Poor Health Literacy in Nigeria: Causes, Consequences and Measures to improve it.

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make an appropriate decisions concerning their health. It is one of the link by which the health status of individual and the health indices and statistics of our country can be improved upon. Factors influencing health literacy in Nigeria include the culture and belief system, poor and ineffective communication, lack of education and low educational level, and low socioeconomic status Low health literacy predisposes to poorer health status, poorer disease outcome, lack of understanding in the use of preventive services, frequent hospital visitations amongst others. Factors influencing health literacy must be identified and modified to help improve the health literacy level of the populace. This will invariably improve the health status of the populace with a resultant improvement in the health indices of our country. This is a call for the Government and Health Care Professionals to acknowledge low health literacy as a problem and, therefore, be willing to play their roles in tackling this problem to achieve a healthy Nation

Practical Approach to the Management of the Severely Injured.

Events associated with severely injured victims are common occurrences. These injured patients should be properly managed to achieve good outcome. Trauma algorithm protocols are known to improve therapeutic process and outcome. However, most hospitals in our subregion that attend to severely injured patients are yet to develop an algorithm treatment protocols for the management of these patients. The ambulance system in Nigeria is still un-coordinated and unsupervised. Most of the existing ambulances are not well equipped and usually not manned by experienced paramedics. Therefore, transfer of severely injured victims is fraught with danger during transit. Communication link to inform the trauma centres ahead of transfer is virtually non-existent. Upgrading of the trauma systems in Nigeria is necessary to prevent unnecessary mortality among the resourceful age group that are mostly affected by events causing severely injured patients .

Anterior knee pain associated with an anterior superior patellar bony spur: a case report.

Anterior knee pain is a common presentation in Orthopaedic out patient practice. However anterior superior patellar spur is an uncommon cause.This case presentation is to highlight an anterior superior patellar spur with quadriceps tendonitis. The patient is a 52 year old man who presented with a recurrent anterior knee pain. The radiographic study revealed an anterio-superior patellar spur. The patient had a depo steroid injection as an adjunct therapy to physiotherapy and has been pain free.

Pipkin fractures: fracture of the head of femur a case report.

Pipkin fracture is the fracture of the head of the femur. It can be associated with neck of femur fracture or/and posterior dislocation of the hip. This fracture is very rare fracture and has not been reported at our sub-region. We present this fracture in a 26 year old with a type I Pipkin fracture treated with closed reduction and percutaneous k-wire fixation. Five (5) year after, she was very appreciative of her management with satisfactory remodeling of her femoral head.

Basic arthroscopy: a review paper.

Arthroscopy is a key hole surgical procedure that is used to visualized, diagnosed and treat pathologies inside a joint. Though it offers numerous advantages, it is technically demanding and requires a learning curve. Moreso, its uses in making diagnosis and therapeutic interventions are rewarding. However, the procedure is not yet widely practiced in our sub-region. This review to bring to fore the advantages of arthroscopic procedures, the indications and contraindications and to stimulate interest of these procedures in our sub region The literature materials on arthroscopic procedures were reviewed The era of extensive opening of joint for surgical procedure is coming to an end. The use of arthroscopic procedures in management of patients will improve the quality of care received by the patients. This review is to stimulate interest of arthroscopy in our sub-region.

Profile of amputations in Lagos University Teaching Hospital, Lagos, Nigeria.

BACKGROUND: Amputation is a common surgical procedure for which there are several indications. There are few research works on the profile of amputation in Lagos. OBJECTIVE: The study is to determine the pattern of amputation at the Lagos University Teaching Hospital, Lagos, and to identify the indications, types, morbidity and mortality associated with amputation. METHODS: This was a retrospective study carried out at the Lagos University Teaching Hospital between Jan.2007 and Dec. 2009. All records of patients were retrieved and selected data collated. RESULTS: A total of 127 patients presented between Jan. 2007 and Dec. 2009 with various indications for amputation. The mean age was 43.0 +/- 19.4 years. Male: female ratio was 1.7 to 1. Diabetic foot gangrene was the leading cause of amputation occurring in 55.14% of patients studied. Other major indications were trauma and malignancies. Below-knee amputation was the commonest type done (46.6%). Sepsis was the commonest complication (11.8%). The mortality rate of 11.8% was mainly due to co-morbidities. CONCLUSION: Amputation in our centre is more likely to be done on males and diabetics. Majority was below knee and was associated with significant mortality. Increasing public enlightenment and early presentation are needed to reduce morbidity and mortality as well as improve limb salvage in our population.

Deep vein thrombosis: risk factors and prevention in surgical patients.

BACKGROUND: Deep vein thrombosis (DVT) is a cause of preventable morbidity and mortality in hospitalized surgical patients. The occurrence of the disease is related to presence of risk factors, which are related primarily to trauma, venous stasis and hyper-coagulability. DVT seems not to be taken seriously by many surgeons in Nigeria. This is despite comprehensive studies that show no real differences in racial demography of the disease. OBJECTIVE: To highlight the importance of physician awareness about DVT especially its risks and prevention methods. METHODS: A detailed literature search was completed to extrapolate articles that described DVT risks and prevention. This involved hand and online searches. Specific search terms used included DVT/risk factors/prevention. The searches generated 468 papers. Of these 57 papers were included in the review. RESULTS: Predominant risk factors for DVT include middle or old age, prolonged surgery, trauma, confinement, presence of malignancy and insertion of deep venous catheters. In women, contraceptive use, hormone replacement therapy, pregnancy and the puepernum are a additional risk factors. Prophylactic measures include those directed at eliminating venous stasis and those directed at changes in blood coagulability. CONCLUSION: Deep Venous Thrombosis is a common disease with fatal and serious long term burdensome complications. We must target primary and secondary prophylaxis to improve survival and reduce morbidity from this preventable disease.

Profile of spinal injuries in Lagos, Nigeria.

STUDY DESIGN: Retrospective study. OBJECTIVE: To describe the pattern and outcome of spinal cord injuries in Lagos, Nigeria. SETTING: Nigeria, Lagos. METHODS: This retrospective review of cases was conducted at Lagos University Teaching Hospital (LUTH), Lagos, between January 1992 and December 2006. RESULTS: A total of 468 cases of spinal cord injury over the 15-year period were studied. Three hundred and twelve of them (66.2%) were aged 40 years and below, with the peak age incidence as 21-30 years. There were 328 males (70.1%) and 140 females (29.9%) showing a male to female ratio of 2.34:1. Road traffic accident accounted for 362 (77.4%) patients. At presentation, 430 (91.9%) of the injuries were of ASIA (American Spinal Injury Association) class A. Lumbar spine was affected in 278 (59.4%) of patients, whereas cervical spine accounted for 142 (30.3%). The most frequently seen complication was bedsore, seen in 163 (59.9%) of 272 patients that had complications. On discharge, 230 patients (49.1%) were in ASIA class A and 34 (7.5%) in ASIA E. Eighty-two patients (17.5%) died. CONCLUSION: Spinal injuries in Lagos occurred mostly in young adult males affecting mainly the lumbar spine. Traffic-related incidents were the leading cause and bedsore the most common complication.

Arterial injuries in civilian practice in Lagos, Nigeria.

OBJECTIVE: This is a retrospective study of patients managed at the Lagos University Teaching Hospital for peripheral arterial injuries from January 1995 to April 2003. The aim was to study the pattern of peripheral arterial injuries in Lagos. Nigeria and to look at the outcome of management and see what improvements could be made in future. METHOD: Data was collated from case notes of patients, operation register in theatre and admission and discharge books from the surgical wards and the data bank of consultants involved in patients' management. RESULT: Forty-one patients. 37 males and 4 females. were treated within the study period (M:F ratio of 9:1). Twenty three patients (56.1%) suffered gunshot injuries during armed robbery attacks while 9 patients (22.0%) had stab injuries in civilian violence. Twenty-one patients (3 with gunshot injuries and 18 non gunshot penetrating injuries) were managed by direct suturing of vessels. Eight patients had prosthetic graft interposition while 2 patients had reversed saphenous vein grafts. Two patients had the superficial branches of their radial arteries tied up at the wrist. CONCLUSION: Gun shot injuries from armed robbery attack was the commonest cause of peripheral arterial injuries in this environment during the period of study.

Efficacy and safety of enoxaparin, a low molecular weight heparin in the prevention of deep vein thrombosis in Nigerian patients after orthopaedic surgery.

The objective was to determine the efficacy and safety of Enoxaparin as an antithrombotic agent in orthopaedic patients at risk for thromboembolism. 49 patients who had lower limb orthopaedic surgery were studied. They received subcutaneous Enoxaparin 40mg 12 hours before surgery and subsequently, daily for one week. Blood specimens were drawn at 2 and 12 hours after the first injection, and 24 hours after the fourth injection for anti Factor Xa assay. Specimens were also taken preoperatively, 1st, 5th and 7th post operative days (POD) for determination of Packed Cell Volume (PCV), Haemoglobin level, White Blood Cell (WBC) and Platelet Counts. The mean pre-treatment, 2, 12 and 24 hours anti Factor Xa clotting times were 14.5 +/- 0.8, 36.2 +/- 5.6, 30.6 +/- 9.8 and 25.8 +/- 9.3 seconds respectively. The changes were significant, P = 8.2 x 10(-12). The 2 and 24 hours clotting times corresponded to plasma heparin concentration level of 0.12 - 0.22U/ml read off from prepared Enoxaparin standardisation curve. Significant changes were observed in haemoglobin level, PCV, WBC and Platelet Counts when preoperative, 1st, 5th and 7th POD mean values were compared by Analysis of Variance--P < 0.01 in all cases. The study showed that Enoxaparin 40 mg daily caused hypocoagulation within prophylactic range of 0.12 - 0.22U/ml of heparin in the plasma. Changes in blood counts were within the limits expected post surgery.