Audit of medication errors by anesthetists in North Western Nigeria.

BACKGROUND: Safety issues are an important aspect of anesthesia practice. The relevance of medication and drug administration errors in our everyday practice is an important aspect of medical audit. Although there have been few case reports of drug administration errors by anesthetists, there is paucity of information regarding medication errors in anesthetic practice in Nigeria. We set out to study the incidence of medication errors among anesthesia practitioners in Kaduna State, North Western Nigeria and to suggest ways to minimize such errors. MATERIALS AND METHODS: A questionnaire-based study was conducted among physician anesthetists and nurse anesthetists working in the major secondary and tertiary hospitals in Kaduna State, North Western Nigeria. The data obtained was analyzed using SPSS Version 17.0 and the data presented in relevant charts and tables. RESULTS: A total of 43 persons responded to the questionnaire with a high response rate of 86% and a male/female ratio of 2.3:1. Most of the anesthetists (38 or 88%) work in tertiary government hospitals. Twenty-four (56%) of them admitted to ever having a medication error, and 34 (79%) of them attributed the medication error to problems with drug labeling from manufactures using similar labels for different drugs. Untoward sequelae resulted in 44% of the patients that were affected by these medication errors and these ranged from cardiac arrest to delayed recovery from anesthesia. Majority of the respondents recommended vigilance, double checking of drug labels, and color coding of syringes as ways to minimize medication errors. CONCLUSION: Medication errors do occur in the everyday practice of anesthetists in Nigeria as in other countries and can lead to morbidity and mortality in our patients. Routine audit and reporting of critical incidents including errors in drug administration should be encouraged. Reduction of medication errors is an important aspect of patient safety, and vigilance remains the watchword.

Operative vaginal deliveries in Zaria, Nigeria.

BACKGROUND: Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings. STUDY DESIGN: Labor records on operative vaginal delivery cases and matched controls who had spontaneous vaginal deliveries between January 1997 and December 2001 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were analyzed with respect to mode of delivery, indication for operative vaginal delivery, anesthesia use, fetal 5-min Apgar score, birth weight, fetal, and maternal complications. RESULTS: Of 7,327 deliveries at the center in the study period, 262 (3.6%) were by operative vaginal deliveries. Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy procedures were performed selectively (6.1%). Operative vaginal deliveries were more commonly employed on primigravida (78.6%) compared to multiparas and the most common indication was delayed second stage of labor. Forcep- and vacuum-assisted deliveries were both associated with maternal and newborn complications. There was no significant difference in the use of anesthesia between forceps and vacuum deliveries. CONCLUSION: Operative vaginal delivery rates in this center are comparable to other centers as are the possible complications. Making these procedures safer will improve safe motherhood in settings where there are performed.

Contraceptive choices among women in Zaria, Nigeria.

AIMS/OBJECTIVE: To study the choice of contraceptive usage and the factors responsible for such choices in northern Nigeria. DESIGN: A cross-sectional study. SETTING: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. SUBJECTS: New clients attending the reproductive health centre. MAIN OUTCOME MEASURES: Choice of contraceptive, reason for choice, knowledge and source of knowledge about contraceptives. RESULTS: Four hundred and eighteen clients were interviewed. Three hundred and seventy two (89%) knew at least one method of contraception; 50.7% used injectable contraceptives, 22.5% intrauterine contraceptive devices, 13.9% Norplant and 10.3% oral contraceptive pills. One hundred and forty four (34.5%) were referred by midwives and 25.6% by other nurses. CONCLUSIONS: The most commonly used contraceptive in our environment is the injectable method.

Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria.

BACKGROUND/OBJECTIVE: To document the premenstrual and menstrual symptoms of Muslim women, with a view to providing adequate and sensitive care. METHODS: Two hundred Muslim women were interviewed at Ahmadu Bello University Teaching Hospital and Muslim Specialist Hospital, both in Zaria between August and October 2003. RESULTS: Premenstrual symptoms were present in 23.8% of the women and breast pain was the commonest symptom (50%). Self-medication was practiced by those who needed medication for the premenstrual symptoms (29.8%). Premenstrual symptoms were significantly associated with lower parity (p = 0.02), previous (p = 0.03) and current (p = 0.01) contraceptive use and dysmenorrhoea (p = < 0.001). Dysmenorrhoea was present in 36.4% and was significantly associated with lower age (p = 0.03), and lower parity (p = 0.01). CONCLUSIONS: Health care workers and the general public need to be aware of premenstrual symptoms and dysmenorrhoea in order to provide adequate care and support that is sensitive to Muslim women's needs. Health care providers should also be aware that premenstrual symptoms are more likely to coexist with dysmenorrhoea and provide therapies that can cater for both problems whenever possible.

Sex ratio at birth in Zaria, Nigeria.

AIM: The objectives of this study were to determine the sex ratio at birth in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria and its relationship with certain pathologies including breech presentation, twin delivery, major degree placenta praevia and abruptio placentae. METHODOLOGY: A retrospective analysis of records of all deliveries in the hospital between 1 January 1991 and 31 December 2002 (10 years) was carried out. To minimize bias, breech presentation included singletons only and placenta praevia included only major degrees confirmed at Caesarean section. RESULTS: The total number of deliveries during the study period was 12 845. The male:female ratio was 1.12. Sex ratio at birth was not significantly associated with any of the conditions studied, although there was a slight male preponderance with placenta praevia (57.3% in babies born to mothers with major degree placenta praevia compared to 52.7% in babies born to mothers without placenta praevia) and first twins (56.3% compared to 52.7% among singletons), and a slight female preponderance with singleton breech presentation (50.9% compared to 47.2% among non-breech deliveries). CONCLUSION: The findings in this study may reflect racial, dietary or environmental variations or a combination of these factors. They may also be as a result of bias from hospital data, emphasizing the need for accurate population-based records of births and other vital statistics.

Puerperal complications of episiotomies at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

OBJECTIVES: To establish the epidemiological variables associated with episiotomies and their puerperal complications at Ahmadu Bello University Teaching Hospital Zaria, in order to institute appropriate management including preventive measures. DESIGN: A prospective cohort study. SETTING: Ahmadu cello University Teaching Hospital, Zaria, Nigeria. METHODS: A cohort of all consecutive patients that underwent vaginal deliveries during a 12-week period were followed up for six weeks in order to determine the distribution and determinants of episiotomy and its complications. RESULTS: The episiotomy rate was 35.6% of all vaginal deliveries. Episiotomies were significantly associated with primigravidity being performed in 88.5% of all primigravidae. The mean delivery-repair interval was 60.5 minutes. The most common puerperal complication of episiotomies was perineal pain that lasted an average of 5.5 days. Other complications included asymmetry (32.9%), infection (23.7%), partial dehiscence (14.5%), skin tags (7.9%), haemorrhage (5.3%) and extension of the incision (1.3%). The complications were not significantly associated with any potential risk factor. CONCLUSION: In view of the very high episiotomy rate among primigravidae, it is recommended that the episiotomy rate among primigravidae be reduced by re-acquainting accoucheurs with the indications for episiotomy. Attention needs to be given to adequate pain relief for all women who have had an episiotomy and the delivery-repair interval in this unit should be reduced by provision of materials for episiotomy repair in the delivery suite.

The epidemiology of infantile hypertrophic pyloric stenosis in Greater Glasgow area, 1980-96.

The annual incidence of infantile hypertrophic pyloric stenosis (IHPS) in Greater Glasgow area from 1980 to 1996 was calculated. An increasing incidence was observed between 1980 and 1988 but not thereafter. There is a suggestion that environmental factors may play a role in the aetiology of this condition.