Audit of medication errors by anesthetists in North Western Nigeria

Background: Safety issues are an important aspect of anesthesia practice. The relevance of medication and drug administration errors in our everyday practice is an important aspect of medical audit. Although there have been few case reports of drug administration errors by anesthetists, there is paucity of information regarding medication errors in anesthetic practice in Nigeria. We set out to study the incidence of medication errors among anesthesia practitioners in Kaduna State, North Western Nigeria and to suggest ways to minimize such errors.Materials and Methods: A questionnaire‑based study was conducted among physician anesthetists and nurse anesthetists working in the major secondary and tertiary hospitals in Kaduna State, North Western Nigeria. The data obtained was analyzed using SPSS Version 17.0 and the data presented in relevant charts and tables.Results: A total of 43 persons responded to the questionnaire with a high response rate of 86% and a male/female ratio of 2.3:1. Most of the anesthetists (38 or 88%) work in tertiary government hospitals. Twenty‑four (56%) of them admitted to ever having a medication error, and 34 (79%) of them attributed the medication error to problems with drug labeling from manufactures using similar labels for different drugs. Untoward sequelae resulted in 44% of the patients that were affected by these medication errors and these ranged from cardiac arrest to delayed recovery from anesthesia. Majority of the respondents recommended vigilance, double checking of drug labels, and color coding of syringes as ways to minimize medication errors.Conclusion: Medication errors do occur in the everyday practice of anesthetists in Nigeria as in other countries and can lead to morbidity and mortality in our patients. Routine audit and reporting of critical incidents including errors in drug administration should be encouraged. Reduction of medication errors is an important aspect of patient safety, and vigilance remains the watchword.Key words: Anesthetic practice, medication errors, safet

Age at menarche and the menstrual pattern of secondary school adolescents in northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Population studies on normal and dysfunctional characteristics of menstrual cycles are scarce in Ethiopia. In addition variability in menarcheal age and menstrual characteristics are common. Knowledge on this variability is necessary for patient education and to guide clinical evaluation.</p> <p>Methods</p> <p>A cross sectional study was conducted in two small towns called Dabat and Kola Diba, northwest Ethiopia between April and May 2007. Systematic sampling method was used to select 622 school girls from two secondary schools. A pretested questionnaire prepared in Amharic was used to gather data. Selected girls cooperated in answering the questionnaire in their classrooms under the supervision of the research team. Only 612 of the adolescent females were included in the final analysis, of which 305 were from Koladiba High School and 307 from Dabat.</p> <p>Results</p> <p>The age of the study subjects ranges between 14 and 19 with a mean (standard deviation) of 16.9 ± 1 years. About 92.2% had attained menarche by the time the survey was conducted. The probit analysis of the <it>status quo </it>data yielded a median (CI) age at menarche of 14.8 (13.9-15.3) years. The average age at menarche by recall method was 15.8 ± 1 years. The mean age at menarche was 0.3 years younger for urban females compared with rural ones (p < 0.001). A cycle length between 21 and 35 days was observed in 70.3% of the girls. The mean duration of flow was 4 ± 1.3 days with a range of 2-7 days. The menstrual cycles were irregular in 42.8% of the subjects. The overall prevalence of dysmenorrhoea was 72% among these subjects. Premenstrual symptoms were present in 435 of the females (75.4%). The leading sources of menarcheal information to the adolescents were mothers (39.7%), followed by their friends (26.6%) and teachers (21.8%).</p> <p>Conclusion</p> <p>In this study age of menarche was found to be delayed which is even higher than the findings indicated similar studies conducted in Ethiopia and other African countries. A significant number of students complain of abnormal menstrual cycle, dysmenorrhoea and premenstrual symptoms which call for appropriate counselling and management.</p

Growth status and menarcheal age among adolescent school girls in Wannune, Benue State, Nigeria

<p>Abstract</p> <p>Background</p> <p>Menarcheal age is a sensitive indicator of environmental conditions during childhood. The aim of study is to determine the age at menarche and growth status in adolescents in a rural area of Tarka, Wannune, Nigeria.</p> <p>Methods</p> <p>Data on 722 female students (aged 12-18 years) were collected in February 2009. Height and weight were measured. Body mass index (BMI; kg m^-2) was used as an index of relative weight.</p> <p>Results</p> <p>Mean and median menarcheal age calculated by probit analysis were 13.02 (SD 3.0) (95% CI: 13.02-13.07), and age 13.00 (SD 2.8) (95% CI: 12.98-13.04), respectively. Girls who reach menarche are significantly heavier and taller with higher BMIs than those of their pre-menarcheal peers.</p> <p>Conclusion</p> <p>The age of menarche is probably still declining in Nigeria. Although BMI is an important factor in the onset of menstruation, some other unmeasured environmental variables may be implicated in this population.</p

Operative vaginal deliveries in Zaria, Nigeria

Background : Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings Study design : Labor records on operative vaginal delivery cases and matched controls who had spontaneous vaginal deliveries between January 1997 and December 2001 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were analyzed with respect to mode of delivery, indication for operative vaginal delivery, anesthesia use, fetal 5-min Apgar score, birth weight, fetal, and maternal complications. Results : Of 7,327 deliveries at the center in the study period, 262 (3.6%) were by operative vaginal deliveries. Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy procedures were performed selectively (6.1%). Operative vaginal deliveries were more commonly employed on primigravida (78.6%) compared to multiparas and the most common indication was delayed second stage of labor. Forcep- and vacuum-assisted deliveries were both associated with maternal and newborn complications. There was no significant difference in the use of anesthesia between forceps and vacuum deliveries. Conclusion : Operative vaginal delivery rates in this center are comparable to other centers as are the possible complications. Making these procedures safer will improve safe motherhood in settings where there are performed

Antenatal clinical pelvimetry in primigravidae and outcome of labour

Background/Objectives: To determine the relationship between antenatal clinical pelvimetry and the outcome of labour in primigravidae in order to assess the importance of the procedure. Method: A retrospective study of clinical pelvimetry and outcome of labour in primigravidae. Results: The total number of primigravidae included in the study was 268 and of these, 74 were adjudged to have adequate pelvis at antenatal clinical pelvimetry. The APGAR scores at one and five minutes were significantly higher among infants born to mothers who had clinically adequate pelvis at antenatal assessment compared to the APGAR scores of infants born to mothers who did not have antenatal clinical pelvimetry but this association became insignificant after controlling for booking status. Infants born to booked mothers had significantly higher APGAR scores than those who were not booked (&#967;2 = 36.52, p

Puerperal complications of episiotomies at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Objectives: To establish the epidemiological variables associated with episiotomies and their puerperal complications at Ahmadu Bello University Teaching Hospital Zaria, in order to institute appropriate management including preventive measures. Design: A prospective cohort study. Setting: Ahmadu cello University Teaching Hospital, Zaria, Nigeria. Methods: A cohort of all consecutive patients that underwent vaginal deliveries during a 12- week period were followed up for six weeks in order to determine the distribution and determinants of episiotomy and its complications. Results: The episiotomy rate was 35.6% of all vaginal deliveries. Episiotomies were significantly associated with primigravidity being performed in 88.5% of all primigravidae. The mean delivery-repair interval was 60.5 minutes. The most common puerperal complication of episiotomies was perineal pain that lasted an average of 5.5 days. Other complications included asymmetry (32.9%), infection (23.7%), partial dehiscence (14.5%), skin tags (7.9%), haemorrhage (5.3%) and extension of the incision (1.3%). The complications were not significantly associated with any potential risk factor. Conclusion: In view of the very high episiotomy rate among primigravidae, it is recommended that the episiotomy rate among primigravidae be reduced by re-acquainting accoucheurs with the indications for episiotomy. Attention needs to be given to adequate pain relief for all women who have had an episiotomy and the delivery-repair interval in this unit should be reduced by provision of materials for episiotomy repair in the delivery suite. East African Medical Journal Vol.80(7) 2003: 351-35

Pattern of postoperative pain management among adult surgical patients in a low-resource setting

Elizabeth Ogboli-Nwasor,1 Sa&amp;rsquo;adatu T Sule,2 Lazarus MD Yusufu31Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 2Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 3Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, NigeriaObjective: Postoperative pain is one of the most common complications of surgery. The pattern of management varies between centers. The current study aimed to study the prescription pattern and the common drugs used in the management of postoperative pain in adult surgical patients at Ahmadu Bello University Teaching Hospital (ABUTH; Zaria, Nigeria).Methods: Following ethical approval, a prospective observational study of consecutive adult patients who had surgery at the ABUTH Zaria was performed from January to December 2005. The data were entered into a proforma and analyzed using the Minitab statistical package.Results: One hundred and thirty-eight patients were included in the study. The age range was 17 to 80 years, with a mean age of 41 years. One hundred and thirty-two (95.7%) of the prescriptions were written solely by the surgeon or surgical resident; passive suggestions were given by the anesthetists for only six patients (4.3%). Intermittent intramuscular injections of opioids/opiates were prescribed for 126 patients (91.3%), while nine patients (6.5%) received intermittent intramuscular injections with non-steroidal anti-inflammatory drugs. Oral paracetamol was prescribed for six patients (4.3%), while three patients (2.1%) received no postoperative analgesic. Moderate pain was recorded in 48 patients (34.8%), and 90 patients (65.2%) had mild pain 8 hours after their operation before subsequent doses of analgesics were given. More females (81 patients [58.7%]), than males (42 patients [29.7%]) suffered moderate to severe pain. The reported side effects were nausea (reported by 32.6% of patients), dry mouth (21.7%), vomiting (13.0%), and urinary retention (6.5%), with 32.6% of patients experiencing no side effects. The three patients who received no analgesics experienced vomiting as a side effect. Despite the high incidence of pain and other side effects, 108 patients (78.2%) still reported that the methods of postoperative pain management were satisfactory.Conclusion: Despite recent advances and the development of more effective techniques for postoperative pain control, a high proportion of patients still experience moderate to severe postoperative pain. Intermittent intramuscular injection of analgesic medication remains the mainstay of postoperative pain management at the ABUTH Zaria. Anesthetists should be more involved in postoperative analgesia prescriptions and should include other forms of multimodal pain management in their regimens. With proper application of current knowledge and training, postoperative pain management can be improved.Keywords: postoperative, pain management, adult surger