Nigerian resident doctors' work schedule: A national study

Background and Aim

The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety.

Subjects and Methods

A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05.

Results

The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48-72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%).

Conclusion

The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.

Acute Urinary Retention due to Haematometrocolpos from Imperforate Hymen in a Pubescent Nigerian Girl

BACKGROUND

Cryptomenorrhoea is an uncommon gynaecological condition in the adolescent age group. While cyclical abdominal pain is the usual clinical symptom, patients with atypical presentation require a high index of suspicion and meticulous evaluation.

OBJECTIVE

This case report describes atypical presentation of haematometrocolpos in a pubescent Nigerian female.

METHODS

A case of acute urinary retention in an adolescent girl, due to haematometrocolpos, is presented. A 13-year-old supposedly premenarcheal girl presented at the Children Emergency Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria with acute urinary retention of twelve hours' duration. There was no preceding history of difficulty with voiding. About 1,200mls of urine was drained from the bladder with a self-retaining catheter. Examination revealed an 18-week-sized cystic abdomino-pelvic mass, and the vagina was closed with a bulging membrane at the introitus. Abdomino-pelvic ultrasonography revealed a distended uterus containing fluid with low level echo, typifying the ground-glass appearance. Trans-hymenal ultrasonography using a 2.5-7.5MHz endocavitary probe confirmed a ballooned-out vagina with similar content, with a 2mm thick hymen at the distal end.

RESULTS

Hymenectomy was performed with spontaneous drainage of the menstruum. She was discharged after successful trial of voiding without catheter.

CONCLUSION

Though uncommon, haematometrocolpos from lower genital obstruction should be considered as a differential diagnosis of lower urinary tract obstruction in pubescent girls. Trans-hymenal ultrasonography is accessible and accurate for assessing the level of obstruction and the thickness of the intervening tissue.

Severe Maternal Outcomes Associated with Abortion-Related Sepsis at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria: Experience from the Last Decade of Millennium Development Goal Era

BACKGROUND

Abortion-related sepsis contributes significantly to reproductive morbidity and preventable mortality in Nigeria. Effective strategies to combat the associated Severe Maternal Outcomes (SMO) requires reliable statistics and an understanding of the immediate contributors.

METHODS

A retrospective review of women managed for abortion-related sepsis between September, 2006 and August, 2015 at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. The socio-demographic characteristics, pattern of presentation, reasons for termination of pregnancy and clinical outcomes were analysed. Life-threatening complication rate, mortality index and maternal mortality ratio were determined using the WHO "Near-Miss" concept.

RESULTS

Overall, 128 women were managed for abortion-related sepsis, with 11,565 live births within the decade. Eighty (79.6%) of the 88 women with induced abortions were not on contraception, though pregnancy was not desired. Interference with education, paternity dispute and short inter-pregnancy interval were the commonest reasons for pregnancy termination. Near-misses were recorded in 67.5% of the women, especially anaemia requiring at least 4units of blood and laparotomy for non-caesarean indications. The mortality-index and case fatality rate were 13.9% and 9.4% respectively, predominantly due to multiple organ dysfunction from overwhelming sepsis.

CONCLUSION

The life-threatening complication rate and mortality index associated with abortion-related sepsis at the OAUTHC remain bothersome, with a 1:7.5 chance of mortality once diagnosed. The maternal near-misses identified in this study would serve as alert signals to Physicians on the risk of maternal death in these women. Strategies should be implemented to facilitate access to contraception, standardised abortion-related services and hospital-based interventions to care for maternal near-misses.

Incidental finding of complete situs inversus in a polytraumatized adult

BACKGROUND

Situs inversus is a rare abnormality typically posing a diagnostic dilemma during routine evaluation of acute abdominal emergencies such as in acute appendicitis and cholecystitis. It is rare to detect such in the setting of trauma.

OBJECTIVE

To report an incidental finding of complete situs inversus in a poly-traumatized adult.

METHODS

The clinical records of the patient including preoperative evaluation, intra-operative findings and postoperative care were reviewed.

RESULT

A 53 year old man presented with difficulty breathing, left sided chest pain, generalized abdominal pain and distension 18 hours after a vehicular road traffic accident. Examination revealed features of left sided haemothorax, absent heart sounds, generalized peritonitis and limb injuries. Plain chest radiograph confirmed left haemothorax with dextrocardia. He had a left closed thoracostomy tube drainage and exploratory laparotomy which revealed complete situs inversus of intra-abdominal organs alongside a jejunal perforation which was repaired. Postoperative recovery was uneventful.

CONCLUSION

Complete situs inversus is uncommon and may not be anticipated in evaluation of trauma patients. Preoperative clinical and radiological evaluation may however be helpful in making a pre-operative diagnosis and further management.