Background: Breast cancer (BC) risk prediction models, such as the Gail model, have been develope... more Background: Breast cancer (BC) risk prediction models, such as the Gail model, have been developed and widely used to identify women at higher risk of having breast cancer in developed countries. However, no model exists for Black women of sub-Saharan Africa (SSA). Because African women have different risk profiles, it is of public health importance to develop a Black women-specific model. Methods: A total of 1,880 hospital-based cases and 2,166 population-based controls from the Nigerian Breast Cancer Study (NBCS, 1998∼2015) were included in the analysis. Subjects were randomly divided into the training (2/3 of the data) and validation sets (1/3 of the data), and multivariate logistic regressions were used to derive the model. Risk factors were selected based on previous NBCS findings and literature review. Calibration and discrimination performances were assessed using the observed/expected ratio (O/E) and concordance statistic (C-index), respectively. Results: The final model inc...
The objective of this study is to determine the impact of group psychological therapy (GPT) on th... more The objective of this study is to determine the impact of group psychological therapy (GPT) on the mental health of obstetric fistula patients. It was a comparative pre and post intervention design. All patients had GPT prior to surgery and mental health assessment conducted before and after surgical repair. There was a significant reduction in proportion of those with severe mental health status after surgery. Specifically, the proportion of those with depression score of 4 and above reduced from 71.7% to 43.4%, and those with score of less than 4 increased from 28.3 to 56.6 percent. There was a significant reduction in those with very low self-esteem from 65.0% to 18.3%. Suicidal ideation reduced generally; severe (15.0 to 0%), moderate (16.7 to 5.0%) and mild (25.0 to 21.7%) and those without increased (43.3 to 73.3%). In conclusion, GPT is a useful adjunct to OF care as it improves their overall mental health status.
Racial/ethnic disparities in breast cancer mortality continue to widen but genomic studies rarely... more 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 underlyin...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 21, 2018
Purpose Among Nigerian women, breast cancer is diagnosed at later stages, is more frequently trip... more 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...
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2018
Risk prediction models have been widely used to identify women at higher risk of breast cancer. W... more Risk prediction models have been widely used to identify women at higher risk of breast cancer. We aimed to develop a model for absolute breast cancer risk prediction for Nigerian women. A total of 1,811 breast cancer cases and 2,225 controls from the Nigerian Breast Cancer Study (NBCS, 1998-2015) were included. Subjects were randomly divided into the training and validation sets. Incorporating local incidence rates, multivariable logistic regressions were used to develop the model. The NBCS model included age, age at menarche, parity, duration of breastfeeding, family history of breast cancer, height, body mass index, benign breast diseases, and alcohol consumption. The model developed in the training set performed well in the validation set. The discriminating accuracy of the NBCS model [area under ROC curve (AUC) = 0.703, 95% confidence interval (CI), 0.687-0.719] was better than the Black Women's Health Study (BWHS) model (AUC = 0.605; 95% CI, 0.586-0.624), Gail model for wh...
Gene expression changes within the Hippo pathway were found to be associated with large tumor siz... more 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), w...
Functional studies have elucidated the role of the mammalian target of rapamycin (mTOR) pathway i... more Functional studies have elucidated the role of the mammalian target of rapamycin (mTOR) pathway in breast carcinogenesis, but to date, there is a paucity of data on its contribution to breast cancer risk in women of African ancestry. We examined 47,628 SNPs in 61 mTOR pathway genes in the genome wide association study of breast cancer in the African Diaspora study (The Root consortium), which included 3,686 participants (1,657 cases). Pathway- and gene-level analyses were conducted using the adaptive rank truncated product (ARTP) test for 10,994 SNPs that were not highly correlated (r2 < 0.8). Odds ratio (OR) and 95% confidence interval (CI) were estimated with logistic regression for each SNP. The mTOR pathway was significantly associated with overall and estrogen receptor-negative (ER-) breast cancer risk (P = 0.003 and 0.03 respectively). PRKAG3 (Padj = 0.0018) and RPS6KA3 (Padj = 0.061) were the leading genes for the associations with overall breast cancer risk and ER- breast...
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Jul 4, 2017
Genome-wide association studies have identified ~100 common genetic variants associated with brea... more Genome-wide association studies have identified ~100 common genetic variants associated with breast cancer risk, the majority of which were discovered in women of European ancestry. Due to different patterns of linkage disequilibrium, many of these genetic markers may not represent signals in populations of African ancestry. We tested 74 breast cancer risk variants and conducted fine-mapping of these susceptibility regions in 6,522 breast cancer cases and 7,643 controls of African ancestry from three genetic consortia (AABC, AMBER and ROOT). Fifty-four of the 74 variants (73%) were found to have odds ratios that were directionally consistent with those previously reported, of which twelve were nominally statistically significant (P < 0.05). Through fine-mapping, in six regions (3p24, 12p11, 14q13, 16q12/FTO, 16q23, 19p13) we observed seven markers that better represent the underlying risk variant for overall breast cancer or breast cancer subtypes, whereas in another two regions ...
Multiple breast cancer loci have been identified in previous genome-wide association studies, but... more Multiple breast cancer loci have been identified in previous genome-wide association studies, but they were mainly conducted in populations of European ancestry. Women of African ancestry are more likely to have young-onset and estrogen receptor (ER) negative breast cancer for reasons that are unknown and understudied. To identify genetic risk factors for breast cancer in women of African descent, we conducted a meta-analysis of two genome-wide association studies of breast cancer; one study consists of 1,657 cases and 2,029 controls genotyped with Illumina's HumanOmni2.5 BeadChip and the other study included 3,016 cases and 2,745 controls genotyped using Illumina Human1M-Duo BeadChip. The top 18,376 single nucleotide polymorphisms (SNP) from the meta-analysis were replicated in the third study that consists of 1,984 African Americans cases and 2,939 controls. We found that SNP rs13074711, 26.5 Kb upstream of TNFSF10 at 3q26.21, was significantly associated with risk of estrogen...
Cancer Epidemiology, Biomarkers & Prevention, 2014
Background: Physical activity (PA) is modifiable and linked to decreased breast cancer risk but i... more Background: Physical activity (PA) is modifiable and linked to decreased breast cancer risk but its impact has not been investigated among indigenous African populations. Methods: From 2011 to 2013, 558 cases and 1,014 controls were recruited into the African Breast Cancer Study in Nigeria, Cameroon, and Uganda, and completed a culturally tailored PA questionnaire that assesses habitual PA the year before diagnosis/interview. PA sub-scores (housework, occupational, and leisure PA) and a total PA score were calculated (metabolic equivalent of task, MET-hours/day). Multiple logistic regressions were performed, adjusting for age, body mass index (BMI), study sites, and menopausal status. The models were then stratified by BMI and study site, respectively. Results: The overall PA score among controls (17.8 MET-hours/day on average) was mainly composed by housework PA and occupational PA with little leisure PA (7.0, 10.3, and 0.5 MET-hours/day, respectively). Multivariable analyses showe...
African Journal of Midwifery and Women's Health, 2011
Objective: This study examines whether the non-pneumatic anti-shock garment (NASG) reduces blood ... more Objective: This study examines whether the non-pneumatic anti-shock garment (NASG) reduces blood loss and mortality from uterine atony. Method: The sample was taken from delivering women at four referral facilities in nigeria who suffered obstetric haemorrhage, from which a subset of women with aetiology of post-partum uterine atony were examined. Data were collected by hospital staff and included 139 women, 54 in the pre-intervention phase and 85 in the NASG intervention phase. Differences in demographics, condition on study entry, treatment and outcomes were examined. Relative risks and 95% confidence intervals were used for primary outcomes of blood loss and mortality. Results: Median measured blood loss decreased from 360 ml pre-intervention to 30 ml in the NASG phase (P < 0.001). Mortality was reduced 72% for women treated with the NASG from 16.7% pre-intervention to 4.7% during the NASG phase (relative risk = 0.28, 95% confidence interval 0.09–0.87). Conclusion: The NASG sh...
We examined help-seeking behaviors and factors influencing their choice of hospital care in women... more We examined help-seeking behaviors and factors influencing their choice of hospital care in women currently leaking urine. Materials and methods: This study was part of a multistage community survey conducted among 5001 women in Nigeria who participated in the Ibadan Urinary Incontinence Household Survey. Help-seeking behavior was analyzed among 139 respondents currently leaking urine within the population surveyed. Results: The mean age of those currently leaking urine was 35.7 years (standard deviation = 15.8). Only 18 (12.9%) had ever sought help, of which 15 had received hospital care. Logistic regression analysis showed that the odds of seeking hospital care was higher among less educated women (odds ratio [OR] = 4.05, 95% confidence interval [CI]: 1.17-13.89) and among those with severe incontinence (OR = 4.20, 95% CI: 1.24-14.29). Reasons mentioned for not seeking hospital care include a belief that the condition is not life-threatening (51.2%), do not believe there is treatment (18.2%), lack of funds (1.7%), too shy to disclose (2.5%), afraid of complications (1.7%), other (2.5%), and no reason (22.3%). Conclusion: This study shows that very few women, currently experiencing urinary incontinence have sought medical care (approximately 1 in 10); and that the barriers identified are similar to those identified in previous studies, except that these women lack the necessary funds to seek care.
Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe mate... more Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity. The Non-pneumatic Anti-Shock Garment (NASG), a first-aid lower-body compression device, may decrease adverse outcomes from obstetric hemorrhage. This article is the first to report the effect of the NASG for PPH. Methods This pre-intervention/NASG study of 854 women was conducted in four referral facilities in Nigeria and two in Egypt between 2004-2008. Entry criteria were women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≥ 750 mL and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. The Wilcoxon rank-sum test and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss, emergency hysterectomy, mortality, morbidity (each individually), and a combined va...
Background: Breast cancer (BC) risk prediction models, such as the Gail model, have been develope... more Background: Breast cancer (BC) risk prediction models, such as the Gail model, have been developed and widely used to identify women at higher risk of having breast cancer in developed countries. However, no model exists for Black women of sub-Saharan Africa (SSA). Because African women have different risk profiles, it is of public health importance to develop a Black women-specific model. Methods: A total of 1,880 hospital-based cases and 2,166 population-based controls from the Nigerian Breast Cancer Study (NBCS, 1998∼2015) were included in the analysis. Subjects were randomly divided into the training (2/3 of the data) and validation sets (1/3 of the data), and multivariate logistic regressions were used to derive the model. Risk factors were selected based on previous NBCS findings and literature review. Calibration and discrimination performances were assessed using the observed/expected ratio (O/E) and concordance statistic (C-index), respectively. Results: The final model inc...
The objective of this study is to determine the impact of group psychological therapy (GPT) on th... more The objective of this study is to determine the impact of group psychological therapy (GPT) on the mental health of obstetric fistula patients. It was a comparative pre and post intervention design. All patients had GPT prior to surgery and mental health assessment conducted before and after surgical repair. There was a significant reduction in proportion of those with severe mental health status after surgery. Specifically, the proportion of those with depression score of 4 and above reduced from 71.7% to 43.4%, and those with score of less than 4 increased from 28.3 to 56.6 percent. There was a significant reduction in those with very low self-esteem from 65.0% to 18.3%. Suicidal ideation reduced generally; severe (15.0 to 0%), moderate (16.7 to 5.0%) and mild (25.0 to 21.7%) and those without increased (43.3 to 73.3%). In conclusion, GPT is a useful adjunct to OF care as it improves their overall mental health status.
Racial/ethnic disparities in breast cancer mortality continue to widen but genomic studies rarely... more 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 underlyin...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 21, 2018
Purpose Among Nigerian women, breast cancer is diagnosed at later stages, is more frequently trip... more 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...
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2018
Risk prediction models have been widely used to identify women at higher risk of breast cancer. W... more Risk prediction models have been widely used to identify women at higher risk of breast cancer. We aimed to develop a model for absolute breast cancer risk prediction for Nigerian women. A total of 1,811 breast cancer cases and 2,225 controls from the Nigerian Breast Cancer Study (NBCS, 1998-2015) were included. Subjects were randomly divided into the training and validation sets. Incorporating local incidence rates, multivariable logistic regressions were used to develop the model. The NBCS model included age, age at menarche, parity, duration of breastfeeding, family history of breast cancer, height, body mass index, benign breast diseases, and alcohol consumption. The model developed in the training set performed well in the validation set. The discriminating accuracy of the NBCS model [area under ROC curve (AUC) = 0.703, 95% confidence interval (CI), 0.687-0.719] was better than the Black Women's Health Study (BWHS) model (AUC = 0.605; 95% CI, 0.586-0.624), Gail model for wh...
Gene expression changes within the Hippo pathway were found to be associated with large tumor siz... more 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), w...
Functional studies have elucidated the role of the mammalian target of rapamycin (mTOR) pathway i... more Functional studies have elucidated the role of the mammalian target of rapamycin (mTOR) pathway in breast carcinogenesis, but to date, there is a paucity of data on its contribution to breast cancer risk in women of African ancestry. We examined 47,628 SNPs in 61 mTOR pathway genes in the genome wide association study of breast cancer in the African Diaspora study (The Root consortium), which included 3,686 participants (1,657 cases). Pathway- and gene-level analyses were conducted using the adaptive rank truncated product (ARTP) test for 10,994 SNPs that were not highly correlated (r2 < 0.8). Odds ratio (OR) and 95% confidence interval (CI) were estimated with logistic regression for each SNP. The mTOR pathway was significantly associated with overall and estrogen receptor-negative (ER-) breast cancer risk (P = 0.003 and 0.03 respectively). PRKAG3 (Padj = 0.0018) and RPS6KA3 (Padj = 0.061) were the leading genes for the associations with overall breast cancer risk and ER- breast...
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Jul 4, 2017
Genome-wide association studies have identified ~100 common genetic variants associated with brea... more Genome-wide association studies have identified ~100 common genetic variants associated with breast cancer risk, the majority of which were discovered in women of European ancestry. Due to different patterns of linkage disequilibrium, many of these genetic markers may not represent signals in populations of African ancestry. We tested 74 breast cancer risk variants and conducted fine-mapping of these susceptibility regions in 6,522 breast cancer cases and 7,643 controls of African ancestry from three genetic consortia (AABC, AMBER and ROOT). Fifty-four of the 74 variants (73%) were found to have odds ratios that were directionally consistent with those previously reported, of which twelve were nominally statistically significant (P < 0.05). Through fine-mapping, in six regions (3p24, 12p11, 14q13, 16q12/FTO, 16q23, 19p13) we observed seven markers that better represent the underlying risk variant for overall breast cancer or breast cancer subtypes, whereas in another two regions ...
Multiple breast cancer loci have been identified in previous genome-wide association studies, but... more Multiple breast cancer loci have been identified in previous genome-wide association studies, but they were mainly conducted in populations of European ancestry. Women of African ancestry are more likely to have young-onset and estrogen receptor (ER) negative breast cancer for reasons that are unknown and understudied. To identify genetic risk factors for breast cancer in women of African descent, we conducted a meta-analysis of two genome-wide association studies of breast cancer; one study consists of 1,657 cases and 2,029 controls genotyped with Illumina's HumanOmni2.5 BeadChip and the other study included 3,016 cases and 2,745 controls genotyped using Illumina Human1M-Duo BeadChip. The top 18,376 single nucleotide polymorphisms (SNP) from the meta-analysis were replicated in the third study that consists of 1,984 African Americans cases and 2,939 controls. We found that SNP rs13074711, 26.5 Kb upstream of TNFSF10 at 3q26.21, was significantly associated with risk of estrogen...
Cancer Epidemiology, Biomarkers & Prevention, 2014
Background: Physical activity (PA) is modifiable and linked to decreased breast cancer risk but i... more Background: Physical activity (PA) is modifiable and linked to decreased breast cancer risk but its impact has not been investigated among indigenous African populations. Methods: From 2011 to 2013, 558 cases and 1,014 controls were recruited into the African Breast Cancer Study in Nigeria, Cameroon, and Uganda, and completed a culturally tailored PA questionnaire that assesses habitual PA the year before diagnosis/interview. PA sub-scores (housework, occupational, and leisure PA) and a total PA score were calculated (metabolic equivalent of task, MET-hours/day). Multiple logistic regressions were performed, adjusting for age, body mass index (BMI), study sites, and menopausal status. The models were then stratified by BMI and study site, respectively. Results: The overall PA score among controls (17.8 MET-hours/day on average) was mainly composed by housework PA and occupational PA with little leisure PA (7.0, 10.3, and 0.5 MET-hours/day, respectively). Multivariable analyses showe...
African Journal of Midwifery and Women's Health, 2011
Objective: This study examines whether the non-pneumatic anti-shock garment (NASG) reduces blood ... more Objective: This study examines whether the non-pneumatic anti-shock garment (NASG) reduces blood loss and mortality from uterine atony. Method: The sample was taken from delivering women at four referral facilities in nigeria who suffered obstetric haemorrhage, from which a subset of women with aetiology of post-partum uterine atony were examined. Data were collected by hospital staff and included 139 women, 54 in the pre-intervention phase and 85 in the NASG intervention phase. Differences in demographics, condition on study entry, treatment and outcomes were examined. Relative risks and 95% confidence intervals were used for primary outcomes of blood loss and mortality. Results: Median measured blood loss decreased from 360 ml pre-intervention to 30 ml in the NASG phase (P < 0.001). Mortality was reduced 72% for women treated with the NASG from 16.7% pre-intervention to 4.7% during the NASG phase (relative risk = 0.28, 95% confidence interval 0.09–0.87). Conclusion: The NASG sh...
We examined help-seeking behaviors and factors influencing their choice of hospital care in women... more We examined help-seeking behaviors and factors influencing their choice of hospital care in women currently leaking urine. Materials and methods: This study was part of a multistage community survey conducted among 5001 women in Nigeria who participated in the Ibadan Urinary Incontinence Household Survey. Help-seeking behavior was analyzed among 139 respondents currently leaking urine within the population surveyed. Results: The mean age of those currently leaking urine was 35.7 years (standard deviation = 15.8). Only 18 (12.9%) had ever sought help, of which 15 had received hospital care. Logistic regression analysis showed that the odds of seeking hospital care was higher among less educated women (odds ratio [OR] = 4.05, 95% confidence interval [CI]: 1.17-13.89) and among those with severe incontinence (OR = 4.20, 95% CI: 1.24-14.29). Reasons mentioned for not seeking hospital care include a belief that the condition is not life-threatening (51.2%), do not believe there is treatment (18.2%), lack of funds (1.7%), too shy to disclose (2.5%), afraid of complications (1.7%), other (2.5%), and no reason (22.3%). Conclusion: This study shows that very few women, currently experiencing urinary incontinence have sought medical care (approximately 1 in 10); and that the barriers identified are similar to those identified in previous studies, except that these women lack the necessary funds to seek care.
Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe mate... more Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity. The Non-pneumatic Anti-Shock Garment (NASG), a first-aid lower-body compression device, may decrease adverse outcomes from obstetric hemorrhage. This article is the first to report the effect of the NASG for PPH. Methods This pre-intervention/NASG study of 854 women was conducted in four referral facilities in Nigeria and two in Egypt between 2004-2008. Entry criteria were women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≥ 750 mL and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. The Wilcoxon rank-sum test and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss, emergency hysterectomy, mortality, morbidity (each individually), and a combined va...
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Papers by Oladosu A Ojengbede