Major limb amputations at a teaching hospital in the sub-Saharan Africa: Any change in trend?

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Results of Operative Fixation of Fractures of the Ankle at a Tertiary Hospital in a Developing Country

Background: Operative fixation of ankle fractures is becoming popular in developing countries. The concern however is the outcome of care. The objective was to evaluate the results of open reduction and internal fixation (ORIF) of fractures of the ankle in our hospital.Methods: All cases ORIF of fractures of the ankle at the University College Hospital (UCH), Ibadan between March 2010 and December 2012 were recruited into the study. The indications for surgery, techniques of fixation, time interval between injury and presentation as well as outcome  measures like time to union, complications and functional outcomes were evaluated.Results: Seventy patients who had ORIF of ankle fractures were studied. Twenty-one (30%) were open fractures while forty-nine (70%) were closed. Sixty (85.7%) patients presented within the first week of injury, 4 (5.7%) after 4 weeks, 4 (5.7%) after 6 weeks and 2 (2.9%) after 52 weeks. Time to union averaged 12.6±4.1weeks. Complications included wound infection 14.3%, wound dehiscence with exposed implants 2.9%, malunion 8.6% and non union 5.7%. Good to excellent functional outcomes were achieved in 77.1% of the patients.Conclusion: ORIF is a viable option in the treatment of ankle fractures

Building Semantic Causal Models to Predict Treatment Adherence for Tuberculosis Patients in Sub-Saharan Africa

Poor adherence to prescribed treatment is a major factor contributing to tuberculosis patients developing drug resistance and failing treatment. Treatment adherence behaviour is influenced by diverse personal, cultural and socio-economic factors that vary between regions and communities. Decision network models can potentially be used to predict treatment adherence behaviour. However, determining the network structure (identifying the factors and their causal relations) and the conditional probabilities is a challenging task. To resolve the former we developed an ontology supported by current scientific literature to categorise and clarify the similarity and granularity of factors

PIH6 Pattern and Determinants of Willingness to Pay for Antenatal and Postnatal Physiotherapy in Nigeria

Pattern and Determinants of Willingness to Pay for Antenatal and Postnatal Physiotherapy in Nigeria Fatoye F1, Mbada C2, Gebrye T3, Tejumola OO2, Fatoye C4, Odele AC5, Oyewole OO6, Ogundele AO7, Akinwande OA8 1Manchester Metropolitan University, Manchester, LIN, UK, 2Obafemi Awolowo University, Ile-Ife,, Nigeria, 3Manchester Metropolitan University, Manchester, UK, 4Manchester Metropolitan University, Manchester, LAN, UK, 5University of Ibadan, Ibadan, Nigeria, 6Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, 7Olabisi Onabanjo University Teaching Hospital, Iwo, Nigeria, 8University College Hospital, Ibadan, Nigeria OBJECTIVES: The aim of this study was to examined the willingness to pay (WTP) for antenatal and postnatal physiotherapy among pregnant women and nursing mothers in Nigeria. METHODS: A total of 120 pregnant women were purposively recruited for this cross-sectional study. Ethical approval was sought from the Health Research and Ethical Review Committee of the Obafemi Awolowo University Teaching Hospitals Complex. A five-section WTP and short form 12 (SF-12) health survey were used to assess the determinants of willingness to pay for antenatal and postnatal physiotherapy, as well as mental health domains of the respondents. Data were analysed using descriptive and inferential statistics. RESULTS: The mean age of the participants was 28.9 ± 5.02 years. A high ‘no WTP’ rate of 64.2% was found in the study. Significant associations were found between WTP for antenatal and postnatal physiotherapy and income (χ2 = 26.526, p = 0.001), education (χ2 = 30.404, p = 0.001), ethnicity (χ2 = 13.865, p = 0.001) and mental health domain of SF-12 (χ2 = 11.150, p = 0.004). Those in middle socio-economic status were not willing to pay for physiotherapy with a percentage of 87.0%, whereas, those in high economic status were WTP with a percentage of 20.93%. It was also observed that the participants with three number of visits to the clinic had the highest frequency for ‘no WTP’ at 9.09%. CONCLUSIONS: The findings of this study suggest that there was a high prevalence of no WTP for physiotherapy among pregnant women and nursing mothers in Nigeria. Ethnicity, income, socio-economic class, and education influenced WTP for physiotherapy. This study may be of interest to decision makers when setting up and evaluating different interventions for pregnant women and nursing mothers

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

An ontology for factors affecting tuberculosis treatment adherence behavior in sub-Saharan Africa

Olukunle Ayodeji Ogundele,1 Deshendran Moodley,1 Anban W Pillay,1 Christopher J Seebregts1,2 1UKZN/CSIR Meraka Centre for Artificial Intelligence Research and Health Architecture Laboratory, School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 2Jembi Health Systems NPC, Cape Town, South Africa Purpose: Adherence behavior is a complex phenomenon influenced by diverse personal, cultural, and socioeconomic factors that may vary between communities in different regions. Understanding the factors that influence adherence behavior is essential in predicting which individuals and communities are at risk of nonadherence. This is necessary for supporting resource allocation and intervention planning in disease control programs. Currently, there is no known concrete and unambiguous computational representation of factors that influence tuberculosis (TB) treatment adherence behavior that is useful for prediction. This study developed a computer-based conceptual model for capturing and structuring knowledge about the factors that influence TB treatment adherence behavior in sub-Saharan Africa (SSA).Methods: An extensive review of existing categorization systems in the literature was used to develop a conceptual model that captured scientific knowledge about TB adherence behavior in SSA. The model was formalized as an ontology using the web ontology language. The ontology was then evaluated for its comprehensiveness and applicability in building predictive models. Conclusion: The outcome of the study is a novel ontology-based approach for curating and structuring scientific knowledge of adherence behavior in patients with TB in SSA. The ontology takes an evidence-based approach by explicitly linking factors to published clinical studies. Factors are structured around five dimensions: factor type, type of effect, regional variation, cross-dependencies between factors, and treatment phase. The ontology is flexible and extendable and provides new insights into the nature of and interrelationship between factors that influence TB adherence. Keywords: tuberculosis, treatment adherence behavior, influencing factor, conceptual model, ontolog