Direct Integration of Government Funding and Family Support for Musculoskeletal Tumor Care in a Resource-Constrained Country

&lt;i&gt;Background:&lt;/i&gt; Malignant musculoskeletal tumor (MMST) outcome reflects the level of supportive care provided. In Nigeria, the supportive care available to patients with MMST is limited by a lack of funding. Patients often present late, and receive only orthodox care as psychosocial care is not available. We evaluated the effect of direct incorporation of government funding and family support on MMST patient acceptance and completion of treatment. &lt;i&gt;Methods:&lt;/i&gt; A 3-year prospective multicenter intention-to-treat study was undertaken in a tertiary care setting. The first step was a nonselective randomization of MMST patients into 2 groups, Wesley Guilds Hospital Firm A (WGHFA) and Wesley Guilds Hospital Firm B (WGHFB) using the computer software Excel. The control group was WGHFA, which consisted of patients who self-financed their oncology care. The WGHFB patients’ governments (local or state) provided funds according to medical reports and the patients had relatives who offered psychosocial support. The second step entailed treatment (surgery, chemotherapy and radiotherapy) and follow-up. Outcome measures were the interval between presentation at hospital and surgical intervention, acceptability of limb amputation, completeness of treatment courses, duration of hospital stay and mortality. The reproducibility of the methodology was reappraised at the Federal Medical Center. Kruskal-Wallis analysis was used, and an alpha error of &lt;0.05 at a CI of 95% was taken to be significant. &lt;i&gt;Results:&lt;/i&gt; A total of 112 cases of MMST were managed during the study period. Seventy-one (63.4%; 37 WGHFA; 34 WGHFB) met the inclusion criteria. Age, sex, tribe, religion, comorbid factors and mean weekly income were not significant factors influencing improved MMST care among the WGHFB patients. 32 WGHFB versus 7 WGHFA patients accepted the treatment plan. The mean duration of hospital stay before surgery (p &lt; 0.001), discharge against medical advice (p &lt; 0.000), limb salvage (21 vs. 2, p &lt; 0.001), limb amputation (3 vs. 12, p &lt; 0.05, 95% CI 8.3–37.9), completeness of treatment (33 vs. 7, p &lt; 0.05), mean duration of hospital stay, in days (23 vs. 39, p &lt; 0.05) and mortality at 1-year follow-up (13 vs. 28, p &lt; 0.02) were significant. &lt;i&gt;Conclusion:&lt;/i&gt; The cost of cancer care is a challenge for patients with MMST in a resource-constrained country such as Nigeria. Direct integration of the government and family into MMST care will serve as a link between the cancer patient and the source of funds. It raises the possibility of an effective psychosocial approach to improve patient outcome through enhanced treatment acceptability and completion, and so reduce morbidity and short-term mortality.</jats:p

Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors influencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that influence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6±66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount’s disease and rickets) and club foot. The mean hospital stay before surgery was 12±8.8 days (range 1-38days). The mean duration of operation was 78.4±36min. (range 30-195 min). The total length of hospitalization was 34.97±19.91 days in males and 41.97±25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient’s age (P=0.002), indication for surgery (P=0.008), length of preoperative hospital stay (P=0.048), length of operation (P<0.001) and intraoperative blood loss above 200ml (P<0.001) were found to be statistically significant factors adversely affecting the surgical wound outcome. We conclude that most of the factors that predicted poor outcome in this study were patient and environment-related and are preventable. There is need to upgrade facilities in health institutions in Nigeria

Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors influencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that influence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6±66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount’s disease and rickets) and club foot. The mean hospital stay before surgery was 12±8.8 days (range 1-38days). The mean duration of operation was 78.4±36min. (range 30-195 min). The total length of hospitalization was 34.97±19.91 days in males and 41.97±25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient’s age (P=0.002), indication for surgery (P=0.008), length of preoperative hospital stay (P=0.048), length of operation (P<0.001) and intraoperative blood loss above 200ml (P<0.001) were found to be statistically significant factors adversely affecting the surgical wound outcome. We conclude that most of the factors that predicted poor outcome in this study were patient and environment-related and are preventable. There is need to upgrade facilities in health institutions in Nigeria

Predictive factors for primary amputation in trauma patients in a Nigerian University Teaching Hospital

Background: The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face.Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients.Design: A prospective study of post-traumatic primary limb amputations.Setting: The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004.Subjects: Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004.Results: Sixty six traumatised patient limbs were primarily amputated during the study period.The male: female ratio was 3.7:1 and means age was 28.6 years ±16.6(range: 4-7lyears). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 ± 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex , occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS.Conclusion: Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality