Spatial and temporal distribution of optimal maize sowing dates in Nigeria.

Climate change and inter-annual variability cause variation in rainfall commencement and cessation which has consequences for the maize growing season length and thus impact yields. This study therefore sought to determine the spatially explicit optimum maize sowing dates to enable site specific recommendations in Nigeria. Gridded weather and soil data, crop management and cultivar were used to simulate maize yield from 1981-2019 at a scale of 0.5°. A total of 37 potential sowing dates between 1 March and 7 November at an interval of 7 days for each year were evaluated. The optimum sowing date was the date which maximizes yield at harvest, keeping all other management factors constant. The results show that optimum sowing dates significantly vary across the country with northern Nigeria having notably delayed sowing dates compared to southern Nigeria which has earlier planting dates. The long-term optimal sowing dates significantly (p<0.05), shifted between the 1980s (1981-1990), and current (2011-2019), for most of the country. The most optimum planting dates of southern Nigeria shifted to later sowing dates while most optimum sowing dates of central and northern Nigeria shifted to earlier sowing dates. There was more variation in optimum sowing dates in the wetter than the drier agro-ecologies. Changes in climate explain changes in sowing dates in wetter agro-ecologies compared to drier agro-ecologies. The study concludes that the optimum sowing dates derived from this study and the corresponding methodology used to generate them can be used to improve cropping calendars in maize farming in Nigeria.

A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050.

OBJECTIVE: There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS: An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS: Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS: Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.

Digital technology in maize nutrient management research in northern Nigeria amid COVID-19 pandemic.

The COVID-19 pandemic has been a life threatening and spreads wildly with physical human contact. Physical distancing is recommended by health experts to prevent the spread; thus, agronomic research has to be designed in conformity to this preventive standard during the pandemic. Consequently, this study was designed to evaluate the reliability of using digital tools in nutrient management research amid the COVID-19 pandemic in northern Nigeria. Fifty extension agents (EAs) were selected across 15 LGAs of Kaduna and Kano states. The EAs were trained on how to generate fertilizer recommendation using an android mobile phone-based nutrient expert (NE), to measure farmers' field sizes using UTM Area measure mobile phone app, and open data kit to record, submit and aggregate data during the exercise. Each EA covered 50 farms, where two nutrient management practices-one determined by the farmers: farmer fertilizer practice (FFP), and the other generated using the NE were evaluated. Results show that around 90% of the farmers have an average field size of 1.13 ha. All selected farmers used improved maize varieties for planting, among which 21% been able to use the exact recommended or lower seed rate. Use of inorganic fertilizer was 33% higher than the average recommended NE rate, while average yield of the NE fields was 48% higher than for the FFP. The results of this study indicate that yield can be improved with site-specific nutrient management (SSNM) extension approach. The SSNM using digital tools as the NE seem promising and befits to agronomic research in northern Nigeria amid the COVID-19 pandemic.

The status of specialist neurosurgical training in Nigeria: A survey of practitioners, trainers, and trainees.

OBJECTIVE: Despite the well-known neurosurgical workforce deficit in Sub-Saharan Africa, there remains a low number of neurosurgical training programs in Nigeria. This study sought to re-assess the current status of specialist neurosurgical training in the country. METHODS: An electronic survey was distributed to all consultant neurosurgeons and neurosurgery residents in Nigeria. Demographic information and questions relating to the content, process, strengths, and challenges of neurosurgical training were explored as part of a broader survey assessing neurosurgical capacity. Descriptive statistics were used for analysis. RESULTS: Respondents identified 15 neurosurgical training centers in Nigeria. All 15 are accredited by the West African College of Surgeons (WACS), and 6 by the National Postgraduate Medical College of Nigeria (NPMCN). The average duration of core neurosurgical training was 5 years. Some identified strengths of Nigerian neurosurgical training included learning opportunities provided to residents, recent growth in the neurosurgical training capacity, and satisfaction with training. Challenges included a continued low number of training programs compared to the population density, lack of subspecialty training programs, and inadequate training infrastructure. CONCLUSION: Despite the high number of neurosurgery training centers in Nigeria, compared to other West African countries, the programs are still limited in number and capacity. Although this study shows apparent trainee satisfaction with the training process and contents, multiple challenges exist. Efforts at improving training capacity should focus on continuing the development and expansion of current programs, commencing subspecialty training, driving health insurance to improve funding, and increasing available infrastructure for training.

Severity and Predictors of Outcome of Motorcycle-Associated Head Injury: An Experience from a Regional Neurosurgery Centre in Northern Nigeria.

BACKGROUND: Motorcycle-associated head injury is one of the leading causes of disability and deaths, with its main victims being the motorcyclists, passengers, and pedestrians in their young productive age group. This study determines the role of severity and some predictive factors on survival and mortality of motorcycle-associated head injury. METHODS: This is a cross-sectional study using data of patients managed for motorcycle-associated head injuries between December 2014 and November 2016. The patients' biodata, clinical findings, and management outcomes were analyzed using Statistical Packages for the Social Sciences version 20. RESULTS: A total of 184 patients were analyzed, most of whom (81%) were aged ≤40 years and with a male dominance of 6.7:1. Pupillary abnormality was seen in 43.5% of the patients, and severe head injury occurred in 34.2% of the patients. Hemorrhagic contusion was the most common computed tomography (CT) finding (16.3%). Among 20.8% of the patients who died, 63.2% had severe head injury. CONCLUSIONS: Motorcycle-associated head injury predominantly occurred among young men who used a motorcycle for commercial purposes. The survival rate was higher among patients who had brain CT scan performed, extra-axial clots, and operative treatment. However, high mortality was seen among patients who could not afford brain CT scan, and who had bilateral pupillary dilatation, CT findings of abnormalities that are not surgically amenable, and severe head injury.

Childhood Hydrocephalus in Sokoto: Experience with 401 Series.

BACKGROUND: Hydrocephalus is a complex and multifactorial neurological disorders. Childhood hydrocephalus like other chronic childhood illness is a major contributor to poor quality of life and huge financial burden to the affected family and nation. Epidemiological factors tend to vary with geographical location. Unlike in developed countries, most data from developing countries showed infection as the most common etiology. This study was conducted to analyze our epidemiological features of childhood hydrocephalus in Sokoto with a review of the literature. AIMS: The aims of this study were to determine the frequency of causes of hydrocephalus in Sokoto and to determine the short-term outcomes of treatment and compare results with the literatures. MATERIALS AND METHODS: This was a retrospective study with patients' data from the theatre records, patients' case notes, and radiological records. Outcomes were based on complications and changes in the occipitofrontal circumferences. Criteria for statistical significant was P < 0.05. RESULTS: One hundred and thirty-eight patients satisfied inclusion criteria. No sex preponderance was found with a mean age of 16.41 months. Maternal illiteracy rate was 60% with 49.3% of the parents at lower socioeconomic class. Infection was the most frequent etiology (45.7%). Myelomeningocele associated hydrocephalus was also common (16.7%). However, post-hemorrhagic hydrocephalus was rare (2.9%). Mean preoperative and postoperative occipitofrontal circumferences were 54.22 cm and 47.92 cm, respectively, with P = 0.001. CONCLUSION: Poverty and illiteracy were strongly associated with childhood hydrocephalus in our patients. Infection was predominantly associated with morbidity with large number of patients being lost to follow-up.

Giant Encephalocele in Sokoto, Nigeria: A 5-Year Review of Operated Cases.

OBJECTIVE: Encephalocele is a common congenital malformation of the central nervous system; however, giant encephaloceles are rare. The use of folic acid supplementation and termination of pregnancies, which are prenatally diagnosed with encephaloceles and other congenital malformation of the central nervous system, has significantly reduced the occurrence of this type of congenital malformation, especially in developed countries. METHODS: This was a retrospective review over a 5-year period from January 2006 to December 2010 at the Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The records of patients with giant encephalocele were retrieved from the case notes of patients who had excision and repair for encephalocele. RESULTS: Seventy-three patients had excision and repair of encephalocele over the study period. However, the records of only 50 patients were retrieved. Fourteen (28%) of the 50 whose records were retrieved had giant encephalocele. There were 4 male and 10 female patients (1:2.5). Thirteen (92.9%) had the lesion located in the occipital region, whereas in 1 patient (7.1%) the lesion was at the vertex. Three (21%) of the cases had microcephaly, 1 (7.1%) had macrocephaly, and 1 (7.1%) developed postoperative hydrocephalus. The average size of defect was 2.43 cm, and the size of the lesion ranged from 12 × 6 cm to 40 × 50 cm. The average maternal age was 20.3 years (n = 6), and the paternal age was 29 years (n = 4). Four out of 7 (57%) mothers had febrile illness in early pregnancy. Seven out of 10 patients (70%) did not have antenatal care. CONCLUSIONS: This condition is more common in children conceived during the period when farm products are yet to be harvested, and whose mothers did not attend antenatal care visits. It is recommended that mothers should be educated on the necessity of preconception folic acid. Implementation of a national strategy on food fortification is also advised. We recommend surgery after the first month of life to reduce poor early postoperative outcomes. In developing countries and centers with suboptimal pediatric intensive care units, surgical intervention is preferred after the first month of life with good temperature control, adequate fluid replacement following rupture of the sac, blood transfusion availability, and, only if necessary, complex cranial reconstruction.

Developing a Guideline for Neurotrauma in Nigeria.

BACKGROUND: The Nigerian Academy of Neurological Surgeons in 2019 resolved to standardize the practice of neurosurgery in Nigeria. It set up committees to standardize the various aspects of neurosurgery, such as neurotrauma, pediatrics, functional, vascular, skull base, brain tumor, and spine. The Committee on Neurotrauma convened and resolved to study most of the available protocols and guidelines in use in different parts of the world. OBJECTIVE: To formulate a standard protocol for the practice of neurotrauma care within the Nigerian locality. METHODS: The Committee split its membership into 3 subcommittees to cover the various aspects of the Neurotrauma Guidelines, such as neurotrauma curriculum, standard neurotrauma management protocols, and neurotrauma registry. Each subcommittee was to research on available models and formulate a draft for Nigerian neurotrauma. RESULTS: All the 3 subcommittees had their reports ready on schedule. Each concurred that neurotrauma is a major public health challenge in Nigeria. They produced 3 different drafts on the 3 thematic areas of the project. The subcommittees are: 1. Subcommittee on Fellowship, Training and Research Curriculum; 2. Subcommittee on Standard Protocols and Management Guidelines; and 3. Subcommittee of the Nigerian Neurotrauma Registry. CONCLUSION: The committee concluded that a formal protocol for neurotrauma care is long overdue in Nigeria for the standardization of all aspects of neurotrauma. It then recommended the adoption of these guidelines by all institutions offering services in Nigeria using the management protocols, opening a registry, and mounting researches on the various aspects of neurotrauma.

Balanced nutrient requirements for maize in the Northern Nigerian Savanna: Parameterization and validation of QUEFTS model.

Establishing balanced nutrient requirements for maize (Zea mays L.) in the Northern Nigerian Savanna is paramount to develop site-specific fertilizer recommendations to increase maize yield, profits of farmers and avoid negative environmental impacts of fertilizer use. The model QUEFTS (QUantitative Evaluation of Fertility of Tropical Soils) was used to estimate balanced nitrogen (N), phosphorus (P) and potassium (K) requirements for maize production in the Northern Nigerian Savanna. Data from on-farm nutrient omission trials conducted in 2015 and 2016 rainy seasons in two agro-ecological zones in the Northern Nigerian Savanna (i.e. Northern Guinea Savanna "NGS" and Sudan Savanna "SS") were used to parameterize and validate the QUEFTS model. The relations between indigenous soil N, P, and K supply and soil properties were not well described with the QUEFTS default equations and consequently new and better fitting equations were derived. The parameters of maximum accumulation (a) and dilution (d) in kg grain per kg nutrient for the QUEFTS model obtained were respectively 35 and 79 for N, 200 and 527 for P and 25 and 117 for K in the NGS zone; 32 and 79 for N, 164 and 528 for P and 24 and 136 for K in the SS zone; and 35 and 79 for N, 199 and 528 for P and 24 and 124 for K when the data of the two zones were combined. There was a close agreement between observed and parameterized QUEFTS predicted yields in each of the agro-ecological zone (R2 = 0.69 for the NGS and 0.75 for the SS). Although with a slight reduction in the prediction power, a good fit between the observed and model predicted grain yield was also detected when the data for the two agro-ecological zones were combined (R2 = 0.67). Therefore, across the two agro-ecological zones, the model predicted a linear relationship between grain yield and above-ground nutrient uptake until yield reached about 50 to 60% of the yield potential. When the yield target reached 60% of the potential yield (i.e. 6.0 t ha-1), the model showed above-ground balanced nutrient uptake of 20.7, 3.4 and 27.1 kg N, P, and K, respectively, per one tonne of maize grain. These results suggest an average NPK ratio in the plant dry matter of about 6.1:1:7.9. We concluded that the QUEFTS model can be widely used for balanced nutrient requirement estimations and development of site-specific fertilizer recommendations for maize intensification in the Northern Nigerian Savanna.

Knotting of a nasogastric feeding tube in a child with head injury: A case report and review of literature.

Nasogastric intubation is one of the most common routine nonoperative procedures available for the hospital care of patients. The insertion and removal of this tube is associated with many complications. The complications include trauma, nasal septal abscess and inadvertent entry into the cranial cavity and trachea, ulceration, bleeding from varices and perforation. Knotting of the nasogastric tube is one of the very rare complications of nasogastric intubation particularly in children. To the best of our knowledge there are very few reported cases in children. The technique used in the patient was the application of a steady tug which allows the lower oesophageal sphincter to open, therefore enabling the removal of the nasogastric tube. The possible predispositions to knotting of a nasogastric tube include small bore tubes, excess tube length and gastric surgery. We postulate that reduced gastric tone is another possible predisposing factor with head injury being the most likely reason in the index patient. We also challenge the fact that the small sized stomach is a risk factor for knotting of a feeding tube if the functional status and tone are normal, because of the rarity in children.

Subpericranial shunt valve placement: a technique in patients with friable skin.

INTRODUCTION: One of the nightmares of placing a shunt in patients with friable skin is an exposed shunt or shunt valve with risk of infection of the hardware which may lead to meningitis or ventriculitis with poor outcome. Another feared complication is cerebrospinal fluid (CSF) leak from the wound with subsequent wound dehiscence. The patients at risk of shunt hardware exposure include children who have fragile skin or skin at risk (either from prematurity, malnutrition, steroid therapy or very large head with pressure on the skin). METHOD/TECHNIQUE: This technique involves making a scalp incision with the pericranium taken in one layer with the galea or if the galeal flap has been raised, a pericranial incision is made and a pericranial flap is raised. A subpericranial pouch is developed and a shunt passer used to tunnel the shunt to the abdomen. The pericranial layer is closed, the galea and subcutaneous layer also approximated, and a continuous subcurticular stitch applied. RESULT: We present a malnourished infant with postinfective hydrocephalus having a thin skin requiring a ventriculoperitoneal shunt. A subpericranial technique was used and the patient did well. CONCLUSION: This technique is simple and provides a water-tight wound cover, with the pericranium giving reinforcement and better tensile strength, as well as a fairly good protection for the shunt valve. This is useful in preventing CSF leaks and exposure of the shunt with the associated morbidity and mortality.

Effects of α-tocopherol and ascorbic acid in the severity and management of traumatic brain injury in albino rats.

BACKGROUND: Traumatic brain injury (TBI) is accompanied by substantial accumulation of biomarkers of oxidative stress and depletion of antioxidants reserve which initiate chain reactions that damage brain cells. The present study investigated the role of ascorbic acid and α-tocopherol on the severity and management of TBI in rats. MATERIALS AND METHODS: Wistar rats were subjected to closed head injury using an accelerated impact device. Rats were administered 45 mg/kg and 60 mg/kg body weight of ascorbic acid, α-tocopherol or a combination of the two vitamins for 2 weeks pre- and post injury. Blood and brain tissue homogenates were analyzed for vitamin C, vitamin E, malondialdehyde, superoxide dismutase, and creatine kinase activities. RESULTS: The results indicated that TBI caused significant (P < 0.05) decreased in vitamins C and E levels in the blood and brain tissue of TBI-untreated rats. The activities of superoxide dismutase in TBI rats were markedly reduced when compared with non traumatized control and showed a tendency to increased following supplementation with vitamins C and E. Supplementation of the vitamins significantly (P < 0.05) reduced malondialdehyde in the treatment groups compared with the TBI-untreated group. CONCLUSION: The study indicated that pre and post treatment with ascorbic acid and α-tocopherol reduced oxidative stress induced by brain injury and effectively reduced mortality rate in rats.

Necrotizing fasciitis: a comparative analysis of 56 cases.

BACKGROUND: The term necrotizing fasciitis (NF) is now used in a generic sense to include all diffuse necrotizing soft-tissue infections except gas gangrene. It is a synergistic, polymicrobial soft-tissue infection associated with rapid progression, extensive necrosis, profound systemic toxemia, considerable morbidity and a high mortality rate. Although the disease is no respecter of age and affects a wide age group, adults are known to be more commonly affected than children. AIMS: To highlight the differences and similarities in the modes of presentation and results of intervention of NF in children and adults. PATIENTS AND METHODS: A four-year prospective descriptive analysis of all consecutive patients with NF (excluding cancrum oris and Fournier's gangrene) treated at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2001 to December 2004. RESULTS: A total of 56 patients were treated of which 32 (57.1%) were children < or = 15 years, while the remaining 24 (42.9%) were adults aged >15 years. There were 31 males and 25 females, giving the male-to-female ratio of 1.2:1; the corresponding ratios for children and adults were 1.7:1 and 1.1:2, respectively. The age ranged from six days to 70 years (mean 19.9 years). Trauma and minor skin infections were the main precipitating factors. The total body surface area (BSA) involved ranged from 1-16% (children 2-16%, adults 1-7%) with a mean of 4.3% (children 5.9%, adults 2.7%). The trunk was the most commonly involved anatomical region of the body (50.0%) in children, while in adults it was the lower limb (54.2%). In both children and adults, infection was mainly polymicrobial. The most common mode of wound resurfacing was by second intention in children (46.9%) and split-thickness skin grafting (STSG) in adults (37.5%). Septicemia was a common complication in both age groups. Mortality was 9.4% and 16.7% among children and adults, respectively. CONCLUSION: NF is more common in children than adults in northwestern Nigeria. Early recognition, aggressive surgical treatment and supportive therapy remain the essential keys to success.

Convexity meningioma presenting as postpartum eclampsia.

A 37-year-old woman, Para 5(+0) presented with a 1 year history of recurrent convulsions and progressive weakness of the right side of the body. She had been treated for postpartum eclampsia in her last delivery but symptoms recurred 3 months later. Evaluation including computerized tomography scan of the brain suggested a parieto-temporal meningioma, which was completely excised at craniotomy. Histology confirmed this to be a meningioma. The patient was well at 8 months of follow up. The growth of meningiomas may increase during pregnancy due to presence of receptors for progestational hormones in the tumour and the meningioma may become symptomatic in pregnancy, presenting as eclampsia. Close follow up of patients with eclampsia is necessary to identify neurological features that may lead to a diagnosis of meningioma. Early diagnosis is essential if a good outcome is to be ensured.