Team approach concept in management of oro-facial clefts: a survey of Nigerian practitioners

<p>Abstract</p> <p>Background</p> <p>Cleft palate craniofacial teams have evolved across the globe in the last 20 years in compliance with the interdisciplinary concept of management of oro-facial clefts. An interdisciplinary care allows a coordinated treatment protocol for the patient. The objective of this study was to evaluate oro-facial cleft care in Nigeria with particular emphasis on the compliance of the practitioners to the team approach concept.</p> <p>Methods</p> <p>A snapshot survey was conducted among specialists that attended the Pan African Congress on Cleft Lip and Palate, at the International Institute of Tropical Agriculture, Nigeria in February 2007.</p> <p>Result</p> <p>Sixty three respondents successfully completed and returned the questionnaire for analysis. Mean age of respondents was 43.5 years and the range was 38–62 years.</p> <p>Male to female ratio was 2.7:1. Oral and Maxillofacial Surgeons and Plastic Surgeons constituted the majority of respondents (38.1% and 22.2%) respectively. Only 47.6% (n = 30) of the specialists belonged to cleft teams. Majority of Oral and Maxillofacial Surgeons and Plastic Surgeons belonged to cleft teams (70% and 63.3% respectively) while speech pathologists and orthodontists were less represented (20% and 36.7% respectively) in teams.</p> <p>Conclusion</p> <p>Findings from this study suggests that interdisciplinary care for the cleft patient does not appear to have been fully embraced in Nigeria. This may be a result of several reasons ranging from non availability of the requisite specialists, the relatively young age of cleft care practice in this part of the world to the poor state of infrastructure.</p

Medical and dental students’ willingness to administer treatments and procedures for patients living with AIDS

Background. Nearly three decades after the discovery of the human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS)epidemics continue to pose significant challenges to low-income countries in sub-Saharan Africa.Objective. To assess medical and dental students’ willingness to perform specific techniques and procedures on people living with AIDS (PLWA).Methods. A survey was done among medical and dental students (N=304) at a Nigerian University using a 21-item questionnaire that elicitedresponses on sociodemographic characteristics and willingness to perform specific techniques and procedures. Analysis of variance (ANOVA) andan independent t-test were used to determine the influence of sociodemographic variables. Multiple regression analyses were used to determine the predictors of willingness.Results. The cohort of medical and dental students was willing to care for PLWA. Almost all medical students were either undecided or unwillingto perform mouth-to-mouth resuscitation. A higher proportion of dental students were either undecided or unwilling to assist during surgery, toothextractions and other procedures they considered to be invasive. More medical than dental students were willing to carry out surgical procedures.Previous personal encounters with AIDS patients, religion, and satisfaction with instructions influenced medical and dental students’ willingness tocare for PLWA, while knowing a family member living with AIDS (R2=0.22, p&lt;0.001) was the strongest predictor of willingness to care for PLWA.Conclusion. Extensive use of clinical clerkships and exposure through direct experience are viable strategies necessary for optimising and enhancingmedical and dental students’ dispositions to perform procedures and care for PLWA

Mandibular reconstruction: a new defect classification system

This paper presents a new mandibular segmental defect classification system (La-Co-CE) with a view to highlight the complexity and difficulty of the reconstruction with free autogenous bone grafts which the most frequently used method for surgeons practicing in developing countries. We submit that defect classification systems will continue to remain relevant if surgeons are to is pre-operatively classify the envisaged operative difficulty and objectively compare the outcome postoperatively. Key words: Mandibular reconstruction, defect, classification

Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria

Background: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP.Materials and Methods: A cross‑sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score.Results: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16‑42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable (P &lt; 0.001).Conclusion: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.Key words: Antenatal clinics, awareness, cleft lip, knowledge, pregnant wome

Broadening conceptions of medical student mistreatment during clinical teaching: message from a study of &ldquo;toxic&rdquo; phenomenon during bedside teaching

Hector Oladapo Olasoji Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria Purpose: Part of the local hidden curriculum during clinical training of students in the University of Maiduguri medical college in Nigeria, metaphorically referred to as &ldquo;toxic&rdquo; practice by students, are situations where a teacher belittles and/or humiliates a student who has fallen short of expected performance, with the belief that such humiliation as part of feedback will lead to improvement in future performance. Through a framework of sociocultural perspective, this study gathered data to define the breadth and magnitude of this practice and identify risk and protective factors with the aim of assessing effectiveness of current intervention strategies. Materials and methods: Using a mixed method research approach, quantitative data were collected from fourth-year medical students in a Nigerian medical college through a survey questionnaire, and qualitative data were obtained through a face-to-face, individual, semi-structured interview of students attending the same institution.Results: Findings indicate that many students continue to experience &ldquo;toxic&rdquo; practice, with only very few reporting the incidents to relevant authorities, raising important questions about the appropriateness of current intervention efforts.Conclusion: Current intervention strategies grossly underestimate the influence of institutional forces that can lead to or promote this behavior. Acknowledgment of this has implications for an appropriate intervention strategy. Keywords: clinical teaching, verbal interactions, belittling, socio-cultural perspective, intervention&nbsp

African oral histoplasmosis mimicking lip carcinoma: case report

A case of Iocalised African histoplasmosis with an unusual presentation in a 56 year old Nigerian farmer is reported. The lesion presented as an ulcer clinically mimicking squamous cell carcinoma of the lower lip. An incisional biopsy and culture studies confirmed African histoplasmosis and the utcer healed spontaneously without treatment. This case is reported to highlight the unusual location and clinical course of African histoplasmosis

Cleft lip and palate surgery in children: Anaesthetic considerations

Background: The Care of cleft patients is very challenging. Team cleft care is usually lacking in many developing countries due to shortage of qualified manpower. This study is aimed at highlighting anaestheticchallenges in the management of cleft in children.Patients and Methods: This was a study of cleft lip and palate patients who were managed during team cleft care activities at University of Maiduguri Teaching Hospital and Federal Medical Centre Nguru both in northeastern Nigeria from January to June 2009.Results: One hundred and six cleft patients presented for surgicalrepair under general or local anaesthesia. Fifteen (14%) patients all of whom children were unfit for general anaesthesia due to various medical reasons. Ninetyone (86%) cleft patients comprising 53(50%) childrenand 38(36%) adults had cleft repair under halothane general endotracheal anaesthesia and local anaesthesia, respectively. There was no anaesthetic complications recorded under local anaesthesia. Fifteen percent ofchildren who received general endotracheal anaesthesia suffered various anaesthetic complications which included hypoxia (3.8%), laryngospasm (1.9%), kinking of endotracheal tube (5.7%), inadvertent extubation(1.9%) and pulmonary aspiration (1.9%). There was no mortality or anaesthesia-related morbidity at the time of discharge in all the cases. Conclusion: We conclude that anaesthesia for cleft lip and palate repair in hospital based team-cleft care activities in our environment is relatively safe. We recommend general anaesthesia with controlled ventilation for children and local anaesthesia for adult and older children who can cooperate