain a challenge in sub-Sahara African (SSA). Early identification of at-risk women might help in instituting focused counselling against FGM medicalisation. We hypothesised that the risk of medicalised FGM by girls/women is associated with socioeconomic status (SES) their household belongs. We used 2010-2019 Demographic and Health surveys data from 13 countries in SSA. We analysed information on 214,707 women (Level 1) nested within 7299 neighbourhoods (Level 2) from the 13 countries (Level 3). We fitted 5 multivariable binomial multilevel logistic regression models using the MLWin 3.03 module in Stata. The estimation algorithms adopted was the first order marginal quasi-likelihood linearisation using the iterative generalised least squares. The odds of FGM medicalisation increased with the wealth status of the household of the woman, with 29%, 45%- and 75%-times higher odds in the middle, richer and richest household wealth quintiles, respectively than those from the poorest households (p < 0.05). The more educated a woman and the better a woman's community SES was, the higher her odds of reporting medicalisation of FGM. Rural community was associated with higher odds of medicalised FGM than urban settings. Medicalised FGM is common among women from a high socioeconomic, educational background and rural settings of SSA. We recommend a culturally sensitive policy that will discourage perpetuation of FGM, particularly by healthcare providers. Future studies should focus on identifying drivers of FGM among the high social class families in the society in SSA.
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http://dx.doi.org/10.1016/j.ssmph.2020.100602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251377PMC
August 2020

Perception Determinants of Women and Healthcare Providers on the Effects of Oil Pollution on Maternal and Newborn Outcomes in the Niger Delta, Nigeria.

Int J Womens Health 2020 25;12:197-205. Epub 2020 Mar 25.

Department of Environmental Health, Faculty of Public Health, University of Ibadan, Ibadan, Oyo State, Nigeria.

Purpose: This qualitative study examined the perception determinants of women and their local healthcare providers on exposure to oil pollution and its adverse effects on maternal and newborn outcomes in selected communities with history of oil spillage and gas flaring in the Niger Delta region of Nigeria.

Participants And Methods: Thirty-nine participants were used in this study, which included community women leaders (n=2), women of reproductive ages (n=32) and healthcare providers (n= 3 female nurses and 2 male doctors) in the selected communities in the Niger Delta region of Nigeria. The participants were chosen through purposive sampling. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted among the participants and recorded in line with research protocols. The recordings of the FGDs and IDIs were transcribed, coded and analysed using Nvivo 10.

Results: Four major themes emerged relating to the perception determinants of women and healthcare workers on the effects of oil pollution on maternal and newborn outcomes. The first theme relates to the fact that personal experiences influence risk perception. The second theme associated perception with cultural norms, values and practices. The third theme shows that perception is influenced by the level of environmental threat or hazard, while the fourth theme borders around the influence of hospital-related factors on risk perception.

Conclusion: The study strongly suggested that both women and local healthcare providers perceived that oil pollution could have adverse effects on maternal and newborn outcomes. However, their perceptions were influenced by the cultural beliefs of the people, individual experiences, environmental and hospital-related factors. We believe that increasing awareness on the importance of attending antenatal care during pregnancy, making hospital charges affordable for pregnant women, and general environment conduciveness will improve maternal and newborn health in communities affected by oil pollution in the Niger Delta region.
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http://dx.doi.org/10.2147/IJWH.S235536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104144PMC
March 2020

Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study.

BMC Complement Med Ther 2020 Mar 20;20(1):93. Epub 2020 Mar 20.

Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA.

Background: Previous research has revealed high rates of traditional medicine usage in Nigeria. Reports of widespread contamination of herbal medicine products and higher rates of noncompliance with Western medications among traditional medicine users have raised concerns about the safety of traditional medicine use. Few studies have explored how demographic factors predict rates of traditional medicine use in the general population.

Methods: We conducted interviews of 748 adult women recruited from the communities in the city of Ibadan, Nigeria from 2013 to 2015. A structured questionnaire was created to collect data on rates of traditional medicine use and demographic factors such as age, education, ethnicity, and occupation. Multivariate logistic regressions were run to examine factors related to traditional medicine use, and the effects were measured with odds ratios (OR) along with 95% confidence interval (95%CI).

Results: The overall proportion of traditional medicine use was 81.6%. Women from the Ibo and Hausa ethnic groups were significantly less likely to use traditional medicine than the majority Yoruba group (OR 0.25, 95%CI 0.10-0.63;, OR 0.43, 95%CI 0.24-0.76) respectively). In addition, educated women were less likely than their non-educated counterparts to have used traditional medicine, with the biggest effect seen in women with a secondary education (OR 0.42, 95%CI 0.21-0.85).

Conclusions: We found a high rate of traditional medicine usage, consistent with that found in prior research. A novel finding was the significance of ethnicity as a predictor for usage rates.
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http://dx.doi.org/10.1186/s12906-020-02881-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083039PMC
March 2020

Breast Cancer Knowledge Assessment of Health Workers in Ibadan, Southwest Nigeria.

JCO Glob Oncol 2020 03;6:387-394

Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL.

Purpose: Breast cancer is the most common cancer among women, and in low- to middle-income countries late-stage diagnosis contributes to significant mortality. Previous research at the University College Hospital, a tertiary hospital in Ibadan, Nigeria, on social factors contributing to late diagnosis revealed that many patients received inappropriate initial treatment.

Methods: The level of breast cancer knowledge among health practitioners at various levels of the health system was assessed. We developed a tool tailored to local needs to assess knowledge of symptoms, risk factors, treatments, and cultural beliefs. The recruitment included doctors, nurses, and pharmacists in public hospitals, physicians and pharmacists in private practice, nurses and health care workers from primary health care centers, community birth attendants, and students in a health care field from state schools.

Results: A total of 1,061 questionnaires were distributed, and 725 providers responded (68%). Seventy-eight percent were female, and > 90% were Yoruba, the dominant local ethnic group. The majority were Christian, and 18% were Muslim. Median knowledge score was 31 out of 56, and the differences in scores between health care worker types were statistically significant ( < .001). Nearly 60% of the participants believed breast cancer is always deadly. More than 40% of participants believed that keeping money in the bra causes breast cancer, and approximately 10% believed that breast cancer is caused by a spiritual attack.

Conclusion: Our questionnaire revealed that, even at the tertiary care level, significant gaps in knowledge exist, and knowledge of breast cancer is unacceptably low at the level of community providers. In addition to efforts aimed at strengthening health systems, greater knowledge among community health care workers has the potential to reduce delays in diagnosis for Nigerian patients with breast cancer.
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http://dx.doi.org/10.1200/JGO.19.00260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126761PMC
March 2020

Knowledge of front-line health workers on the role of urethral catheterization for primary prevention of obstetric fistula in Ibadan, Nigeria.

Transl Androl Urol 2019 Aug;8(4):379-386

Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria.

Background: Obstetric fistula (OF), a preventable debilitating condition is mostly caused by prolonged obstructed labour (POL). The aim of bladder catheterization is to allow for healing process by preventing tension to adjoining tissues and improve blood supply. This study assessed the knowledge of catheterization in the prevention of OF among health workers in Ibadan, Nigeria.

Methods: A cross sectional study among 147 health workers providing obstetric care in the labour and post-delivery wards using a self-administered questionnaire in 10 selected primary health centres was conducted. The knowledge of catheterization for primary prevention of OF was assessed on a three-point scale. Data was analysed using SPSS version 20. Logistic regression was used to determine the association between health workers socio-demographics and professional characteristics and their knowledge of catheterization for OF prevention.

Results: The mean age of participants was 41.6 (SD =8.9) years. Fifty-six (38.1%) of the participants had good knowledge of catheterization for OF prevention. Higher proportion (41.3%) of registered nurses and/or midwives had good knowledge of catheterization for OF prevention compared to those who attended school of hygiene. Health workers who had practiced for between 7-9 years were about seven times more likely to have good knowledge of catheterization compared to those who had worked for less than 3 years (OR =6.929, 95% CI, 1.755-27.357).

Conclusions: Majority of health workers had poor knowledge of catheterization in OF prevention. There is need for training and re-training of health workers in primary health care centres (PHC) on the vital role of bladder catheterization following prolonged/obstructed labour so as to reduce the burden of OF.
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http://dx.doi.org/10.21037/tau.2019.03.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732097PMC
August 2019

Causes and remedies for low research productivity among postgraduate scholars and early career researchers on non-communicable diseases in Nigeria.

BMC Res Notes 2019 Jul 15;12(1):403. Epub 2019 Jul 15.

Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.

Objective: The aim of the descriptive, cross sectional, questionnaire-based study reported here was to explore the causes of low productivity in non-communicable diseases research among postgraduate scholars and early career researchers in Nigeria and identify measures that could facilitate increased research output.

Results: The 89 respondents were masters-level, doctoral scholars and resident doctors who attended a workshop. Majorities of the respondents (over 70%) either agreed or strongly agreed that factors contributing to poor non-communicable diseases research productivity include a dearth of in-country researchers with specialized skills, inability of Nigerian researchers to work in multidisciplinary teams, poor funding for health research, sub-optimal infrastructural facilities, and limited use of research findings by policy makers. Almost all the respondents (over 90%) agreed that potential strategies to facilitate non-communicable diseases research output would include increased funding for research, institutionalization of a sustainable, structured capacity building program for early career researchers, establishment of Regional Centers for Research Excellence, and increased use of research evidence to guide government policy actions and programs.
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http://dx.doi.org/10.1186/s13104-019-4458-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628473PMC
July 2019

Germline variants and somatic mutation signatures of breast cancer across populations of African and European ancestry in the US and Nigeria.

Int J Cancer 2019 12 27;145(12):3321-3333. Epub 2019 Jun 27.

Center for Clinical Cancer Genetics & Global Health, Department of Medicine, University of Chicago, Chicago, IL.

Somatic mutation signatures may represent footprints of genetic and environmental exposures that cause different cancer. Few studies have comprehensively examined their association with germline variants, and none in an indigenous African population. SomaticSignatures was employed to extract mutation signatures based on whole-genome or whole-exome sequencing data from female patients with breast cancer (TCGA, training set, n = 1,011; Nigerian samples, validation set, n = 170), and to estimate contributions of signatures in each sample. Association between somatic signatures and common single nucleotide polymorphisms (SNPs) or rare deleterious variants were examined using linear regression. Nine stable signatures were inferred, and four signatures (APOBEC C>T, APOBEC C>G, aging and homologous recombination deficiency) were highly similar to known COSMIC signatures and explained the majority (60-85%) of signature contributions. There were significant heritable components associated with APOBEC C>T signature (h = 0.575, p = 0.010) and the combined APOBEC signatures (h = 0.432, p = 0.042). In TCGA dataset, seven common SNPs within or near GNB5 were significantly associated with an increased proportion (beta = 0.33, 95% CI = 0.21-0.45) of APOBEC signature contribution at genome-wide significance, while rare germline mutations in MTCL1 was also significantly associated with a higher contribution of this signature (p = 6.1 × 10 ). This is the first study to identify associations between germline variants and mutational patterns in breast cancer across diverse populations and geography. The findings provide evidence to substantiate causal links between germline genetic risk variants and carcinogenesis.
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http://dx.doi.org/10.1002/ijc.32498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851589PMC
December 2019

Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors.

Obstet Gynecol Int 2019 10;2019:6456141. Epub 2019 Feb 10.

Genitourinary/Urogynaecology Unit, Faculty of Clinical Science, UI, Ibadan, Nigeria.

Background: Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury.

Methods: A retrospective data collection of UVF cases managed from January 2012-December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma.

Results: Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure.

Conclusion: Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.
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http://dx.doi.org/10.1155/2019/6456141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387707PMC
February 2019

Author Correction: Characterization of Nigerian breast cancer reveals prevalent homologous recombination deficiency and aggressive molecular features.

Nat Commun 2019 01 14;10(1):288. Epub 2019 Jan 14.

Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

The original version of this Article contained an error in the author affiliations. The affiliation of Kevin P. White with Tempus Labs, Inc. Chicago, IL, USA was inadvertently omitted. This has now been corrected in both the PDF and HTML versions of the Article.
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http://dx.doi.org/10.1038/s41467-018-07886-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331546PMC
January 2019

An Online Support Group Intervention for Adolescents Living with HIV in Nigeria: A Pre-Post Test Study.

JMIR Public Health Surveill 2018 Nov 28;4(4):e12397. Epub 2018 Nov 28.

Department of Reproductive, Maternal, Newborn and Child Health, Family Health International (FHI 360), Durham, NC, United States.

Background: Adolescents living with HIV (ALHIVs) enrolled in HIV treatment services experience greater loss to follow-up and suboptimal adherence than other age groups. HIV-related stigma, disclosure-related issues, lack of social support, and limited HIV knowledge impede adherence to antiretroviral therapy (ART) and retention in HIV services. The 90-90-90 goals for ALHIVs will only be met through strategies targeted to meet their specific needs.

Objectives: We aimed to evaluate the feasibility of implementing a social media-based intervention to improve HIV knowledge, social support, ART adherence, and retention among ALHIV aged 15-19 years on ART in Nigeria.

Methods: We conducted a single-group pre-post test study from June 2017 to January 2018. We adapted an existing support group curriculum and delivered it through trained facilitators in 5 support groups by using Facebook groups. This pilot intervention included five 1-week sessions. We conducted structured interviews with participants before and after the intervention, extracted clinical data, and documented intervention implementation and participation. In-depth interviews were conducted with a subset of participants at study completion. Quantitative data from structured interviews and group participation data were summarized descriptively, and qualitative data were coded and summarized.

Results: A total of 41 ALHIV enrolled in the study. At baseline, 93% of participants reported existing phone access; 65% used the internet, and 64% were Facebook users. In addition, 37 participants completed the 5-session intervention, 32 actively posted comments in at least one session online, and at least half commented in each of the 5 sessions. Facilitators delivered most sessions as intended and on-time. Participants were enthusiastic about the intervention. Aspects of the intervention liked most by participants included interacting with other ALHIVs; learning about HIV; and sharing questions, experiences, and fears. The key recommendations were to include larger support groups and encourage more group interaction. Specific recommendations on various intervention components were made to improve the intervention.

Conclusions: This novel intervention was feasible to implement in a predominantly suburban and rural Nigerian setting. Social media may be leveraged to provide much-needed information and social support on platforms accessible and familiar to many people, even in resource-constrained communities. Our findings have been incorporated into the intervention, and an outcome study is underway.

Trial Registration: ClinicalTrials.gov NCT03076996; https://clinicaltrials.gov/ct2/show/NCT03076996 (Archived by WebCite at http://www.webcitation.org/73oCCEBBC).
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http://dx.doi.org/10.2196/12397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291681PMC
November 2018

Characterization of Nigerian breast cancer reveals prevalent homologous recombination deficiency and aggressive molecular features.

Nat Commun 2018 10 16;9(1):4181. Epub 2018 Oct 16.

Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

Racial/ethnic disparities in breast cancer mortality continue to widen but genomic studies rarely interrogate breast cancer in diverse populations. Through genome, exome, and RNA sequencing, we examined the molecular features of breast cancers using 194 patients from Nigeria and 1037 patients from The Cancer Genome Atlas (TCGA). Relative to Black and White cohorts in TCGA, Nigerian HR + /HER2 - tumors are characterized by increased homologous recombination deficiency signature, pervasive TP53 mutations, and greater structural variation-indicating aggressive biology. GATA3 mutations are also more frequent in Nigerians regardless of subtype. Higher proportions of APOBEC-mediated substitutions strongly associate with PIK3CA and CDH1 mutations, which are underrepresented in Nigerians and Blacks. PLK2, KDM6A, and B2M are also identified as previously unreported significantly mutated genes in breast cancer. This dataset provides novel insights into potential molecular mechanisms underlying outcome disparities and lay a foundation for deployment of precision therapeutics in underserved populations.
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http://dx.doi.org/10.1038/s41467-018-06616-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191428PMC
October 2018

A longitudinal study of the prevalence and characteristics of breast disorders detected by clinical breast examination during pregnancy and six months postpartum in Ibadan, Southwestern Nigeria.

BMC Womens Health 2018 09 19;18(1):152. Epub 2018 Sep 19.

Centre for Population and Reproductive Health, College of Medicine, Ibadan, Nigeria.

Background: Breast disorders cause great anxiety for women especially when they occur in pregnancy because breast cancer is the most common cause of cancer related deaths in women. Majority of the disorders are Benign Breast Diseases (BBD) with various degrees of associated breast cancer risks. With increasing breast cancer awareness in Nigeria, we sought to determine the prevalence and characteristics of breast disorders among a cohort of pregnant women.

Methods: A longitudinal study of 1248 pregnant women recruited in their first trimester- till 26 weeks gestational age consecutively from selected antenatal clinics (ANCs), in Ibadan, Southwest Nigeria. A pretested interviewer- administered questionnaire was used to collect information at recruitment. Clinical Breast Examination (CBE) using MammaCare® technique was performed at recruitment and follow up visits at third trimester, six weeks postpartum and six months postpartum. Women with breast disorders were referred for Breast Ultrasound Scan (BUS) and those with Breast Imaging Reporting and Data System (BIRADS) ≥4 had ultrasound guided biopsy. Statistical analysis was performed using Stata version 14.

Results: Mean age of participants was 29.7 ± 5.2 years and mean gestational age at recruitment was 20.4 ± 4.4 weeks. Seventy-two participants (5.8%) had a past history of BBD and 345 (27.6%) were primigravidae. Overall, breast disorder was detected among 223 (17.9%) participants and 149 (11.9%) had it detected at baseline. Findings from the CBE showed that 208 (69.6%) of 299 breast disorders signs found were palpable lumps or thickenings in the breast, 28 (9.4%) were persistent pain, and 63 (21.1%) were abscesses, infection and mastitis. Twenty out of 127 (15.7%) participants who had BUS performed were classified as BIRADS ≥3. Lesions found by BUS were reactive lymph nodes (42.5%), prominent ducts (27.1%), fibroadenoma (9.6%), breast cysts (3.8%) and fibrocystic changes (2.5%). No malignant pathology was found on ultrasound guided biopsy.

Conclusions: Breast lump is a major breast disorder among pregnant women attending antenatal clinics in Ibadan. Routine clinical breast examination and follow up of pregnant women found with breast disorders could facilitate early detection of pregnancy associated breast cancer in low resource settings.
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http://dx.doi.org/10.1186/s12905-018-0647-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147054PMC
September 2018

Inherited Breast Cancer in Nigerian Women.

J Clin Oncol 2018 10 21;36(28):2820-2825. Epub 2018 Aug 21.

Yonglan Zheng, Shengfeng Wang, Dezheng Huo, Toshio F. Yoshimatsu, Jing Zhang, Gabriela E.S. Felix, and Olufunmilayo I. Olopade, The University of Chicago, Chicago, IL; Tom Walsh, Suleyman Gulsuner, Silvia Casadei, Ming K. Lee, and Mary-Claire King, University of Washington, Seattle, WA; Temidayo O. Ogundiran, Adeyinka Ademola, Adeyinka G. Falusi, Abideen O. Oluwasola, Adewumi Adeoye, Abayomi Odetunde, Chinedum P. Babalola, Oladosu A. Ojengbede, Stella Odedina, Imaria Anetor, University of Ibadan; Clement A. Adebamowo, Centre for Bioethics and Research, Ibadan, Oyo, Nigeria, and University of Maryland School of Medicine, Baltimore, MD; and Gabriela E.S. Felix, Fundação Oswaldo Cruz and Universidade Federal da Bahia, Bahia, Brazil.

Purpose: Among Nigerian women, breast cancer is diagnosed at later stages, is more frequently triple-negative disease, and is far more frequently fatal than in Europe or the United States. We evaluated the contribution of an inherited predisposition to breast cancer in this population.

Patients And Methods: Cases were 1,136 women with invasive breast cancer (mean age at diagnosis, 47.5 ± 11.5 years) ascertained in Ibadan, Nigeria. Patients were selected regardless of age at diagnosis, family history, or prior genetic testing. Controls were 997 women without cancer (mean age at interview, 47.0 ± 12.4 years) from the same communities. BROCA panel sequencing was used to identify loss-of-function mutations in known and candidate breast cancer genes.

Results: Of 577 patients with information on tumor stage, 86.1% (497) were diagnosed at stage III (241) or IV (256). Of 290 patients with information on tumor hormone receptor status and human epidermal growth factor receptor 2, 45.9% (133) had triple-negative breast cancer. Among all cases, 14.7% (167 of 1,136) carried a loss-of-function mutation in a breast cancer gene: 7.0% in BRCA1, 4.1% in BRCA2, 1.0% in PALB2, 0.4% in TP53, and 2.1% in any of 10 other genes. Odds ratios were 23.4 (95% CI, 7.4 to 73.9) for BRCA1 and 10.3 (95% CI, 3.7 to 28.5) for BRCA2. Risks were also significantly associated with PALB2 (11 cases, zero controls; P = .002) and TP53 (five cases, zero controls; P = .036). Compared with other patients, BRCA1 mutation carriers were younger ( P < .001) and more likely to have triple-negative breast cancer ( P = .028).

Conclusion: Among Nigerian women, one in eight cases of invasive breast cancer is a result of inherited mutations in BRCA1, BRCA2, PALB2, or TP53, and breast cancer risks associated with these genes are extremely high. Given limited resources, prevention and early detection services should be especially focused on these highest-risk women.
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http://dx.doi.org/10.1200/JCO.2018.78.3977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161833PMC
October 2018

Genetic variation in the Hippo pathway and breast cancer risk in women of African ancestry.

Mol Carcinog 2018 10 14;57(10):1311-1318. Epub 2018 Jun 14.

Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois.

Gene expression changes within the Hippo pathway were found to be associated with large tumor size and metastasis in breast cancer. The combined effect of genetic variants in genes of this pathway may have a causal role in breast cancer development. We examined 7086 SNPs that were not highly correlated (r  < 0.8) in 35 Hippo pathway genes using data from the genome-wide association study of breast cancer from the Root Consortium, which includes 3686 participants of African ancestry from Nigeria, United States of America, and Barbados: 1657 cases (403 estrogen receptor-positive [ER+], 374 ER-) and 2029 controls. Gene-level analyses were conducted using improved AdaJoint test for large-scale genetic association studies adjusting for age, study site and the first four eigenvectors from the principal component analysis. SNP-level analyses were conducted with logistic regression. The Hippo pathway was significantly associated with risk of ER+ breast cancer (pathway-level P = 0.019), with WWC1 (P = 0.04) being the leading gene. The pathway-level significance was lost without WWC1 (P = 0.12). rs147106204 in the WWC1 gene was the most statistically significant SNP after gene-level adjustment for multiple comparisons (OR = 0.53, 95%CI = 0.41-0.70, P  = 0.025). We found evidence of an association between genetic variations in the Hippo pathway and ER+ breast cancer. Moreover, WWC1 was identified as the most important genetic susceptibility locus highlighting the importance of genetic epidemiology studies of breast cancer in understudied populations.
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http://dx.doi.org/10.1002/mc.22845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662580PMC
October 2018
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