Paediatric burn injuries in Enugu, South-East Nigeria: A 7-year multi-centre retrospective review.

Burn injuries contribute significantly to childhood morbidity and mortality. This study was designed to document the pattern of presentation and outcome of pediatric burn injury in Enugu. METHODS: All children with burn injuries over a 7-year period (June 2011 to May 2018) and were managed at three tertiary health institutions, were studied. Information including their socio-demographics, clinical features and treatment outcome were obtained and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0. RESULTS: 198 out of 201 records were available for analysis. Most (186; 93.9%) burn injuries occurred at home. Hot liquid (112; 56.7%) was the commonest cause of burn injury. A lot of substances were used topically for first aid, raw eggs (52; 31%) being the commonest. The outcome had significant association with cause of injury, depth of injury, total burn surface area (TBSA), and inhalation injury. Most were safely discharged home while a total of thirteen (6.6%) children died. LA50 was 54.87%, while the maximum TBSA salvaged was 65%. CONCLUSION: Burn injuries in children in this environment remain a serious challenge in the face of widespread lack of awareness regarding safe practices in handling hot and flammable items at home.

Isolated penile degloving from milling machine injury in a child.

Degloving injuries of the male perineum are an uncommon urological emergency often requiring reconstruction. They are usually related to industrial and/or agricultural machinery and tend to involve both the penile shaft and the scrotal skin. Adolescents and young adults are the usual victims. The treatment options commonly employed include the use of the degloved skin either as a flap or more often as a free skin graft, yielding variable results. Other modalities include the use of free split skin grafts or free full thickness skin grafts (FTSG) (Wolfe grafts). We report a case of degloving injury in a 10-year-old child, with injury exclusively affecting the skin of the penile shaft, who presented in the sub-acute phase. Optimization of the wound and subsequent cover of the defect with an FTSG yielded a good outcome and patient satisfaction.

Evaluation of neonatal circumcision training for resident doctors in a developing country.

BACKGROUND: There is a high prevalence of neonatal circumcision (NC) in Sub-Saharan Africa. However, when providers do not have adequate training on the procedure, neonatal circumcision can result in complications. There are indications that the reported high complication rate of NC in the current setting might be a reflection of inadequate training of the providers. In order to establish a framework for better training of providers of NC, it may be necessary to evaluate the providers' opinions of their training and competence of the procedure. OBJECTIVE: The opinions of surgical, paediatric, and obstetrics-gynaecology resident doctors were evaluated for their exposure to, training on and perceived competence of neonatal circumcision. STUDY DESIGN: The resident doctors in surgery, paediatrics and obstetrics-gynaecology (OBGYN) at two teaching hospitals in southeastern Nigeria were surveyed using a self-developed questionnaire. The self-assessment survey evaluated the residents' exposure and training on NC, and their perceived competence of the procedure. The responses from the different specialties were compared. Data were analysed using Statistical package for Social Sciences (SPSS). RESULTS: The summary of findings is shown in Table below: The confidence in the ability to perform the NC did not significantly differ between the sexes (male 53/87 vs female 6/15; P = 0.22) and the level of training (SHO, Senior house officer 7/17, Registrar 24/42, senior registrar 28/43; P = 0.24). DISCUSSION: A substantial proportion of residents who encountered neonatal circumcision considered their training in NC to be sub-optimal, despite their perceived exposure to the procedure. Notwithstanding this deficiency of training, the majority of the residents planned to perform NC and this presaged an expectedly higher rate of complications. Well-thought-out and structured training, comprising lectures, workshops and hands-on training, for the resident doctors and the other providers of NC might address these shortcomings and minimise complications. This may further be strengthened with a government policy on circumcision. The limitations of the study included: (1) It was a self-assessment survey and this introduced bias in the assessment of competency; (2) There were no outcome measures in the survey for those who had practical exposure vs those who did not. CONCLUSION: The resident doctors perceived that their exposure, training and competence in NC might be sub-optimal. Curriculum modification that incorporates appropriate hands-on training in NC might address these deficiencies.

Virilized external genitalia in young girls: clinical characteristics and management challenges in a low-resource setting.

OBJECTIVE: Virilization of the external genitalia in young girls (VEG) manifests mostly as ambiguity of the genitalia and elicits concerns and uncertainties especially in settings with poor awareness. This study evaluates the profile and challenges of VEG in southeast Nigeria. METHODS: We analyzed 23 children with VEG managed in 2 referral centers in southeast Nigeria from June 2005 to January 2013. RESULTS: They presented at median age of 13.3 months (interquartile range [IQR] 3 months-3 years). The cases included 3 (13%) of Prader type 1, 6 (26%) of type 2, 11 (48%) of type 3, and 3 (13%) of type 4. Five of the Prader type 3 and all 3 cases of Prader type 4 were reared as male prior to presentation. Following evaluation, all the cases were assigned female gender at a mean age of 2.7 years (range 2 months-10.5 years). Appropriate feminizing genitoplasty was undertaken in all the cases and after a follow-up period of 3 months to 5 years (mean 2 years), 2 patients developed vaginal stenosis, and 3 cases had surgical wound infection. Poor awareness, delayed presentation, inadequate facilities, and lack of trained manpower were the challenges in the management of the cases. CONCLUSION: VEG in our setting is associated with delayed management. Focused health education and public awareness programs, and improved healthcare funding may improve outcome and minimize the need for gender reassignment.

Post-burn pruritus: need for standardization of care in Nigeria.

It is generally agreed among burn care specialists that pruritus (itching) is a very common and distressing complication of burn injuries that results in extreme discomfort. There is no consensus on treatment modality worldwide but there are generally accepted methods of managing amelioration. This survey aims to study the knowledge, attitudes and practices of Nigerian burn specialists who manage various degrees of burn injuries in our environment. The purpose is to find out whether there are any uniform modalities of care for these patients, with the view of possibly providing standardization. To this end, a structured questionnaire was designed and distributed to plastic surgeons from across Nigeria. Findings showed that 88.6% of the plastic surgeons had no form of assessment tool or method for evaluating post-burn pruritus, leaving only 11.4% believing they had a method of assessing the severity of post-burn pruritus. With regard to treatment, 57.1% would use oral medications as first-line treatment, 22.9% would use injectables, 8.6% would use topical agents, 5.7% would only reassure the patients and another 5.7% would use a combination of oral and topical agents together. 85.7% of these plastic surgeons and burn care specialists did not have any form of anti-pruritic regimen, as only 14.3% indicated having this. Hence, there is no standardization in the management of pruritus in Nigeria and there is an urgent need for a management protocol.

Il est généralement admis parmi les spécialistes du traitement des brûlures que prurit (démangeaisons) est une complication très fréquente et douloureuse des brûlures qui se traduit par une gêne extrême. Actuellement, il n'ya pas de consensus globale sur les modalités de traitement, mais il y a des méthodes de gestion de l'amélioration généralement acceptées. Cette enquête vise à étudier les connaissances, attitudes et pratiques des spécialistes des brûlures nigérians qui gèrent divers degrés de brûlures dans notre environnement. Le but est de savoir s'il existe des modalités uniformes de soins pour ces patients, en vue de fournir éventuellement normalisation. À cette fin, un questionnaire structuré a été conçu et distribué aux chirurgiens plasticiens à travers le Nigeria. Un total de 88,6% des chirurgiens plasticiens n'avait aucune forme d'outil d'évaluation ou d'une méthode d'évaluation de prurit consecutif aux brûlures tandis que seulement 11,4% d'entre eux croyaient qu'ils avaient une méthode d'évaluation de la gravité de prurit suite aux brûlures. En ce qui concerne le traitement, 57,1% utiliseraient médicaments par voie orale comme traitement de première ligne, 22,9% utiliseraient injectables, 8,6% utiliseraient des agents topiques, 5,7% ne feraient que rassurer les patients, et un autre 5,7% utiliseraient une combinaison d'agents oraux et topiques ensemble. 85,7% de ces chirurgiens plasticiens et spécialistes des brûlures n'ont pas toute forme de traitement anti-prurigineux, puisque seulement 14,3% ont indiqué qu'ils avaient une certaine régime. Par conséquent, il n'existe pas de normalisation dans la gestion du prurit au Nigeria et il ya un besoin urgent d'un protocole de gestion.