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

Pharyngo-cutaneous fistula post total-laryngectomy: A local experience

Background: Pharyngo-cutaneous fistula is a major complication of total laryngectomy. Despite its significant impact on the patients' nutrition and management outcome, there is lack of consensus for recognising high-risk patients and factors associated with fistula formation. Hence, this study was aimed at determining the incidence of pharyngocutaneous fistula and factors associated with fistula formation.Methods: A retrospective collection of data on all cases of laryngeal cancer diagnosed histologically and had total laryngectomy, in the  Otorhinolaryngology Department of a tertiary centre in Southwestern, Nigeria, from 2007 – 2016. The data collected includeage, gender, tumour stage, tracheostomy, adjuvant therapy extent of laryngectomy procedure and factors for pharyngo-cutaneous fistula.Results: Forty-two patients had total laryngectomy, male to female ratio was 7.4:1 and mean age was 52.3 ± 2.1 years. All patients had pathological diagnosis of stage 3 (83.3%) and stage 4 (16.7%) laryngeal cancer, respectively. The incidence of pharyngo-cutaneous fistula was11.9% and the factors related to fistula formation were prior radiotherapy treatment and diabetes. Age, gender, neck dissection procedures, site of primary tumor and emergency tracheostomy did not contribute to fistula formation. Spontaneous fistula closure was achieved in all cases except one patient who had surgical closure.Conclusion: Pharyngo-cutaneous fistula formation post-surgery is related to the presence of co-morbidities. The high percentage of spontaneous closure underscores the need for a conservative management approach. Keywords: Laryngeal Cancer, Laryngectomy, Neck dissection, Pharyngo-cutaneous fistula, Post-surgery, Radiotherap

Mothers’ perspectives of newborn hearing screening programme

Background: Newborn hearing screening programs identifies newborns with hearing loss. The early identification enables prompt intervention through hearing rehabilitation. Accurate knowledge of the program and its benefit will impact on the uptake of the program by the citizenry. We hypothesized that there is a gap in the knowledge of parents on hearing screening and rehabilitation measures in Nigeria.Aim: To determine the knowledge and perceptions of mothers of newborn children on hearing screening.Methods: A cross sectional observational study among mothers of newborn children at immunization clinics. Semi structured questionnaire on gestational duration, mode of delivery, birth asphyxia, knowledge on hearing loss and newborn hearing screening were administered.Results: Participants were 48 mothers with age range from 18 to 42 years. Awareness of newborn hearing screening was poor among the mothers; sources of information on newborn hearing screening were antenatal clinic, mass media and friends. The educational level of the participants had no association with awareness (p = 0.11), but the willingness to accept newborn hearing screening, was associated with socioeconomic status (p = 0.04) and the level of education (p = 0.02). The participants were not aware of factors responsible for hearing loss in childhood.Conclusion: There is inadequate knowledge about newborn hearing screening and risk factors for infant hearing loss among the mothers, though they demonstrate willingness to accept the newborn hearing screening. Funding: None declaredKeywords: Hearing loss, hearing screening, immunization, mother, newbor

Tonsillar enlargement in apparently healthy adults in a rural community in Nigeria

Background: Tonsillar enlargement could worsen airway obstruction thereby causing apnea and hypoventilation. This is rarely investigated especially in developing country, hence this study which was aimed at determining the prevalence of enlarged palatine tonsils and comparing the degree of obstruction with selected anthropometric measurements in healthy adults in a rural community.Methods: A cross-sectional study of apparently healthy adults (≥ 18 years) in Oyo community, South Western Nigeria. The participants were selected using multistage random sampling technique. Interviewer assisted structured questionnaire was administered to obtain information on age, gender, occupation, history of smoking and snoring. Ear, nose and throat examination was done and Brodsky grading of tonsil documented. The neck circumference (cm), weight (kilogram) and height (meter) were measured and their Body Mass Indices (BMI) calculated. The data was analysed using IBM- Statistical Package for Social Sciences (SPSS) version 20 and text of association between tonsillar grade, and BMI and Neck circumference was performed using Chi Square.Results: Participants were 408 subjects, consisting 202 (49.5%) males and 206 (50.5%) females, the mean age was 37 ± 15.2 years. One hundred and fifteen (28.2%) participants had enlarged Palatine tonsils of which; 70 (17.2%) had grade 1 enlargement, 33(8.1%) had grade II enlargement, and 12(2.9%) had grade III enlargement. None of the participants had grade IV tonsillar enlargement. The Mean Body Mass 2 Index was 24.32 ± 4.50 kg/m and mean neck circumference was 34.08 ± 2.70cm. Palatine tonsillar enlargement was significantly associated with young age (p = 0.01), female gender (p = 0.02), and neck circumference (p =0.01), but not with high BMI (P = 0.06).Conclusion: Tonsillar enlargement is prevalent, and it is associated with young age, and female gender, but not with Body Mass Index and neck circumference.Keywords: Adults, Body mass index, Gender, Neck circumference, Palatine Tonsi

Readiness of Nigerian Health‑Care Workers to Work during COVID‑19 Pandemic

Introduction: Health‑care professionals of all cadres are the utmost valuable resource during pandemics and maintaining an adequateworkforce of health professionals during an emergency is critical to ensure uninterrupted provision of services that are essential for patient care. Aim: Examine readiness of health‑care workers (HCWs) to provide service in the course of the COVID‑19 pandemic and the factors influencing their decision. Methodology: This was a cross‑sectional study of Nigerian health sector workers HCWs in the course of the COVID‑19 pandemic. The respondents were recruited using HCWs focus groups on WhatsApp and Telegram social medial platforms. Results: A total of 481 HCWs were recruited, consisting of 288 females and 193 males (M: F, 1:1.5), mean age = 30.71 ± 5.9 years. MostHCWs (97.3%) showed a willingness to provide service during the pandemic; 73.3% of the HCWs were willing to work if supplied with adequate personal protective equipment (PPE) although 5.8% were less willing to work without proper PPE. Factors supporting  unwillingness to work during the pandemic were: concerns about the lack of adequate testing for COVID‑19 (48.9%), lack of disability insurance plan (40.1%), fear of being infected (47.2%), and the risk of infection in family members (24.5%). The readiness to work was related to the job cadres of the HCWs (P = 0.001), while the provision of additional incentives and a change in the working conditions would influence the readiness of the HCWs to work. Conclusion: HCWs were ready to provide service in the course of the COVID‑19 pandemic if there was a safe work environment, although the availability of PPE and other personal factors would influence their willingness to work, while improvement in working conditions would motivate HCWs to work. Keywords: COVID‑19, health‑care workers, pandemic, personal protective equipmen

Kaposi Sarcoma: Changing Trend in Calabar, South Eastern Nigeria

Background/objective: Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency, current clinical pattern, and anatomic distribution of KS in Calabar, south-eastern Nigeria and compare this with total malignant skin tumour. Method: All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay. Results: In our study, there were 11 patients (7 males and 4 females), with a male: female ratio of 1.75: 1. This was the commonest malignant skin tumor (38%) followed by squamous cell carcinoma (SCC) (34.5%) and the age ranged from 21 \u96 60 years (mean 42.9years). Nine patients (81.8%) were HIV positive including the 4 females (age ranged from 21 -45 years) and 2(18.2%) HIV negative, aged 59 and 60years. The lower limb was the commonest site (50%). Atypical lesions involved the eyelids/ nose and penis. Conclusion: KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour.Contexte: Le sarcome de Kaposi est \ue0 l\u92heure actuelle la plus fr\ue9quente des tumeurs malignes cutan\ue9es dans certaines zones d\u92Afrique. Il s\ue9vissait \ue0 l\u92\ue9tat end\ue9mique avant l\u92av\ue8nement de l\u92infection par le virus de l\u92immunod\ue9ficience humaine (VIH). La pr\ue9valence s\u92est accrue avec l\u92\ue9mergence l\u92infection par le VIH. L\u92objectif de ce travail est de d\ue9crire la fr\ue9quence, le mode de pr\ue9sentation clinique usuel, et la distribution anatomique du sarcome de Kaposi \ue0 Calabar dans le Sud-est du Nigeria et de proc\ue9der a une comparaison avec l\u92ensemble des tumeurs malignes cutan\ue9es. M\ue9thode: Tous les patients ayant un sarcome de Kaposi confirme histologiquement et ayant consulte au Centre Hospitalier Universitaire de Calabar de janvier 2005 a d\ue9cembre 2006 ont \ue9t\ue9 consid\ue9r\ue9 comme un \ue9chantillon de la population des tumeurs malignes cutan\ue9es. Le diagnostic de l\u92infection VIH \ue9tait base sur la technique ELISA. R\ue9sultats: Notre \ue9tude comptait 11 patients (7 hommes et 4 femmes), avec un sexe ratio homme femme de 1,75. Il s\u92agissait de la tumeur maligne cutan\ue9e la plus fr\ue9quente (38%) suivi par le carcinome a cellule squameuses (34,5%). L\u92\ue2ge variait de 21 a 60 ans pour une moyenne de 42,9 ans. Neuf patients (81,8%) \ue9tait s\ue9ropositifs y compris les 4 femmes 9age allant de 21 \ue0 45 ans). Deux patients \ue2g\ue9s respectivement de 59 et de 60 ans \ue9taient s\ue9ron\ue9gatifs. La localisation la plus fr\ue9quente \ue9tait le membre inferieur (50%) ; les l\ue9sions atypiques concernaient les paupi\ue8res, le nez et le p\ue9nis. Conclusion: Le sarcome de Kaposi est de nos jours la plus fr\ue9quente des tumeurs malignes cutan\ue9es dans notre r\ue9gion et sa forme associ\ue9e au VIH est le type clinique le plus courant. Une pr\ue9vention efficace et le traitement de l\u92infection VIH pourrait r\ue9duire la pr\ue9valence de cette tumeu

Burden of hearing loss in Subsaharan Africa: Snapshot from an ENT clinic in Nigeria

Background: Disabling hearing loss is a prevalent public health issue, with significant impact on patients’ communication. The disability associated with hearing loss depends on the severity of the hearing loss. There are limited rehabilitative measures in resource challenged environment. This study assesses the incidence, the factors for hearing impairment and the management outcome. Methods: A descriptive three-year chart review of patients managed for hearing loss in a tertiary health center in a developing country. The data collected include demographic data, clinical presentation and risk factors for hearing loss, audiometric reports, rehabilitative measures and management outcome. Results: The patients with ear symptoms managed within the study period were 1350, of whom 498 (36.8%) had hearing loss of varying degrees. These included 145 (29.1%) males and 353 (70.9%) females with male to female ratio of 1:2.4. The age ranged from 8 to 80 years (median age of 35.7). Disabling hearing loss in the better-hearing ear occurred in 216 (43.4%) of cases. Increasing age and chronic supportive otitis media were associated with disabling hearing loss. The hearing thresholds improved with hearing aids and ear surgical procedures; nonetheless the patients’ rehabilitation was impaired by limited resources. Conclusion: There is poor rehabilitation of people with hearing loss, though management outcome is commendable in a few of them. Health education will reduce the risk factors for disabling hearing loss and improved rehabilitative measures are needed for these individuals

Kaposi Sarcoma: Changing Trend in Calabar, South Eastern Nigeria

Background/objective: Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency, current clinical pattern, and anatomic distribution of KS in Calabar, south-eastern Nigeria and compare this with total malignant skin tumour. Method: All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay. Results: In our study, there were 11 patients (7 males and 4 females), with a male: female ratio of 1.75: 1. This was the commonest malignant skin tumor (38%) followed by squamous cell carcinoma (SCC) (34.5%) and the age ranged from 21 60 years (mean 42.9years). Nine patients (81.8%) were HIV positive including the 4 females (age ranged from 21 -45 years) and 2(18.2%) HIV negative, aged 59 and 60years. The lower limb was the commonest site (50%). Atypical lesions involved the eyelids/ nose and penis. Conclusion: KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour.Contexte: Le sarcome de Kaposi est à l heure actuelle la plus fréquente des tumeurs malignes cutanées dans certaines zones d Afrique. Il sévissait à l état endémique avant l avènement de l infection par le virus de l immunodéficience humaine (VIH). La prévalence s est accrue avec l émergence l infection par le VIH. L objectif de ce travail est de décrire la fréquence, le mode de présentation clinique usuel, et la distribution anatomique du sarcome de Kaposi à Calabar dans le Sud-est du Nigeria et de procéder a une comparaison avec l ensemble des tumeurs malignes cutanées. Méthode: Tous les patients ayant un sarcome de Kaposi confirme histologiquement et ayant consulte au Centre Hospitalier Universitaire de Calabar de janvier 2005 a décembre 2006 ont été considéré comme un échantillon de la population des tumeurs malignes cutanées. Le diagnostic de l infection VIH était base sur la technique ELISA. Résultats: Notre étude comptait 11 patients (7 hommes et 4 femmes), avec un sexe ratio homme femme de 1,75. Il s agissait de la tumeur maligne cutanée la plus fréquente (38%) suivi par le carcinome a cellule squameuses (34,5%). L âge variait de 21 a 60 ans pour une moyenne de 42,9 ans. Neuf patients (81,8%) était séropositifs y compris les 4 femmes 9age allant de 21 à 45 ans). Deux patients âgés respectivement de 59 et de 60 ans étaient séronégatifs. La localisation la plus fréquente était le membre inferieur (50%) ; les lésions atypiques concernaient les paupières, le nez et le pénis. Conclusion: Le sarcome de Kaposi est de nos jours la plus fréquente des tumeurs malignes cutanées dans notre région et sa forme associée au VIH est le type clinique le plus courant. Une prévention efficace et le traitement de l infection VIH pourrait réduire la prévalence de cette tumeu