Nexus between Public Spaces and City Image: A Case Study of Akure, Nigeria

Public spaces connect one part of the city to the other. They are related to the physical elements of the city that shape the image. This study examined the nexus created by the relationship between the physical environment of public spaces and city image. The study noticed neglect which threatens the physical environment of public spaces and discourages users. The relationship assessment was based on the image of the physical and natural features of public spaces as perceived by the users. This study analyses the linkages between the uses and the physical environment in relation to public spaces to improve the city image of Akure, Nigeria and provides an insight into the user's perception of the totality of the physical environment in the context of legibility, imageability and perception to understand how the image of the city is formed. The study summarizes and interprets findings from the quantitative research approach using a structured questionnaire conducted with 384 respondents from the core, transitional and peripheral zones in Akure. The data obtained were subjected to single factor descriptive analysis, inferential analysis and hypothesis testing. The results showed there is a positive relationship between public spaces and city image. The study recommends that public spaces development must inculcate planning and control strategies and a holistic policy by managers of public spaces to improve the image of the city, effort should be geared towards creating an attractive space to attract visitors and investors through investment in public spaces

Comparing the effects of haematoma block and conscious sedation in adults with distal radius fractures

Background: Distal radius fractures present frequently to the orthopaedic surgeon following high velocity injuries in the young or low velocity injuries in the elderly. Haematoma block or conscious sedation can be applied to provide anaesthesia during reduction. Comparing the effects of both anaesthetic methods is yet to be fully evaluated.Objective: To compare the pain level and quality of reduction using haematoma block and conscious sedation following reduction of distal radius fractures.Design: Prospective comparative cross-sectional study.Patients and Methods: Seventy patients with distal radius fractures were grouped for closed reduction; in one group conscious sedation was used and the other, haematoma block. All patients had pain measured with Visual Analogue Scale and quality of reduction by measuring palmar tilt on plain radiograph.Main Outcome Measures: Severity of pain and palmar tilt on radiograph measured before and after reduction.Results: The modal age group was 60 years (40%) with a slightly higher female preponderance (57.1%). Majority, 54.3% had injuries following fall on outstretched hand. The mean Visual Analogue Score for pain following conscious sedation and haematoma block post reduction was 3.5 and 2.4 respectively. The mean palmar tilt of radius for conscious sedation and haematoma groups were 10.1 and 10.9 degrees respectively. There was no statistically significant difference in the efficacy of both anaesthetic methods.Conclusion: The choice anaesthesia for reduction of distal radius fracture on should be based on surgeon’s preference, patient’s wish and history of drug reactions.Keywords: Distal Radius Fractures, Haematoma Block, Conscious Sedatio

Evaluation of an accelerated Ponseti protocol for the treatment of talipesequinovarus in Nigeria

Background: The commonest congenital musculoskeletal deformity worldwide is talipes equino varus (CTEV). Of the various treatment methods available, the most acceptable treatment currently for CTEV worldwide is serial manipulation and casting using the Ponseti technique. The Ponseti technique consists of weekly manipulation and casting for an average of six to eight weeks followed by bracing of the feet till school age. Some studies have shown evidence that more frequent casts may have similar outcomes with weekly casts using the Ponseti method. This study compared the efficacy of management of idiopathic CTEV using an accelerated protocol of twice weekly casts, with the standard weekly Ponseti protocol.Methods: The study was a randomized case control study with a group of patients undergoing an accelerated casting protocol involving twice weekly casts compared with another group who went through the normal weekly Ponseti protocol.Results: A total of 45 feet in 28 patients were studied. The study showed a significantly shorter treatment period in the accelerated protocol (39 days) compared with the standard protocol (52 days); with no significant increase in the number of casts needed for treatment.Conclusions: A twice weekly Ponseti casting protocol enables completion of the casting period earlier than the standard Ponseti method.Keywords: Talipes equinovarus; Ponseti treatment; Accelerated Ponseti Protocol; Serial Castin

Predictive factors for primary amputation in trauma patients in a Nigerian University Teaching Hospital

Background: The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face.Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients.Design: A prospective study of post-traumatic primary limb amputations.Setting: The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004.Subjects: Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004.Results: Sixty six traumatised patient limbs were primarily amputated during the study period.The male: female ratio was 3.7:1 and means age was 28.6 years ±16.6(range: 4-7lyears). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 ± 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex , occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS.Conclusion: Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality

Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors influencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that influence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6±66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount’s disease and rickets) and club foot. The mean hospital stay before surgery was 12±8.8 days (range 1-38days). The mean duration of operation was 78.4±36min. (range 30-195 min). The total length of hospitalization was 34.97±19.91 days in males and 41.97±25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient’s age (P=0.002), indication for surgery (P=0.008), length of preoperative hospital stay (P=0.048), length of operation (P<0.001) and intraoperative blood loss above 200ml (P<0.001) were found to be statistically significant factors adversely affecting the surgical wound outcome. We conclude that most of the factors that predicted poor outcome in this study were patient and environment-related and are preventable. There is need to upgrade facilities in health institutions in Nigeria

Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors influencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that influence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6±66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount’s disease and rickets) and club foot. The mean hospital stay before surgery was 12±8.8 days (range 1-38days). The mean duration of operation was 78.4±36min. (range 30-195 min). The total length of hospitalization was 34.97±19.91 days in males and 41.97±25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient’s age (P=0.002), indication for surgery (P=0.008), length of preoperative hospital stay (P=0.048), length of operation (P<0.001) and intraoperative blood loss above 200ml (P<0.001) were found to be statistically significant factors adversely affecting the surgical wound outcome. We conclude that most of the factors that predicted poor outcome in this study were patient and environment-related and are preventable. There is need to upgrade facilities in health institutions in Nigeria

Direct Integration of Government Funding and Family Support for Musculoskeletal Tumor Care in a Resource-Constrained Country

&lt;i&gt;Background:&lt;/i&gt; Malignant musculoskeletal tumor (MMST) outcome reflects the level of supportive care provided. In Nigeria, the supportive care available to patients with MMST is limited by a lack of funding. Patients often present late, and receive only orthodox care as psychosocial care is not available. We evaluated the effect of direct incorporation of government funding and family support on MMST patient acceptance and completion of treatment. &lt;i&gt;Methods:&lt;/i&gt; A 3-year prospective multicenter intention-to-treat study was undertaken in a tertiary care setting. The first step was a nonselective randomization of MMST patients into 2 groups, Wesley Guilds Hospital Firm A (WGHFA) and Wesley Guilds Hospital Firm B (WGHFB) using the computer software Excel. The control group was WGHFA, which consisted of patients who self-financed their oncology care. The WGHFB patients’ governments (local or state) provided funds according to medical reports and the patients had relatives who offered psychosocial support. The second step entailed treatment (surgery, chemotherapy and radiotherapy) and follow-up. Outcome measures were the interval between presentation at hospital and surgical intervention, acceptability of limb amputation, completeness of treatment courses, duration of hospital stay and mortality. The reproducibility of the methodology was reappraised at the Federal Medical Center. Kruskal-Wallis analysis was used, and an alpha error of &lt;0.05 at a CI of 95% was taken to be significant. &lt;i&gt;Results:&lt;/i&gt; A total of 112 cases of MMST were managed during the study period. Seventy-one (63.4%; 37 WGHFA; 34 WGHFB) met the inclusion criteria. Age, sex, tribe, religion, comorbid factors and mean weekly income were not significant factors influencing improved MMST care among the WGHFB patients. 32 WGHFB versus 7 WGHFA patients accepted the treatment plan. The mean duration of hospital stay before surgery (p &lt; 0.001), discharge against medical advice (p &lt; 0.000), limb salvage (21 vs. 2, p &lt; 0.001), limb amputation (3 vs. 12, p &lt; 0.05, 95% CI 8.3–37.9), completeness of treatment (33 vs. 7, p &lt; 0.05), mean duration of hospital stay, in days (23 vs. 39, p &lt; 0.05) and mortality at 1-year follow-up (13 vs. 28, p &lt; 0.02) were significant. &lt;i&gt;Conclusion:&lt;/i&gt; The cost of cancer care is a challenge for patients with MMST in a resource-constrained country such as Nigeria. Direct integration of the government and family into MMST care will serve as a link between the cancer patient and the source of funds. It raises the possibility of an effective psychosocial approach to improve patient outcome through enhanced treatment acceptability and completion, and so reduce morbidity and short-term mortality.</jats:p

Perception and knowledge of mothers on causes and treatment of rickets associated knee deformity in Ile-Ife, Osun State, Nigeria

This descriptive cross-sectional community-based study was carried out in Ile-Ife, Nigeria to assess the knowledge of mother’s on the aetiology of rickets associated knee deformities and the cultural perception of its treatment. Data collection was done using interviewer based semi structured questionnaires. A total of 464 questionnaires were administered with a response rate of 86.9%. Over half (59.8%; N=241) and 36.5% (147) of the mothers were aware of children with knee deformity and rickets, respectively. Ninety-one (22.6%) mothers had the correct knowledge and perception of the true meaning of rickets. Rickets associated knee deformity aetiology was wrongly perceived to be mainly hereditary (53.8%), cancer (50.9%) and bone infection (48.1%). Very low proportions of mothers had correct knowledge on the causes of rickets such as inadequate exposure to sunshine (21.3%) or inadequate intake of calcium (21.1%). The knowledge of aetiology of rickets was influenced by education (P<0.02), skilled occupation (P<0.0001) and the previous birth of a child with knee deformity from rickets (P<0.001). The mother’s cultural perceptions of treatment for childhood rickets associated knee deformities was significantly affected by age (P<0.001), education, (P<0.001), skilled occupation (P<0.000), history of knee deformity (P<0.04) and mothers with children diagnosed to have knee deformity (P<0.004). Lack of finance, poor compliance to treatment, too long treatment periods, lack of information on where to seek for treatment and unaffordable treatment were among the important factors affecting completeness of treatment of knee deformity due to rickets. In conclusion, the awareness of mothers about rickets in Nigeria is still very low. It is a major reason for late presentation or complete failure to seek for adequate treatment of the knee deformity due to rickets. Increase and sustain public health enlightenment programmes are necessary for prevention. Health policy should incorporate free surgical fees for the established knee deformity to encourage community participation in the management of the condition

Perception and knowledge of mothers on causes and treatment of rickets associated knee deformity in Ile-Ife, Osun State, Nigeria

This descriptive cross-sectional community-based study was carried out in Ile-Ife, Nigeria to assess the knowledge of mother’s on the aetiology of rickets associated knee deformities and the cultural perception of its treatment. Data collection was done using interviewer based semi structured questionnaires. A total of 464 questionnaires were administered with a response rate of 86.9%. Over half (59.8%; N=241) and 36.5% (147) of the mothers were aware of children with knee deformity and rickets, respectively. Ninety-one (22.6%) mothers had the correct knowledge and perception of the true meaning of rickets. Rickets associated knee deformity aetiology was wrongly perceived to be mainly hereditary (53.8%), cancer (50.9%) and bone infection (48.1%). Very low proportions of mothers had correct knowledge on the causes of rickets such as inadequate exposure to sunshine (21.3%) or inadequate intake of calcium (21.1%). The knowledge of aetiology of rickets was influenced by education (P<0.02), skilled occupation (P<0.0001) and the previous birth of a child with knee deformity from rickets (P<0.001). The mother’s cultural perceptions of treatment for childhood rickets associated knee deformities was significantly affected by age (P<0.001), education, (P<0.001), skilled occupation (P<0.000), history of knee deformity (P<0.04) and mothers with children diagnosed to have knee deformity (P<0.004). Lack of finance, poor compliance to treatment, too long treatment periods, lack of information on where to seek for treatment and unaffordable treatment were among the important factors affecting completeness of treatment of knee deformity due to rickets. In conclusion, the awareness of mothers about rickets in Nigeria is still very low. It is a major reason for late presentation or complete failure to seek for adequate treatment of the knee deformity due to rickets. Increase and sustain public health enlightenment programmes are necessary for prevention. Health policy should incorporate free surgical fees for the established knee deformity to encourage community participation in the management of the condition

Perception and knowledge of mothers on causes and treatment of rickets associated knee deformity in Ile-Ife, Osun State, Nigeria

This descriptive cross-sectional community-based study was carried out in Ile-Ife, Nigeria to assess the knowledge of mother’s on the aetiology of rickets associated knee deformities and the cultural perception of its treatment. Data collection was done using interviewer based semi structured questionnaires. A total of 464 questionnaires were administered with a response rate of 86.9%. Over half (59.8%; N=241) and 36.5% (147) of the mothers were aware of children with knee deformity and rickets, respectively. Ninety-one (22.6%) mothers had the correct knowledge and perception of the true meaning of rickets. Rickets associated knee deformity aetiology was wrongly perceived to be mainly hereditary (53.8%), cancer (50.9%) and bone infection (48.1%). Very low proportions of mothers had correct knowledge on the causes of rickets such as inadequate exposure to sunshine (21.3%) or inadequate intake of calcium (21.1%). The knowledge of aetiology of rickets was influenced by education (P<0.02), skilled occupation (P<0.0001) and the previous birth of a child with knee deformity from rickets (P<0.001). The mother’s cultural perceptions of treatment for childhood rickets associated knee deformities was significantly affected by age (P<0.001), education, (P<0.001), skilled occupation (P<0.000), history of knee deformity (P<0.04) and mothers with children diagnosed to have knee deformity (P<0.004). Lack of finance, poor compliance to treatment, too long treatment periods, lack of information on where to seek for treatment and unaffordable treatment were among the important factors affecting completeness of treatment of knee deformity due to rickets. In conclusion, the awareness of mothers about rickets in Nigeria is still very low. It is a major reason for late presentation or complete failure to seek for adequate treatment of the knee deformity due to rickets. Increase and sustain public health enlightenment programmes are necessary for prevention. Health policy should incorporate free surgical fees for the established knee deformity to encourage community participation in the management of the condition