Abdominal trauma in a semi-urban tertiary health institution

Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting. Methods: It was a descriptive (combined retrospective and prospective) study of all patients with abdominal trauma admitted and managed at Ekiti State University Teaching Hospital, Ado-Ekiti between January 2013 and December 2016. Data on socio-demographics, clinical profile, investigations, treatments and outcome were entered into a spread sheet and analyzed using SPSS version 20.0. Results: A total of 2728 trauma patients presented during the study period. Of these, 68 (2.5%) suffered from abdominal injuries. Their ages ranged from 6 to 72 years (mean 30.3±13.2). Fifty-nine (86.8%) were males while 9 (13.2%) were females (M: F ratio = 6.6:1). Forty-nine (72.1%) sustained blunt trauma while 19 (27.9%) had penetrating injuries. Road traffic incident (RTI) (n=41; 60.3%) was the most common source of trauma, followed by assault: gunshot (n=9; 13.2%), and stab (n=7; 10.3%). Spleen (n=23; 33.8%) was the most common solid organ injured followed by the liver (n=7; 10.3%) while small bowel (n=8; 11.8%) was the most common hollow viscous injured. Forty-seven (69.1%) required operative intervention. Post-operative complication rate was 17% with wound infection (12.5%) predominating. The mortality rate was 4 (5.9%). Conclusion: RTI and assault are major causes of abdominal injury. Measures to reduce RTI, youth restiveness and criminal activities will stem the tide

Financial cost of hypertension in urban and rural tertiary health facilities in Southwest, Nigeria: A comparative cross-sectional study

Background: The financial cost of hypertension could result in serious economic hardship for patients, their households, and the community. To assess and compare the direct and indirect cost of care for hypertension in urban and rural tertiary health facilities. Material and Methods: A comparative cross-sectional study was carried out in two tertiary health facilities which are located in urban and rural communities of the southwest, Nigeria. Four hundred and six (204 urban, 202 rural) hypertensive patients were selected from the health facilities using a systematic sampling technique. A pretested semi-structured, interviewer-administered questionnaire adapted from that used in a previous study was used for data collection. Information on biodata, and direct and indirect costs was collected. Data entry and analysis were done using IBM SPSS Statistics for Windows, Version 22.0. Results: More than half of the respondents were females (urban, 54.4%; rural, 53.5%) and in their middle age (45-64 years) (urban, 50.5%; rural, 51.0%). The monthly cost of care for hypertension was significantly higher in urban than in rural tertiary health facilities (urban, ₦19,703.26 [$54.73]; rural, ₦18,448.58 [$51.25]) (P < 0.001). There was a significant difference in the direct cost (urban, ₦15,835.54 [$43.99]; rural, ₦14,531.68 [$40.37]) (P < 0.001), although the indirect cost (urban, ₦3,867.72 [$10.74]; rural, ₦3,916.91 [$10.88]) (P = 0.540) did not show much difference between the groups. The cost of drugs/consumables and investigations contributed more than half (urban, 56.8%; rural, 58.8%) of the cost in both health facilities. Conclusion: The financial cost of hypertension was higher in the urban tertiary health facility; therefore, more government support is needed in this health facility to close the financial gap

Perceptions and Practice of Early Diagnosis of Sickle Cell Disease by Parents and Physicians in a Southwestern State of Nigeria

Background. Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess the practice and perception of early SCD diagnosis among a group of parents and physicians in Nigeria. Patients and Methods. This was a cross-sectional descriptive study conducted to assess the opinions and practice of early diagnosis of SCD among 135 physicians caring for SCD patients and 164 mothers of children with SCD in a southwestern state of Nigeria. Results. Most physicians 132 (97.8%) were aware of prenatal SCD diagnosis, but only 51 (37.8%) would recommend it. Most physicians 129 (95.6%) routinely recommend premarital SCD genetic counseling and testing, and 89 (65.1%) were aware of the national government newborn screening program but lesser proportion 75 (55.6%) were willing to recommend it. Amongst the mothers, 154 (94%) and 158 (96%) had encountered genetic counseling for SCD and were willing to offer newborn screening to their children, respectively. On the contrary, fewer mothers 42 (25%) were aware of prenatal SCD diagnosis, 28 (17%) were willing to partake in it, and 44 (26%) were undecided. There were discrepancies in the willingness by physicians to practice early SCD diagnosis and its uptake by mothers (p<0.0001). The commonest reason given by both the physicians and mothers for not practicing SCD prenatal diagnosis was the high cost of the procedure. Conclusion. The perceptions and practice of early SCD diagnosis was suboptimal in the study locality. Scaling up awareness and universal coverage are required