Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd­5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy

The effectiveness of clinician education on the adequate completion of laboratory test request forms at a tertiary hospital

Background: Inadequately completed laboratory test request forms contribute to preanalytical errors and limit the advice of pathologists when interpreting laboratory test results. Educating clinicians about this has been proposed by several studies as a strategy to reduce the occurrence. Aim: We aimed to determine the effectiveness of such education on the prevalence of adequately completed laboratory test request forms. Subjects and Methods: This was a quasi-experimental study conducted at the chemical pathology laboratory of the Lagos University Teaching Hospital; Nigeria. Incoming laboratory request forms were audited for a period of 1 month looking out for eight data variables. Subsequently; intensive clinician education was undertaken via seminars; publications; and orientation programs on 670 clinicians for 6 weeks duration. After that; a repeat audit for the same data variables was conducted for another period of 1 month. A Z-test of significance for the comparison of independent proportions was conducted for form errors pre- and post-intervention. Results: Error rates for missing variables pre- and post-clinician education were: Name pre = 0 (0%); post = 0 (0%); age pre = 330 (21.6%); post = 28 (1.9%); P 0.001; gender pre

Influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria

Fertility pattern and reproductive behaviours affect infant death in Nigeria. Household food insecurity and poor care practices also place children at risk of morbidity and mortality. The objectives of this study were to assess the influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria. The study employed a descriptive cross-sectional design. A semi-structured questionnaire was used to collect data from 423 mothers of under-five children and their children in the households selected through multistage sampling methods. Food-insecure households were five times more likely than secure households to have wasted children (crude OR=5.707, 95 percent CI=1.31-24.85). Children with less educated mothers were significantly more likely to be stunted. The prevalence of food insecurity among households in Ile-Ife was high. Households with food insecurity and less educated mothers were more likely to have malnourished children (Afr J Reprod Health 2010; 14[4]: 123-132)

Challenges of Otolaryngologic Referral in a Nigerian Tertiary Hospital

Background: The referral system offers one strategy for making the best use of hospitals and tertiary healthcare services. The aim of this study was to analyze the referral system of patients to the otorhinolaryngologist and to examine the use of in-house referral system in the teaching hospital set up. Methods: This was a retrospective review of all patients referred to the ENT Department between January 2000 and December 2007. Data retrieved from all referral notes included the review of referral letter; demographic; referral status; clinical presentations and examination findings. These data were entered into the SPSS computer software version 11.0 and analysed Results: A total of 1402 cases were analyzed. The patients' ages ranged from 3weeks to 90yrs; with 70.4of cases being below 40yrs of age while 25.9were between 40-64yrs and 3.7were above 65yrs. The Male to female sex ratio was 1:1. The majority (70.4) of the patients had at least primary school education. The rest (29.6) had no formal education. Slight over half (51.5) of the patients were unemployed. The rest were either civil servants or self employed. Out of the 1402 patients that were referred to the hospital; in-house referral accounted for 74.1; 7.2of came from private health facility and 4.3were self referrals. Out of the 1038 in-house referrals; 42.8were from GOPD; 5.0from Staff clinic; 13.3from surgery; 4.7from medicine; 3.5from Obstetrics and Gynaecology; 10from paediatrics and 10.4from ophthalmology and 10.3from ENT staffs such as residents; ENT Nurse Practitioner and ENT supporting staffs such as speech therapist and audiologist. Conclusion: The challenges of referral to the otolaryngologists are enormous thus the need to organize continuous medical education for the family physician; to make patients have confidence in the primary care physician; early referral of patients and to allow the otorhinolaryngologist to focus on the cutting edge issues of the specialty

Clinico-Pathological Pattern of Nasopharyngeal Carcinoma in Ilorin, Nigeria

Nasopharyngeal carcinoma is an uncommon tumour in Nigeria but the burden of the disease in terms of morbidity and mortality is very high. The aim of the study was to document the clinic-pathological characteristics of nasopharyngeal carcinoma in Ilorin, North central Nigeria. This was a retrospective review of all patients seen in ENT department, University of Ilorin Teaching Hospital with the diagnosis of nasopharyngeal carcinoma between January 1st 1999 and December 31st,2008. The patient's biodata, clinical presentation and histopathological findings are presented. The histopathological diagnosis was in accordance with the 1991 WHO classification. A total of 30 patients with histologically confirmed nasopharyngeal carcinoma seen during the study period accounted for 2% of the total cancers recorded in Ilorin cancer registry. There were 20 males and 10 females with a mean age of 48.7 ± 15.9 years. The commonest presenting complaint was cervical lymphadenopathy in 96.7% of patients followed by epistaxis (66.7%) and hearing loss (66.7%). Identifiable risk factors included regular intake of ungutted salted smoked fish (76.7%) and tobacco use (23.3%) with some having both risk factors. Histologically, undifferentiated carcinoma was the commonest (70%) followed by welldifferentiated keratinizing squamous cell carcinoma (20%) and differentiated nonkeratinizing squamous cell carcinoma (10%).Undifferentiated carcinoma was the commonest type of nasopharyngeal carcinoma reported from this study especially among males in the 4th and 5th decades of life. Identifiable risk factors included consumption of ungutted salted smoked fish with tobaccon usage. Early diagnosis with effective referral system and easy access to radiotherapy would improve the survival outcome in patients with the disease

A etiological profile of nasal trauma in Ilorin North-Central Nigeria

The nose being the most prominent part of the face is easily traumatized in facial injuries and these has been found to be common among the Caucasians compared to the Africans and Asians. The aim is to ighlight the Aetiological profile of nasal trauma in Ilorin orth-central Nigeria. Method: A prospective study was carried out at the University of Ilorin Teaching Hospital Ilorin; Ilorin; north central Nigeria over a period of one and half years of all trauma cases seen at the A/E department of the hospital and those with nasal trauma were further studied. The data retrieved include demographic data; clinical presentation; and timing of presentation; examination findings; intervention offered and the outcome. Data were entered into SPSS 11.0 and analyzed descriptively. Results : A total of one hundred and six (106) patients with nasal trauma were seen during the study period with a prevalence rate of 7. The age range 6months to 65years with the majority of the patients in the age range 21-34 years (35.8). The Male to female ratio was 1.7:1.0 and most patients were students ( 28.3); followed by the traders ( 22.6) the least were children (8.5).Road traffic injury (RTI) constituted the highest cause of the nasal trauma ( 57.5);assaults (17);falls from heights ( 8.5) and others were 17.Majority of the patients presented within 1-6hours of occurrence of the injury (61.3) and only 24.5presented less than an hour of the incidence. The common forms of presentation were epistaxis (40.6); nasal lacerations and epistaxis (25.5) and nasal fractures in only 10.4.Involvement of both the passengers and the pedestrians was (57.5) and most of them; 44.3had surgical intervention and 40.6had conservative treatment with a mortality rate of 0.9. Conclusions: The prevalence of nasal trauma is 7with RTI being the commonest cause in nearly two thirds of cases and cases of assaults only accounted for 17.The commonest forms of presentation were epistaxis;nasal lacerations and nasal fractures in that order and most of them were surgically treated. Measures should be adopted to reduce incidence of RTI; with regulations enforced to protect pedestrians most of whom were the victims of these injuries