A review of noma cases in a tertiary hospital located in a conflict endemic region in Nigeria.

Noma, a neglected tropical disease (NTD), is a preventable oro-facial gangrenous infection causing destruction of oro-facial tissues if untreated. This descriptive study was conducted in North-Eastern Nigeria which has witnessed armed insurgency increasing risk of noma. Data was obtained from patients' records at a tertiary hospital after a dental educational outreach using radio and visits to the hospital's ante/postnatal clinics. Data analysis was conducted at 95% confidence interval with p≤ 0.05 considered significant. Records of 49 patients were retrieved but 31 (63.3%) were utilised due to poor documentation. Age ranged from 2-63 years. Children (0-16 years) and Adults (17-59 years) were 67.7% and 25.8% respectively. Males were 13 (41.9%) and females, 18 (58.1%). Poor oral hygiene and malnutrition were common findings. Stage (WHO Staging System) 2 (51.6%) and 4 (22.6%) were the most common presentation. Successfully managed and referred cases were 51.6% and 48.4% respectively. Successful management was associated with early stages of noma (p = <0.001). Children were most vulnerable. Outreaches using radio and education to pregnant women and nursing mothers can boost early presentation and better outcomes. Attention to case documentation and inclusion of noma into the WHO list of NTDs are recommended.

Mandibular fractures in Kano, Northwest Nigeria: aetiology and pattern of presentation.

BACKGROUND: Mandibular fractures are universal in distribution but its aetiologies and presentation patterns differ from one country to another because of varying socioeconomic, cultural and geographical factors. We analysed the aetiological factors and presentation patterns of mandibular fractures in a tertiary hospital at Nigeria's second largest city. METHODS: Patients with isolated mandibular fractures at Aminu Kano Teaching Hospital, Kano were prospectively reviewed over a 12-months period. Patients' demographic information and fracture characteristics (aetiology, site, pattern and number of fracture) were recorded and analysed. RESULTS: One hundred and forty eight patients presented with 180 mandibular fractures. There were eight fold higher men with mandibular fractures than women (M: F = 8.3:1) with highest incidence in third decade of life. Road traffic accidents (84.46%) was the major aetiology while iatrogenic fracture (0.68%) was found in one patient. Mandibular body was the most fractured site (41.11%) with parasymphyseal and angle regions accounting for 27.78% and 23.89% of total recorded fractures respectively. CONCLUSIONS: Mandibular fractures in Kano, Northwest Nigeria occurred predominantly in men in the third decade and are mostly caused by road traffic accidents. The majority of these fractures involved the mandibular body.

Workplace assault and its' impact to service delivery amongst dental professionals at Tertiary Hospitals in Northern Nigeria

Objective: The growing global public health concern of workplace assaults has necessitated that workers' health and safety be given same priority as patient's safety. The study assessed the prevalence of workplace assault and its' impact on service delivery among dental professionals at tertiary hospitals in Northern Nigeria. Methods: A cross-sectional survey of 60 dental professionals working in tertiary hospitals actively involved in undergraduate and postgraduate trainings for dental workforce in Northern Nigeria. Multi-stage sampling technique was used in selection of respondents and participation was voluntary. Data was collected using structured self-administered questionnaire. Statistical analysis was done using SPSS version 23.0 and p-value ≤ 0.05 was considered statistically significant. Ethical approval was received. Results: Sixty percent dentists and 40.0% dental auxiliaries participated in the study. Assault prevalence was 38.3% observed more among dental professionals (44.0%) in their first year in practice. Types of assaults experienced were; non-physical 19 (82.6%) with loud shouting and threats as most frequent, physical 3 (13.0%) with bullying and mobbing most frequent, and combination was 1 (4.4%). Patients (60.9%) and relatives (52.2%) were major culprits, and long appointment (65.2%) and treatment cost (60.9%) were main reasons for assault. Respondents (39.1%) expressed impact on their productivity and 69.6% respondents were ill-prepared to handle it. Conclusion: The prevalence of workplace assaults on dental professionals was fairly high and those in their first year in practice suffer more assault than others. Assault preventive programs should however specifically target this group in consideration with the unique nature and varied needs of each healthcare institutions

Social impact of cleft lip repair on married adults: an uncommon finding from a semi-urban African settlement.

An orofacial cleft may have an appreciable psychosocial impact on patients that could affect their social lives, including the choice of who they marry. We retrospectively reviewed the impact of repair of cleft lip on marriage in adult patients in our institution by questioning a group of patients treated from July 2009-June 2017. There were 120 adult patients who had cleft lips repaired, of whom 17 (14%) patients changed their marital status. The mean (SD) ages of the 17 were 32 (1), range 20-41, years. Five of the 17 were men, and 12 women, with a male:female ratio of 0.4: 1. All 17 patients confirmed that the unrepaired cleft affected the choice of who they initially married. After repair, the five male patients married additional wives (one wife each (n=4), and two wives (n=1)). Of the 12 female patients all divorced their spouses, but only nine had remarried at the time of the study. We conclude that unrepaired cleft lip in an adult in our environment may affect the choice of partner. This choice may be altered if facial aesthetics improve after repair of the cleft.

Anaesthesia for cleft lip surgeries in a resource poor setting: techniques, outcome and safety.

INTRODUCTION: Cleft lip and palate is one of the more common congenital malformation and the most common craniofacial anomalies in children. The treatment is expensive and requires specialised care. Access to this care in middle and low income countries is compounded by socioeconomic status of patients and their relation and also the inadequacy of expertise in medical personnel and infrastructure. Objective: the study aimed to review the techniques of anaesthesia used in a low resource setting in terms of the techniques, outcome, and safety. METHODS: This is a retrospective review of 79 cases done in a resource poor setting. Information regarding the patients, surgeries and modes of anaesthesia were retrieved from the case notes. RESULTS: A total of 62 patients were operated with incomplete cleft accounting for 37 (59.7%), complete 23(37.1%), and 2 (3.2%) as bilateral. Forty-six (74.2%) of patients had their surgery done with ketamine anaesthesia without endotracheal intubation, 14 (22.6%) had regional anaesthesia and 2 patients (3.2%) had general anaesthesia with endotracheal intubation. CONCLUSION: This study demonstrates that with careful planning and expertise, cleft lip repair can be done safely in resource poor setting.