G. Falade - Academia.edu (original) (raw)

Papers by G. Falade

Trials, Apr 12, 2024

Background Preterm birth complications are the leading cause of newborn and under-5 mortality. Ov... more Background Preterm birth complications are the leading cause of newborn and under-5 mortality. Over 85% of all preterm births occur in the late preterm period, i.e. between 34 and < 37 weeks of gestation. Antenatal corticosteroids (ACS) prevent mortality and respiratory morbidity when administered to women at high risk of an early preterm birth, i.e. < 34 weeks' gestation. However, the benefits and risks of ACS in the late preterm period are less clear; both guidelines and practices vary between settings. Emerging evidence suggests that the benefits of ACS may be achievable at lower doses than presently used. This trial aims to determine the efficacy and safety of two ACS regimens compared to placebo, when given to women with a high probability of late preterm birth, in hospitals in low-resource countries. Methods WHO ACTION III trial is a parallel-group, three-arm, individually randomized, double-blind, placebo-controlled trial of two ACS regimens: dexamethasone phosphate 4 × 6 mg q12h or betamethasone phosphate 4 × 2 mg q 12 h. The trial is being conducted across seven sites in five countries-Bangladesh, India, Kenya, Nigeria, and Pakistan. Eligible women are those with a gestational age between 34 weeks 0 days and 36 weeks 5 days, who have

Pediatric Research, Jan 8, 2024

BACKGROUND: Moderate-to-late preterm infants (32-34 weeks GA) have increased risk of neonatal mor... more BACKGROUND: Moderate-to-late preterm infants (32-34 weeks GA) have increased risk of neonatal morbidities compared to term infants, however dedicated nutritional guidelines are lacking. METHODS: Moderate-to-late preterm infants received a preterm formula (n = 17) or breastmilk (n = 24) from age 2-10 weeks in a non-randomized, open-label observational study. Anthropometric measurements were assessed biweekly. Blood concentrations of hemoglobin, ferritin, serum retinol, and 25-hydroxy-vitamin D (25OHD) were analyzed at age 2 and 10 weeks. RESULT: Average growth per day was 14.7 g/kg BW/day in formula-fed and 12.8 g/kg BW/day in breastmilk-fed infants but not different from each other. Length and head circumference in both groups were in line with the median reference values of the Fenton growth chart. At 10 weeks of age, hemoglobin tended to be higher in the formula-fed group (10.2 g/dL vs. 9.6 g/dL, p = 0.053). 25OHD increased in formula-and breastmilk-fed infants from 73.8 to 180.9 nmol/L and from 70.7 to 97.6 nmol/L, respectively. Serum retinol only increased in the formula-fed group (0.63 to 1.02 µmol/L, p < 0.001). CONCLUSION: Breastfeeding resulted in adequate growth in moderate-late preterm infants but was limiting in some micronutrients. The preterm formula provided adequate micronutrients, but weight gain velocity was higher than the Fenton reference value.

Data Collection Forms. (ZIP 2651 kb)

International Health, Mar 21, 2019

Background: Oxygen is an essential medical therapy that is poorly available globally. We evaluate... more Background: Oxygen is an essential medical therapy that is poorly available globally. We evaluated the quality of oxygen therapy in 12 secondary-level Nigerian hospitals, including access to oxygen equipment, equipment functionality, healthcare worker knowledge and appropriateness of use. Methods: We conducted a three-part evaluation of oxygen access and use involving: (1) facility assessment (including technical evaluation of oxygen equipment), (2) clinical audit (children and neonates admitted January 2014-December 2015) and (3) survey of healthcare worker training and experience on the clinical use of oxygen (November 2015). Results: Oxygen access for children and newborns is compromised by faulty equipment, lack of pulse oximetry and inadequate care practices. One hospital used pulse oximetry for paediatric care. Eleven hospitals had some access to oxygen supplies. Testing of 57 oxygen concentrators revealed two (3.5%) that were 'fit for use'. Overall, 14.4% (3708/25 677) of children and neonates received oxygen some time during their admission; 19.4% (1944/10 000) of hypoxaemic children received oxygen; 38.5% (1217/3161) of children who received oxygen therapy were not hypoxaemic. Conclusions: Oxygen access for children in Nigerian hospitals is poor, and likely results in substantial excess mortality. To improve oxygen access for children globally we must focus on actual provision of oxygen to patients-not simply the presence of oxygen equipment at the facility level. This requires a systematic approach to improve both oxygen (access [including equipment, maintenance and affordability]) and oxygen use (including pulse oximetry, guidelines and continuing education).

Frontiers in Public Health

BackgroundBetween 2013 and 2022, Nigeria did not meet globally defined targets for pneumonia cont... more BackgroundBetween 2013 and 2022, Nigeria did not meet globally defined targets for pneumonia control, despite some scale-up of vaccinations, oxygen and antibiotics. A deliberate focus on community-based programs is needed to improve coverage of protective, preventive and treatment interventions. We therefore aimed to describe caregiver knowledge and care seeking behaviour for childhood pneumonia, in a high child mortality setting in Nigeria, to inform the development of effective community-based interventions for pneumonia control.MethodsWe conducted a cross-sectional household survey in Kiyawa Local Government Area, Jigawa State, Nigeria between December 2019 and March 2020. We asked caregivers about their knowledge of pneumonia symptoms, prevention, risks, and treatment. A score of 1 was assigned for each correct response. We showed them videos of pneumonia specific symptoms and asked (1) if their child had any respiratory symptoms in the 2-weeks prior; (2) their subsequent care-s...

Nigerian Postgraduate Medical Journal

One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO)... more One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO). On the whole, one thousand, seven hundred and seventy nine (1,779) pleural spaces were studied, fifteen pleural spaces (0.8%), with mean age of 23 +/- 4.5 years had RPO. Among these 15 patients with RPO, the mean period of lung collapse before pneumothorax (PThx) was evacuated was 31.8 +/- 21.8 days and for hydrothorax (HThx) was 31.3 +/- 30.1 days; for 15 patients without RPO (controls), matched for age and sex, the mean period of lung collapse before CTTD was 7.5 +/- 4.1 days and 5.4 +/- 1.3 days respectively for PThx and HThx. The differences in the period of lung collapse among patients with RPO and those without, for each pleural disease was statistically significant (P < 0.03). Volume of pleural fluid drained before RPO was noticed was 2196 +/- 1103 mls, for the 15 matched patients without RPO (controls), it was 1060 +/- 115 mls (p < 0.05). Volume of pleural fluid drained among the patients with SR (Severe response), MR (mild to moderate response) and RD (radiological diagnosis) did not correlate with severity of response. We conclude that prevention of RPO is the desired goal in the management of pleural effusion or Pneumothorax. RPO is commonest among young patients who have had lung collapse for 7 or more days. In these circumstances RPO is prevented, its incidence and severity reduced by methods of gradual evacuation of PThx or pleural fluid drainage.

PLOS ONE

Introduction Serious bacterial neonatal infections are a major cause of global neonatal mortality... more Introduction Serious bacterial neonatal infections are a major cause of global neonatal mortality. While hospitalized treatment is recommended, families cannot access inpatient treatment in low resource settings. Two parallel randomized control trials were conducted at five sites in three countries (Democratic Republic of Congo, Kenya, and Nigeria) to compare the effectiveness of treatment with experimental regimens requiring fewer injections with a reference regimen A (injection gentamicin plus injection procaine penicillin both once daily for 7 days) on the outpatient basis provided to young infants (0–59 days) with signs of possible serious bacterial infection (PSBI) when the referral was not feasible. Costs were estimated to quantify the financial implications of scaleup, and cost-effectiveness of these regimens. Methods Direct economic costs (including personnel, drugs and consumable costs) were estimated for identification, prenatal and postnatal visits, assessment, classifica...

Journal of Case Reports, Sep 18, 2017

A 10 year old boy with clinical features consistent with a left tuberculous loculated empyema had... more A 10 year old boy with clinical features consistent with a left tuberculous loculated empyema had intercostal drainage (ICD) of the empyema which was rapidly complicated by extensive surgical emphysema and pneumothorax. An urgent chest computed tomography (CT) scan confirmed the diagnosis of ruptured hydatid cyst. A successful left thoracotomy and repair of the fistulae was achieved. This scenario adds to the list of protean manifestations of pulmonary hydatidosis.

A27. PEDIATRIC LUNG INFECTION AND CRITICAL CARE AROUND THE WORLD, 2019

Lancet, 2015

WHO recommends referral to hospital for possible serious bacterial infection in young infants age... more WHO recommends referral to hospital for possible serious bacterial infection in young infants aged 0-59 days. We aimed to assess whether oral amoxicillin treatment for fast breathing, in the absence of other signs, is as efficacious as the combination of injectable procaine benzylpenicillin-gentamicin. In a randomised, open-label, equivalence trial at five sites in DR Congo, Kenya, and Nigeria, community health workers followed up all births in the community, identified unwell young infants, and referred them to study nurses. We randomly assigned infants with fast breathing as a single sign of illness or possible serious bacterial infection, whose parents did not accept referral to hospital, to receive either injectable procaine benzylpenicillin-gentamicin once per day or oral amoxicillin treatment twice per day for 7 days. A person who was off-site generated randomisation lists using computer software. Trained health professionals gave injections, but outcome assessors were masked ...

International Journal of Infectious Diseases, 2014

to collect data. Data entry and analysis was done using SPSS version 15. Results: The total numbe... more to collect data. Data entry and analysis was done using SPSS version 15. Results: The total number of respondents was 17,812. comprising, 73.6% males and 26.4% females. A higher proportion (33.7%) had no formal education, aged 18-59 years (72.6%) and 29.2% live below $2/day. The three topmost facility at which health care is normally sought for fever were chemist shop (26.3%), state hospital (25.3%) and private clinics (21.5%). The distance to these preferred facilities was less than 500 meters in 50.1% of cases while up to 71.7% of respondents spend less than a fifth on their income on health. Majority of household heads aged 18-59 years (75.2%) use private health facilities as compared to other age groups (p<0.001). Conclusion: In resource poor settings, patronage of patent medicine shops and private clinic for febrile illness is high. This observation must inform the design of any health care intervention or surveillance. System-wide defects in the health care delivery system may be contributory to this behaviour pattern. Healthcare interventions or surveillance activities that are solely based at traditional Government established facilities will not provide comprehensive results.

Annals of Tropical Paediatrics: International Child Health, 2001

Clinical predictors of a positive bacterial culture from lung aspirate or blood culture were inve... more Clinical predictors of a positive bacterial culture from lung aspirate or blood culture were investigated in 90 children under 5 years of age with lobar pneumonia on whom both lung aspiration and blood culture were performed. Of the 66 children with a respiratory rate of $ 50 breaths/min, 35 (53%) had positive bacterial lung aspirates compared with only ve (21.7%) of 23 children with a respiratory rate of , 50 breaths/min (odds ratio [OR] 4.06, 95% con dence interval [CI] 1.24-15.46, p 5 0.02). Of the 41 children with positive lung aspirates, 31 (76%) had negative blood cultures. In contrast with children with positive lung aspirates, there were no clinical predictors of a positive blood culture. A respiratory rate of $ 50 breaths/min in children with radiological evidence of lobar pneumonia would support lung aspiration as a positive result is signi cantly more likely than in children with a lower respiratory rate.

EClinicalMedicine, 2019

Background: Hypoxaemia is a common complication of pneumonia and a major risk factor for death, b... more Background: Hypoxaemia is a common complication of pneumonia and a major risk factor for death, but less is known about hypoxaemia in other common conditions. We evaluated the epidemiology of hypoxaemia and oxygen use in hospitalised neonates and children in Nigeria. Methods: We conducted a prospective cohort study among neonates and children (< 15 years of age) admitted to 12 secondary-level hospitals in southwest Nigeria (November 2015-November 2017) using data extracted from clinical records (documented during routine care). We report summary statistics on hypoxaemia prevalence, oxygen use, and clinical predictors of hypoxaemia. We used generalised linear mixed-models to calculate relative odds of death (hypoxaemia vs not). Findings: Participating hospitals admitted 23,926 neonates and children during the study period. Pooled hypoxaemia prevalence was 22.2% (95%CI 21.2-23.2) for neonates and 10.2% (9.7-10.8) for children. Hypoxaemia was common among children with acute lower respiratory infection (28.0%), asthma (20.4%), meningitis/encephalitis (17.4%), malnutrition (16.3%), acute febrile encephalopathy (15.4%), sepsis (8.7%) and malaria (8.5%), and neonates with neonatal encephalopathy (33.4%), prematurity (26.6%), and sepsis (21.0%). Hypoxaemia increased the adjusted odds of death 6-fold in neonates and 7-fold in children. Clinical signs predicted hypoxaemia poorly, and their predictive ability varied across ages and conditions. Hypoxaemic children received oxygen for a median of 2-3 days, consuming ∼3500 L of oxygen per admission. Interpretation: Hypoxaemia is common in respiratory and non-respiratory acute childhood illness and increases the risk of death substantially. Given the limitations of clinical signs, pulse oximetry is an essential tool for detecting hypoxaemia, and should be part of the routine assessment of all hospitalised neonates and children.

PubMed, Dec 1, 2002

A 1,600 gm baby with sirenomelia (caudal regression syndrome) associated with extensive anomalies... more A 1,600 gm baby with sirenomelia (caudal regression syndrome) associated with extensive anomalies in the internal organs occurring in one of a set of monochromic twins delivered at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Shagamu, Nigeria is being reported. The baby lived for approximately twenty hours. The co-twin had no obvious malformation.

Acta Cytologica, 1999

ABSTRACT

Annals of Tropical Paediatrics, 1990

Prothrombin time, serum albumin, aminotransferases and liver size were evaluated in 40 consecutiv... more Prothrombin time, serum albumin, aminotransferases and liver size were evaluated in 40 consecutive cases of kwashiorkor. Eleven (27.5%) of the 40 patients died. Eight out of the 11 patients who died had a prolonged prothrombin time of more than 3 s above the control compared to only 4 out of the 29 who survived (p = 0.005). Mean serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) albumin, globulin and liver size were abnormal but similar in both groups. These results may indicate a predictive mortality value of prothrombin time in kwashiorkor.

Annals of Tropical Medicine and Parasitology, Apr 1, 2000

One hundred and eight children with acute, symptomatic, uncomplicated, falciparum malaria were ra... more One hundred and eight children with acute, symptomatic, uncomplicated, falciparum malaria were randomized to receive chloroquine (for 3 days) plus chlorpheniramine alone (for seven days) (CQ± CP group; N 5 55) or, in a sequential treatment, chloroquine plus chlorpheniramine for 3 days followed, on the fourth day, by a single oral dose of sulfadoxine± pyrimethamine (25 mg sulfadoxine/kg) (CQ± CP± SP group; N 5 53). The mean (S.D.) parasite-clearance time in the CQ± CP group [2.1 (0.7) days; range 5 1± 5 days] was similar to that in the CQ± CP± SP [2.1 (0.8) days; range 5 1± 5 days]. The fever-clearance times were also similar: 1.2 (0.1) days (range 5 1± 3 days) v. 1.1 (0.4) days (range 5 1± 3 days). The cure rates on days 14, 21 and 28 were 98.2%, 96.3% and 92.7%, respectively in the CQ± CP group, and 100%, 100% and 96.2%, respectively, in the CQ± CP± SP group. The rates of gametocyte carriage were low and similar (5.4% in the CQ± CP group and 3.8% in the CQ± CP± SP group) throughout the duration of the study. Both treatment regimens were relatively well tolerated, the main adverse reactions being similar: sleepiness (on day 1) and pruritus (on days 1± 3). No adverse effect was attributable to SP. The results indicate that sequential treatment, for 3 days with CQ and CP, followed by a single dose of SP, is effective and well tolerated in children with acute, uncomplicated, falciparum malaria and may be an alternative treatment for CQ-and/or SP-resistant falciparum malaria. Treatment with a CQ± CP combination (CQ and CP for 3 days and then CP alone for another 4 days) is also effective but requires continuing administration after the signs and symptoms of acute malaria have disappeared.

Malaria Journal, Dec 1, 2010

Background: Several studies have demonstrated the efficacy of artemisinin-combination therapy (AC... more Background: Several studies have demonstrated the efficacy of artemisinin-combination therapy (ACT) across malaria zones of the world. Fixed dose ACT with shorter courses and fewer tablets may be key determinants to ease of administration and compliance. Methods: Children aged one year to 13 years presenting with uncomplicated Plasmodium falciparum malaria were recruited in Ibadan, southwestern Nigeria. A total of 250 children each were randomly assigned to receive three doses of artesunate/sulphamethoxypyrazine/pyrimethamine (AS + SMP) (12 hourly doses over 24 hours) or three doses of artesunate/amodiaquine (AS + AQ) (daily doses over 48 hours). Efficacy and safety of the two drugs were assessed using a 28-day follow-up and the primary outcome was PCR-corrected parasitological cure rate and clinical response. Results: There were two (0.4%) early treatment failures, one in each treatment arm. The PCR corrected cure rates for day 28 was 97.9% in the AS + AQ arm and 95.6% in the AS + SMP arm (p = 0.15). The re-infection rate was 1.7% in the AS + AQ arm and 5.7% in the AS + SMP arm (p = 0.021). The fever clearance time was similar in the two treatment groups: 1-2 days for both AS + SMP and AS + AQ (p = 0.271). The parasite clearance time was also similar in the two treatment groups with 1-7 days for AS + SMP and 1-4 days for AS + AQ (p = 0.941). The proportion of children with gametocytes over the follow-up period was similar in both treatment groups. Serious Adverse Events were not reported in any of the patients and in all children, laboratory values (packed cell volume, liver enzymes, bilirubin) remained within normal levels during the follow-up period but the packed cell volume was significantly lower in the AS + SMP group. Conclusions: This study demonstrates that AS + SMP FDC given as three doses over 24 hours (12-hour intervals) has similar efficacy as AS + AQ FDC given as three doses over 48 hours (24-hour interval) for the treatment of uncomplicated Plasmodium falciparum malaria in children in Nigeria. Both drugs also proved to be safe. Therefore, AS + SMP could be an alternative to currently recommended first-line ACT with continuous resistance surveillance.

Trials

Background Current debates in Global Health call for expanding methodologies to allow typically s... more Background Current debates in Global Health call for expanding methodologies to allow typically silenced voices to contribute to processes of knowledge production and intervention design. Within trial research, this has typically involved small-scale qualitative work, with limited opportunities for citizens to contribute to the structure and nature of the trial. This paper reports on efforts to move past typical formative trial work, through adaptation of community conversations (CCs) methodology, an action-oriented approach that engages large numbers of community members in dialogue. We applied the CC method to explore community perspectives about pneumonia and managing the health of children under-5 in Northern Nigeria to inform our pragmatic cluster randomised controlled trial evaluating a complex intervention to reduce under-5 mortality in Nigeria. Methods We conducted 12 rounds of community conversations with a total of 320 participants, in six administrative wards in Kiyawa Lo...