Developing a Low-resource Approach to Trauma Patient Care - Findings from a Nigerian Trauma Registry.

BACKGROUND: Trauma is a worldwide problem that results in significant morbidity and mortality in developing countries. OBJECTIVE: This study looks at the demography of trauma from data abstracted from a Nigerian trauma registry and considers the peculiarities of a low-resource setting from this perspective. METHODS: Trauma registry data from January 2013 to June 2014 were analyzed. RESULTS: A total of 542 patients were included in the study. The mean age of the patients was 33.43 ± 12.79 years; the median time from injury to arrival at the hospital was 3 h (interquartile range IQR 1 - 5.1 h); three-quarters of the patients sustained their injuries on the road-tricycles were rarely involved in road traffic injuries (RTIs) (6.9% of RTIs) but were used in transporting a third of the patients whose data on means of transportation were captured. There were 15 (2.7%) deaths in the first 24 h period postinjury covered by the study - 13 (86.7%) of these patients had head-and-neck injury. About half of the assault injury (50.5%) was from persons known to the victim. The shock indices suggested that a majority of the patients were not at a high risk of mortality. CONCLUSION: Most of the trauma patients at our hospital were in low- to middle-income categories. The median time to arrival of injured patients was 3 h (IQR 1 - 6 h). Most injuries occurred on the road because of RTIs. The involvement of tricycles in accidents was uncommon, but they were used fairly commonly by lay responders in transporting the injured victim to hospital. A high proportion of assailants were known to the victim. The use of trauma registries provides essential data for prioritizing limited resources and can guide a contextualized approach to reducing trauma and improving trauma patient care.

Psychometric testing of Ibadan low back pain disability questionnaire.

BACKGROUND: The Ibadan Low Back Pain Disability Questionnaire (ILBPDQ) was developed to meet the need for a LBP treatment outcome measure that was appropriate for the Nigerian culture and environment. The objective of this study was to determine the psychometric properties of ILBPDQ. METHODS: This study used the validation design. One hundred and forty-two participants with LBP (LBPPs) and 142 age and sex-matched participants without LBP (NLBPPs) were included. The LBPPs were recruited consecutively from Physiotherapy clinics of selected tertiary hospitals in the six geopolitical zones of Nigeria. Both LBPPs and NLBPPs completed the ILBPDQ - the LBPPs completed the Numerical Pain Rating Scale (NPRS). The ILBPDQ was completed by 113 LBPPs two days after initial assessment. Sixty-four of the LBPPs received physiotherapy for 5-weeks, after which they were reassessed using ILBPDQ and NPRS. RESULTS: ILBPDQ score of LBPPs was significantly higher than that of NLBPPs (construct validity) and LBPPs NPRS score correlated significantly with their ILBPDQ score (r = 0.50) at baseline and post intervention (r =0.35) (divergent validity). ILBPDQ scores at baseline and 48 hours later for LBPPs correlated significantly (Intra Class Correlation =0.80) (test re -test reliability). Cronbach's α for ILBPDQ was 0.84 (internal consistency). The postintervention ILBPDQ and NPRS scores for LBPPs were significantly lower than their pre-intervention ILBPDQ scores (responsiveness) and NPRS scores. The changes in ILBPDQ and NPRS scores of the LBPPs correlated significantly (r =0.62) (responsiveness). CONCLUSION: The ILBPDQ demonstrated evidence of validity, reliability and responsiveness. FUNDING: University of Ibadan Senate Research Grant.

Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire.

BACKGROUND: Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment. OBJECTIVE: This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ). METHODS: Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version. RESULTS: The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP. CONCLUSION: A scale for assessing disability in LBP is made available for use in Nigeria and similar populations. FUNDING: None declared.

Prevalence and predictors of low back pain in a Southern Nigerian hospital.

Background: Low back pain (LBP) is the most common musculoskeletal disease in adults. The data on LBP from Sub-Saharan Africa are inadequate. The aim of this study was to assess the prevalence and analyze the predictors of LBP among hospital staff in a Nigerian tertiary hospital. Materials and Methods: The study participants were recruited using an opt-in approach, with the aim of including representative numbers from each professional cadre. Each participant gave formal consent. Ethical clearance was obtained. Results: Five hundred and sixty-three participants with the mean age of 36.0 ± 8.3 years and 62% female were interviewed. The point prevalence of LBP was 234 (42% [95% confidence interval [CI]: 37%-45%]). Profession was a significant predictor of LBP (P = 0.001) - nurses (53% [95% CI 43%-63%]), administrative officers (49% [95% CI 40%-59%]), engineers (50% [95% CI 24%-76%]), and health information staff (50% [95% CI 26%-75%]) had the highest prevalence. In univariate regression, female gender, increasing age, body mass index ≥25 kg/m2, and frequently adopting a bending posture, were significantly associated with LBP, while in multivariate regression, only the female gender was a significant predictor. Conclusion: The pattern of both the professions at risk, due to the well-known mechanisms of poor ergonomics, and the marked risk for the female gender, in the hospital setting, suggest underresourced work and societal environments as the underlying factors-more research is needed.

RésuméContexte: La douleur dans le bas du dos est la maladie musculeux-squelettique la plus commune parmi les adultes. Les données sur la douleur dans le bas du dos de l'Afrique sub-saharienne ne sont pas adéquates. Le but de cette communication était est d'évaluer la prévalence et d'analyser les indicateurs de la douleur dans le bas du dos parmi les travailleurs dans l'hôpital tertiaire au Nigeria. Methodes: Les participants de l'étude ont été sélectionnés à travers l'approche opt-in, pour bien représenter les gens de chaque niveau professionnel. Chaque participant a donné son consentement. L'autorisation éthique a été obtenue. Resultats: Cinq cents soixante-trois participants de l'âge moyen de 36.0 ± 8.3 et 62% de femelles ont été interviewés. Le point de prévalence de la douleur dans le bas du dos était 234 [42% (95% CI 37 ­ 45%)]. La profession est un indicateur important de la douleur dans le bas du dos (P - 0.001) ­ les infirmiers [53% (95% CI 43 ­ 63%)], les directeurs administratifs [49% (95% CI 40 ­ 59%)], les ingénieurs [50% (95% CI 24 ­ 76%)] et les travailleurs de l'information de santé [50% (95% CI 26 ­ 75%)] ont eu la plus prévalence. Dans la régression univariée, sexe féminin, l'âge croissant, IMC ≥ 25kg/m2 et adoptant fréquemment une posture de flexion, ont été associés à la douleur dans le bas du dos, tandis que dans la régression multivariée, seulement le sexe féminin était un indicateur important. Conclusion: Le schéma des deux professions sont à risque dû aux mécanismes bien reconnus de pauvres ergonomiques, et le risque marqué pour le sexe féminin, en milieu hospitalier, suggère un travail sous financé et les environnements de société en tant que facteurs sous-jacents - plus de recherche est nécessaire.

Prevalence and predictors of low back pain in a Southern Nigerian hospital

Background: Low back pain (LBP) is the most common musculoskeletal disease in adults. The data on LBP from Sub-Saharan Africa are inadequate. The aim of this study was to assess the prevalence and analyze the predictors of LBP among hospital staff in a Nigerian tertiary hospital. Materials and Methods: The study participants were recruited using an opt-in approach, with the aim of including representative numbers from each professional cadre. Each participant gave formal consent. Ethical clearance was obtained. Results: Five hundred and sixty-three participants with the mean age of 36.0 ± 8.3 years and 62% female were interviewed. The point prevalence of LBP was 234 (42% [95% confidence interval [CI]: 37%­45%]). Profession was a significant predictor of LBP (P = 0.001) ­ nurses (53% [95% CI 43%­63%]), administrative officers (49% [95% CI 40%­59%]), engineers (50% [95% CI 24%­76%]), and health information staff (50% [95% CI 26%­75%]) had the highest prevalence. In univariate regression, female gender, increasing age, body mass index ≥25 kg/m2, and frequently adopting a bending posture, were significantly associated with LBP, while in multivariate regression, only the female gender was a significant predictor. Conclusion: The pattern of both the professions at risk, due to the well-known mechanisms of poor ergonomics, and the marked risk for the female gender, in the hospital setting, suggest underresourced work and societal environments as the underlying factors-more research is needed