Papers by Bolajoko Olusanya
The level of clinical care and facilities to support the often more viable full-term newborns wit... more The level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings. However, the nature of the required care is not evident in current literature. This study therefore set out to determine maternal and perinatal profile of surviving full-term newborns with normal birth weight in a poorly-resourced setting. Methods: A retrospective cohort study of newborns with gestational age ≥37 weeks and birth weight ≥2500g recruited in an inner-city maternity hospital in Lagos, Nigeria. Primary factors/outcomes were determined by multivariate logistic regression analyses and population attributable risk (PAR). Results: Of the 2687 full-term newborns with normal birth weight studied, 242 (9.0%) were admitted into special care baby unit (SCBU) representing 53.6% of all SCBU admissions. Fetal distress, low 5minute Apgar scores, neonatal sepsis and hyperbilirubinemia as well as maternal factors such as primiparity, type of employment, lack of antenatal care and emergency cesarean delivery were predictive of SCBU admission. The leading contributors to SCBU admission were neonatal sepsis (PAR=96.8%), and hyperbilirubinemia (PAR=58.7%). Conclusion: A significant proportion of newborns requiring special care are full-term with normal birth weight and are associated with modifiable risk factors that can be effectively addressed at appropriately equipped secondary-level hospitals. Prenatal maternal education on avoidable risk factors is warranted.
To determine the pattern of and factors associated with changes in nutritional status in early in... more To determine the pattern of and factors associated with changes in nutritional status in early infancy in a resource-poor setting. A cohort study in Lagos, Nigeria, in which the nutritional status at birth was compared with status at the first postnatal check-up routinely scheduled for 6-8 weeks based on the World Health Organization's multicenter growth reference and the Centers for Disease Control and Prevention 2000 growth charts. Factors associated with improved, worsened or steady nutritional status at follow-up based on z-scores for weight-for-age, length-for-age and weight-for-length were determined with multinomial regression analysis. The mean length-for-age and weight-for-length based on the Centers for Disease Control and Prevention for the 445 full-term singletons studied were higher than the corresponding World Health Organization's multicenter growth reference values at birth and at follow-up, while mean weight-for-age was lower at birth but higher subsequently. Some 20.7% of infants were undernourished by at least one nutritional measure initially, which declined to 16.4% at follow-up. Also 8.1% of the infants remained undernourished, 8.3% became undernourished, and 5.6% became well-nourished at follow-up. Low birthweight full-term infants were significantly likely to remain undernourished (p < 0.001) or become well-nourished (p < 0.001) at follow-up while the offspring of elderly mothers (p = 0.024) or first-time mothers (p = 0.036) had an elevated risk of remaining undernourished by at least one measure at follow-up. Many infants are likely to exhibit individual nutritional changes at variance with the overall/summary trend. Those whose nutritional status is likely to deteriorate or remain poor require timely intervention to minimize the risk of subsequent developmental delays/deficits from early infancy.
Archives of Disease in Childhood, 2008
Journal of global health, 2016
In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater nu... more In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assess...
International journal of audiology
The aim of this study was to evaluate self-reported outcomes among hearing aid users (age 16-89 y... more The aim of this study was to evaluate self-reported outcomes among hearing aid users (age 16-89 years; mean 45.8 years) to determine the effectiveness of aural rehabilitation in Nigeria based on the International Outcome Inventory for Hearing Aids (IOI-HA). The responses were evaluated with descriptive statistics, factor analysis of the principal components and multiple regressions. Most respondents reported favorable outcomes in all domains of the inventory, comprising: daily use (mean 4.1; SD 1.2), benefits (mean 3.5; SD 1.1), residual activity limitation (mean 3.4; SD 1.2), satisfaction (mean 3.7; SD 1.2), residual participation restriction (mean 3.5; SD 1.3), impact on others (mean 3.4; SD 1.3) and changes in quality of life (mean 3.8; SD 1.0). The mean score distribution compared favorably with those reported in the developed world. There were significant intercorrelations among all items, and two factors (eigenvalue>1) accounted for 68% of the underlying variance. Impact on...
The Pediatric Infectious Disease Journal, 2015
Dried saliva specimens from 263 neonates in Lagos, Nigeria, were tested for cytomegalovirus (CMV)... more Dried saliva specimens from 263 neonates in Lagos, Nigeria, were tested for cytomegalovirus (CMV) using real-time polymerase chain reaction. The results for 10 infants (3.8%, 95% confidence interval, 2.1-6.8) were found to be positive. Congenital CMV infection was not associated with any of the demographic or maternal factors including HIV. These data demonstrate the high prevalence of congenital CMV infection and the feasibility of CMV screening by real-time polymerase chain reaction testing.
International Journal of Pediatric Otorhinolaryngology, 2011
PLOS ONE, 2015
Available evidence suggests that low-and middle-income countries (LMICs) bear the greatest burden... more Available evidence suggests that low-and middle-income countries (LMICs) bear the greatest burden of severe neonatal hyperbilirubinemia characterized by disproportionately high rates of morbidity, mortality and neurodevelopmental disorders compared to high-income countries. We set out to identify the risk factors that contribute to the burden of severe hyperbilirubinemia in the most developmentally disadvantaged LMICs to highlight areas for action and further research.
The paucity of up-to-date and representative epidemiological data on hearing disorders in Nigeria... more The paucity of up-to-date and representative epidemiological data on hearing disorders in Nigeria has been observed as undermining the effective advocacy of prevention initiatives. This study attempts to address this problem by evaluating the prevalence and pattern of hearing impairment in school entrants. Parental interviews, otoscopy, pure-tone audiometric screening (frequency 0.5-4 kHz) and tympanometric examinations were conducted for a representative sample of 359 school children in an inner city area of Lagos. The prevalence of hearing loss was 13.9%. Middle ear abnormalities were noted in 20.9% of the study population, of which 18.7% were reported with otitis media with effusion. Impacted cerumen, documented in 189 children (52.6%), was the most common disorder. It showed significant association with hearing loss (P<0.001) and school performance (P<0.01). Tympanic membrane abnormalities were observed in 144 (40.1%) children. Of these, 45 (31.3%) showed abnormal tympanograms while 28 (19.4%) reported hearing loss (P<0.05). The early detection and management of hearing problems is relatively rare, thus precluding the determination of possible aetiological factors for the observed abnormalities. Poor public awareness, dearth of relevant facilities and the lack of early screening programmes are major known contributory factors. The well established national immunisation programme offers a cost-effective platform within the primary health-care system for addressing the high prevalence of hearing abnormalities in school children.
The late detection of permanent congenital and early-onset hearing loss (PCEHL) often has severe ... more The late detection of permanent congenital and early-onset hearing loss (PCEHL) often has severe effects on linguistic, speech, cognitive and educational development in affected children. Since newborn hearing screening (NHS) allows most PCEHL to be detected early enough for optimal intervention, the prospects of its introduction in the developing world are reviewed in this paper. It is observed that a simple generalisation on the feasibility of NHS for the developing countries seems inappropriate in view of the diversities in the health and socio-economic status of these countries and the recent favourable reports of universal newborn hearing screening from the region. NHS empowers parents to make timely choices that will allow their hearing impaired children to be given a good start in life and be fully integrated into the wider community. It also compels attention towards the development of essential hearing healthcare services, besides the specific documented benefits. Existing child-healthcare structures such as the expanded programme on immunisation (EPI), baby friendly hospital initiatives (BFHI) and integrated management of childhood illness (IMCI) provide opportunities for the introduction of some form of NHS in many of these countries where routine or systematic childhood hearing screening does not exist. Limited funding, manpower shortages, inadequate support services, low public awareness and the uncertainty regarding the commitment from healthcare practitioners may present some challenges but these are not insurmountable. Pilot studies are necessary in each country to provide empirical data that will guide healthcare providers who wish to introduce such a programme at any level of healthcare delivery.
Newborn hearing screening has been recognized as an essential component of public health care in ... more Newborn hearing screening has been recognized as an essential component of public health care in early childhood in developed countries. However, such screening is yet to be widely embraced in the developing world. The new national health policy in Nigeria seeks, for the first time, to reduce the impact of permanent hearing loss on early childhood development through early detection and timely intervention services. The aim of this paper is to ascertain if newborn hearing screening satisfies the conventional criteria for a screening programme as an early detection strategy in this developing country. A review of the available literature shows that permanent childhood hearing loss is a significant health condition and its detection through screening with oto-acoustic emissions and/or auditory brainstem response is feasible in the target population. Amplification with hearing aids is an effective and preferred option for early intervention by parents. The risk of maternal anxiety from potential falsepositives or the psychological cost of false assurance from false-negatives is unlikely to outweigh the benefit of screening. Newborn hearing screening is therefore a potential early detection strategy for permanent childhood hearing loss in Nigeria.
Background: Parental support for infant hearing loss is essential for a successful infant screeni... more Background: Parental support for infant hearing loss is essential for a successful infant screening programme. However, in developing countries where unfavourable customs and beliefs towards childhood disabilities have been reported, parental support towards infant screening is uncertain and there is presently no published evidence on the subject. Objective: To elicit the views of mothers and would-be mothers in order to ascertain their knowledge on infant hearing loss and their attitudes towards infant hearing screening. Methods: A structured questionnaire consisting of 15 questions was administered to 101 mothers (mean age 31.6 AE 7.3 years, range: 21-55 years) attending two community hospitals in Lagos, Nigeria. The responses were evaluated by descriptive statistics, factor analysis of the principal components and multiple regression analysis. The reliability of the two main domains (knowledge and attitude) was tested for internal consistency by Cronbach's alpha coefficient. Results: Maternal knowledge was highest for measles (73%; mean score 2.54) and ear discharge (73%; mean score 2.51) but low for birth asphyxia (37%; mean score 1.90), traditional medicine (42%; mean score 2.03) and jaundice (47%; mean score 2.09) as causes of hearing loss. Attitude towards neonatal screening was positive in majority of mothers (92%; mean score 2.84) and there was a high acceptance of hearing aids as an early intervention option (84%; mean score 2.70). Five factors (eigenvalue > 1) were
BMC Health Services Research, 2007
Background: Early detection of infants with permanent hearing loss through infant hearing screeni... more Background: Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region.
Objective: To determine the feasibility and effectiveness of hospital-based universal newborn hea... more Objective: To determine the feasibility and effectiveness of hospital-based universal newborn hearing screening programme for the early detection of permanent congenital or early-onset hearing loss (PCEHL) in Lagos, Nigeria. Methods: A cross-sectional pilot study based on a two-stage universal newborn hearing screening by non-specialist health workers using transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem-response (AABR) in an innercity maternity hospital over a consecutive period of 40 weeks. The main outcome measures were the practicality of screening by non-specialist staff with minimal training, functionality of screening instruments in an inner-city environment, screening coverage, referral rate, return rate for diagnosis, yield of PCEHL and average age of PCEHL confirmation. Results: Universal hearing screening of newborns by non-specialist staff without prior audiological experience is feasible in an inner-city environment in Lagos after a training period of two-weeks. Notwithstanding excessive ambient noise within and outside the wards, it was possible to identify a test site for TEOAE screening within the hospital. The screening coverage was 98.7% (1330/1347) of all eligible newborns and the mean age of screening was 2.6 days. Forty-four babies out of the 1274 who completed the two-stage screening were referred yielding a referral rate of 3.5%.
objectives To establish the incidence, correlates and hearing screening outcomes of infants with ... more objectives To establish the incidence, correlates and hearing screening outcomes of infants with severe neonatal jaundice in Nigeria.
Hearing loss is the most prevalent chronic disability and a major contributor to the global burde... more Hearing loss is the most prevalent chronic disability and a major contributor to the global burden of disease. Its effects are far-reaching and can lead to severely restricted developmental outcomes for children and limited vocational prospects for adults. The benefits of intervention are dramatic and can significantly improve developmental outcomes, especially in infants identified early. Hearing health care services in developing regions such as sub-Saharan Africa are however severely limited, leaving affected individuals without access to secondary and tertiary intervention. Tele-audiology has potential for improved access to specialist hearing health services including identification, diagnosis and intervention. There has been limited experience so far with tele-audiology in industrialized countries. In the sub-Saharan region, the continued growth in Internet connectivity and general technological advances make tele-audiology an important approach to consider in the management of hearing loss. Pilot studies are warranted to investigate the potential obstacles to the widespread implementation of telehealth in the delivery of hearing health care in poorly-resourced communities, in line with World Health Organization initiatives.
Developing countries account for a disproportionate burden of infant hearing loss globally but th... more Developing countries account for a disproportionate burden of infant hearing loss globally but the prospects of the more ideal universal newborn hearing screening (UNHS) have been debated. The Joint Committee on Infant Hearing (JCIH) of USA has consistently proposed targeted newborn hearing screening (TNHS) for such countries. This study therefore set out to examine the appropriateness of JCIH risk factors as a basis for TNHS in Sub-Saharan Africa and Southeast Asia. From a review of relevant literature published in PubMed in the last 10 years, evidence on the effectiveness of TNHS based on JCIH or other risk factors is sparse or limited. Consistent with the prevailing epidemiological profile of these countries additional putative risk factors not listed or more prevalent than those listed by JCIH such as maternal hypertensive disorders in pregnancy, lack of skilled attendant at delivery, non-elective cesarean delivery and infant undernutrition have been demonstrated besides consanguinity. While TNHS has intuitive appeal in resource-poor settings, it is likely to be fraught with diverse operational constraints that could significantly curtail its effectiveness in these two regions. Well-conducted pilot UNHS studies to determine context-specific risk factors, screening efficiency and the potential trade-offs are warranted in each country prior to embarking on TNHS where UNHS is not immediately practicable.
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Papers by Bolajoko Olusanya