Waiting time for emergency abdominal surgery in Zaria, Nigeria.

BACKGROUND: Management of surgical emergencies in Nigeria is characterised by mismatch between supply of facilities and demand for care. This study aimed to evaluate the waiting time between presentation at hospital with acute abdominal disease and operative intervention. PATIENTS AND METHOD: We prospectively studied adult patients with abdominal diseases requiring emergency operation. The interval between presentation and first contact with emergency room doctors was defined as T1; time from contact to decision to operate as T2; time taken to resuscitate patient T3 and to commencement of operation T4. Causes of delay and its impact on outcome of treatment were noted. RESULTS: There were 488 patients, mean age 32 +/-1.7 SD years. TT ranged between 0.8 and 79.0 hours, mean 22.3 +/- 10.0 hours. In 81.6% operative intervention was delayed beyond 6 hours of which financial constraints accounted for 53.8%. T3 accounted for the longest delay (0.5 -53.0 hours). Patients of lower socio-economic class had longer T3 (p<0.005). Waiting for complementary investigations caused delay in 22.1%. Post-operative complications (p=0.0001) and their severity were higher in patients with longer TT. Prolonged TT (p<0.001), ASA grade (0.005) and time from onset of symptoms to admission (p=0.009) were associated with mortality. Patients whose operations were delayed beyond 24 hours had a longer hospital stay. CONCLUSION: Emergency abdominal operations were delayed in our patients mainly because of scarce financial resources. Delayed interventions were associated with higher morbidity and mortality.

Paediatric surgical research and publications in a developing country setting.

BACKGROUND: Research and publications are important in advancing quality of care as well as improving knowledge. Paediatric surgical research and publications in sub Saharan Africa have not been given much focused attention. MATERIALS AND METHODS: A retrospective review of published work in paediatric surgery from a major paediatric surgical centre in Nigeria from 1969 - 2005. All published work were reviewed for nature of research, organ/system and disease condition studied, nature of publication, volume of publication in relation to staffing as well as journal of publication. RESULTS: During the period there were 153 publications consisting of 86 (56.2%) original researches (77 of which were of retrospective study designs and 9 prospective), 56 (36.6%) case reports, 8 (5.2%) letters and 4 (2.6%) review articles. None of the studies and publications was funded. More publications were made when the department of surgery was better staffed. Congenital anomalies (57, 37.3%) and surgical infections (28, 18.3%) were more frequently studied and in 82 (53.4%) publications the gastrointestinal tract was the focus. Most publications were in general medical journals (58, 37.9%) and general paediatric journals (54, 35.3%) but publications in paediatric surgical journals has continued to increase over the years and reached 25.9% by 2005. Some of the difficulties and challenges faced included lack of funding, poor staffing and inadequate facilities for laboratory research. CONCLUSION: Paediatric surgical research and publication in Nigeria is increasing but faces important limitations. Advocacy efforts are needed to improve funding. Networking as well as collaboration is necessary to improve the quality and spectrum of research.