Timing of death at National Trauma Center, Abuja, Nigeria

Background: We aimed to analyse the burden and timing of trauma deaths over a 1-year period at a trauma centre in Nigeria.Methods: This was a retrospective review of in-hospital trauma deaths during the period of January to December 2015. Sociodemographic data, cause of injury, mode of presentation, time interval between presentation and death, injury diagnoses, treatment, and place of death were analysed.Results: There were 2230 trauma consultations during the study period; 85 were brought in dead from the scene. We analysed data from 103 of 121 in-hospital deaths. Patient ages ranged from 0 to 90 years, with a mean age of 31.1. The male-to-female ratio was 5:1. Following injury, 46.6% of the victims presented directly to our tertiary centre, while 53.4% were referred from other hospitals. Most of the injuries were from RTA. Isolated head injury was the predominant diagnosis (44.7%), followed by polytrauma (29%). Immediate deaths (exclusive of those brought in already dead) comprised 5.8% of cases; 37.9% were early deaths and 56.3% were late deaths.Conclusions: The timing of trauma deaths closely approximated the original trimodal description in North America about half a century ago even though advances in trauma care have resulted in changes from this pattern in developed countries. Regionalised integrated care including prehospital trauma services are recommended.Keywords: trauma; mortality; timin

Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.

BackgroundUnderstanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children's surgical care in low- and middle-income countries (LMICs).MethodsWe searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality.FindingsWe identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7.InterpretationOur findings show that many areas of children's surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered "Essential Pediatric Surgical Procedures" as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care

An Evaluation of the Impact of Fluctuating Oil Revenue and the Performance of the Nigerian Economy: An Econometric Analysis

The up and down movement in  the price of crude oil in recent years  has led to increasing concern about its macroeconomic implications for the Nigerian economy as economic planning has become very uncertain given the fact that the economy is highly vulnerable to oil price fluctuations. It is with this view in mind that this paper empirically analyses the impact of fluctuating oil revenue and the performance of the Nigerian economy between 1999 to 2016 (a seventeen years period of democratic governance), using secondary data sourced from Central Bank of Nigeria Statistical Bulletin and World Bank Development Indicators with VAR econometric tools of analysis. After appropriate stationary and robustness checks, the study finds out that oil price shocks (proxy for oil revenue) retards economic growth as it has a negative relationship with economic growth. An interesting outcome from the VAR Block Exogeneity Test is the unidirectional causality running from Oil Revenue to Real Gross Domestic Product (economic growth) which reveals the fact that during the years under reference, proceeds from oil export were mainly responsible for the level of astronomical growth recorded in the economy.  The study concludes that oil price fluctuation paints an unstable future for the Nigerian economy because macroeconomic variables like employment, interest rate and price stability become victims. Both fiscal and monetary tools are frequently revised to keep the system afloat during price shocks. Nigeria remains a victim of these policy shocks because of overdependence on oil export earnings. A major policy recommendation is the need for policy makers to concentrate on policies that will strengthen and stabilize the macroeconomic structure of the Nigerian economy with specific focus on alternative sources of government revenue (reduction of dependence on oil proceeds) and reduction in monetization of crude oil receipts (fiscal discipline). &nbsp

History and development of trauma registry: lessons from developed to developing countries

BACKGROUND: A trauma registry is an integral component of modern comprehensive trauma care systems. Trauma registries have not been established in most developing countries, and where they exist are often rudimentary and incomplete. This review describes the role of trauma registries in the care of the injured, and discusses how lessons from developed countries can be applied toward their design and implementation in developing countries. METHODS: A detailed review of English-language articles on trauma registry was performed using MEDLINE and CINAHL. In addition, relevant articles from non-indexed journals were identified with Google Scholar. RESULTS: The history and development of trauma registries and their role in modern trauma care are discussed. Drawing from past and current experience, guidelines for the design and implementation of trauma registries are given, with emphasis on technical and logistic factors peculiar to developing countries. CONCLUSION: Improvement in trauma care depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component. Hospitals and governments in developing countries should be encouraged to establish trauma registries using proven cost-effective strategies

Understanding Etiologies of Road Traffiffic Crashes, Injuries, and Death for Patients at National Hospital Abuja: A Qualitative Content Analysis Using Haddon\u27s Matrix

Road traffic crashes and sequelae are reaching pandemic proportions globally and have currently achieved disproportionately high levels in Nigeria. Quantitative studies are accumulating in the peer-reviewed literature, but there is a paucity of qualitative research in Nigeria. Data for this study of structural and behavioral factors of road traffic crashes and injuries in Federal Capital Territory were collected in semi-structured interviews with crash survivors at National Hospital Abuja. Interviews were analyzed via qualitative content analysis, revealing crash location and participant beliefs about crash etiologies. Units of analysis were developed from participant statements and were structured within four a priori etiologic categories using Haddon\u27s (1980) matrix: human-, vehicle-, physical environment-, and socioeconomic environment-related. Subcategories were generated. Human-related subcategories included reckless behavior and drivers, limited technical knowledge and skill. Vehicle-related subcategories included vehicular disrepair and lack of safety equipment. Physical environment-related subcategories included road disrepair, infrastructural inadequacy, and weather. Socioeconomic environment-related subcategories included government, prehospital care, money, and prayer. Subcategories were organized temporally by pre-event, event, and post-event phases, with most units of analysis allocated in the preevent phase. These qualitative results can be utilized to guide future research along community-aligned priorities, and to structure community-engaged preventative and interventional efforts

Understanding Etiologies of Road Traffic Crashes, Injuries, and Death for Patients at National Hospital Abuja: A Qualitative Content Analysis Using Haddon’s Matrix

Road traffic crashes and sequelae are reaching pandemic proportions globally and have currently achieved disproportionately high levels in Nigeria. Quantitative studies are accumulating in the peer-reviewed literature, but there is a paucity of qualitative research in Nigeria. Data for this study of structural and behavioral factors of road traffic crashes and injuries in Federal Capital Territory were collected in semi-structured interviews with crash survivors at National Hospital Abuja. Interviews were analyzed via qualitative content analysis, revealing crash location and participant beliefs about crash etiologies. Units of analysis were developed from participant statements and were structured within four a priori etiologic categories using Haddon’s (1980) matrix: human-, vehicle-, physical environment-, and socioeconomic environment-related. Subcategories were generated. Human-related subcategories included reckless behavior and drivers, limited technical knowledge and skill. Vehicle-related subcategories included vehicular disrepair and lack of safety equipment. Physical environment-related subcategories included road disrepair, infrastructural inadequacy, and weather. Socioeconomic environment-related subcategories included government, prehospital care, money, and prayer. Subcategories were organized temporally by pre-event, event, and post-event phases, with most units of analysis allocated in the pre-event phase. These qualitative results can be utilized to guide future research along community-aligned priorities, and to structure community-engaged preventative and interventional efforts

Anticonvulsant and sedative activities of aqueous leave extract of Leucas martinicensis (Jacq.) R. Br

Leucas martinicensis is a medicinal plant used in traditional medicine to treat convulsions and epilepsy. The present study was to evaluate the anticonvulsant and sedative effects of the aqueous leave extract of L. martinicensis in Wistar rats. The anticonvulsant activities of L. martinicensis (50, 100, 200 or 400 mg/kg i.p.) were evaluated using maximal electroshock seizure (MES) - and strychnine (STR) -induced seizure models while the sedative properties were evaluated using the diazepaminduced sleep model in Wistar rats. The 400 mg/kg of the extract protected rats (100%) against seizures in both models while at 200 mg/kg seizure protection (100%) was only in STR model. There was a significant (p<0.05) delay in the onset and reduction in the duration of seizure in the two models in unprotected rats. L. martinicensis exerted sedative effect by significantly reducing the onset (sleep latency) and increasing the total duration of sleep induced by diazepam. These results suggest that aqueous extract of L. martinicensis may possess anticonvulsant and sedative properties that might show efficacy against primary generalised seizures and secondarily generalised tonic -clonic seizures in humans. It also lends pharmacological credence to the use of the plant in traditional medicine for the management of epilepsy and convulsions.Keywords: Leucas martinicensis; Epilepsy; Traditional medicine; Anticonvulsant; slee

Management and outcomes of gastrointestinal congenital anomalies in low, middle and high income countries: Protocol for a multicentre, international, prospective cohort study

Introduction: Congenital anomalies are the fifth leading cause of death in children globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally.Methods and Analysis: The Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators will prospectively collect observational data on consecutive patients presenting for the first time, with one of seven common congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation and Hirschsprung\u27s disease).Patient recruitment will be for a minimum of 1 month from October 2018 to April 2019 with a 30-day post-primary intervention follow-up period. Anonymous data will be collected on patient demographics, clinical status, interventions and outcomes using REDCap. Collaborators will complete a survey regarding the resources and facilities for neonatal and paediatric surgery at their centre.The primary outcome is all-cause in-hospital mortality. Secondary outcomes include the occurrence of post-operative complications. Chi-squared analysis will be used to compare mortality between LMICs and HICs. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.Ethics and Dissemination: At the host centre, this study is classified as an audit not requiring ethical approval. All participating collaborators have gained local approval in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for open access publication in a peer reviewed journal.Trial Registration Number: NCT03666767

Histopathologic spectrum of childhood tumours in a Tertiary Hospital: a ten-year review

Background: There has been a growing public health burden of childhood tumours in low and middle income countries (LMICs) as the trend in epidemiological transition continues to vary. Objective: The objective of this report is to determine the spectrum of childhood tumours at a tertiary hospital in Nigeria. Methods: A retrospective review of the histopathology register over the period January 2006 to December 2015. Results: The total paediatric tumour cases was 248, including 143 (57.7%) females and 105 (42.3%) males, aged 0 \u2013 12 years (mean 6.1years \ub1 3.97 SD). The age group 2 - 5 year cohort had the highest prevalence of tumour. The predominant tumour based on tissue of origin was epithelial neoplasms 88 (35.5%), vascular neoplasms 56 (22.6%), neural neoplasm 42 (16.9%), mesenchymal neoplasm 37 (14.9%), germ cell neoplasm 13 (5.2%) and haematopoietic neoplasms 12 (4.8%). Majority of the tumours were benign, 148 (59.7%) and malignant 100 (40.3%). The most predominant benign tumour was haemangioma 33 (13.3%) and predominant malignant tumour was lymphoma 22 (8.9%). Conclusion: Benign tumours remain the commonest neoplasm of children in this hospital-based data. Development and implementation of a tumour registry would provide a more comprehensive information