Chronic Wounds in Children: Prevalence, Aetiological Types and Predilection Sites in a Rural Setting in an Emerging Economy

The aim of this study was to determine the prevalence, aetiological types and predilection sites of chronic wounds in children. This study was a cross sectional study conducted on children aged 0-15 years. Through cluster sampling technique, children with wounds were recruited and evaluated. Demographic and clinical data were collected and analyzed. Descriptive statistics were used to summarize variables and Chi-squared test was used to achieve comparison between age groups and sexes. Statistical significance was defined as p<0.05. The results show that one thousand and ten children were screened for wounds out of which 107 children with 115 wounds were found. 16.5% of these wounds were chronic with a prevalence rate of 2.0%. Chronic wound prevalences in the school aged (47.4%) and adolescent (52.6%) children were 0.9% and 1.0% respectively (x2 = 0.821; p = 0.359 Yates’ corrected, Fisher’s exact test 2-sided) and statistically insignificant. 57.9% were caused by trauma and majority (89.5%) occurred in the lower limbs (x2=0.000; p=1.000 Yates’ corrected, Fisher’s exact test 2-sided) without any statistical significance. Prevalence of chronic wounds in the children population was very low. The commonest aetiological type was inadequately treated traumatic wounds which progressively healed on institution of appropriate wound treatment

Microbial Spectrum and Antibiogram of Non-surgical Wounds in Children in a Rural Setting in Nigeria

The aim of this study was to determine the microbial spectrum and susceptibility pattern of non-surgical wound infections in children in a rural setting in our environment. This study was a cross sectional study of children aged 0 to 15 years in Bakassi, Nigeria. The children were screened for non-surgical wounds using an interviewer administered semi-structured questionnaire. Identified wounds were evaluated clinically for signs of infection and specimens were collected and cultured using standard microbiologic techniques. Susceptibility test was performed on all the isolated Micro-organisms. Data were collected and analysed using SPSS version 20 for windows. Sixty four wound infections out of a total of 115 wounds giving an infection rate of 55.7% were encountered. Of 64 wound cultures, 46.9% (30/64,) yielded mono-microbial growth, while poly-microbial growth of two and three microorganisms were obtained in 46.9% (30/64) and 1.6% (1/64) specimens respectively.A total of 92 organisms were isolated belonging to seven different species. Staphylococcus aureus (n= 57/92, 62.0%) and Streptococcus pyogenes (n = 30/92, 32.6%) were the predominant pathogens isolated. High rate of community acquired Methicillin Resistant Staphylococcus aureus (MRSA) (38/57, 66.7%) was observed. The microbial spectrum of non-surgical wounds of children in rural communities is wide. The high rate of antimicrobial resistance particularly MRSA and high predominance of S. pyogenes are potential sources of dire consequence in management and long term morbidity

Utilization of banked blood in pediatric surgical procedures in Calabar, Nigeria

Background: Performing major surgery in a child demands that blood is cross-matched and saved to be transfused as indicated. Because the cost of cross-matching and donation of blood can be enormous and may equal or surpass the cost of surgery in our setting, it is pertinent to evaluate its utilization. The aim of this study was to determine how banked blood meant for pediatric surgical procedures was utilized with the hope of streamlining our blood requisition policy. This may be useful to pediatric and other surgeons involved in the operative care of children in similar settings. Materials and Methods: This was a prospective study of all children who had ELECTIVE or EMERGENCY surgical procedures between January 2009 and June 2010. The age, sex, nature of surgery, blood loss, banked units of blood and amount transfused were collected and analyzed. Results: Eighty two patients had 81 units of blood banked for them. Forty - eight and half units (59.9%) of the banked blood were for the emergency group but only 18 units (22.2%) were actually transfused at the end (P = 0.044) leading to inadequate use of the product. Conclusion: Banking large quantities of blood but utilizing only little is tantamount to inadequate use and delays surgical intervention. Indirectly, it increases cost of surgery. There is need to rationalize our blood ordering habits without causing harm to patients

Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria

Background: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion. Patients and Methods: The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16. Results: Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123). Conclusion: DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways