Comparison of pain response during neonatal circumcision with or without a topical anaesthetic formulation in an urban hospital in Jos, Nigeria

Background: Circumcision is the commonest surgical procedure performed in male neonates, usually without anaesthesia. Recent research had shown that new-borns have the anatomical and functional components required for perception of painful stimuli, and that unmanaged pain can have long-lasting effects on neurological function. A topical application of eutectic mixture of local anaesthetics (EMLA) has been shown to be a safe and effective method of pain control during neonatal circumcision.Objective: To determine whether topical anaesthesia (EMLA) decreases pain response during neonatal circumcision, with the overall purpose of recommending its use in Hospitals.Methods: This was a randomized, double blind intervention study that compared pain scores between neonates who had circumcision with or without topical anaesthesia. Neonates were randomly assigned to either treatment or control group. A full physical examination was done, with weight, heart rate, respiratory rate, oxygen saturation measured before and after the circumcision. Acute behavioural pain response was quantified using the Neonatal Infant pain scale [NIPS] and results compared between the two groups.Results: The mean age of the neonates in the study was 12 ±2 days. The mean of the weight for the intervention group was 3.7±0.5kg and that of the control group was 3.6±0.7kg. Also the mean of the head circumference in the intervention group was 38.4±0.3cm and that of the control group was 38.5±0.2cm. The mean of the length in the intervention group was 53.4±0.3cm and that of the control group was 53.3±0.7cm. The control and the intervention group were similar with regards to the physical characteristics. Neonates who had topical anaesthesia before circumcision had statistically, significant lower mean NIPS score compared to the control group (4.56 ±0.9 versus 5.94 ±0.2), P = 0.001. Also, they had smaller decreases in transcutaneous oxygen levels, from 96.11±1.8 to 93.3±3.2, compared to the control group, from 95.97±1.8 to 89.83±2.2. They also had smaller increases in heart rate compared to the control group, from 139.67±5.4 to 142.19±3.6 beats per minute versus, from 139.42±5.26 to 152.3±6.3 beats per minute; and respiratory rates, from 48.22±1.9 to 49.1±3.0 compared to from 48.28±1.9 to 53.2±2.9 in the control group.Conclusion: Neonates receiving topical anaesthesia before the circumcision experienced significantly less pain, smaller decreases in transcutaneous oxygen levels, smaller increases in heart rate and respiratory rate than controls.Keywords: EMLA, Local Anaesthesia, Male Circumcision, Pain Measuremen

Effect of patient-centred care on patient satisfaction with care among type-2 diabetes mellitus patients in an urban hospital in Lokoja, north central Nigeria

Background: As the number of patients with chronic health conditions like diabetes mellitus (DM) continues to increase, health systems cannot cope if they continue to focus on the disease rather than the person. This requires a good doctor-patient encounter which will motivate the patients to adhere to treatment, make behavioural changes, and to self-manage their problems. There is a growing realisation that patient-centred care (PCC) which addresses the needs and preferences of patients may also be the most cost effective way to improve health outcomes for the growing number of patients with chronic conditions.Aims: To compare Patient Centred Care with routine care in terms of patient satisfaction in type 2 DM patients and to have a baseline data for future studies.Methods: This was a hospital based randomized control trial carried out between December 2016 and May 2017. A systematic sampling technique was used to select 34 type-2 DM patients from 30 to 80 years of age. Each group had 17 subjects allocated using even and odd numbers inside an envelope from which patient made their free choices.A self-administered patient satisfaction questionnaire (MISS 21 questionnaire) was then given to them after they have left the consultation room, so they could be free to express themselves and the satisfaction scores were stored in the computer. The data collected, was then collated, coded manually, and analyzed using SPSS 16 computer software.Results: In the intervention group, 10 respondents were female while 7 were male; in the control group, 9 respondents were female and 8 were male. The difference between the control and the intervention group was not significant. The application of the PCC during the consultation led to significantly higher patient satisfaction (88.2%) than the control group (41.2%), p = 0.014, amongst type 2 DM patients. The study also revealed that the mean satisfaction score at the end of the study was significantly higher in the study group (4.8+0.524) than that of the control (3.8+0.725), p ≤ 0.001.Conclusion: The use of patient-centred care technique of consultation significantly improves patient satisfaction with care among type 2 DM patients.Keywords: Patient-centred care, Satisfaction, Type-2 diabetes, Consultatio

Prevalence and pattern of gender based violence as seen at Federal Medical Centre, Lokoja, North Central Nigeria

Background: Gender based violence (GBV) is any abuse directed at an individual based on his/her biological sex, identity or perceived adherence to socially defined expectations. GBV has been shown to pose a global health problem and many cases go unreported especially in developing countries. Knowledge of the pattern of GBV can help to formulate appropriate preventive measures and proffer solutions to many dangerous practices aggravating this problem in the society.Methods: This is a hospital based, cross sectional descriptive study of all consenting patients with GBV that presented at Federal Medical Centre (FMC), Lokoja between September 2017 and August 2018. Data was collected with interviewer-administered structured questionnaire and analysed with SPSS version 21 computer software.Results: Out of a total of 3089 patients which were seen during the study period, 278 of them had features of GBV. Therefore, the prevalence of GBV at the study centre was 9.0%. GBV was found to be commonest within the age range of 20 to 29 years (38.5%) and most of them were females (95.7%). Sexual violence was the commonest type of GBV experienced by the respondents in the study population (65.2%) followed by physical violence (53.3%). The most common clinical feature was pain (74.1%). Other complaints include: bruises (29.9%), facial swelling (19.4%), lacerations (13.3%) and bleeding (12.6%).Conclusion: Both men and women experience GBV but majority of GBV survivors were females. The commonest type of GBV among the respondents was sexual violence. Pain, bruises, facial swelling, lacerations and bleeding were the most common clinical features.Keywords: Gender, violence, abuse, rape, survivor