Informed consent for surgery in Nigeria: Is the practice adequate?

To evaluate the adequacy of the use of informed consent in surgical practice from the patients’ perspective. The study was carried out in the department of Surgery, University of Calabar Teaching Hospital, Calabar, over a six-month period. A structured questionnaire was administered post operatively on patients, and parents/guardians of minors, who agreed to participate in the exercise. Data obtained included sociodemographic characteristics, description of surgery they had, whether surgical procedure was explained to them pre operatively or not, who gave the explanation, their level of understanding and their opinion on the process of obtaining the consent. Ninety one patients participated in the study. Male to female ratio was 3.8:1, with average age of 33.6 years (SD ± 13). Most of them (94.6%) had some level of formal education. Seventy nine patients (86.8%) knew the description of the surgical procedure. Pre operative explanation of the surgical procedure was given to 70.3% of the patients but 27.5% of these did not understand the explanation. A significant number of the patients (51.6%) were not satisfied with the explanation given. Even though all the patients had the consent form signed either by themselves or on their behalf by a close relative, 46.2% of them did not understand the content of the consent form and 67.1% did not understand the implication of what they had signed. The practice of informed consent for surgery is not adequate. Surgeons need to be further educated to improve their practice in this regard. The consent process needs to be simplified to enhance patients’ understanding and participation

Motorcycle Road Traffic Injuries in Southern Nigeria: The Small Motorcycle as a Prevention Strategy

Background: The commonest mode of public transportation in Uyo is by motorcycle. There are two sizes of motorcycle in common use – the big one (Qlink or Skygo model, made in China) and the small one (C90, made in China). The study was carried out to determine if there is a lower risk of RTI severe enough to be brought to the hospital, attributable to using a small motorcycle.Methods: Motorcycle RTI victims admitted at the Accident and Emergency department of the University of Uyo Teaching Hospital (UUTH), were reviewed prospectively over a 15 month period. Three community visual surveys of the proportion of small to large motorcycles were also conducted.Results: A total of 131 RTI victims were reviewed over 15 months. The visual surveys of motorcycles in Uyo revealed that the mean proportion of small to large is 38 to 62, a ratio of 1:1.6. Eighty-three (63.3%) of the 131 RTI’s involved motorcycles. 74 of these occurred in large motorcycles. There was a statistically significant relationship between motorcycle size and occurrence of an RTI severe enough to be brought to hospital.Conclusion: There is a lower risk of RTI severe enough to be brought to hospital, from using a small motorcycle

Reasons for patronage of traditional bone setters

Aims and Objectives: The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS.Materials and Methods: A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS’ treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment. Data Analysis: Analysis was done with SPSS software Version 20.Results: A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1. Conclusions and Recommendations: With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.Keywords: Fractures, impressions, reasons for patronage of traditional bone setter

Domestic injuries in childhood in Lagos, Nigeria

A prospective study was carried out to ascertain the pattern of soft tissue and skeletal injuries sustained by children at home in Lagos, Nigeria. 182 patients who entered the study sustained 185 injuries . Age ranged from 7days to 14years with mean of 5.17years. Male to female ratio was 1.28:1. Fall was the leading cause of injury accounting for 162 cases (89.0%). Fracture was the most common injury sustained (86.8%) with supracondylar fracture of the humerus being the single most common fracture (28.5%). Injuries sustained by children at home can have far-reaching consequences. Prevention involves active participation of all stakeholders. Nigerian Journal of Surgical Sciences Vol. 17 (1) 2007: pp. 33-3

Diagnosis and treatment of pyogenic bone infections

Background: Pyogenic osteomyelitis is still frequently seen in the developing world and the treatment of chronic osteomyelitis presents a considerable challenge despite advances in microbiological techniques, antibiotics and surgical techniques. Acute haematogenous osteomyelitis is commoner in children. Results: In the pre-antibiotic era, mortality rate was high and progression to chronic osteomyelitis was common. A near similar scenario still exists in many developing countries due to the combination of inappropriate and/ or inadequate antibiotic therapy, delayed presentation and unorthodox interventions by traditional healers. Discussion: Chronic osteomyelitis may result from poorly treated or untreated acute osteomyelitis, open fractures, surgery for an array of orthopaedic conditions and from contiguous spread from infected soft tissue as may occur in diabetic foot infections. A large array of treatment techniques hinged on sequestrectomy/debridement, management of dead space, improvement of oxygenation and perfusion to ischaemic tissue exist. Despite these, total eradication of disease is difficult. Conclusion: This article summarizes the pathology and methods of management available for pyogenic osteomyelitis. In its acute and chronic forms, the disease is likely to remain prevalent in the developing world until issues of ignorance, poverty and prompt access to appropriate and efficacious medical care are addressed

Injuries in children: the Lagos experience

No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 4(1&2) 2005: 54-6

Treatment of Congenital Genu Recurvatum - a Preliminary Report

Background: Congenital genu recurvatum is a rare anomaly which is diagnosed clinically. Treatment may be non surgical or surgical. Study was aimed at demonstrating the efficacy of non-operative treatment of the condition by manipulation and serial correction with casting.Methodology: This was a prospective study of consecutive patients with congenital genu recurvatum presenting at a teaching hospital over a four year period entered the study. Socio-demographic characteristics of the patients were obtained, they were then examined and investigated. Treatment was by manipulation and serial correction with Plaster of Paris application (POP) which was changed every three weeks until correction of deformity was achieved. Patients were followed up till walking when a final review was done.Results: Five patients were seen over the period of this report. There were 4 females and 1 male; mean age was 14.2days. The deformity affected the right knee in 40%, the left in 20% and was bilateral in 40% of cases. An average of 6 casts over a mean period of 14 weeks (range 10 to 20  weeks) were needed to achieve full correction of the deformities. All the patients had good outcome of treatment without the need for surgery.Conclusion: Congenital genu recurvatum is predominant in the female. In this study, the patients responded excellently to serial manipulation and casting. Surgery was not necessary in of the patients.Key Words: Congenital; Genu recurvatum; Surger

The home: common place of childhood injuries

No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 4(1&2) 2005: 67-7

Head injury: Calabar Teaching Hospital experience

This study was undertaken as part of a wider prospective study by the University of Calabar Teaching Hospital Trauma Study Group. The specific objective was to highlight the pattern, distribution causative and contributory factors to head injury in our locality and to assess the outcome of treatment. The overall aim was to establish those epidemiological factors which may be targeted in the prevention and improvement of outcome. This paper is the preliminary report of this on-going study. The pattern and distribution of head injuries shows that a typical head injured patient in our locality is a male, aged between 21 and 30 years involved in a motorcycle related accident. Accidents frequently occured between 7 and 9pm and though 75% of patients arrived in hospital within 6 hours of injury, 17% of all cases died probably from suboptimal in-hospital care even in a tertiary centre. None of the patients used a protective helmet or restraining seatbelt. Prevention remains the key management option in these injuries. Nigerian Journal of Surgical Sciences Vol. 17 (1) 2007: pp. 14-2