Picture Cards Versus Physical Examination: A Proof-of-Concept Study to Improve the SOSAS Survey Tool

INTRODUCTION

The Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool is used to determine the unmet surgical needs in the community and has been validated in several countries. A major weakness is the absence of an objective assessment to verify patient-reported surgically treatable conditions. The goal of this study was to determine whether a picture portfolio, a tool previously shown to improve parental recognition of their child's congenital deformity, could improve the accuracy of the SOSAS tool by how it compares with physical examination. This study focused on children as many surgical conditions in them require prompt treatment but are often not promptly diagnosed.

METHODS

We conducted a descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions among children and adults in a mixed rural-urban area of Lagos, Southwest Nigeria. The picture portfolio was administered only to children and the surgical conditions to be assessed were predetermined using an e-Delphi process among pediatric surgeons. The modified The Surgeons OverSeas Assessment of Surgical Needs-Nigeria Survey Tool (SOSAS-NST) was administered to household members to collect other relevant data. Data were analyzed using the REDCap analytic tool.

RESULTS

Eight hundred and fifty-six households were surveyed. There were 1984 adults (49.5%) and 2027 children (50.5%). Thirty-six children met the predetermined criteria for the picture portfolio-hydrocephalus (n = 1); lymphatic malformation (n = 1); umbilical hernia (n = 14); Hydrocele (n = 5); inguinal hernia (n = 10) and undescended testes (n = 5). The picture portfolio predicted all correctly except a case of undescended testis that was mistaken for a hernia. The sensitivity of the picture portfolio was therefore 35/36 or 97.2%.

CONCLUSIONS

The SOSAS-NST has improved on the original SOSAS tool and within the limits of the small numbers, the picture portfolio has a high accuracy in predicting diagnosis in children in lieu of physical examination.

New method to estimate femoral head size from the trochanteric length of the femur

INTRODUCTION

Preoperative planning is an important step before any joint replacement surgery. In developing countries standardised radiographs and planning tools might not be available but nevertheless hemiarthroplasties are performed in certain trauma cases. An equation should be devised to allow a preoperative estimation of the expected femoral head size dimensions in those situations.

MATERIALS AND METHODS

35 lower limbs of human cadavers were studied. The estimated femoral head (EFH) size of each femur was obtained by measuring the trochanteric length (TL) (in cm) and using the equation 'EFH = 16 + (0.7 × TL)'. The hip joint was dissected, and the actual size of the femoral head (AFH) was measured on the specimen.

RESULTS

There was a correlation between the EFH and AFH (p = 0.0001). Accepting a range of ±3 mm the femoral head size was predicted correctly in 31 hips (89%), for ±4 mm in 33 hips (94%) and for ±5 mm in 35 hips (100%), respectively.

CONCLUSIONS

A simple tape measurement and the equation Femoral head size = {16 + (0.7 × Trochanteric Length)} ±5 mm gives a rather reliable guess for the expected femoral head size. It might be useful as pre-operative planning tool if no standardised radiographs are available.

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%.

Prevalence of surgically correctable conditions among children in a mixed urban-rural community in Nigeria using the SOSAS survey tool: Implications for paediatric surgical capacity-building

Background

In many low- and middle-income countries, data on the prevalence of surgical diseases have been derived primarily from hospital-based studies, which may lead to an underestimation of disease burden within the community. Community-based prevalence studies may provide better estimates of surgical need to enable proper resource allocation and prioritization of needs. This study aims to assess the prevalence of common surgical conditions among children in a diverse rural and urban population in Nigeria.

Methods

Descriptive cross-sectional, community-based study to determine the prevalence of congenital and acquired surgical conditions among children in a diverse rural-urban area of Nigeria was conducted. Households, defined as one or more persons ‘who eat from the same pot’ or slept under the same roof the night before the interview, were randomized for inclusion in the study. Data was collected using an adapted and modified version of the interviewer-administered questionnaire—Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool and analysed using the REDCap web-based analytic application.

Main results

Eight-hundred-and-fifty-six households were surveyed, comprising 1,883 children. Eighty-one conditions were identified, the most common being umbilical hernias (20), inguinal hernias (13), and wound injuries to the extremities (9). The prevalence per 10,000 children was 85 for umbilical hernias (95% CI: 47, 123), and 61 for inguinal hernias (95% CI: 34, 88). The prevalence of hydroceles and undescended testes was comparable at 22 and 26 per 10,000 children, respectively. Children with surgical conditions had similar sociodemographic characteristics to healthy children in the study population.

Conclusion

The most common congenital surgical conditions in our setting were umbilical hernias, while injuries were the most common acquired conditions. From our study, it is estimated that there will be about 2.9 million children with surgically correctable conditions in the nation. This suggests an acute need for training more paediatric surgeons.

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