Backpack use and associated problems among primary school children in Nigeria: a call to action by stakeholders

Background: Carrying backpacks is believed to contribute to the musculoskeletal problems in school children. Studies on the use of backpacks by Nigerian school children are scanty.Objectives: To evaluate the use of backpack and associated problems among primary school children.Methods: A cross-sectional descriptive study was carried out on 813 children in six primary schools in Ado-Ekiti. Information about backpack use and associated problems were obtained.Results: 788 (96.9%) children carried backpacks daily. The backpacks were all double strapped and 85% pupils wore them on both shoulders. The backpacks of 64.1% of the pupils contained educational materials. In 79.1% of cases, the backpacks exceeded 10% of their body weights. Pain and loss of sporting time were associated with carrying backpacks in 23.2% and 8.2% respectively, 15.3% took analgesic and 5.5% had medical consultations because of backpack injuries. No pupil missed school and none was hospitalised for backpack injury. Complaint of pain was significantly associated with older subjects, carrying heavier backpack and longer period of carrying packs (p<0.001).Conclusion: Backpack use and associated health problems are common among school children in the study area. Health workers should enquire about backpack use in children presenting with back and shoulder pain. We recommend more studies on backpack use. Also, Government and other stakeholders should draw up guidelines regarding the use of backpacks in Nigeria as practiced in other countries. Professional bodies including the Paediatric Association of Nigeria (PAN), and other stakeholders should be involved in formulating such guidelines.Keywords: Backpacks, School children, Pain, Dysfunction, Nigeri

The Financial Implication of Treating Motorcycle Limb Trauma in a Developing Country - The Patient's Perspective

Background: The total cost of care of injuries is usually much more than the cost of hospitalization. This study was designed to determine the total cost to the patient, of limb injuries sustained from motorcycle crashes.Method: The study design was based on the cost-of illness method. Only patients who were employed and could estimate their daily income; and who completed their course of treatment, and were followed up for two years were included in the study. Results: 60 patients satisfied the criteria for inclusion. The total cost of treatment ranged from N4,715.00 to N141,655.00 with a mean of N37,615.15 ± N30,908.00 SD. It represented between 4.09% and 310.48% of patients' annual income. The medical costwas 48.4% of the total while the balance was made of lost productivity (39.0%) and cost of vehicle repair/replacement (12.6%). Lower limb injuries were significantly more expensive to treat than upper limb injuries.Conclusion: The cost of treating injuries from trauma remains a large burden to patients especially in a country where health insurance coverage is poor.Key words: Cost analysis, motorcycle, trauma, injury, limb

Antiretroviral Drug as a Cause of Bilateral Avascular Necrosis of the Femoral Head

Background: Avascular necrosis (AVN) is one of the most dreadful disease conditions of the hip which may be very difficult to treat if not detected early. Protease inhibitor is useful in combined antiretroviral therapy but now being reported as one of the causes of AVN. In this case report, we present a case of bilateral avascular necrosis in a patient undergoing treatment with antiretroviral drugs.Method: The case note of the patient was used along with the review of relevant literature.Result: A 30-year-old graduate with positive retroviral status, separated from her husband having lost her only child from an undisclosed illness (suspected to be AIDS) is presented. The cause and progression of the necrosis and the challenges of deep operation in the hip call for a wellplanned universal basic precautionary measures even though the patient is financially handicapped.Conclusion: Avascular necrosis as a complication of treating patients with protease inhibitor should be borne in mind while commencing the drug. Nevertheless, physicians should regularly watch out to arrest the progression at the early stage by involvement of Orthopaedic Specialists.Key words: Protease inhibitor. Avascular necrosis. Early diagnosis

Bacterial cultures from sinus track and bone in Nigerians with chronic osteomyelitis

Chronic osteomyelitis of the long bones is common in the tropics, despite advances in antimicrobial therapy and surgical treatment. Attempts to isolate the causative pathogen are often done by surface swabs from the discharging sinuses and findings may differ from bone sampling isolates. This study aimed to establish the correlation between sinus and bone culture. A 2-year prospective study was under taken at Federal Medical Centre Owo, Nigeria, from May 2002 to April 2004. Of 25 patients, bacteria were cultured from 11(44%) sinus tracks and 7(28%) bone samples with only 45% concordance between the cultures. The isolation of a single organism especially Staphylococcus aureus from the bone correlated well with that of sinus track culture. Malawi Medical Journal Vol. 17(2) 2005: 47-4

Knowledge and Attitude of Healthcare Workers Towards Traditional Bone Setters In Benue State

Introduction: Traditional bone setting (TBS) is an art that is still flourishing to the detriment of patients. Some healthcare workers are aiding the practice, thus calling for reasons. This study ascertained the opinions of healthcare workers on TBS and the contention of incorporation into Modern Orthopaedic Services (MOS).Method: A self-explicit questionnaire with sociodemography and impressions of healthcare workers on TBS was administered across the various health institutions in a rural and an urban community of Benue State.Result: Three-hundred healthcare workers responded with 266 (88.7%) and 34 (11.3%) from urban and rural communities respectively. In all, 167 (55.6%) had not heard of any form of TBS advertisement. Advertisement by orthodox practitioners was never allowed in the last one year while majority 190 (63.3%) were not supporting TBS advertisement. However, 144 (48.1%) support incorporation into MOS. TBS was believed to have more patronage (70.3%) than MOS, mainly because it was cheaper. Significantly, 147(49.0%) disapproved TBS practice, 112 (37.3%) approved and 41 (13.7%) not sure. Majority 183 (61.0%) declined TBS treatment in case of any fracture. Educational status has no correlation with approval and patronage of TBS. Acceptance of TBS and opinion on incorporation into MOS were based on the outcome of their relations who had patronized TBS.Conclusion: As TBS has come to stay, strict ethical monitoring should be enforced. Both practices should be allowed to advertise (their services). Incorporation of TBS into MOS, if approved, should be steered by moral philosophy from the medical council. Government needs to adequately equip all secondary healthcare centres with basic facilities for effective initial management of patients with musculoskeletal lesions.Keywords: Traditional Bone Setters. Healthcare Workers. Knowledge, Attitud

Locked Intramedullary Nailing of Femur and Tibia in a Semi Urban Area

Background: Long bone fractures of the extremities are increasingly becoming a common clinical presentation of the trauma patients to the emergency unit of most urban hospital in Nigeria due to increasing vehicular traffic on our roads. Locked intramedullary nailing is the gold standard for operative treatment of these injuries.Patients and Methods: 104 consecutive patients with 108 fractures of femur and tibia who had Surgical Implant Generation Network (SIGN) locked intramedullary nailing over a period of two years from September 2004 to August 2006 was evaluated for its effectiveness.Results: There were 72 males and 32 females giving a ratio of 2.3:1.The mean age was 36.6years SD±15.2 and 88 (81.5%) femoral and 20 (18.5%) tibia fractures. Fractures was closed and open in 86 (79.6%) and 22 (20.4%) patients respectively. Gustillo and Andersen grades of open fractures was I 7 (31.8%), II 8 (36.4%), IIIA 4 (18.2%) and IIIB 3 (13.6%. The open method of reduction was used. Indications for fixation were: Recent factures in 73 (67.6%) and non union in 35(32.4%). Average time to union was 4.5 SD±1.92 with a range of 3 to 9 months. The mean duration of follow up was 36 months. Mean duration of hospital stay was 36.8 days SD±39.2.Conclusion: We concluded that locked intramedullary nailing using SIGN nail was safe and achieved satisfactory union of fracture of Femur and Tibia.Key words: Intramedullary nail, SIGN

Patronage of traditional bonesetters in Makurdi, north-central Nigeria

Ndubuisi OC Onyemaechi,1 Omolade A Lasebikan,2 Itodo C Elachi,3 Sunday O Popoola,4 Kehinde S Oluwadiya4 1Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, 2Department of Orthopaedic Surgery, National Orthopaedic Hospital, Enugu, 3Department of Surgery, Benue State University Teaching Hospital, Makurdi, 4Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria Background: Despite the numerous complications associated with traditional bonesetters’ (TBS) practices, their patronage has remained high in developing countries. The aim was to study the reasons patients seek TBS treatment. Methods: This was a descriptive hospital-based study of 120 patients who were treated by TBS. The sociodemographic profile of the patients, details of injuries sustained, reasons for TBS patronage, duration of TBS treatment, the number of TBS visited, the reason for abandoning TBS treatment, patients’ belief about the TBS practice, and outcome of their treatment were studied. Results: Out of 418 patients who presented with musculoskeletal injuries, 120 patients who had been treated by TBS before presentation met the inclusion criteria. The mean age of the patients was 37.4±10.5 years. Advice of relatives and friends, as seen in 35 (29.2%) patients, was the most common reason for TBS patronage. Other reasons were cheaper cost (number [n]=30; 25%), sociocultural belief (n=17; 14.2%), easy accessibility (n=15; 12.5%), fear of amputation (n=13; 108%), and fear of operation (n=10; 8.3%). There was no correlation between these factors and age, marital status, occupation, and educational status (P=0.41). Forty-two (35%) patients believed TBS were not useful, a nuisance (n=30; 25%), useful (n=38; 31.7%), or indispensable (n=10; 8.3%). The opinion of patients about the outcome of TBS practice was: very satisfactory (n=0; 0%); satisfactory but with deficiencies (n=24; 20%); unsatisfactory (n=80; 66.7%); and no idea (n=16; 13.3%). Conclusion: Advice of relatives and friends was the main reason for patronizing TBS. The majority of patients lost confidence in the TBS practice after patronizing them due to the high complication rate. Keywords: utilization, traditional bonesetters, developing countr