Medical ethics in sub-Sahara Africa: closing the gaps.

Background: Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices.Objectives: To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria.Methods: A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues.Results: A total of 307(76.2% ) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether “Ethical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to “patient’s wishes”, on the other hand over two-third of the respondents 211 (68.7%) agreed that “doctor should do what is best” irrespective of the patient’s opinion. There were significant differences (p<0.05) between the perception of physicians and non-physicians on many ethical issues.Conclusion: This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals.Keywords: Medical ethics, sub-Sahara Africa

Pediatric ophthalmic indications for examination under anesthesia in Ilorin, Nigeria

Objective: To determine the ophthalmic indications and challenges for pediatric ocular examination under anesthesia (EUA).Methods: The surgical register and patients’ records of children who underwent EUA between 1990 and 2007 were examined to document patients’ bio data, diagnoses and details of procedures and anesthesia.Results: Thirty-nine children underwent EUA during the 18-year period. The indications included congenital glaucoma (20 cases, 21.3%) and congenital cataract (5 cases, 12.8%). There were two cases each (5.1%) of microphthalmia, megalocornea, and squint. A case each of other indications constituted the remaining 10.3%.Conclusion: The commonest ophthalmic indication for EUA among children is congenital glaucoma. Most of the children (36, 92.3%) had inhalational anesthesia administered by anesthetists at great cost to their parents. Werecommend the use of ketamine anesthesia administered by nonanesthetist with some training in anesthetic resuscitation procedure, for short pediatric procedure such as EUA in resource-challenged settings

Poor cataract surgical output: Eye care workers perspective in north central Nigeria

Background: Cataract remains a disease of priority being the leading cause of blindness globally. Although surgically curable, cataract surgical output has remained low in Nigeria, Kwara state inclusive. Astudy was carried out to investigate the perception of eye care workers (ECW) on low surgical output and their adjudged reasons; this has hitherto notbeing evaluated.Materials and Methods: A cross-sectional quantitative survey with the aid of pretested structured questionnaire of all ECW and qualitative survey using in-depth interview on selected workers in Kwara State, Nigeria was done.Results: A total of 142 out of the 157 ECWs (90.5%) working in the 14 surgical eye centers in the state were interviewed with a mean age of 40.37 years, SD ± 8.67. There were 94 (66.2%) females, with a female to male ratio of 2:1. 91 (64.1%) participants were of the opinion that the numbers of cataract surgeries in the state were inadequate. Hospital-basedand human resource efficiency-related issues such as long clinic waiting time, multiple paying and procedural sites, poor staff mix, and gaps in available human resource were the major reasons given for low cataract output. Others reasons were high cost and fear of surgery, distance of eye clinics from patients.Conclusions: Regular operational researches, proper deployment, and efficient use of human and material resources in addition to subsidized cost and appropriate health education to allay fear of surgery are steps that could enhance cataract surgical output

Blindness Caused by Pterygium – A Case Report

Pterygium leading to bilateral blindness and forcing patient to quit job is uncommon. This is a case report of a 46 year old indigent woman who had blinding pterygia over 10 years. She could not afford pterygium excision offered in a private eye clinic where she initially presented after a period of unsuccessful self medication. She was forced out of sewing job consequent to her inability to thread needle, difficulty reading number on the tape rule and difficulty recognising faces of her clients. Six years later, she presented at eye clinic of the University of Ilorin Teaching Hospital, Nigeria with advanced bilateral pterygia. Having defaulted from clinic over 4 months for lack of fund, the patient, after concession, had successful bilateral pterygia excision using bare sclera technique with Mitomycin C (MMC) dab. There was restoration of the lost vision. Pterygium is a cause of avoidable blindness with consequential impact on quality of life. Eye care providers should identify individual patient challenges to reduce avoidable blindness. Keywords: Avoidable blindness, Patient challenges, Pterygium, Quality of lif

Beliefs, Attitudes and Health-seeking behavior towards ocular cancers among adults in Abuja, Nigeria

Background: To assess the beliefs attitudes, and health seeking behaviors towards ocular cancers among adults in Abuja.Methods: A descriptive cross-sectional survey of 1,887 Nigerians between June and September 2009 using interviewer-administered questionnaire.Results: The respondents’ reported refraining from interacting with persons afflicted with ocular cancers along these lines: eating together 261/669 (39%), hugging 149/668 (22%), shaking hands 106/561 (19%), laying on the same bed 328/560 (59%), and contracting marriage 462/558 (83%) with ocular cancer patients. However, 416/486 (85.6%) respondents would support getting appropriate health interventions for ocular cancers.Level of education was associated with positive attitudes towards ocular cancers patients (P<0.05). The respondents’ belief on characteristics of ocular cancers included “dangerous” 814/840 (96.6%), unknown nature 19/840 (2.3%); potential to cause blindness 849/882 (96.3%); potentially fatal 665/870 (76.4%), nonfatal 205/870 (23.6%). Also, the respondents believed treating ocular cancer is necessary 651/679 (95.9%) and unnecessary 28/679 (4.2%). About management of ocular cancers, 560/683 (82%) will consult eye doctors while 123/683 (18%) will seek other methods. Suggestions on how to improve management of ocular cancers were: improve public awareness 28.1%, train personnel 16.3%, provision of facilities 17.8%, establish national ocular cancer reference center 13.2% and free/subsidized treatment 13.2%.Conclusion:  Though significant proportion of respondents had the correct beliefs and attitudes towards ocular cancers, effective health education needs to be mounted to reinforce these positive beliefs and attitudes and also convert those with the wrong notions. This will in the long run improve health seeking behaviors.Keywords: ocular cancers, beliefs, attitudes, healthseeking behavior

Surgical removal of eyes in a tertiary institution in North eastern Nigeria

Background Surgical eye removal is performed for various end-stage eye diseases to provide adequate comfort, replace volume and give good functional and cosmetic appearance. The pattern of eye removal is unknown for North Eastern Nigeria. Objective To determine the indications for eye removal in the study community. Method Records of all the patients whose eyes were removed between January 2002 and December 2008 were reviewed retrospectively. Age, sex, diagnosis and type of surgery were recorded. Results A total of 67 eyes were removed during the period consisting of 46 males (68.7%). Mean age was 29.5 years (range 4 months to 90 years). Indications for surgery were trauma, 26 (38.8%), infection, 21 (31.3%), anterior staphyloma, 14 (20.9%), tumor 4, (6.0%) and painful blind eye, 2 (3.0%). Evisceration was performed in 55 (82.1%), enucleation, 11 (16.4%) and exenteration, 1 (1.5%) patient. In children (n = 28), the indications were trauma and anterior staphyloma in 10 patients (35.7%) each, tumor in 4 (14.3%), infection in 3 (10.7%) and painful blind eye (mooren's ulcer) in 1 (3.6%) of the children respectively. In adults (n = 39), indications were infections, 18 (46.2%), trauma, 16 (41.0%), anterior staphyloma, 4 (10.3%) and painful blind eye due to advanced glaucoma, 1 (2.6%). Conclusion Trauma, infections, and anterior staphyloma were the major indications for eye removal. Most of the indications were avoidable

Questionnaire study to gain an insight into the manufacturing and fitting process of artificial eyes in children: an ocularist perspective

Purpose To gain an insight into the manufacturing and fitting of artificial eyes in children and potential improvements to the process. Method An online qualitative survey was distributed to 39 ocularists/prosthetists in Europe and Canada. Participants were recruited through purposive sampling, specifically maximum variation sampling from the researcher’s contacts and an online search. Results The findings highlighted the current impression technique as being the most difficult yet most important part of the current process for both the ocularist and child patient. Negatively affecting obtaining a good impression, the child patients distress can be reduced by their parents by providing encouragement, reassurance, practicing the insertion and removal of the artificial eye and being matter of fact. Whilst improvements to the current process provided mixed views, the incorporation of current technology was perceived as not being able to meet the requirements to produce aesthetically pleasing artificial eyes. Conclusion The current artificial eye process can be seen as an interaction with its success being dependent on the child patient’s acceptance and adjustment which is dependent on the factors associated to the process. Investigation into the needs of the patient and whether technology can improve the process are the next steps in its advancement

Refractive ocular conditions and reasons for spectacles renewal in a resource-limited economy

<p>Abstract</p> <p>Background</p> <p>Although a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community.</p> <p>Methods</p> <p>A retrospective review of case records of 1,413 consecutive patients seen in a private optometry practice, Nigeria between January 2006 and July 2007.</p> <p>Results</p> <p>A total number of 1,216 (86.1%) patients comprising of (486, 40%) males and (730, 60%) females with a mean age of 41.02 years SD 14.19 were analyzed. The age distribution peaked at peri-adolescent and the middle age years. The main ocular complaints were spectacles loss and discomfort (412, 33.9%), blurred near vision (399, 32.8%) and asthenopia (255, 20.9%). The mean duration of ocular symptoms before consultation was 2.05 years SD 1.92. The most common refractive errors include presbyopia (431, 35.3%), hyperopic astigmatism (240, 19.7%) and presbyopia with hyperopia (276, 22.7%). Only (59, 4.9%) had myopia. Following correction, there were reductions in magnitudes of the blind (VA<3/60) and visually impaired (VA<6/18-3/60) patients by (18, 58.1%) and (89, 81.7%) respectively. The main reasons for renewal of spectacles were broken lenses/frame/scratched lenses/lenses' falling off (47, 63.4%).</p> <p>Conclusions</p> <p>Adequate correction of refractive errors reduces visual impairment and avoidable blindness and to achieve optimal control of refractive errors in the community, services should be targeted at individuals in the peri-adolescent and the middle age years.</p

Assessment of pain perception during ophthalmic surgical procedures

No Abstract.Tropical Journal of Health Sciences Vol. 15 (2) 2008: pp. 11-1