Major extremity amputations: Indications and post surgery challenges in a Nigeria tertiary institution

Amputation is an ancient procedure which has been practiced for centuries for a variety of indications. The goal of the procedure is to eliminate potential threat to the patient while producing a viable stump for easy rehabilitation.Objective: To identify the indications, postoperative complications and peculiarities of patients with amputation in a native African population.Materials and Methods: This was a prospective study carried out on all consenting patients who had extremity amputation at Federal Medical Centre, Birnin Kebbi, from June 2015 to May 2016. Results: During the study period, there were 47 amputations in 47 patients (34 males and 13 females). The mean age of the patients was 35.73 ± 19.43 years. The most common indication for amputation was traditional bone setter's (TBS) gangrene accounting for 44.7% of cases, followed by diabetic foot syndrome at 25.5%. Camel bites accounted for 6.4% of the amputations. The most common type of amputation was below­knee amputation (46.8%), followed by above­knee amputation (25.5%). Five (10.7%) patients had surgical site infection and only 2.1% of the patients developed phantom limb sensation. None of these patients was fitted with a prosthesis due to the high cost or nonavailability of the prosthesis.Conclusion: Complications of TBS intervention were the leading cause of amputation in this study. Gangrene following camel bites was also found to be a peculiar cause for amputation in this environment. Appropriate public health interventions are necessary to reduce the incidence of preventable gangrene. Provision of prosthesis with adequate technical support is essential to proper rehabilitation of the amputees

Utility and Effectiveness of Computerised Motion Sensitivity Screening Tests in Rural Onchocercal Community Survey

BACKGROUND: Non-invasive tool of community diagnosis for onchocercal endemicity needs to be identified and ascertained for their utility and effectivity in order to facilitate the control of onchocerciacis in sub-Saharan Africa OBJECTIVE: To determine the utility and effectiveness of the Wu-Jones Motion Sensitivity Screening Test (MSST) in detecting optic nerve diseases in onchocercal-endemic rural Africa. METHODS: MSST was applied to sampled subjects in the selected communities of Raja in Sudan; Bushenyi in Uganda; Morogoro in Tanzania; and of Ikom; Olamaboro and Gashaka in Nigeria. Basically; six points within the central field of vision were repeatedly tested at 1/3 meter from the screen of a laptop computer in a room darkened. Motion sensitivity was expressed as a percentage of motion detected in the individual eye and this was averaged for the community. RESULTS: A total of 3;858 eyes of 2;072 patients were examined. Seventy-six percent of the subjects completed the test; at an average test time of 120.4 (66.7) seconds. The overall mean motion sensitivity of all eyes tested was 88.49 (17.49). At a cut-off point of 50; 6.4of all subjects tested were subnormal; while at 70cutoff; 13.3were subnormal. The highest proportion of 50cutoff sub-normality was recorded at Morogoro at 12.7. CONCLUSION: Motion Sensitivity Screening Test was widely accepted and easily administered to the rural and largely illiterate subjects studied. Our data suggest that the proportion of severe field defects by MSST in a community; with cutoff at 33; best correlates with optic nerve disease prevalence; while proportion of defect from a higher cut-off level at about 50; best correlates with overall ocular morbidity

Pharmacists and Nurses Perception of Medication Errors in a Nigerian University Teaching Hospital

Purpose: To investigate the type and frequency of all medication dispensing and administration errors as perceived by pharmacists and nurses respectively; and the factors associated with such errors in a Nigerian university teaching hospital. Methods: The study was conducted at the Obafemi Awolowo University Teaching Hospitals; Ile-Ife and Ilesa; Nigeria. Data was collected by the use of pre-tested questionnaire administered to 35 pharmacists and a stratified sample of 130 nurses over a period of 2 weeks. The questionnaires were sorted and analysed. Results: The pharmacists that responded (80) cited incorrect drug; incorrect strength of drug (70) and wrong dose of drug (60) as the most common dispensing errors. Fifty percent of pharmacists put the estimated frequency of occurrence of these dispensing errors at 1 per 100 prescriptions dispensed. Most of the nurses (65) identified administration of wrong drug; administration of wrong dose (63) and wrong time of drug administration (57) as the most frequently occurring medication administration errors in the teaching hospital. All the pharmacists and 78of nurses identified excess workload as the most important factor contributing to errors in medication dispensing and administration respectively. Conclusion: The fundamental factor perceived to be contributing to errors in medication dispensing and administration was excess workload resulting from insufficient members of staff

Pharmacists and Nurses Perception of Medication Errors in a Nigerian University Teaching Hospital

Purpose: To investigate the type and frequency of all medication dispensing and administration errors as perceived by pharmacists and nurses respectively; and the factors associated with such errors in a Nigerian university teaching hospital. Methods: The study was conducted at the Obafemi Awolowo University Teaching Hospitals; Ile-Ife and Ilesa; Nigeria. Data was collected by the use of pre-tested questionnaire administered to 35 pharmacists and a stratified sample of 130 nurses over a period of 2 weeks. The questionnaires were sorted and analysed. Results: The pharmacists that responded (80) cited incorrect drug; incorrect strength of drug (70) and wrong dose of drug (60) as the most common dispensing errors. Fifty percent of pharmacists put the estimated frequency of occurrence of these dispensing errors at 1 per 100 prescriptions dispensed. Most of the nurses (65) identified administration of wrong drug; administration of wrong dose (63) and wrong time of drug administration (57) as the most frequently occurring medication administration errors in the teaching hospital. All the pharmacists and 78of nurses identified excess workload as the most important factor contributing to errors in medication dispensing and administration respectively. Conclusion: The fundamental factor perceived to be contributing to errors in medication dispensing and administration was excess workload resulting from insufficient members of staff.) cited incorrect drug; incorrect strength of drug (70) and wrong dose of drug (60) as the most common dispensing errors. Fifty percent of pharmacists put the estimated frequency of occurrence of these dispensing errors at 1 per 100 prescriptions dispensed. Most of the nurses (65) identified administration of wrong drug; administration of wrong dose (63) and wrong time of drug administration (57) as the most frequently occurring medication administration errors in the teaching hospital. All the pharmacists and 78of nurses identified excess workload as the most important factor contributing to errors in medication dispensing and administration respectively. Conclusion: The fundamen- tal factor perceived to be contributing to errors in medication dispensing and administration was excess workload resulting from insufficient members of staff

Trachoma: an Ancient and Contemporary Scourge

Trachoma is an ancient yet contemporary scourge. It is a specific kerato-conjunctivitis caused by certain serovars of Chlamydia trachomatis. It affects an estimated 84 million people and remains the commonest communicable cause of blindness in 6 million people. WHO has introduced the SAFE strategy which needs to be implemented with more determination in Nigeria if the level of trachoma blindness is to be positively impacted. This is particularly in the area of identification of communities in need of intervention through more widespread application of Rapid assessment methods. The challenges in trachoma research remain to improve the accurate diagnosis of active disease; to monitor emergence of antibiotic resistance and to improve the understanding of transmission and reservoirs of the infectious agent

Psychosocial dynamics of psychoactive substance misuse among Nigerian Adolescents

Background: Psychoactive substance misuse has for many years been an issue of increasing health and social importance in Nigeria. This is especially so for the critical adolescent period marked by several changes including the psychological phenomenon of experimentation. Studies carried out in the last two decades in Nigeria have identified adolescents as a major group involved in the use of psychoactive substances. However, most studies employed quantitative methods to gather information on drug misuse. In developing programmes for prevention and control of drug misuse it is important to complement quantitative information with qualitative data. This article reviews the available data on drug use in Nigerian adolescents and utilises a qualitative method to explore the psychosocial dynamics of drug use among adolescents. Methods: Review of current literature on drug use among adolescents in Nigeria and in-depth interviews of two adolescents with poly-drug misuse to identify psychosocial dynamics surrounding their use of psychoactive substances. Results: Surveys suggest that in both in-and out-of-school adolescents, the socially acceptable drugs like alcohol and cigarettes are commonly used. The patients interviewed illustrate the important 'gateway' theory of drug progression. Psychological dynamics identified include peer pressure, experimentation and conduct problems while social factors include poverty, family problems, and social acceptability of local alcoholic drinks like palm-wine. Conclusion: These identified factors must be utilised in developing drug prevention programmes. The public health implications of the social acceptability of palm wine, especially its consumption by children, needs to be further explored

The Persistence of chlamydial inclusions in clinically quiescent trachoma

Most of the trachoma patients seen at the Guinness Eye Clinic in Kaduna; Northern Nigeria today are in the healed or quiescent stages of evolution and disease intensity is largely trivial. A significant proportion however; seem to have recrudescence of the active stages; a phenomenon that is usually attributed to reinfection