Faculty of Dentistry

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Open Access
A proposed one-stop-shop approach for the delivery of integrated oral, mental, sexual and reproductive care to adolescents in Nigeria
(Pan African Medical Journal, 2020) Morenike Oluwatoyin Folayan; Nadia Adjoa Sam-Agudu; Abiola Adeniyi; Elizabeth Oziegbe; Nneka Maureen Chukwumah; Boladale Mapayi
The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.
Open Access
A radiographic study of the mandibular third molar root development in different ethnic groups.
(Journal of Forensic Odonto-Stomatology, 2017-12-01T00:00:00Z) Liversidge, H M; Peariasamy, K; Folayan, M O; Adeniyi, A O; Ngom, P I; Mikami, Y; Shimada, Y; Kuroe, K; Tvete, I F; Kvaal, S I
BACKGROUND The nature of differences in the timing of tooth formation between ethnic groups is important when estimating age. AIM To calculate age of transition of the mandibular third (M3) molar tooth stages from archived dental radiographs from sub-Saharan Africa, Malaysia, Japan and two groups from London UK (Whites and Bangladeshi). MATERIALS AND METHODS The number of radiographs was 4555 (2028 males, 2527 females) with an age range 10-25 years. The left M3 was staged into Moorrees stages. A probit model was fitted to calculate mean ages for transitions between stages for males and females and each ethnic group separately. The estimated age distributions given each M3 stage was calculated. To assess differences in timing of M3 between ethnic groups, three models were proposed: a separate model for each ethnic group, a joint model and a third model combining some aspects across groups. The best model fit was tested using Bayesian and Akaikes information criteria (BIC and AIC) and log likelihood ratio test. RESULTS Differences in mean ages of M3 root stages were found between ethnic groups, however all groups showed large standard deviation values. The AIC and log likelihood ratio test indicated that a separate model for each ethnic group was best. Small differences were also noted between timing of M3 between males and females, with the exception of the Malaysian group. These findings suggests that features of a reference data set (wide age range and uniform age distribution) and a Bayesian statistical approach are more important than population specific convenience samples to estimate age of an individual using M3. CONCLUSION Some group differences were evident in M3 timing, however, this has some impact on the confidence interval of estimated age in females and little impact in males because of the large variation in age.
Open Access
Addressing Ebola-related Stigma
(Global Health Action, 2014) Mariam Davtyan; Brandon Brown; Morenike Oluwatoyin Folayan
Background HIV/AIDS and Ebola Virus Disease (EVD) are contemporary epidemics associated with significant social stigma in which communities affected suffer from social rejection, violence, and diminished quality of life. Objective To compare and contrast stigma related to HIV/AIDS and EVD, and strategically think how lessons learned from HIV stigma can be applied to the current EVD epidemic. Methods To identify relevant articles about HIV/AIDS and EVD-related stigma, we conducted an extensive literature review using multiple search engines. PubMed was used to search for relevant peer-reviewed journal articles and Google for online sources. We also consulted the websites of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and the National Institutes of Health to retrieve up-to-date information about EVD and HIV/AIDS. Results Many stigmatizing attitudes and behaviors directed towards those with EVD are strikingly similar to those with HIV/AIDS but there are significant differences worthy of discussion. Both diseases are life-threatening and there is no medical cure. Additionally misinformation about affected groups and modes of transmission runs rampant. Unlike in persons with EVD, historically criminalized and marginalized populations carry a disproportionately higher risk for HIV infection. Moreover, mortality due to EVD occurs within a shorter time span as compared to HIV/AIDS.
Open Access
Addressing the socio-development needs of adolescents living with HIV/AIDS in Nigeria : a call for action
(African Journal of Reproductive Health, 2014) Morenike O. Folayan; Morolake Odetoyinbo; Brandon Brown; Abigail Harrison Affiliations
The widespread use of antiretroviral therapy and remarkable success in the treatment of paediatric HIV infection has changed the face of the Human Immunodeficiency Virus (HIV) epidemic in children from a fatal disease to that of a chronic illness. Many children living with HIV are surviving into adolescence. This sub-population of people living with HIV is emerging as a public health challenge and burden in terms of healthcare management and service utilization than previously anticipated. This article provides an overview of the socio-developmental challenges facing adolescents living with HIV especially in a resource-limited setting like Nigeria. These include concerns about their healthy sexuality, safer sex and transition to adulthood, disclosure of their status and potential stigma, challenges faced with daily living, access and adherence to treatment, access to care and support, and clinic transition. Other issues include reality of death and implications for fertility intentions, mental health concerns and neurocognitive development. Coping strategies and needed support for adolescents living with HIV are also discussed, and the implications for policy formulation and programme design and implementation in Nigeria are highlighted. L'utilisation généralisée de la thérapie antirétrovirale et des succès remarquables dans le traitement de l'infection du VIH chez les enfants a changé le visage de l'épidémie du virus d'immunodéficience humaine (VIH) chez les enfants d'une maladie mortelle ? celui d'une maladie chronique. Beaucoup d'enfants vivant avec le VIH survivent ? l'adolescence. Cette sous-population de personnes vivant avec le VIH est en train de devenir un problème de santé publique et de la charge en termes de gestion des soins de santé et l'utilisation des services que prévu avant. Cet article donne un aperçu des défis du développement social auxquels sont confrontés les adolescents vivant avec le VIH en particulier dans un contexte de ressources limitées comme le Nigeria. Il s'agit notamment des préoccupations concernant leur santé sexuelle, les rapports sexuels protégés et le passage ? l'âge adulte, la divulgation de leur statut et de la stigmatisation potentielle, les défis rencontrés dans la vie quotidienne, l'accès au traitement et l'observance du traitement, l'accès aux soins et au soutien, et la transition de la clinique. D'autres questions comprennent la réalité de la mort et des implications pour les intentions de la fécondité, des problèmes de santé mentale et le développement neurocognitif. Les stratégies d'adaptation et le soutien nécessaire pour les adolescents vivant avec le VIH sont également discutés, et les implications pour la formulation des politiques et de la conception des programmes et la mise en oeuvre au Nigeria sont mis en évidence.
Open Access
Association between developmental dental anomalies, early childhood caries and oral hygiene status of 3–5-year-old children in Ile-Ife, Nigeria
(BMC Oral Health, 2020) Morenike Oluwatoyin Folayan; Michael Alade; Abiola Adeniyi; Maha El Tantawi; Tracy L. Finlayson
Background To determine the association between developmental dental anomalies (DDA), early childhood caries (ECC) and oral hygiene status of 3–5-year-old children resident in Ile-Ife, Nigeria. Methods This was a cross-sectional study. We analyzed data for 3–5-year-olds extracted from the dataset of a household survey collected to determine the association between ECC and maternal psychosocial wellbeing in children 0–5-year-old. The outcome variables for the study were ECC and poor oral hygiene. The explanatory variable was the presence of developmental dental anomalies (supernumerary, supplemental, mesiodens, hypodontia, macrodontia, microdontia, peg-shaped lateral, dens evaginatus, dens invaginatus, talons cusp, fusion/germination, hypoplasia, hypomineralized second molar, fluorosis, amelogenesis imperfecta). The prevalence of each anomaly was determined. Poisson regression analysis was conducted to determine the association between presence of developmental dental anomalies, ECC and oral hygiene status. The model was adjusted for sex, age and socioeconomic status. Results Of the 918 children examined, 75 (8.2%) had developmental dental anomalies, 43 (4.7%) had ECC, and 38 (4.1%) had poor oral hygiene. The most prevalent developmental dental anomalies was enamel hypoplasia (3.9%). Of the 43 children with ECC, 6 (14.0%) had enamel hypoplasia and 3 (7.6%) had hypomineralized second primary molar. There was a significant association between ECC and enamel hypoplasia (p < 0.001) and a borderline association between ECC and hypomineralized second primary molars (p = 0.05). The proportion of children with poor oral hygiene (PR: 2.03; 95% CI: 0.91–4.56; p = 0.09) and ECC (PR: 2.02; 95% CI: 0.92–4.46; p = 0.08) who had developmental dental anomalies was twice that of children with good oral hygiene and without ECC respectively, although the differences did not reach statistical significance.
Open Access
Association between early childhood caries and malnutrition in a sub-urban population in Nigeria.
(BMC Pediatrics, 2019) Morenike Oluwatoyin Folayan; Olujide Arije; Maha El Tantawi; Kikelomo Adebanke Kolawole; Mary Obiyan; Olaniyi Arowolo; Elizabeth O. Oziegbe
Background To determine the association between malnutrition and early childhood caries (ECC) in children resident in sub-urban, Nigeria. Methods This study was a subset of a larger cross-sectional study the data of which was generated through a household survey conducted in Ile-Ife, Nigeria. The study’s explanatory variable was malnutrition (underweight, overweight, wasting and stunting) and the outcome variable was ECC. Poisson regression analysis was used to determine the association between ECC and malnutrition. Variables (sex, frequency of sugar consumption, maternal knowledge of oral hygiene, oral hygiene status) associated with ECC in the primary study were adjusted for to obtain the adjusted prevalence ratio (APR). Results Of the 370 children, 20 (5.41%) were underweight, 20 (5.41%) were overweight, 67 (18.11%) were wasting, 120 (32.43%) were stunted and 18 (4.86%) had ECC. Factors associated with ECC were being stunted, underweight, overweight and fair oral hygiene. The prevalence of ECC was lower in children who were stunted (APR: 0.14; 95% CI: 0.03–0.69; p = 0.02), almost seven times higher in children who were overweight (APR: 6.88; 95% CI: 1.83–25.85; p < 0.001), and predictively absent in children who were underweight (APR: 0; 95% CI: 0–0; p < 0.001) when compared with children who had normal weight. Non-significant risk indicators for ECC included consuming sugar between meals three times a day or more, having low socioeconomic status and being female.
Open Access
Association Between Environmental Health, Ecosystem Vitality, and Early Childhood Caries
(Frontiers in Pediatrics, 2020) Morenike O. Folayan; Maha El Tantawi; Robert J. Schroth; Arthur M. Kemoli; Balgis Gaffar; Rosa Amalia; Carlos A. Feldens
Background: Environmental issues lead to serious health problems in young growing children. This study aims to determine the association between a country's level of environmental health, ecosystem vitality, and prevalence of early childhood caries (ECC). Methods: This was an ecological study. The data for the explanatory variables—country-level environmental performance index (EPI), environmental health, and ecosystem vitality—were obtained from the Yale Center for Environmental Law and Policy. The outcome variables were country-level prevalence of ECC in 0- to 2-year-old and 3- to 5-year-old children. The country EPI, environmental health, and ecosystem vitality were matched with country ECC prevalence for 0- to 2-year-olds and 3- to 5-year-olds for the period of 2007 to 2017. Differences in the variables by country income level were determined using ANOVA. Multivariate ANOVA was used to determine the association between ECC prevalence in 0- to 2-year-olds and 3- to 5-year-olds, and EPI, environmental health, and ecosystem vitality, adjusting for each country's per-capita gross national income. Results: Thirty-seven countries had complete data on ECC in 0- to 2-year-old and 3- to 5-year-old children, EPI, environmental health, and ecosystem vitality scores. There were significant differences in ECC prevalence of 0- to 2-year-olds and 3- to 5-year-olds between countries with different income levels. Also, there were significant differences in EPI (P < 0.0001), environmental health score (P < 0.0001), and ecosystem vitality (P = 0.01) score by country income levels. High-income countries had significantly higher EPI scores than did low-income countries (P = 0.001), lower-middle-income countries (P < 0.0001), and upper-middle-income countries (P < 0.0001). There was an inverse non-significant relationship between ECC prevalence and EPI in 0- to 2-year-olds (B = −0.06; P = 0.84) and 3- to 5-year-olds (B = −0.30; P = 0.50), and ecosystem vitality in 0- to 2-year-olds (B = −0.55, P = 0.08) and 3- to 5-year-olds (B = −0.96; P = 0.02). Environmental health was directly and non-significantly associated with ECC in 0- to 2-year-olds (B = 0.20; P = 0.23) and 3- to 5-year-olds (B = 0.22; P = 0.32). Conclusions: There was a complex relationship between various indicators of environmental performance and ECC prevalence. The association with EPI and ecosystem vitality was inverse whereas the association with environmental health was direct. Only the inverse association with ecosystem vitality in 3–5 year old children was significant. There may be higher risk of ECC with greater economic development, industrialization, and urbanization, while better ecosystem vitality may offer protection against ECC through the rational use of resources, healthy life choices, and preventive health practices.
Open Access
Association between malocclusion, caries and oral hygiene in children 6 to 12 years old resident in suburban Nigeria
(BMC Oral Health, 2019) Kikelomo Adebanke Kolawole; Morenike Oluwatoyin Folayan
Background: There are conflicting opinions about the contribution of malocclusions to the development of dental caries and periodontal disease. This study’s aim was to determine the association between specific malocclusion traits, caries, oral hygiene and periodontal health for children 6 to 12 years old. Methods: The study was a household survey. The presence of malocclusion traits was assessed in 495 participants. The caries status and severity were assessed with the decayed, missing, and filled teeth (dmft/DMFT) index and the pulpal involvement, ulceration, fistula and abscess (pufa/PUFA) index. The Simplified Oral Hygiene Index (OHI-S) and Gingival Index (GI) were used to assess periodontal health. The association between malocclusion traits, the presence of caries, poor oral hygiene, and poor gingival health were determined with chi square and logistic regression analyses. Statistical significance was inferred at p < 0.05. Results: Seventy-four (14.9%) study participants had caries, with mean (SD) dmft/DMFT scores of 0.27 (0.82) and 0.07 (0.39), respectively, and mean (SD) pufa/PUFA index scores of 0.09 (0.43) and 0.02 (0.20), respectively. The mean (SD) OHI-S score was 1.56 (0.74) and mean (SD) GI score was 0.90 (0.43). Dental Aesthetic Index scores ranged from 13 to 48 with a mean (SD) score of 20.7 (4.57). Significantly greater proportions of participants with crowding (p = 0.026) and buccal crossbite (p = 0.009) had caries. Significantly more children with increased overjet (p = 0.003) and anterior open bite (p = 0.008) had moderate to severe gingivitis. Poor oral hygiene (OR: 1.83; CI: 1.05–3.18 p = 0.033), crowding (OR: 1.97; CI: 1.01–3.49; p = 0.021) and buccal crossbite (OR: 6.57; CI: 1.51–28.51 p = 0.012) significantly increased the odds of having caries. Poor oral hygiene (p < 0.001), increased overjet (p = 0.003), and anterior open bite (p = 0.014) were the only significant traits associated with gingivitis.
Open Access
Association between maternal socioeconomic factors, decision‐making status, and dental utilization by children with early childhood caries in sub‐urban Nigeria
(American Association of Public Health Dentistry, 2020) Morenike Oluwatoyin Folayan; Micheal Alade; Abiola Adeniyi; Maha El Tantawi; Tracy L. Finlayson
AbstractAimTo determine the association between maternal education, income, and decision‐making status and the presence of early childhood caries (ECC) and dental‐service utilization among young children.MethodsThis cross‐sectional study was based on data from a household survey of 1,549 mother‐preschool‐aged‐child dyads conducted in Ife Central Local Government Area, Nigeria. The explanatory variables were maternal education, income, and decision‐making status (related to healthcare, large household purchases, and visits to family/relatives). Outcome variables were the presence of ECC and the child's history of dental‐service utilization. Poisson regression analyses were conducted to identify factors associated with outcomes; the models were adjusted for maternal age, child's socioeconomic status, oral hygiene status, and frequency of sugar consumption.ResultsThe study recruited 1,549 mother–child dyads, of which 66 (4.3 percent) children had ECC, and 90 (5.9 percent) children had a history of dental‐service utilization. Fewer than half (42.3 percent) of the mothers earned between N18,001($49.00) and 60,000 ($168.00) per month. Also, 896 (57.8 percent) reported not making any independent decisions, 152 (9.8 percent) made one of three decisions independently, and 313 (20.2 percent) made two or three decisions independently. In the adjusted model, children of mothers with monthly income higher than N60,000 were more likely to have used dental services than were those whose mother's monthly income was less than or equal to N18,000 (adjusted prevalence ratio = 2.29; 95%CI: 1.30–4.02; P = 0.004). No other maternal factor was associated with ECC.ConclusionsAlthough maternal socioeconomic factors and decision‐making abilities were not associated with ECC prevalence, more preschool children whose mothers had high income used dental services.
Open Access
Association between water, sanitation, general hygiene and oral hygiene practices of street-involved young people in Southwest Nigeria
(BMC Oral Health, 2020) Morenike Oluwatoyin Folayan; Mary O. Obiyan; Atinuke O. Olaleye
Abstract Background Oral hygiene practices can be linked to personal hygiene practices, including access to water and other sanitation facilities. The objective of the study was to determine if there is an association between oral hygiene practices and water and sanitation hygiene (WASH) practices among street-involved young people (SIYP). Methods A cross-sectional study recruited SIYP age 10–24 years in two States in Nigeria recruited through respondent-driven sampling in December 2018. Interviewer-administered questionnaires were used to collect data on water access, sanitation, personal and oral hygiene. The instruments used for collecting the data were standardized tools for measuring the phenomena studied. The association between knowledge and practice of oral hygiene; oral hygiene and water, sanitation and hygiene (WASH); and indicators of good oral hygiene were determined using binary logistic regression guided by two models. Results A total of 845 study participants were recruited. The proportion of SIYP with good knowledge of oral hygiene was low (31.2%), and fewer had good oral hygiene practice (8.9%). There were significant associations between knowledge and practice of tooth cleaning, use of fluoride-containing toothpaste, dental flossing, consumption of sugar between meals, and frequency of dental check-ups (p < 0.001 respectively). Respondents with good water collection and storage practices (AOR: 2.01; 95% CI: 1.24–3.24; P = 0.005) and those residing in Lagos (AOR: 2.85; 95% CI: 1.61–5.06; P = 0.001) had a higher likelihood of having good oral hygiene. Conclusion Good oral hygiene practices of SIYP in Nigeria is associated with access to water collection and storage. WASH programs can have an impact on health through improved oral hygiene practices.
Open Access
Associations between a history of sexual abuse and dental anxiety, caries experience and oral hygiene status among adolescents in sub-urban South West Nigeria
(BMC Oral Health, 2021) Morenike Oluwatoyin Folayan; Maha El Tantawi; Nourhan M. Aly; Abiola Adetokunbo Adeniyi; Elizabeth Oziegbe; Olaniyi Arowolo; Michael Alade; Boladale Mapayi; Nneka Maureen Chukwumah; Olakunle Oginni; Nadia A. Sam-Agudu
Abstract Introduction: Sexual and oral health are important areas of focus for adolescent wellbeing. We assessed for the prevalence of sexual abuse among adolescents, oral health factors associated with this history, and investigated whether sexual abuse was a risk indicator for dental anxiety, caries experience and poor oral hygiene. Methods: This was a cross-sectional study conducted between December 2018 and January 2019 among adolescents 10–19 years old in Ile-Ife, Nigeria. Survey data collected included respondents’ age, sex, and socioeconomic status, oral health risk factors (dental anxiety, frequency of tooth brushing intake of refined carbohydrates in between meals, fossing, dental visits, smoking, alcohol intake, use of psychoactive substances), caries experience, oral hygiene status, history of sexual abuse, and sexual risk behaviors (age of sexual debut, history of transactional sex, last sexual act with or without condom, multiple sex partners). Regression models were constructed to determine the association between outcome variables (dental anxiety, presence of caries experience and poor oral hygiene) and explanatory variables (oral health risk factors and history of sexual abuse). Results: The prevalence of sexual abuse in our cohort was 5.9%: 4.3% among males and 7.9% among females. A history of sexual abuse was associated with alcohol consumption (p=0.009), cigarette smoking (p=0.001), and a history of transactional sex (p=0.01). High/severe dental anxiety was significantly associated with increased odds of a history of sexual abuse (AOR=1.81; 95% CI 1.10, 2.98), but not with caries experience (AOR=0.66; 95% CI 0.15, 2.97) nor poor oral hygiene (AOR=1.68; 95% CI 0.95, 2.96). Dental anxiety was associated with increased odds of alcohol intake (AOR=1.74; 95% CI 1.19, 2.56), twice daily tooth brushing (AOR=1.48; 95% CI 1.01, 2.17) and daily consumption of refined carbohydrates in-between-meals (AOR=2.01; 95% CI 1.60, 2.54). Caries experience was associated with increased odds of using psychoactive substances (AOR=4.83; 95% CI 1.49, 15.62) and having low socioeconomic status (AOR=0.40; 95% CI 0.18, 0.92). Poor oral hygiene was associated with increased odds of having middle socio‑economic status (AOR=1.43; 95% CI 1.05, 1.93) and daily consumption of refined carbohydrates in-between-meals (AOR=1.38; 95% CI 1.08, 1.78).
Open Access
Associations between COVID-19 testing status, non-communicable diseases and HIV status among residents of sub-Saharan Africa during the first wave of the pandemic.
(BMC Infectious Diseases, 2022-06-13T00:00:00Z) Folayan, Morenike O; Abeldaño Zuñiga, Roberto Ariel; Virtanen, Jorma I; El Tantawi, Maha; Abeldaño, Giuliana Florencia; Ishabiyi, Anthonia Omotola; Jafer, Mohammed; Al-Khanati, Nuraldeen Maher; Quadri, Mir Faeq Ali; Yousaf, Muhammad Abrar; Ellakany, Passent; Nzimande, Ntombifuthi; Ara, Eshrat; Khalid, Zumama; Lawal, Folake Barakat; Lusher, Joanne; Popoola, Bamidele O; Idigbe, Ifeoma; Khan, Abeedha Tu-Allah; Ayanore, Martin Amogre; Gaffar, Balgis; Osamika, Bamidele Emmanuel; Aly, Nourhan M; Ndembi, Nicaise; Nguyen, Annie Lu
This study determined if non-communicable disease status, HIV status, COVID-19 status and co-habiting were associated with COVID-19 test status in sub-Saharan Africa. Data of 5945 respondents age 18-years-old and above from 31 countries in sub-Saharan Africa collected through an online survey conducted between June and December 2020, were extracted. The dependent variable was COVID-19 status (testing positive for COVID-19 and having symptoms of COVID-19 but not getting tested). The independent variables were non-communicable disease status (hypertension, diabetes, cancer, heart conditions, respiratory conditions, depression), HIV positive status, COVID-19 status (knowing a close friend who tested positive for COVID-19 and someone who died from COVID-19) and co-habiting (yes/no). Two binary logistic regression models developed to determine associations between the dependent and independent variables were adjusted for age, sex, employment, sub region and educational status. Having a close friend who tested positive for COVID-19 (AOR:6.747), knowing someone who died from COVID-19 infection (AOR:1.732), and living with other people (AOR:1.512) were significantly associated with higher odds of testing positive for COVID-19 infection, while living with HIV was associated with significantly lower odds of testing positive for COVID-19 infection (AOR:0.284). Also, respondents with respiratory conditions (AOR:2.487), self-reported depression (AOR:1.901), those who had a close friend who tested positive for COVID-19 infection (AOR:2.562) and who knew someone who died from COVID-19 infection (AOR:1.811) had significantly higher odds of having symptoms of COVID-19 infection but not getting tested. Non-communicable diseases seem not to increase the risk for COVID-19 positive test while cohabiting seems to reduce this risk. The likelihood that those who know someone who tested positive to or who died from COVID-19 not getting tested when symptomatic suggests there is poor contact tracing in the region. People with respiratory conditions and depression need support to get tested for COVID-19.
Open Access
Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria.
(PLOS ONE, 2016) Folayan, Morenike Oluwatoyin; Harrison, Abigail; Brown, Brandon; Odetoyinbo, Morolake; Stockman, Jamila K; Ajuwon, Ademola J; Cáceres, Carlos F
Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83). History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.
Open Access
Associations between psychological wellbeing, depression, general anxiety, perceived social support, tooth brushing frequency and oral ulcers among adults resident in Nigeria during the first wave of the COVID-19 pandemic
(BMC Oral Health, 2021) Morenike Oluwatoyin Folayan; Olanrewaju Ibikunle Ibigbami; Ibidunni Olapeju Oloniniyi; Olakunle Oginni; Olutayo Aloba
Introduction: The aims of this study were to determine the associations between psychological wellbeing, and the frequency of tooth brushing and presence of oral ulcers during the COVID-19 pandemic; and to identify the medi ating roles of psychological distress (general anxiety and depression) and perceived social support in the paths of observed associations. Methods: This cross-sectional study recruited 996 adults in Nigeria between June and August 2020. Data collected through an online survey included outcome variables (decreased frequency of tooth brushing and presence of oral ulcers), explanatory variable (psychological wellbeing), mediators (general anxiety symptoms, depression symptoms and perceived social support) and confounders (age, sex at birth, educational and employment status). Multivariate logistic regression was used to determine the risk indicators for the outcome variables. A path analysis was conducted to identify the indirect efect of mediators on the association between the outcome and explanatory variables. Results: Of the 966 respondents, 96 (9.9%) reported decreased tooth-brushing frequency and 129 (13.4%) had oral ulcers during the pandemic. The odds of decreased tooth-brushing during the pandemic decreased as the psychological wellbeing increased (AOR: 0.87; 95% CI: 0.83–0.91; p<0.001) and as generalized anxiety symptoms increased (AOR: 0.92; 95% CI: 0.86–0.98; p=0.009). The odds of having an oral ulcer was higher as the generalized anxiety symptoms increased (AOR: 1.15; 95% CI: 01.08–1.21; p<0.001). Only generalized anxiety (indirect efect: 0.02; 95% CI: 0.01–0.04; P=0.014) signifcantly mediated the relationship between wellbeing and tooth-brushing accounting for approximately 12% of the total efect of wellbeing on decreased toothbrushing. Generalized anxiety (indirect effect 0.05; 95% CI: −0.07–0.03; P<0.001) also signifcantly mediated the relationship between wellbeing and presence of oral ulcer accounting for 70% of the total efect of wellbeing on presence of oral ulcer. Depressive symptoms and perceived social support did not significantly mediate the associations between psychological wellbeing, decreased frequency of tooth brushing and the presence of oral ulcers. Conclusion: Patients who come into the dental clinic with poor oral hygiene or oral ulcers during the COVID-19 pandemic may benefit from screening for generalized anxiety and psychological wellbeing to identify those who will benefit from interventions for mental health challenges.
Open Access
Black market blood transfusions for Ebola
(plos one, 2014) Folayan, Morenike O; Brown, Brandon; Yakubu, Aminu
Poor health systems and structures in countries affected by Ebola virus disease (EVD) have compounded difficulties in access to hospital care for Ebola patients. With this low healthcare access, individuals may be forced to seek alternative remedies for the management of EVD. One major study suggested that the transfusion of whole blood and serum from patients who had recovered from EVD reduces the risk of EVD-related fatality (Citation1), with additional rigorous studies underway including patients in the current epidemic in West Africa (Citation2–Citation4) .
Open Access
Challenges with study procedure fidelity when conducting household survey: reports from the field.
(BMC Research Notes, 2019-08-07T00:00:00Z) Folayan, Morenike Oluwatoyin; Alade, Micheal O; Oziegbe, Elizabeth O
The aim of the study was to identify reasons for protocol deviations during conduct of large epidemiological surveys despite training of field workers, validating clinicians, and providing field supervisory support. Enquiries focused on breaches of recruitment procedures, privacy, confidentiality, and informed consent. The case study was a household survey conducted in Ile-Ife, Nigeria.
Open Access
Changes in the prevalence of dental caries in primary school children in Lagos State, Nigeria.
(Original Article, 2014) Sofola, O O; Folayan, M O; Oginni, A B
Objectives: To evaluate the changes in the prevalence of dental caries in Lagos State over a 3 years period and the role of age, sex, and playing in the changes observed. Materials and Methods: Three primary schools in Lagos State, Nigeria were randomly selected for the study. Six hundred and thirty‑three children age 2-12 years, were examined for caries in 2000 while 513 children were examined in 2003. The prevalence of tooth decay and the prevalence of untreated tooth decay were calculated for the two years, that is, 2000 and 2003. Also the degree of unmet treatment need among the population with caries experience was measured. Differences in the prevalence and severity of dental caries in the primary and permanent dentition were assessed. Results: Approximately 18% of children had untreated tooth decay in their primary dentition in 2003: A 26.1% increase from 2000. About 12.0% of the decay, extracted, and filled teeth (deft) index was seen with decayed teeth in 2000 and 16.6% in 2003. Extracted primary teeth decreased from 2.5% in 2000 to 1.5% in 2003. The change in mean deft between 2000 (0.42) and 2003 (0.47) was 11.9%. Over the study period, the overall reduction in the prevalence of dental caries was 34.8% in the permanent dentition. The decline was larger among children aged 5-9 years (62.1%) and among females (75%). Conclusion: The study showed no overall changes in caries severity but a decrease in caries prevalence in the permanent dentition over the study period. The largest decline in caries prevalence in the permanent dentition was observed in children aged 5-9 years and females. On the contrary, there was an increase in the caries prevalence in the primary dentition.
Open Access
Commentary
(Frontiers in oral health, 0202) Singhal, Sonica; Farmer, Julie; Quiñonez, Carlos
A newly identiﬁed pneumonia outbreak was ﬁrst reported in China in December 2019. This was caused by a highly infectious pathogen named the severe acute respiratory coronavirus 2 (SARCoV-2). It has caused the global pandemic, coronavirus disease 2019 (COVID-19), which has aﬀected 1% of the global population (79,231,893 cumulative cases up to 27 December 2020) and disrupted the world’s usual socioeconomic daily activities [1]. As a result, managing and solving the COVID-19 crisis is currently a top government priority around the world.
Open Access
Community Inclusion in PrEP Demonstration Projects: Lessons for Scaling Up.
(plos one, 0201) Reza-Paul, Sushena; Lazarus, Lisa; Jana, Smarajit; Ray, Protim; Mugo, Nelly; Ngure, Kenneth; Folayan, Morenike Oluwatoyin; Durueke, Florita; Idoko, John; Béhanzin, Luc; Alary, Michel; Gueye, Daouda; Sarr, Moussa; Mukoma, Wanjiru; Kyongo, Jordan K; Bothma, Rutendo; Eakle, Robyn; Dallabetta, Gina; Presley, Josie; Lorway, Robert
Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects worked to better engage communities and create spaces for community involvement in the planning and roll out of these projects. We describe the community engagement strategies employed by seven Bill & Melinda Gates Foundation-funded PrEP demonstration projects. Community engagement has emerged as a critical factor for education, demand generation, dispelling rumors, and supporting adherence and follow up in the PrEP demonstration project case studies. The increasing global interest in PrEP necessitates understanding how to conduct community engagement for PrEP implementation in different settings as part of combination HIV prevention.
Open Access
Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria
(BMC Public Health, 2020) G. Emmanuel; M. Folayan; G. Undelikwe; B. Ochonye; T. Jayeoba; A. Yusuf; B. Aiwonodagbon; C. Bilali; P. Umoh; K. Ojemeiri; A. Kalaiwo
Abstract Background Men who have sex with men (MSM), female sex workers (FSW) have critical needs for effective HIV prevention tools. This study identified perspectives of MSM, FSW and policy makers on the needs for, barriers to, and challenges with pre-exposure HIV prophylaxis (PrEP); and the logistics required to support roll-out of PrEP for MSM and FSW in Nigeria. Methods Qualitative and quantitative data were collected through a cross-sectional study. The quantitative data were collected through an online survey administered to 519 MSM, FSW and transgender respondents. The qualitative data were collected through 22 focus group discussions with 140 MSM and 80 FSW, and a two-day consultative workshop with 65 participants. Two open-ended questions in the online survey were also a source of qualitative data. Results of the quantitative data were reported descriptively; the qualitative data were inductively examined with a content analytic approach to construct descriptive categories. The findings from the quantitative and qualitative responses were triangulated. Results Four hundred and ninety-four (95.2%) online respondents had heard about PrEP through community dialogue (71.3%), and 439 (84.6%) supported its use by MSM and FSW. Fewer than half of the respondents were aware of the clinical care required for PrEP, and misconceptions about PrEP were common. Stated barriers to PrEP uptake were stigma, cost, frequency of HIV counseling and treatment services required, and possible drug-drug interactions. Concerns included possible condom migration, increased risk for sexually transmitted infections and pregnancy for FSW, and poor adherence to medication and hospital schedules. Participants felt that trained peer educators and HIV-test counselors could provide information and refer clients to clinics that provide PrEP. PrEP can be provided through peer-led facilities for MSM and FSW, though its access should be expanded to all persons who are at substantial risk for HIV to prevent negative labeling of PrEP. Public awareness about the use of antiretrovirals for HIV prevention is needed to prevent labeling of PrEP users as being HIV positive. Conclusion Although MSM and FSW are interested in the use of PrEP, numerous individual and structural barriers need to be addressed to facilitate access to it in Nigeria.

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