Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care.

Introduction Injuries are the third most important cause of overall deaths globally with one-quarter resulting from road traffic crashes. Majority of these deaths occur before arrival in the hospital and can be reduced with prompt and efficient prehospital care. The aim of this study was to highlight the burden of road traffic injury (RTI) in Lagos, Nigeria and assess the effectiveness of prehospital care, especially the role of Lagos State Ambulance Service (LASAMBUS) in providing initial care and transportation of the injured to the hospital. METHODS: A three-year, retrospective review of road traffic injured patients seen at the Surgical Emergency Room (SER) of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, from January 1, 2012 to December 31, 2014 was conducted. Parameters extracted from the Institution Trauma Registry included bio-data, date and time of injury, date and time of arrival in SER, host status, type of vehicle involved, and region(s) injured. Information on how patients came to the hospital and outcome in SER also were recorded. Results were analyzed using Statistical Package for Social Sciences (SPSS; IBM Corporation; Armonk, New York USA) version 16. RESULTS: A total of 23,537 patients were seen during the study period. Among them, 16,024 (68.1%) had trauma. Road traffic crashes were responsible in 5,629 (35.0%) of trauma cases. Passengers constituted 42.0% of the injured, followed by pedestrians (34.0%). Four wheelers were the most frequent vehicle type involved (54.0%), followed by motor cycles (30.0%). Regions mainly affected were head and neck (40.0%) and lower limb (29.0%). Less than one-quarter (24.0%) presented to the emergency room within an hour, while one-third arrived between one and six hours following injury. Relatives brought 55.4%, followed by bystanders (21.4%). Only 2.3% had formal prehospital care and were brought to the hospital by LASAMBUS. They also had significantly shorter arrival time. One hundred and nine patients (1.9%) died in the emergency room while 235 bodies were brought in dead. CONCLUSION: Less than three percent among the victims of road crashes had formal prehospital care and shorter hospital arrival time. Current facilities for emergency prehospital care in Lagos are inadequate and require improvement. Training lay first-responders, who bring the majority of the injured to hospital, in basic first-aid may improve prehospital care in Lagos. Ibrahim NA , Ajani AWO , Mustafa IA , Balogun RA , Oludara MA , Idowu OE , Solagberu BA . Road traffic injury in Lagos, Nigeria: assessing prehospital care. Prehosp Disaster Med. 2017;32(4):424-430.

Screening for peripheral neuropathy and peripheral arterial disease in persons with diabetes mellitus in a Nigerian University Teaching Hospital.

BACKGROUND: Identifying the risk factors for diabetes mellitus related foot ulceration would save more limbs from amputation. This report focuses on the determining the burden of peripheral arterial disease and neuropathy in persons with diabetes mellitus (DM). METHODS: This is a descriptive study carried out in the Diabetic Clinic of the Lagos State University Teaching Hospital in patients with DM who had no past/present history of foot ulceration. Biothesiometry was employed and ankle brachial pressure indices were measured to evaluate for neuropathy and peripheral arterial disease (PAD) respectively. RESULTS: A total of 225 persons living with DM who met inclusion criteria were recruited consecutively over a 3 months period. Age range was 28-87 years with the mean [61.4 (10.8)] and median (63) years respectively. Patients symptomatic for neuropathy and PAD were 37 and 40 % respectively of the study population. An older age of >60 years and poor glycaemic control were potential predictors of neuropathy. Neuropathy and PAD occurred commonly in the seventh decade of life. CONCLUSION: Given the fairly high proportions of neuropathy and PAD in our patients with DM, we recommend that they be routinely examined in persons with DM.

Pedestrian injuries in the most densely populated city in Nigeria-an epidemic calling for control.

OBJECTIVES: Since the first pedestrian road fatality of 1896, pedestrians still remain vulnerable, with fatalities in Africa being 55% of global statistics. Many previous reports from Nigeria have emphasized passengers and drivers over pedestrians; this study was done in the most densely populated Nigerian city with no previous publication exclusively dedicated to pedestrians-the megacity has been projected by the World Bank to be the third largest in the world by 2015 (after Tokyo and Mumbai), so the study results would aid injury control and reduce morbidity and mortality. METHODS: This is a one-year prospective study on pedestrians attending the surgical emergency room of the busiest referral hospital in Lagos, Nigeria, detailing age, sex, occupation, regions injured, injury mechanism, incident vehicles, highway collisions, and immediate outcomes. RESULTS: Some 702 pedestrians were seen, including 494 (70%) males with overall peak incidence in the third decade, but the peak incidence among females is lower and in the first decade. Common injuries sustained were to the head (40%), lower limbs (35%), upper limbs (9%), multiple regions (6%), pelvis (3%), and others (7%). Gender differences also were noted-the predominant injury location in males was the head, followed by lower limbs; the opposite was true for females, though both regional injuries were fewer in females than in males. Students were 20% of the entire pedestrians, with nearly half of them injured by a motorcycle. The mechanism of injury included crossing a highway (63%), walking along the pavement (17%), standing by a bus stop (12%), at a shop/house (5%), and others (3%). However, 76% injuries occurred on highways, 22% on inner city roads, and 2% elsewhere. Vehicles included motorcycles (33%), cars (27%), buses (22%), trucks (6%), tricycles (2.4%), and other (9%). Overall fatality was 10% and about half were due to being knocked down by buses and cars. CONCLUSIONS: This study suggests a high incidence and significant underreporting of pedestrian injuries. A reduction in morbidity and mortality is possible (from head and lower limb injuries) by traffic calming techniques in crossing the highway, especially injuries due to being struck by motorcycles, cars, and buses.

Child pedestrian injury and fatality in a developing country.

PURPOSE: Child pedestrian injuries and fatalities in developing countries continue to increase. We examined child pedestrian injuries and fatalities in the most populated urban agglomeration in Africa in order to develop control measures. METHODS: Two-year prospective study of injured child pedestrians (≤15 years) at the Surgical Emergency Room (SER) to determine demography, vehicles involved, road location, injury mechanism, pre-hospital transport, injury-arrival time, regions injured, injury severity and fatalities was done. RESULTS: Some 226 pedestrians (114 boys and 112 girls) comprising 42 children aged ≤4 years, 91 aged 5-9 years and 93 aged 10-15 years were seen with car collisions (83 pedestrians, 36.7%), motorcycles (76, 33.6%), buses (41, 18.1%), others (15, 6.6%) and 11 undetermined vehicles. Injuries on the highways were 147 (65%); inner-city roads 77 (34.1%) and two undetermined roads. Crossing the road was responsible for 168 (74.3%) pedestrian injuries; while three other mechanisms produced 58 (25.7%) patients. Regions injured were head (42.9%), lower limbs (35.4%) and others (21.7%). Relatives, bystanders and police/ambulance brought 186 (82.3%), 31 (13.7%) and eight (3.5%) children, respectively; and within 6 h (43.4, 11.5 and 2.2%) and after (38.9, 2.2 and 1.3%). Nineteen deaths (10 brought-in-dead, nine SER deaths) occurred; 15 of them girls, 15 had severe head injury, 15 were brought by relatives. However, fatality risks were truck collisions (OR 5.97), female child (OR 4.25), head injury (OR 4.18) and age ≤4 years (OR 3.7). CONCLUSION: The equal sex incidence, worse female fatality despite similar exposure and injury severity with male, deserve further research. Improved pre-hospital and SER care is needed.

Host, vehicular and environmental factors responsible for road traffic crashes in a Nigerian city: identifiable issues for road traffic injury control.

INTRODUCTION: Road traffic injury (RTI) has assumed major public health importance world-wide and the burden is heavier on the health-care infrastructure of countries in Sub-Saharan Africa. In Nigeria, RTI is the leading cause of trauma related morbidity and mortality. While there are some published epidemiological reports on RTI in the region, studies on the mechanism of causation of road traffic crashes (RTC) are not available. METHODS: Over a 9-month period, we prospectively captured the 571 victims of RTC presenting to a single tertiary health care center in Nigeria. Data collected include demographic data, Mechanism of causation of RTC, Injuries sustained and outcomes. RESULTS: Over three-quarters of the victims are young people and half were either traders (27.5%) or students (20%). Pedestrians, motorcycle riders and open truck occupants (people sitting at the rear loading compartment of trucks) often had fatal injuries. Analysis of collision patterns showed that lone crashes were the most frequent though car-to-motorcycle crashes caused a quarter of the deaths. Host factors (over-speeding driver, driver misjudgment, sleeping driver etc.) were responsible for four-fifths of the crashes while vehicular and environmental factors accounted for the remaining. On binary regression analysis, head injured victims had higher odds of dying than the non-head injured (Odds ratio = 6.5). CONCLUSION: This paper elucidates the mechanisms of causation of and types of injuries sustained following RTC in Nigeria and thus provide opportunities for prevention and control of this unacceptable situation.

Economic burden of drug use in patients with acute burns: experience in a developing country.

Background/Objective. Burn injury is a devastating injury. The economic drain on the patient's purse is equally devastating. Few studies have examined the cost of managing burn patients particularly the drug component. Methods. The financial implication of drug use in the management of 69 consecutive patients admitted by the burn unit over a period of two years was retrospectively analysed. Results. Thirty-six (52.2%) patients were males and 33 (47.8%) females with a mean age of 17.9 years (SD = 18.4). The patients spent an average sum of $91.21 to procure drugs; 84.3% of the costs were for antibiotics, 11.1% for analgesics, and 4.6% for others. Conclusion. Significant amount of money is spent on the procurement of drugs. Most of the money is spent on prescribed antibiotics. Measures that reduce antibiotics use in burn management might relief patients of the huge economic burden associated with its use.

Long bone fractures treated by traditional bonesetters: a study of patients' behaviour.

This is a study of 295 patients (23.1% of 1278 patients with long bone fractures) who had visited the traditional bonesetter (TBS). The initial idea of visiting TBS was mooted by an external person in 75% of cases, whereas to discharge from TBS was usually the patient's idea. The reasons for a patient to opt for aTBS are explored.

Epidemiology of non-trauma surgical deaths.

BACKGROUND AND OBJECTIVES: It is established that 70 % of morbidity and 75 % of mortality in the surgical accident and emergency (A and E) are due to trauma. However, non-trauma deaths still are an important entity requiring a specific study to highlight their pattern, and institute improvement strategies to lower death rates. METHODOLOGY: A retrospective analysis among non-trauma surgical deaths that occurred in the A and E Department of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over 24 months was done. Data collected included age, sex, interval between onset of illness and presentation, clinical features, occurrence of prior hospital visit, investigations done, cadre of surgeons that reviewed the patients and the interventions done as part of treatment before death. RESULTS: 4164 patients visited the A and E, 2916 (70%) were trauma, 1251 (30%) were non-trauma conditions. There were 171 deaths, 129 (75.4%) were trauma deaths while 42 (24.6%) were non-trauma deaths. Thirty (71.4%) of the 42 had complete information for analysis. Age range was 2-95 years (mean 42.7 +/- 21.8 years) comprising 18 males and 12 females. Patients with generalized peritonitis were in the majority 8 (26.7 %) comprising typhoid perforation 4, ruptured appendix 2 and perforated peptic ulcer 2. Terminal malignancies followed closely with 6 deaths (20.0%), 3 from urological causes (2 prostatic and 1 bladder cancer), acute gastrointestinal bleeding 3 (10%), intestinal obstruction 1 (3.3 %) and others. Nineteen patients (63.3%) had visited a previous hospital where they had spent <48 hrs (4 patients), 48hrs -1 week (4 patients) and >1 week (2 patients), undocumented (9 patients). Less than 40% of the patients were able to do the requested investigations (electrolytes, X-rays and ultrasound) or got the desired interventions (blood and antibiotics) CONCLUSION: Non-trauma deaths account for a quarter of the deaths in the A and E, generalised peritonitis and advanced malignancies were the main conditions responsible and characterized by late presentation, having spent a considerable time in a previous private hospitals.

How to present a paper at a scientific meeting.

BACKGROUND AND OBJECTIVES: Presentation of a scientific work is a learned skill that requires constant improvement especially now with the use of computer aided presentation--Microsoft PowerPoint. It addresses the peculiarities of preparation for a conference in a developing country. METHODOLOGY: Description of personal experience acquired through training and practice at scientific conferences has been stated. Relevant books and articles have been cited. RESULTS: The four parts of a presentation (preparation, presentation proper, questions and answer sessions and handling stage fright) and the effects of successful presentations have been highlighted. CONCLUSION: Scientific presentations are essential to a researcher throughout life and the skills can be learned and/ or improved upon through desire to learn, determination to succeed, training and constant practice of the process.

Spinal cord injuries in Ilorin, Nigeria.

BACKGROUND: Spinal Cord Injuries (SCI) usually result from road traffic accidents (RTA), falls, sports and some misadventures. This study was carried out to examine the aetiology of SCI in Ilorin, Nigeria; factors contributory to morbidity and mortality and to suggest measures for reducing them. METHODS: Age, sex, mechanism of injury, complications, duration of treatment and eventual outcome of patients admitted for SCI from 1995 to 1999 were restrospectively studied. RESULTS: Thirty-nine patients, age 19 to 60 years (mean 37.3), 36 males and three females were seen. Cervical spine injuries accounted for 46.2% of the cases. Road traffic accidents caused 67% and falls 23%. Accidents involving passengers in open lorries are associated with SCI when the goods fall on passengers as seen in five of the 26 RTA's (19.2%). More falls from kola-nut (44%) than from palm tree (11%) were observed. Limb paralysis and bladder dysfunction were the commonest complications. Ten patients died, 70% of them had cervical spine injuries. Nine of the ten deaths had multiple transfers to different centres before admission. CONCLUSION: This pattern of SCI in Ilorin, Nigeria showed that RTA has surpassed falls from trees, as the most common cause of SCI in Ilorin and probably in Nigeria. Indeed, the predominant tree implicated in this study has been kola nut tree unlike the palm tree in earlier reports. Imperative measures to improve morbidity and mortality include health education on passenger and load carriage, use of manual or motorised wheel barrow as against bearing heavy load on the head, principles of moving spinal Injured patients taught every road traveller and establishment of spinal centres and training of specialised personnel.

Literature search in medical publications.

The quality of a medical publication rests as much on the research paper as on the literature search prior to writing for publication. The art of literature search and its importance to the various steps in scientific writing have been emphasised in this paper. Many medical authors in West African sub-region learned the art of publishing research work through their senior professional colleagues or by trial and error through the peer review experience of their work. This article is expected to fill this gap in training. It should guide trainee specialists or new entrants, who must do literature search towards publishing research works for earning promotion, advancing knowledge, obtaining grants and fellowship awards, into the "publish or perish" syndrome existing in academic institutions. The current trend of electronic writing has called for a new style of referencing in medical publications, which has been suggested in this paper.