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

MDCAN/MDCN stakeholders’ meeting held at MDCN conference room, Abuja from 26th - 27th July, 2018

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Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy

ABSTRACT Aim: This retrospective analysis documents the features and factors that potentially affect outcomes in septic arthritis in the Cross River Basin area of south-south Nigeria. Patients and Methods: A retrospective analysis of 43 patients who presented with septic arthritis in 45 joints between September 2007 and August 2010. All patients with pain, fever, joint swelling and non-weight bearing/refusal to move the limb and had a joint aspiration productive of a turbid and/or purulent aspirate were included in the analysis. Patients whose joint aspiration produced frank blood or a clear exudate were excluded. Results: There were 24 males and 19 females (M:F = 1.3:1). Forty patients were children while three were adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2 were rural dwellers. Twenty-five children were first seen by a Paediatrician. Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in 12 children and 3 adults. Staphylococcus aureus was the commonest isolated pathogen in both age groups. Conclusion: Injudicious interventions in musculoskeletal conditions consist not only of traditional bone setting and other unorthodox practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa are a function of the skewed distribution of the healthcare workforce and a weak referral chain. The near absence of follow-up culture underscores the need for education on injudicious antibiotic therapy to be directed at patients and physicians. Judicious interventions in musculoskeletal sepsis at first contact and a strengthening of the referral chain are important

Surgical site infection in clean orthopaedic operations: experience from the third world Address for correspondence* Asian Journal of Medical and Clinical Sciences Original Article

Objective: This study was aimed at determining the rate of surgical site infection in clean orthopaedic operations and the contributing factors in the University of Calabar Teaching Hospital, Calabar. Methods: This was a prospective study involving patients who had clean orthopaedic surgeries in the University of Calabar Teaching Hospital over a one year period. Ethical approval was obtained for the study. Data was collected using a proforma and analysis was done with EPI-INFO version 2002. Results: Sixty four patients entered the study with a mean age of 33.7years (SD ±19.3). Six patients (9.38%) had post operative clinical evidence of surgical site infection; there were between 12 to 15 persons in the operating room during their surgeries. Staphyloccus aureus was the most common organism isolated. Four of these patients stayed for additional 1 to 4 weeks in hospital. Conclusion: The rate of surgical site infection following clean orthopaedic surgical operations in our centre is still high compared to figures from developed countries. Appropriate measures need to be instituted to reduce this in view of attendant negative consequences