Splenic injuries in native Africans: Presentation, limitations of management, and treatment outcomes in a civilian trauma service in Southeast Nigeria.

Background: Splenic trauma has emerged as a major global health burden, especially in developing nations with limited diagnostic and therapeutic facilities. The current trend toward nonoperative management (NOM) and adoption of splenic salvage whenever feasible calls for local evaluation of our current practice. The aim of this study was to document the epidemiology and outcomes of management of splenic injuries in our setting. Patients and Methods: This was a multicenter, prospective study of epidemiology and outcomes of patients with splenic injuries recruited over 10 years in southeast Nigeria. Results: Approximately 66% of all patients with abdominal injuries sustained splenic trauma. A total of 313 patients with splenic trauma were recruited; 226 (72.2%) were managed operatively (OM) and 87 (27.8%) conservatively (NOM). Majority (75.7%) had blunt abdominal trauma (BAT), while 24.3% sustained penetrating injuries. Sonographic grading showed that 46 (14.7%), 58 (18.5%), 79 (25.2%), 106 (33.9%), and 24 (7.7%) patients had grades I, II, III, IV, and V injuries, respectively. Isolated splenic injuries occurred in 172 (55%) patients, and the rest (141, 45%) had associated intra-abdominal injuries. Two-thirds (67.1%) were aged 16-45 years. In the OM group, 178 (78.7%) had total splenectomy, while 48 (21.3%) had splenic salvage. There was a statistically significant difference (P = 0.022) in the rate of postoperative complications between the splenectomy and splenorrhaphy groups. The overall mortality rate was 4.5%. Major predictors of morbidity and mortality were high-grade splenic injuries, total splenectomy, multiple injuries, advanced age, and comorbidities. Conclusion: Splenic injuries complicate approximately two-thirds of all abdominal injuries in our environment and majority of these injuries were due to BAT. In this study, majority had OM and splenic salvage rate was relatively low.

Résumé Contexte: Le traumatisme splénique est devenu un fardeau mondial majeur de santé, en particulier dans les pays en développement avec des installations diagnostiques et thérapeutiques limitées. La tendance actuelle vers la gestion non opératoire (NOM) et l'adoption du sauvetage splénique chaque fois que cela appelle à l'évaluation locale de notre pratique actuelle. Le but de cette étude était de documenter l'épidémiologie et les résultats de la gestion des blessures spléniques dans notre contexte. Patients et méthodes: Il s'agissait d'une étude prospective multicentrique de l'épidémiologie et des résultats de patients souffrant de blessures spléniques recrutés sur 10 ans dans le sud-est du Nigéria. Résultats: Environ 66% de tous les patients atteints de blessures abdominales ont subi un traumatisme splénique. Au total, 313 patients atteints de traumatisme splénique ont été recrutés; 226 (72,2%) ont été gérés de manière opératoire (OM) et 87 (27,8%) de manière conservatrice (NOM). La majorité (75,7%) avait un traumatisme abdominal émoussé (BAT), tandis que 24,3% ont subi des blessures pénétrantes. Classement échographique ont montré que 46 (14,7%), 58 (18,5%), 79 (25,2%), 106 (33,9%) et 24 (7,7%) avaient respectivement des grades I, II, III, IV et V, respectivement. Des lésions spléniques isolées se sont produites chez 172 (55%) patients, et le reste (141, 45%) avait des lésions intra-abdominales associées. Les deux tiers (67,1%) étaient âgés de 16 à 45 ans. Dans le groupe OM, 178 (78,7%) avaient une splénectomie totale, tandis que 48 (21,3%) avaient un récupération splénique. Il y avait une différence statistiquement significative (p = 0,022) dans le taux de complications postopératoires entre les groupes de splénectomie et de splénorrhaphie. Le taux de mortalité global était de 4,5%. Les principaux prédicteurs de la morbidité et de la mortalité étaient les blessures spléniques de haut niveau, la splénectomie totale, les blessures multiples, l'âge avancé et les comorbidités. Conclusion: Les blessures spléniques compliquent environ les deux tiers de toutes les blessures abdominales dans notre environnement et la majorité de ces blessures étaient dues à BAT. Dans cette étude, la majorité avait le taux de récupération OM et splénique était relativement faible. Mots-clés: Abdomen, urgence, laparotomie, mortalité, rate, traumatisme.

Knowledge, Attitude and Practice of Healthcare Managers to Medical Waste Management and Occupational Safety Practices: Findings from Southeast Nigeria.

INTRODUCTION: Awareness of appropriate waste management procedures and occupational safety measures is fundamental to achieving a safe work environment, and ensuring patient and staff safety. AIM: This study was conducted to assess the attitude of healthcare managers to medical waste management and occupational safety practices. MATERIALS AND METHODS: This was a cross-sectional study conducted among 54 hospital administrators in Ebonyi state. Semi-structured questionnaires were used for qualitative data collection and analyzed with SPSS statistics for windows (2011), version 20.0 statistical software (Armonk, NY: IBM Corp). RESULTS: Two-fifth (40%) of healthcare managers had received training on medical waste management and occupational safety. Standard operating procedure of waste disposal was practiced by only one hospital (1.9%), while 98.1% (53/54) practiced indiscriminate waste disposal. Injection safety boxes were widely available in all health facilities, nevertheless, the use of incinerators and waste treatment was practiced by 1.9% (1/54) facility. However, 40.7% (22/54) and 59.3% (32/54) of respondents trained their staff and organize safety orientation courses respectively. Staff insurance cover was offered by just one hospital (1.9%), while none of the hospitals had compensation package for occupational hazard victims. Over half (55.6%; 30/54) of the respondents provided both personal protective equipment and post exposure prophylaxis for HIV. CONCLUSION: There was high level of non-compliance to standard medical waste management procedures, and lack of training on occupational safety measures. Relevant regulating agencies should step up efforts at monitoring and regulation of healthcare activities and ensure staff training on safe handling and disposal of hospital waste.