Prevalence and pattern of birth defects in the two tertiary hospitals in Enugu, South East Nigeria: A hospital-based observational study.

BACKGROUND: Birth defects have medical, surgical and aesthetic consequences. The impact of birth defects is particularly severe in low-income countries where health-care resources are limited. AIMS AND OBJECTIVES: The aim of this study was to determine the prevalence and types of birth defects in live newborns delivered at the two tertiary hospitals in Enugu, South East Nigeria. MATERIALS AND METHODS: This was a hospital-based observational study carried out on neonates delivered in the maternity units of the University of Nigeria Teaching Hospital Ituku/Ozalla and Enugu State University Teaching Hospital Parklane, Enugu during the periods of January 2015 and December 2018. All the live-born babies born in the two hospitals during this period were recruited into the study. The neonates were examined by a paediatrician for the presence of birth defects. The birth defects were classified according to the system involved and also into major and minor. RESULTS: During the study period, 9492 babies were born, of which 166 had birth defects, which gave a prevalence of 1.75%. The predominant system affected by birth defects was the musculoskeletal system (45.2%) followed by the central nervous system (34.9%), urogenital system (10.8%) and gastrointestinal tract (9%). 13 (7.8%) patients had their birth defects diagnosed prenatally during the maternal ultrasound scan. Fifteen (9%) and 13 (7.8%) mothers of the neonates who had birth defects were diabetics and hypertensives, respectively. Most of the neonates were delivered vaginally. CONCLUSION: Birth defects are not uncommon. This study showed a prevalence of 1.75% in the two tertiary hospitals in Enugu, South East Nigeria. The most commonly affected system was the musculoskeletal system.

The Ebb and Flow of Neurosurgery in a Re-Emerging Sub-Saharan Center. Lessons from 1025 Consecutive Operated Cases and Progress Models. A Prospective Observational Cohort Study.

BACKGROUND: The evolution of neurosurgery in our center comprises 2 active phases separated by a decade-long latent phase. This study evaluates our experience in the renaissance phase using 1025 cases. We identify paradigms that predict progress under existing practice conditions. METHODS: A prospective observational study was undertaken of all freshly operated patients from 2009 to 2016. Ethical approval was obtained from the hospital institutional review board. Data of enrolled patients were acquired and analyzed using SPSS software for Windows version 21. Inferences were evaluated using a 95% level of significance. Major and intermediate cases were included, whereas bedside cases as well as patients operated on elsewhere were excluded. RESULTS: Of 5132 patients treated, 3033 had surgical lesions, 1129 (33.2 ± 2.7% confidence limit [CL]) were operated on, and 1025 satisfied the study criteria. The unmet surgical load (66.1%) was significant (χ2 = 10.9; degree of freedom = 1; P = 0.001). The most common diseases treated were neurotrauma in 438 patients, congenital malformations in 268, and tumors in 170. The mean annual operative rate was 125 ± 5.7 patients (95% CL). Cases showed significant variability using 1-way analysis of variance (F = 13.77; P = 0.03). Residency training was a positive influence on surgeons' operative rate (χ2 = 7.59; P = 0.02). The mean complication rate was 10.3% ± 2.9%, and the mortality was 5.5% ± 1.7%. CONCLUSIONS: We found a large unmet neurosurgical load. To resolve this situation, we recommend an increase in the number of training programs for neurosurgery residency. As neurosurgery units evolve, their progress may be evaluated using the NESCAPE (Neurosurgery Care Phase Evolution) paradigm.

Management of Brain Abscess: Changing Trend and Experience in Enugu, Nigeria.

BACKGROUND: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. AIM: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. METHODOLOGY: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004-2014) and University of Nigeria Teaching Hospital (2009-2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. RESULTS: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. CONCLUSION: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome.

Management of brain abscess: Changing trend and experience in Enugu, Nigeria

Background: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. Aim: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. Methodology: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004­2014) and University of Nigeria Teaching Hospital (2009­2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. Results: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. Conclusion: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome