Overcrowding of accident & emergency units: is it a growing concern in Nigeria?

Background: The inability of the Nigeria’s Accident and Emergency Departments (AED) to meet current demands is growing among the public and health care professionals. The data supporting perceptions of insufficient capacity are limited. Therefore, this study was intended to determine the prevalence, causes, and effects of overcrowding AEDs in Nigeria.Materials and Methods: This was a cross sectional, descriptive study carried out among AED staff of 3 referral teaching hospitals in Nigeria, using a pre-tested and validated structured questionnaire.Results: The analysis of the 267 AED staff revealed 20-56years (36.40+5.1 mean) age range. One hundred and twenty eight (47.9%) were males, 139 (52.1%) females. Two hundred and fifty nine (97%) agreed that an AED should have a bed capacity of 21-30. Agreement to AED overcrowding in Nigeria was quite considerable. The frequency of AED overcrowding per week was 4-7 times. The average bed occupancy level was 3.25. Agreed common causes of prolonged AED admissions were to be a high volume of critically ill patients, Delayed transfer of patients to the wards, delay in theatre operation, delay in radiological investigations and exceptionally high proportion of patients requiring admission in AED. Also, long pre-review waiting time and haematological delays were more causes. The average waiting time for victims to be seen was 29.7minutes.Conclusion: There are many causes of AED overcrowding in this environment. However, improving AED bed management, better organized and diligent discharge planning, and reducing access block should be a priority to reduce AED overcrowdingKeywords: Overcrowding, accident, emergency surgery, Nigeri

Disasters in Nigeria: A Public Health Perspective

Background: Nigeria is the most populous black nation on earth with some fragile demographic, socio-economic and health indices. The country has been having its own share of both natural and man-made disasters. This paper discussed an overview of disasters and some socio-demographic characteristics of Nigeria, factors in vulnerability of disasters, public health impacts and issues in disaster management in Nigeria among others from a public health perspective and the way forward.Methods: The authors undertook full searches (September-November, 2012) of original research, reports and reviews using Medline, pubMed, Embase and World Health Organisation (WHO) database. Search words were disaster, disasters in Nigeria, and public health impacts. Part of the data used was personal communications and in-press publications.Results: The results revealed significant number of disasters in Nigeria, such as plane crashes, oil pipeline fire explosions, collapsed buildings, terrorist attacks, civil strife, and flood, among others. Some of the identified issues that hampered quick response and recovery included poor and ineffective search and rescue operations, poverty, poor public and community education on disaster management, among others.Conclusion: There is need for public and community education on disaster and its management, disaster preparedness, wellcoordinated and effective search and rescue operations, capacity building, tackling corruption and poverty reduction.Keywords: Disaster, Public Health, Public Education, Disaster Mitigation, Nigeri

hospital waste management as a potential hazard in selected primary healthcare centres in zaria nigeria

The operations of health facilities generate waste; a common characteristic of hospitals and Primary Healthcare centres. However, improper handling of hospital waste constitutes potential risks to the environment and human health. Unfortunately, hospital waste management is not yet carried out with a satisfactory level of safety in many parts of the globe, especially in the underdeveloped world. This study was carried out with the aim of assessing hospital waste management practices among selected Primary Healthcare Centres (PHCs) in Zaria, Nigeria. A cross sectional descriptive study was carried out between October 2012 and March, 2013 using staff of the PHCs and an interviewer-administered questionnaire, checklist and participant observations. Majority of the staff of the PHCs were nurses (37%) and the knowledge score of all the staff was 5 out of 10 (50%). About 73% had training on hospital waste management 31% had reported injury by sharps. Also, 66% use protective hand gloves while doing their work. Wheel barrow was the commonest method of transporting waste and open burning was the final method of waste disposal by the PHCs. There is a need for safer means of waste disposal among the medical facilities visited. It was, therefore, recommended among others that funds should be made available to the PHCs. This is to ensure the acquisition of all facilities needed in hospital waste management and disposal. There should be training and re-training of health staff on current hospital waste management to meet global best practices. http://dx.doi.org/10.4314/njt.v33i2.1

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Mobile caecum and ascending colon syndrome in a Nigerian adult

A mobile caecum and ascending colon is a rare congenital abnormality. Its presentation as a cause of right lower abdominal pain in an adult is usually mis-diagnosed as acute appendicitis. A 42-year-old civil servant presented with a 2-year history of recurrent right lower quadrant pain of the abdomen. The pain was sharp in nature and persistent in the last 2 weeks and centered mainly in the right side of the abdomen. No other associated symptoms were noted. Laboratory investigations did not reveal obvious abnormality. A diagnosis of acute on chronic lower quadrant pain of unknown etiology was made. The patient was resuscitated and had exploratory laparatomy. No abnormalities were found other than the caecum and the whole ascending colon, which were unattached to the posterior peritoneum. Appendectomy and caecopexy, using a lateral peritoneal flap were performed. The diagnosis of mobile caecal syndrome should be considered in patients with chronic right lower quadrant pain, and appendectomy and caecopexy offers a great relief

Herniated Gravid Uterus: Clinical Course and Result of Treatment

Herniated gravid uterus in an incisional hernia of the anterior abdominal wall is relatively rare. A 30-year-old house wife presented with a six month gravid uterus that had herniated through an incisional hernia of the anterior abdominal wall. She had non-operative management till term, when she then had elective lower caesarian section. Physiotherapy of the anterior abdominal wall muscles to improve their tone was done. She subsequently had keel’s repair of the hernia. Aggressive physiotherapy of the anterior abdominal wall muscles followed by keel’s repair may be an alternative surgical technique in patients with a moderate defect of incisional hernia

Quality of Teaching Provided by Surgical Residents: An Evaluation of the Perception of Medical Students

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Surgical Drains: What the Resident Needs To Know

Background: Drains continue to be an important aspect of the management of surgical patients. Its use has been contentious. However, when indicated, it is important that drainage should be practiced with prudence. Methods: Publications from both local and international journals through Medline, pub med and Google search (June-August, 2007) were reviewed. Results: Drains remove content of body organs, secretion of body cavities and tissue fluids such as blood, serum, lymph and other body fluid that accumulate in wound bed after surgical procedures. Therefore, reduction of pressure to surgical site as well as adjacent organs, nerves and blood vessels, enhances wound perfusion and wound healing. Reduction of pain is also achieved. However, drains are now known not to be innocuous especially when they are poorly selected, wrongly used and left in situ for too long. Essentially, passive and active drains are the most practically useful type. Conclusion: Understanding the benefits and applications of surgical drains and tissue responses to constituent material is not only relevant to a practicing surgeon but would help to reduce the abuse of surgical drains. Keywords: Drains, surgery, application Nigerian Journal of Medicine Vol. 17 (3) 2008: pp. 244-25

Stress and Distress of Surgical Practice: the Trainee\'s View

Background: Stress is the body\'s non specific response to any pleasant or unpleasant demand placed upon it. Is surgical practice a stressful profession? Method: It\'s a prospective study, involving surgical residents in sub specialties of surgery. Information was obtained by administered questionnaire. Resident was expected to have spent three months in the surgical field. Results: There were forty one (41) residents; age range was 25year to 42 year (mean 33.44+4.81). There were 35(85.4%) males and 6 (16.6%) females. Thirty eight, (92.7%) of the residents considered surgery to be a stressful profession. Thirty two, (78.1%) considered pediatrics subspecialty to be the most stressful of all. Lack of professionalism and workload were greatest sources of stress in 18 (43.9%) and 11 (26.8%) cases of the residents. In thirty seven, (90.2%) their academic exposures were not adequate. Despite all these short comings, the progress of the training was satisfactory in 26(63.4%) residents. Thirty seven, (90.2%) of the residents would not specialize in surgery if given a second chance. Conclusion: Surgery, as a stressful profession is no longer a debatable issue and a surgical trainee perceives it that way. We recommend that coping mechanisms such as putting appropriate backup support, offer of flexible scheduling to allow time off for critical family and social events are absolutely necessary among our surgical trainees. Keywords: Stress, distress, surgery, trainee,Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 383-38