Funding paediatric surgery procedures in sub-Saharan Africa

BackgroundIn sub-Saharan Africa, there is a growing awareness of the burden of paediatric surgical diseases. This has highlighted the large discrepancy between the capacity to treat and the ability to afford treatment, and the effect of this problem on access to care. This review focuses on the sources and challenges of funding paediatric surgical procedures in sub-Saharan Africa. MethodsWe undertook a search for studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review and data abstraction were completed and resulting data were analysed using Statistical Package for Social Sciences (SPSS) software. ResultsThirty-five studies met our inclusion criteria and were reviewed. The countries that were predominantly emphasized in the publications reviewed were Nigeria, South Africa, Kenya, Ghana and Uganda. The paediatric surgical procedures involved general paediatric surgery/urology, cardiac surgery, neurosurgery, oncology, plastics, ophthalmology, orthopaedics and otorhinolaryngology. The mean cost of these procedures ranged from 60 to 21,140 United States Dollars (USD). The source of funding for these procedures was mostly out-of-pocket payments (OOPs) by the patient’s family in 32 studies, (91.4%) and medical mission/non-governmental organizations (NGOs) in 21 (60%) studies. This pattern did not differ appreciably between the articles published in the initial and latter 5 years of the study period, although there was a trend towards a reduction in OOP funding. Improvements in healthcare funding by individual countries supported by international organizations and charities were the predominant suggested solutions to challenges in funding.ConclusionWhile considering the potential limitations created by diversity in study design, the reviewed publications indicate that funding for paediatric surgical procedures in sub-Saharan Africa is mostly by OOPs made by families of the patients. This may result in limited access to some procedures. Coordinated efforts, and collaboration between individual countries and international agencies, may help to reduce OOP funding and thus improve access to critical procedures

Challenges of Hirschsprung’s disease presenting in an adult: a case report

Hirschprung’s disease is rare in adults; it is often misdiagnosed or undiagnosed. We present a 34 year old man illustrating the clinical characteristic of the pathology, the diagnostic clues and assessing the therapeutic approach. Definitive diagnosis is established on histology specimen from the rectum and the disease was confined to the rectosigmoid .Treatment involved sigmoid colostomy, anterior resection with colorectal anastomosis with a posterior myotomy

Pattern of surgical emergencies in a Nigerian tertiary hospital

Background: Surgical emergencies account for a major part of the surgeon’s workload. Evaluation of pattern of surgical emer- gencies will assist in developing concrete proposals for improved care. The aim was to assess the pattern of surgical emergencies in our center.Methods: We undertook one-year prospective study of all the emergency surgical admissions at Federal Medical Centre Makurdi from January to December 2011.Results: There were 575 surgical emergencies which constituted 56.8% of surgical admission, and 27.2% of allemergency hospital admissions. The commonest trauma cases were soft tissue injuries (30.3%), while the commonest non-trauma case was acute abdomen (41.6%). The mean age of the patients was 33.7 ± 17.2 years.Multiple injuries and traumatic brain injuries requir- ing intensive care monitoring, and malignancies were associated with higher mortality rates (p = 0.001). The 1-year mortality rate was 7.8% and the preventable death rate (PDR) for the trauma-related emergencies was 71.4%.Conclusion: There is a wide spectrum of surgical emergencies in our setting with trauma accounting for a substantial propor- tion of cases. Improved trauma care, neurosurgical services and intensive care facilities may improve the outcome of surgical emergencies in our environment.Keywords: Surgical emergencies; Pattern; tertiary hospital; Nigeria

Photostress Recovery Time Among Welders in Owerri Municipal Council, Southeast, Nigeria

Purpose: The photostress recovery time (PSRT) scores of welders were measured based on age, workexperience and welding-method.Methods: A quasi-experimental study was conducted among 50 purposively sampled welders, who had clear ocular media, healthy fundi and visual acuities of 6/6 or better in the tested eyes. The pre-bleach distant visual acuity of the right eye was determined with the Snellen’s visual acuity chart, while direct ophthalmoscopy was done to rule out media opacities, retinopathies and maculopathies. The  right eye was dazzled for 10 seconds with the light of a direct ophthalmoscope held at 2cm from the eye. The time required in seconds to read at least, three optotypes on the line directly above the baseline acuity was recorded as the PSRT.Results: The 22-31 years age group recorded the least mean PSRT (16±8.8seconds), followed by the 32-41 age group (19.9±6.8 seconds), while the 42-51 years category had the highest mean PSRT (31.4±10.5seconds). Age associated significantly (p˂0.05) with mean PSRT. Welders within the 1-12 years’ work experience had the least mean PSRT (15.9±8.1seconds) while those within the 25-36 years recorded the highest mean PSRT (33.4±9.3seconds). The observed difference in mean PSRT with years of work experience was statistically significant (p˂0.05). Gas welders had significantly (p˂0.05) higher mean PSRT (26.6±9.9secs) than electric arc welders (16.6±9.2secs).Conclusion: Gas welding, increasing age and work-experience were found to be predictive markers of elevated photostress recovery time (PSRT) among welders. This underscores the need for eye-care practitioners to routinize PSRT tests in the ocular assessment of welders. Keywords: Photostress recovery time (PSRT); electric-arc; gas welding; welders; age

Pattern of surgical emergencies in a Nigerian tertiary hospital

Background: Surgical emergencies account for a major part of the surgeon\u2019s workload. Evaluation of pattern of surgical emergencies will assist in developing concrete proposals for improved care. The aim was to assess the pattern of surgical emergencies in our center. Methods: We undertook one-year prospective study of all the emergency surgical admissions at Federal Medical Centre Makurdi from January to December 2011. Results: There were 575 surgical emergencies which constituted 56.8% of surgical admission, and 27.2% of allemergency hospital admissions. The commonest trauma cases were soft tissue injuries (30.3%), while the commonest non-trauma case was acute abdomen (41.6%). The mean age of the patients was 33.7 \ub1 17.2 years.Multiple injuries and traumatic brain injuries requiring intensive care monitoring, and malignancies were associated with higher mortality rates (p = 0.001). The 1-year mortality rate was 7.8% and the preventable death rate (PDR) for the trauma-related emergencies was 71.4%. Conclusion: There is a wide spectrum of surgical emergencies in our setting with trauma accounting for a substantial proportion of cases. Improved trauma care, neurosurgical services and intensive care facilities may improve the outcome of surgical emergencies in our environment. DOI: https://dx.doi.org/10.4314/ahs.v19i1.53 Cite as: Onyemaechi NOC, Urube SU, SO E. Pattern of surgical emergencies in a Nigerian tertiary hospital. Afri Health Sci. 2019;19(1). 1768-1777. https:// dx.doi. org/10.4314/ ahs. v19i1.5

Knowledge, attitude and practice towards epilepsy among secondary school students in Enugu, South East Nigeria

AbstractPurposeThe purpose of this study was to determine the knowledge and attitude of secondary school students to epilepsy and its treatment that could pose as barriers in the treatment and care of epilepsy patients within the community.MethodsThis study was cross-sectional and descriptive in design using a self administered custom designed multiple choice questionnaire with sections on general information on epilepsy, awareness and perception of epilepsy, treatment of epilepsy/seizures and attitude towards people living with epilepsy.ResultsOut of 969 questionnaires analyzed, the majority of the students (87.6%) had heard of epilepsy as a disease. The commonest sources of information were the electronic media (36.4%) and family members (25.6%). More than half (59.4%) had witnessed a convulsion in the past and 8.9% had a family member with epilepsy. Jerking (50.6%) and loss of consciousness (47.4%) were identified as the commonest manifestations of epilepsy. Epilepsy was considered a psychiatric disorder by 51.9% and as an infectious disease by 40.6%. About 39.3% considered epilepsy to be due to spiritual causes, old age or poisoning/bad blood. A total of 63.1% regarded orthodox medicine and prayers as the best means to treat epilepsy, while 6.8% chose herbal remedies. Concerning first aid treatment, 50.6% agreed that an object should be inserted into the mouth, while 49.5% would call for medical help and 28.8% would remove the person from harm. On attitude, 64.9% would not keep a friend with epilepsy, 69.1% would not play with someone with epilepsy, 84.2% would not marry someone with epilepsy. 41.1% of the students said that people with epilepsy should neither marry while 42.2% say they should not have children. Only 39.1.5% had an overall positive attitude towards people living with epilepsy.ConclusionsThere is a persisting poor knowledge, attitude and practice of epilepsy among secondary school students in SE Nigeria. Efforts should be made to include basic facts about disorders with social consequences such as epilepsy in school health education curriculum

Spontaneous Perforation of the Bile Duct in Infants

Spontaneous perforation of the bile duct is a rare disease in children. To date, less than a hundred cases have been reported in English literature. A number of techniques have been applied to achieve preoperative diagnosis yet most cases are diagnosed at operation. A 3-month-old girl presented with fever, vomiting, progressive abdominal distension, jaundice and diarrhoea. Abdominal ultrasonography showed localized collection of fluid that displaced the small bowel to the right side of the abdomen. The fluid was found to be bilious on paracentesis. At laparotomy, biliary pseudocyst was found but the site of perforation was no longer identifiable. Excision of the containing wall and external drainage was carried out. 9 months after operation the child is well. A high index of suspicion should improve diagnosis and ensure early intervention.La perforation spontan\ue9e des canaux biliaires est une affection rare chez les enfants. A ce jour, moins de 100 cas ont \ue9t\ue9 rapport\ue9s dans la litt\ue9rature anglophone. Un certain nombre de techniques ont \ue9t\ue9 mises en oeuvre pour le diagnostic pr\ue9 op\ue9ratoire, n\ue9anmoins la plupart des cas sont de diagnostic per op\ue9ratoire. Une fille de 3 mois avait pr\ue9sent\ue9 de la fi\ue8vre, vomissements, distension progressive de l'abdomen, ict\ue8re et diarrh\ue9e. L'\ue9chographie de l'abdomen avait montr\ue9 une collection liquidienne localis\ue9e refoulant les anses gr\ueales vers le c\uf4t\ue9 droit de l'abdomen. La paracent\ue8se avait retrouv\ue9 un liquide bilieux. La laparotomie avait not\ue9 un pseudo kyste biliaire, mais le si\ue8ge de la perforation n'\ue9tait plus visible. La paroi du contenant a \ue9t\ue9 excis\ue9e et un drainage externe a \ue9t\ue9 r\ue9alis\ue9. Neuf mois apr\ue8s l'op\ue9ration, les suites \ue9taient simples. Une forte suspicion devrait mener au diagnostic et imposer une intervention pr\ue9coce

Bethune round table 2012: 12th annual conference: filling the gap

Background: Our aim was to highlight the impact of collaboration between 2 linked tertiary hospitals in Nigeria and India. Methods: We conducted a review of a collaboration between the Amrita Institute of Medical Sciences and Research Centre (AIMS), Kochi, India, and the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, to exchange personnel for the purpose of further training from August 2007 and December 2011. Results: One neurosurgeon, 2 pediatric surgeons and 1 orthopedic surgeon had additional exposure at AIMS for periods of 3 months to 1 year. Four neurosurgery and 3 pediatric surgery perioperative nurses have also been trained at AIMS for periods of 3 months. A pediatric surgeon was invited as faculty for laparoscopic training at Ilorin in 2010. The collaboration has resulted in exposure to surgical procedures not usually done in our centre. Our pediatric surgery unit has commenced laparoscopic surgery and pyeloplasty for pelvic ureteric junction obstruction in children. The orthopedic surgeon has commenced interlocking nailing and joint replacement. The neurosurgeon has successful done endoscopic third ventriculostomy and microscopic resection of brain tumour. Conclusion: This international collaboration has led to capacity building with significant impact on surgical services at UITH. An international collaboration and exchange program is a feasible and desirable strategy for technology transfer between technology-advanced settings and resource-constrained centres

Congenital anomalies in low- and middle-income countries: the unborn child of global surgery.

Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability

APOE E4 is associated with impaired self-declared cognition but not disease risk or age of onset in Nigerians with Parkinson's disease

The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a two-fold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95% CI: 1.13-3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95% CI 0.19-0.99, p = 0.02)). Of 773 PD with motor phenotype and APOE characterized, tremor-dominant (TD) phenotype predominated significantly in ε2 carriers (87/135, 64.4%) compared to 22.2% in persons with postural instability/gait difficulty (PIGD) (30/135) and 13.3% in indeterminate (ID) (18/135, 13.3%) (p = 0.037). Although the frequency of the TD phenotype was highest in homozygous ε2 carriers (85.7%), the distribution of motor phenotypes across the six genotypes did not differ significantly (p = 0.18). Altogether, our findings support previous studies in other ethnicities, implying a role for APOE ε4 and ε2 as risk and protective factors, respectively, for cognitive impairment in PD