ABSTRACT
Background: In the developing world, access to pediatric surgery has been associated with sociocultural factors and healthcare funding challenges. Aim: This study aims to evaluate health worker (HW) factors in delayed access to appropriate care for children with surgical problems in South East Nigeria. Subjects and Methods: A cross-sectional analysis of the awareness of children's surgery and ability for appropriate referral among 503 HWs of various cadres in South East Nigeria was carried out using a structured questionnaire. Data was analyzed using IBM SPSS 21. Results: Of 419 (83.3%) respondents, 211 (50.4%) were doctors, 217 (51.8%) were aged 26-35 years, 261 (62.3%) indicated awareness of pediatric surgical conditions, 114 (27.2%) knew of sites to examine on the newborn at birth, and 147 (35.1%) inclined to timely referral to experts. Predictors of early referral include age <35 years, (P = 0.001) and cadre: doctors (P = 0.006). Female HWs (P = 0.013) and doctors (P = 0.008) displayed better knowledge of pediatric surgical cases. Delayed referral was mostly HW-related and included inaccurate diagnosis and wrong assumption of competence. Conditions commonly misdiagnosed were intussusception and posterior urethral valve. Conclusion: Awareness of surgical needs of children is poor among HWs in our setting. To address this and improve access to care, there may be a need to incorporate basic training in common pediatric surgical conditions in the training curriculum for HWs at various levels.
Subject(s)
Developing Countries , Parturition , Child , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Nigeria , Pregnancy , Surveys and QuestionnairesABSTRACT
BACKGROUND: The use of ultrasonography to localize the testis in children with undescended testis is still controversial. This study was designed to determine the value of ultrasound in the preoperative assessment of children with undescended testis in a resource-limited setting. METHODS: A retrospective evaluation of all boys undergoing operation for undescended testes at the University of Nigeria Teaching hospital Enugu from June 2005 to December 2009 was performed. The operative findings were compared with the preoperative findings on clinical and ultrasound examinations. RESULTS: Overall, 49 boys with 60 undescended testes (unilateral in 38, and bilateral in 11 cases) were operated on during the study period. The median age of the patients was 5 (range, 1-14) years. At operation, 39 (65%) testes were located at the inguinal region, 17 (28.3%) were intra-abdominal, and 4 (6.7%) were vanishing testes. Of the inguinal testes, 30 (77%) were clinically palpable, and 38 (97.4%) accurately localized by ultrasound (p = 0.006). The intra-abdominal testes, the vanishing testes, and one inguinal testis were not identified with ultrasound. However, two testes identified as inguinal by ultrasound were found intraabdominal at operation, and two of the vanishing testes were recognized as viable testes by ultrasound. CONCLUSIONS: Ultrasound may identify some otherwise nonpalpable inguinal testes and hence affect therapeutic approach. It may, however, be unhelpful in truly abdominal and vanishing testes.
Subject(s)
Cryptorchidism/diagnostic imaging , Developing Countries , Orchiopexy , Preoperative Care/methods , Adolescent , Child , Child, Preschool , Cryptorchidism/surgery , Humans , Infant , Male , Nigeria , Retrospective Studies , UltrasonographyABSTRACT
BACKGROUND: Spontaneous scrotal enterocutaneous fistula (SSECF) is a rare entity both in our local and international literature. No report of such has emanated from south eastern Nigeria. METHOD: The case note of the patient was retrieved and relevant data extracted and summarized. An extensive pubmed search was done and results reviewed and compared with the present case. RESULT: The case report of the successful surgical management of a 7 week male who developed right hemiscrotal SSECF as a result of neglected, irreducible right inguinoscrotal hernia is outlined. A review current literature is also highlighted. CONCLUSION: Spontaneous scrotal enterocutaneous stula is a very rare complication of neglected, educible, strangulated inguinoscrotal hernia. Treatment is invariably inguinal exploration, excision of iseased bowel with end to end anastomosis. Early detection and early repair policy will prevent this.
Subject(s)
Scrotum/surgery , Humans , Infant , Intestinal Fistula/diagnosis , MaleABSTRACT
Rectovaginal fistula may be a complication sexual assault in children. Management of these cases could be daunting with possibilities of significant psychological and physical morbidity. An eight-year-old girl presented with vulvar fecal leakage from a large rectovaginal fistula two weeks after sexual assault. The child was managed by initial diverting colostomy and the fistula repair was carried out via a posterior sagittal approach. This report highlights significance of initial thorough evaluation in cases with suspected traumatic rectovaginal fistula, and demonstrates benefits of posterior sagittal approach in the definitive treatment of large-sized fistula.
