Meconium Peritonitis in Nigerian Children

Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X- rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung’s disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.Contexte: La péritonite à méconium est une maladie rare d'issue fatale. Au Nigéria et en Afrique, seuls quelques cas cliniques se rapportent au sujet. Méthode: Il s'agit d’une étude rétrospective de 10 ans portants sur tous les patients traités pour péritonite à méconium dans les CHU de Maiduguri, de l'Université de Lagos, de Obafemi Awolowo et du Centre Médical Federal Gombe. Résultats: Il s'agissait de 10 nouveau-nés dont 6 filles et 4 garçons. L'âge médian était de 4 jours (étendue 2 à 4 jours). Six des mères avaient eues une surveillance prénatale et 4 avaient eues une échographie prénatale mais le diagnostic de péritonite à méconium n'avait pas été posé. La manifestation clinique la plus fréquente était une distinction abdominale à la naissance chez 9 des 10 patients. La radiographie sans préparation de l'abdomen montrait une calcification et une opacité homogène chez 4 patients et un pneumopéritoine chez 2 patients. A la laparotomie, tous les patients avaient des adhérences inflammatoires et des anses intestinales emmêlées. La forme généralisée était la forme la plus fréquente (7 patients) et on notait un pseudokyste géant chez 2 patients. Le site de perforation le plus fréquent était l'iléon chez 4 patients et le jéjunum chez 3 patients. Chez un patient la perforation s'était bouchée à la laparotomie. L'obstruction intestinale était la cause la plus fréquente de péritonite à méconium chez 7 des 10 patients. Chez les 3 patients restants, la cause est restée inconnue. La plus fréquente procédure exécutée fût la résection anastomose (4 patients). Le taux de mortalité était élevé (50% Conclusion: Nos données révèlent la rareté de la péritonite méconiale et l'occlusion intestinale comme la cause la plus fréquente. Il est recommandé chez les patients avec une cause non identifiée, qu'une biopsie rectale soit faite pour identifier une éventuelle maladie de Hirschsprung. Le diagnostic précoce, une prise en charge chirurgicale correcte et des soins post-opératoires méticuleux devraient améliorer leur survie

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways