Unmet Surgical Need among Adults in A Mixed Urban-Rural Community in Nigeria: A Survey of 1,993 Adults Using the Sosas Survey Tool.

INTRODUCTION: Community-based prevalence studies are known to be more accurate than hospital-based records. However, such community-based prevalence studies are uncommon in low- and middle-income countries including Nigeria. Allocation of resources and prioritization of health care needs by policy makers require data from such community-based studies to be meaningful and sustainable. This study aims to assess the prevalence of common surgical conditions amongst adults in Nigeria. METHODS: A descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions in adults in a mixed rural-urban area of Lagos was conducted. The study population comprised resident members in the Ikorodu Local Government Area (LGA) of Lagos State. Data was collected using a modified version of the interviewer-administered questionnaire, the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool. Data was analysed using the REDCap analytic tool. RESULTS: Eight hundred and fifty-six households were surveyed with a yield of 1,992 adults. There were 95 adults who complained of surgical conditions giving a prevalence rate of 5%. Vast majority of reported conditions were acquired deformities (n=94) while only 1 congenital deformity was reported. Others included breast lumps, anterior neck swelling, and groin swellings. CONCLUSION: The most common surgical complaints in our setting among adults were acquired conditions of the extremities and open wounds/sores. With an estimated population of 90 million adults and approximately 1,200 orthopaedic and general surgeons respectively, the surgeon-to-affected population ratio is 1:10,000. There is a large gap to be filled in terms of surgical manpower development.

INTRODUCTION: Les études de prévalence communautaires sont connues pour être plus précises que les dossiers hospitaliers. Cependant, de telles études de prévalence communautaires sont rares dans les pays à revenu faible et intermédiaire, y compris le Nigeria. L'allocation des ressources et la priorisation des besoins de santé par les décideurs nécessitent des données issues de telles études communautaires pour être significatives et durables. Cette étude vise à évaluer la prévalence des affections chirurgicales courantes chez les adultes au Nigeria. MÉTHODES: Une étude descriptive transversale basée sur la communauté pour déterminer la prévalence des conditions chirurgicales congénitales et acquises chez les adultes dans une zone rurale-urbaine mixte de Lagos a été menée. La population étudiée comprenait des membres résidents de la zone de gouvernement local (LGA) d'Ikorodu, dans l'État de Lagos. Les données ont été collectées à l'aide d'une version modifiée du questionnaire administré par un enquêteur, l'outil d'enquête Surgeons OverSeas Assessment of Surgical Need (SOSAS). Les données ont été analysées à l'aide de l'outil analytique REDCap. RÉSULTATS: Huit cent cinquante-six ménages ont été enquêtés, ce qui a donné 1 992 adultes. Quatre-vingt-quinze adultes se sont plaints de conditions chirurgicales, donnant un taux de prévalence de 5 %. La grande majorité des conditions rapportées étaient des déformations acquises (n=94) tandis qu'une seule déformation congénitale a été signalée. Les autres incluaient des nodules mammaires, des gonflements antérieurs du cou et des gonflements inguinaux. CONCLUSION: Les plaintes chirurgicales les plus courantes dans notre cadre parmi les adultes étaient des conditions acquises des extrémités et des plaies ouvertes/ulcères. Avec une population estimée à 90 millions d'adultes et environ 1 200 chirurgiens orthopédiques et généralistes respectivement, le ratio chirurgien-population affectée est de 1:10,000. Il y a un grand écart à combler en termes de développement de la main-d'œuvre chirurgicale. MOTS CLÉS: Prévalence, Charge de morbidité, Chirurgie, Plaies.

Predictors of Lower Extremity Amputations in Patients with Diabetic Foot Ulcers and Management Outcome.

BACKGROUND: Diabetic foot ulcer is an associated and an increasing problem among individuals with diabetes. The aim of the present study was to evaluate the risk factors for amputation in patients with diabetic foot ulcer as well as common causes of increasing mortality in these patients. METHODS: The design was an observational prospective study carried out between July 2015 and June 2018. The Demographic data of all patients with diabetic foot ulcer seen at Lagos University Teaching Hospital and Nigerian Navy Reference Hospital Lagos with their clinical signs and symptoms as well as basic laboratory results were documented. The ankle brachial index (ABI), history of neuropathy, nephropathy and the relationship between these and lower limb amputation and mortality were collected and analyzed. RESULTS: There were 539 patients with diabetic foot ulcer seen during the 3-year period. The mean age was 62 + 13.7. There was male preponderance with a ratio of 1.7:1. Patient with amputation more often had ABI <0.9. Male sex is a risk factor for amputation. Over 40.5% of the patients had grade I ulcer, 19.5% had grade II, while 22.3%, 12.3% and 5.4% had grade III, IV and V respectively. Amputations were performed in 144(26.7%) patients (48 minor, 96 major). Compared with patients without amputation, patients with amputation differed significantly concerning diabetes and its complications. Mortality rate was 11.8%.

CONTEXTE: L'ulcère du pied diabétique est un problème associé et croissant chez les personnes atteintes de diabète. Le but de la présente étude était d'évaluer les facteurs de risque d'amputation chez les patients atteints d'ulcère du pied diabétique ainsi que les causes courantes d'augmentation de la mortalité chez ces patients. METHODES: La conception était une étude prospective observationnelle réalisée entre juillet 2015 et juin 2018. Les données démographiques de tous les patients atteints d'ulcère du pied diabétique vus au Centre Hospitalier Universitaire de Lagos et à l'hôpital de référence de la Marine Nigériane de Lagos avec leurs signes et symptômes cliniques ainsi que les résultats du laboratoire de base ont été documentés. L'indice brachial de la cheville (ABI), les antécédents de neuropathie, de néphropathie et la relation entre ceux-ci et l'amputation et la mortalité des membres inférieurs recueillis et analysés. RESULTATS: Il y avait 539 patients atteints d'ulcère du pied diabétique vus au cours de la période de 3 ans. L'âge moyen était de 62 ± 13,7 ans. Il y avait une prépondérance masculine avec un ratio de 1,7 : 1 Le patient amputé avait plus souvent un ABI <0,9. Le sexe masculin est un facteur de risque d'amputation. Plus de 40,5% des patients avaient un ulcère de grade I, 19,5% avaient un grade II, tandis que 22,3%, 12,3% et 5,4% avaient un grade III, IV et V respectivement. Des amputations ont été pratiquées chez 144 (26,7%) patients (48 mineurs, 96 majeurs). Par rapport aux patients sans amputation, les patients ayant subi une amputation différaient significativement en ce qui concerne le diabète et ses complications. Le taux de mortalité était de 11,8%. Mots-clés: L'indice brachial de la cheville, amputation, ulcère du pied diabétique, maladie artérielle périphérique.

Scholarly Activities Participation among Surgical Resident Doctors in Nigeria.

BACKGROUND: Scholarly activity in various forms are academic deeds such as researches and research outputs in articles, oral presentations, publications and theses which are disseminated and peer- reviewed. OBJECTIVES: This study aims to assess the level of participation of residents in scholarly activities including their attendance of national and international conferences during residency training. METHODS: This was a descriptive cross-sectional study of 81 resident doctors in General and Orthopaedic surgery, who attended the revision courses organized by their Faculties. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0. RESULTS: The mean age of the respondents was 34.1 ± 4.5 years, and age ranged from 26 years to 48 years. The male: female ratio was 12.5:1. The average number of years of respondents in residency programme was 3.9 ± 1.8 years. 80.3% of the residents had participated in research since commencement of their residency. Only 18.5% of the resident doctors had any publications in a peer-reviewed journal. While 51.9% of residents had attended local and national conferences since the beginning of their training, only 17.3% had had oral and/or poster presentations at local conferences. No resident involved in this study had oral or poster presentation done at any of the international conferences attended, despite an attendance rate of 12.3%. CONCLUSION: Resident doctors should be encouraged to participate in researches and to publish their works. They should also be encouraged to present their works at conferences.

Poor Health Literacy in Nigeria: Causes, Consequences and Measures to improve it.

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make an appropriate decisions concerning their health. It is one of the link by which the health status of individual and the health indices and statistics of our country can be improved upon. Factors influencing health literacy in Nigeria include the culture and belief system, poor and ineffective communication, lack of education and low educational level, and low socioeconomic status Low health literacy predisposes to poorer health status, poorer disease outcome, lack of understanding in the use of preventive services, frequent hospital visitations amongst others. Factors influencing health literacy must be identified and modified to help improve the health literacy level of the populace. This will invariably improve the health status of the populace with a resultant improvement in the health indices of our country. This is a call for the Government and Health Care Professionals to acknowledge low health literacy as a problem and, therefore, be willing to play their roles in tackling this problem to achieve a healthy Nation