Challenges and Frugal Remedies for Lowering Facility Based Neonatal Mortality and Morbidity: A Comparative Study

Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one control were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria

Post Operative pain following Ocular Surgery: Relevant Preventitive Management in the University of Nigeria Teaching Hospital, Enugu

Objective: To determine the optimal time and mode of administration of postoperative analgesics following ocular surgery. Background: Most elective ocular surgery are said to be accompanied by onlymild pain. This knowledge, however, is not available to the prospective patientand this usually results in undue fear of eye surgery. This often results in failureto keep surgery appointments. Post operative pain relief should therefore beproperly targeted and analgesic agents timely administered for greatest effect. Method: A prospective study of the post operative experience of twenty patientswho had different types of ocular surgery. Results: The onset of post operative pain was influenced by the form ofanaesthesia (local or general). When surgery was done under generalanaesthesia, onset of pain was delayed for up to 19 hours whereas in casesdone under local anaesthesia onset of pain was within 2-3 hours. The severity ofpostoperative pain depended on the pain threshold of the patient and type ofanaesthesia. Conclusion: Post operative pain management should start from the timeinformed consent is being sought. A careful explanation of the nature andintensity of pain expected and what could be done to alleviate it should be madeavailable to the patient preoperatively. In the absence of Patient ControlledAnalgesia (PCA) machines, forms of pre-emptive analgesia not dependent onhigh technology should be considered. The advantages of preoperative use ofNon-steroidal Anti-Inflammatory Drugs (NSAIDs) should be explored. Key Words: Post-operative pain, analgesia in ophthalmology Jnl of Medical Investigation and Practice Vol.1 2000: 41-4

Mean Waiting Time and Patients' Satisfaction in GOPD, Federal Medical Centre, Owerri

Background: Waiting time is a major determinant of the patients' level of satisfaction. It is the average time spent by the patient from the time of presentation in the hospital to the time of contact with a health service provider.Objective: To determine the mean waiting time in the Records department/card room and the General Out- Patient Clinic (GOPC) and its relationship with the level of patients' satisfaction.Materials and Methods: A total of 270 randomly selected patients who attended the GOPC of Federal Medical Center Owerri between June and December, 2009 were studied. It was a descriptive cross-sectional study. Data was collected with the aid of a pretested self-administered questionnaire and analyzed by the use of epi-info vers 6.05 statistical package.Results: The mean age of the study population was 47.8 ±4.3years. The study recorded mean waiting times in the records department and GOPC as 35.2 ±1.7mins and 48.4± 2.7mins respectively. However, the cumulative mean waiting time in both units was 83.6±1.6mins. The commonest cause of prolonged waiting time was inadequate manpower to cope with the teeming patient population. About 52.6% and 65.6% of the subjects were satisfied with the services they received in the records department/card room and GOPC respectively.Conclusion: The mean waiting time observed from this study is far higher than the SERVICOM recommended waiting time of less than 45minutes. The causes of prolonged waiting time and patients' dis-satisfaction as noted from this study should be addressed by the staff and management of the hospital.Key words: Waiting time, Satisfaction, Owerr

Dietary Preferences and Pattern in Children with Sickle Cell Disease in Enugu Metropolis

The looks of children with sickle cell anaemia give an impression of malnourishment. Not growing optimally, they have lower weight, height and muscle bulk in the upper limbs than age and sex matched controls. Their underlying state imposes an increased metabolic demand on them. Yet there is simultaneous inadequate nutritional intake and malabsorption in periods of crises. Evidence of depressed appetite also exists. Parents try to combat this through administration of blood tonics. As a first step in assessing the nutritional status of children with sickle cell disease it was decided to conduct a detailed dietary interview. The food intake of children with sickle cell disease attending the sickle cell clinic of the University of Nigeria Teaching Hospital, Enugu was analyzed and compared with that of age matched controls that do not have sickle cell disease. Only differences which P-value was or 0.05 below were accepted as statistically significant. In the age stratum 4 years and under, generally no significant differences were noted in the food consumption pattern of children with sickle cell disease when compared with age-matched controls. However, children with sickle cell disease consumed significantly more spinach than controls. In the age stratum 5-16 years, children with sickle cell disease consumed more of the food items considered. Foods were sourced from mainly the market for all children and when not consumed, it was for similar reasons, mainly expensiveness and child=s dislike. Night blindness seems to occur more in children with sickle cell disease. It is concluded that parents no do not purposely bias quantity or quality of food presentation to children with sickle cell disease despite noticing that relative to their other children, these children looked always ill-fed. The value of taking the specific nutritional needs of these children into considerations in food presentation was discussed. In addition, it is suggested that more attention be paid to nutrition and that nutritionist be involved in the health care and management of these children. Key Words: Sickle Cell Disease; Dietary Preferences; Haemoglobinopathy in Enugu Orient Journal of Medicine Vol.15(1&2) 2003: 49-5