Primary and Revision Amputation Surgery in a Tertiary Institution in South West Nigeria

Background: Amputation is a common elective or emergency surgical procedure. We set out to study the cases undergoing amputation surgery with special interest of determining the prevalence rate of revisionamputation surgery; its indication and trend among patients who had amputation surgery at a tertiary health facility.Method: Study was cross sectional in design and retrospective in nature, conducted in a tertiary health facility selected purposively in a state, South West, Nigeria. Data collection was by reviewing the records of amputation surgery done at a tertiary health facility over a 15-year period (1996- 2010). Data collected were analyzed using the SPSS version 17, and statistical inferences made at p-value .0.05.Results: A total of 124 amputations were done with 9 cases of revision amputation giving a prevalence rate of 7.25%. The commonest indication found for amputation surgery was trauma while it was ascending gangrene for revision amputation. Among those who had revision amputation done, 75% were diabetic while 22% had earlier refused consent for amputation at an appropriate site. An increasing trend in the prevalence of revision amputation was found. There was a statistically significant associationbetween diabetic amputees and their having a revision amputation done with p =0.002.Conclusion: Diabetic amputees are at a higher risk of a revision amputation. Counseling and appropriate diagnostic procedures is essential for prevention

Performance Needs Assessment of Maternal and Newborn Health Service Delivery in Urban and Rural areas of Osun State, South-West, Nigeria

The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based randomly selected PHC facilities. Using a  Performance Needs Assessment framework, desired performances were determined by key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chi-square tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor political will of local government authorities. Improved  government commitment to MNH is needful to address most of the gaps. Afr J Reprod Health 2014; 18[2]: 105-116).Keywords: Performance, maternal health services, health system

Risk factors of surgical site infection following multiple implant surguries in individual patients managed at a tertiary health facility, South west Nigeria

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Femoral Diaphyseal Fractures in Adults: Pattern of Presentation and Outcome

Background: Fractures of the femoral shaft are among the common fractures seen by orthopaedic surgeons. The relative distribution of these fractures depends on multiple factors including the geographic location (urban vs. rural) and country of study. The aim of this paper is to re-evaluate the aetiology, severity and mechanisms of injuries responsible for femoral fractures.Study design: A prospective review of patients presenting at the Accident and Emergency (A/E) Department of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife between February 2011 and January 2012 was carried out.Results: Fifty-six femoral diaphyseal fractures in fifty-five patients with a mean age of 37.4±15.9years were seen. The male to female ratio was 1.7:1. The causes of injury were motor vehicular accidents (39.3%), motorcycle accidents (37.3%), pedestrian injuries (16.1%), fall from height (3.6%), gunshot injury (1.8%) and falling timber (1.8%). All were managed operatively with interlocking intramedullary nailing. Mean time to union was 16.4 ± 4.8 weeks and the complications included missed distal screws, delayed union, superficial and deep wound infection.Conclusions: Motor vehicular and motorcycle crashes still remain the top causative factors of femoral diaphyseal fractures. More intense efforts should be directed towards reducing the menace of road accidents and provision of affordable health care for victims.Key words: Femur, fractures, vehicular crashes, interlocking nai