ABSTRACT
BACKGROUND: The Government of Ghana launched the Rural LPG (RLP) promotion program in 2013 as part of its efforts to reduce fuelwood consumption. The aim of the RLP is to contribute to Ghana's overarching goal to provide LPG access to 50% of Ghana's population by 2020. The RLP has not announced long-term program objectives. However, in the interim the RLP targeted a cumulative total of 170,000 LPG cookstoves to rural households by the end of 2017. As of November 2017, 149,500 rural households had received the LPG cook stoves. Our case study documents Ghana's experiences to date with LPG scale up. METHODS: We carried out a desktop review/document analysis of literature on the RLP. Each document was reviewed for information related to the elements of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework as it pertained to LPG promotion and adoption. In-depth interviews were held among key stakeholders in Ghana. Previously collected data from a field evaluation of the RLP was also assessed. FINDINGS: Generally, our evaluation suggests that the current form of the RLP is not achieving its stated goal. Our evaluation of the RLP in five rural communities showed that about 58% of households had never refilled their LPG cylinders nine months after the initial delivery of a filled cylinder. Only 8% still used their LPG at 18 months post distribution. Cost and distance to LPG filling stations were the main reasons for low LPG use. Beneficiaries did not exclusively use their LPG even at the initial stages when all of them had LPG in their cylinders. Ghana is currently undergoing transitions in the LPG sector including a change from the current private cylinder ownership model to a cylinder recirculation model for the distribution of LPG. There was no evidence of a well-documented implementation framework for the RLP. CONCLUSION: Fuel cost, poor LPG access, and an inadequate implementation framework hinder the RLP implementation.
ABSTRACT
BACKGROUND: Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. METHODS OF STUDY: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. RESULTS: A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. CONCLUSION: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.
ABSTRACT
Background. Urethral stricture is a frequent cause of lower urinary tract obstruction worldwide. The aim of this study is to present our experience with one-stage urethroplasty. Methods. All males that underwent one-stage urethroplasty between January 2001 and December 2010 were retrospectively reviewed. Details of their biodata, clinical presentation, diagnostic investigations, operative treatment, postoperative complications, and other outcome of surgery were extracted and analyzed. Results. Ninety-one patients aged 8-76 years, (mean; 45.6 ± 19.7) with urethral stricture were studied. Postinfective strictures accounted for 58.2% and postprostatectomy strictures for 3.3%. Twenty-six (27.9%) of the strictures were in the posterior urethra of which 18 (59.2%) were posttraumatic. Fifty-seven strictures (61.3%) were in the anterior urethra of which 51 (54.8%) were postinfective. Thirty-nine (42.9%) patients had end to end anastomosis, 29 (31.9%) flap augmentation and 17 (18.7%) tabularized flap substitution, and 6 (6.6%) dorsal onlay grafts (5 with buccal mucosa and 1 with penile skin). There were 18 (19.8%) cases of wound infection, 12 (13.2%) of restricture and 6 (6.6%) cases of urethrocutaneous fistula. Satisfactory urinary stream was found in 77 (84.6%) patients. There was no mortality. Conclusion. Infection is the commonest cause of urethral stricture followed by trauma, and one-stage urethroplasty give excellent results.
