Department of Medicine & Surgery

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Start date: 2004End date: 2009

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    Gastrointestinal Injuries Following Blunt Abdominal Trauma in Children.
    (Nigerian Journal of Clinical Practice, 2008-02-02) Chirdan, L.B.; Uba, A.F.; Chirdan, O.O.
    Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries, one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice.
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    Impact of Health Education on Home Treatment and Prevention of Malaria in Jengre, North Central Nigeria
    (Annals of African Medicine, 2008-02-02) Chirdan, O.O.; Zoakah, A.I.; Ejembi, C.L.
    Background: Malaria accounts for 1 million deaths among children under five annually. It has been shown that improving home treatment and preventing delays in seeking treatment, by teaching women to respond promptly when their children have fever, can decrease malaria related complications and mortality. This study looks at the impact of health education on knowledge of malaria: its recognition, treatment and prevention among caregivers of children under five in Jengre, North Central Nigeria. Methods: The study was a community based intervention study conducted in three stages: A pre-intervention stage, where 150 caregivers, were selected through a multistage sampling technique from the households containing children under five. Information for the baseline was collected through an interviewer administered semi-structured questionnaire. The intervention consisted of a series of health education sessions designed based on findings from the pre-intervention stage. The post-intervention impact assessment was conducted using a modified version of the questionnaire used in the pre intervention stage. Results: Malaria was recognized as one of the diseases that cause fever in community by all the respondents. Sixty-one (40.6%) had adequate knowledge concerning malaria causation, transmission, prevention and treatment. Twenty eight (56%) of respondents reported Self-treatment. There was a statistically significant relationship between years of formal education and first line treatment option (P = .012). Thirty-four (68%) mothers acted within eight hours of onset of fever. The intervention had an effect on perception (P < .001), knowledge (P < .001), malaria prevention practice (P = .001), first line treatment option (P = .031) and the type of treatment given to the children with fever (P = .048). Conclusion: Health education impacted positively caregivers’ knowledge of malaria and their willingness to access antimalarial treatment when their children have fever. Malaria information should be made available to caregivers visiting child welfare clinics. Caregivers should also be integrated into malaria control activities at community level.
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    Perceptions of working conditions amongst health workers in state-owned facilities in northeastern Nigeria
    (Annals of African Medicine, 2009-02-02) Chirdan, O.O.; Akosu, J.T.; Ejembi, C.L.; Bassi, A.P.; Zoakah, A.I.
    Background: The health care sector depends to a large extent on human labor. Poor worker motivation can greatly affect health outcomes and patient safety. There is little information on the health workers’ perceptions of working conditions in resource-poor settings. Method: Three state-owned facilities in each state were selected by simple random sampling technique. The selected facilities were visited on weekdays between 9 and 10 a.m. A self-administered structured questionnaire was given to all health care workers on duty in the facility at the time of visit. Results: A total of 299 questionnaires were returned. The response rate was 85.43%. Two hundred four (68.2%) workers experienced general satisfaction with their current jobs. The relationships between general job satisfaction and presence of conflict at work (P 0.001), freedom of expression (P 0.001), managerial support for staff welfare (P0.001), managerial support for staff career development (P 0.001), availability of tools and consumables in the workplace (P 0.001) and progress towards personal professional goals (P 0.001) were statistically significant. Conclusion: The level of general job satisfaction was high. Though salaries were important, presence of conflict at work, freedom of expression, managerial support for staff welfare, managerial support for staff career development, availability of tools and consumables in the workplace and progress towards personal professional goals appear to play a role in worker motivation.
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    Childhood cancers: Challenges and strategies for management in developing countries
    (African Journal of Paediatric Surgery, 2009-07-07) Chirdan, L.B.; Bode-Thomas, F.; Chirdan, O.O.
    The developing countries bear the greatest burden of childhood cancers as over 90% of the world’s children live in these countries. Childhood cancer in most instances is curable, but many children die from cancer because most children live in developing countries without access to adequate treatment due to high cost of treatment and poor organization in these countries. Initiatives to increase cancer care in developing countries would therefore include establishment of standard cancer care centres, manpower training, establishment of standardized management protocols, procurements of standard drugs and collaboration with international organizations.
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    Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children
    (Annals of African Medicine, 2009-02-02) Chirdan, L.B.; Uba, A. F.; Pam, S.D.; Edino S.T.; Mandong B.M.; Chirdan O.O.
    Background/Purpose: The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-termmorbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods: Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative fi ndings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. Results: There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had signifi cantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month–8 years). Two (9.5%) had recurrent disease after primary excision; fi ve (23.8%) had some degree of functional impairment at the follow-up. Conclusion: While SCT is usually benign, recurrence, malignant transformations in patients who present late and long- term functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivors.
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    Perceptions of working conditions amongst health workers in state-owned facilities in northeastern Nigeria
    (Annals of African Medicine, 2009-01-01) Chirdan, Oluwabunmi O; Akosu, Joeseph T.; Ejembi, Clara L.; Bassi Amos Paul; Zoakah, Ayuba I.
    The health care sector depends to a large extent on human labor. Poor worker motivation can greatly affect health outcomes and patient safety. There is little information on the health workers' perceptions of working conditions in resource-poor settings.Three state-owned facilities in each state were selected by simple random sampling technique. The selected facilities were visited on weekdays between 9 and 10 a.m. A self-administered structured questionnaire was given to all health care workers on duty in the facility at the time of visit.A total of 299 questionnaires were returned. The response rate was 85.43%. Two hundred four (68.2%) workers experienced general satisfaction with their current jobs. The relationships between general job satisfaction and presence of conflict at work (P = 0.001), freedom of expression (P > 0.001), managerial support for staff welfare (P > 0.001), managerial support for staff career development (P > 0.001), availability of tools and consumables in the workplace (P > 0.001) and progress towards personal professional goals (P = 0.001) were statistically significant.The level of general job satisfaction was high. Though salaries were important, presence of conflict at work, freedom of expression, managerial support for staff welfare, managerial support for staff career development, availability of tools and consumables in the workplace and progress towards personal professional goals appear to play a role in worker motivation.
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    Sero-prevalence of hepatitis B surface antigen among primary school pupils in rural Hawal valley, Borno State, Nigeria
    (Journal of Community Medicine and Primary Health Care, 2005-06-09) DN Bukbuk; Bassi Amos Paul; ZM Mangoro
    Background and objective: Hepatitis B virus infection is a major public health problem worldwide and in Africa. In the northeastern part of Nigeria. Information on the prevalence of HBV infection in rural communities is scarce. This study was carried out to determine the sero-prevalence of hepatitis B surface antigen amongst primary school pupils in a rural setting in northeastern Nigeria. Methods: Hepatitis B surface antigen was tested for in 150 apparently healthy children in two primary schools in two rural communities situated in the Hawal valley area in Borno State, North East zone of Nigeria using an Enzyme Linked Immunosorbent Assay technique. Results: The overall sero-positivity of Hepatitis B surface antigen (HBsAg) in the pupils was 44.7% (95% C.I: 36.6 53.0). The prevalence of HBsAg was found to increase with age, rising from 40.6% in children aged 10-11 years to 75% in children aged above 13 years. The sero-prevalence is (47.2%, (95% C.I: 37.5 57.1) among males while among the females it was slightly lower 38.1 % (95 C.I: 23.6 54.4%). The differences in the HbsAg sero-prevalence by age, sex and location were not statistically significant. Conclusion: The high prevalence of HBsAg in the two primary school children provides evidence for an urgent mass immunization for children on entry to the schools.Keywords: HBs Antigenaemia, primary school pupils, rural hawal river valley, northeastern NigeriaJournal of Community Medicine and Primary Health Care 2005, 17(1): 20-23
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    Communities’ Awareness, Perception and Participation in the Community-Based Medical Education of the University of Maiduguri
    (Taylor and Francis, 2006-07-02) Omotara, B. A.; Yahya, S. J.; Shehu, U.; Bello, H. S.; Bassi Amos Paul
    Background: Community-based medical education (CBME) is no longer a new innovation in medical education since the establishment of The Network: Towards Unity for Health (The Network: TUFH) 25 years ago. The CBME of the University of Maiduguri medical college is 14 years old and has never been assessed in terms of the population it serves. The study was conducted to determine the level of awareness, perception, and participation of the communities in CBME. Methods: A cross-sectional survey was carried out in 11 village units of three Local Government Areas (LGAs) using a 14-item structured questionnaire administered to adults in randomly selected households. The questionnaire was based on guide questions used for focus group discussions held earlier with community leaders. Results: Awareness of students’ visits among respondents was 73.7%. Knowledge of the frequency of presence of the students in the communities was 72.2%. ‘‘To examine and treat’’ (33.6%) and ‘‘to ask questions’’ (16.6%) were the most prominent reasons given for the visits. The majority of respondents perceived the visits as beneficial (72.2%). More frequent visits were requested by 54.4% of the respondents. The communities were willing to be more accessible and felt that the LGAs should provide more logistic support to the program. Discussion: This study revealed that communities were aware of students’ visits and knew reasons for the visits, thought visits were beneficial, and were willing to provide more support for these visits.
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    Virtual computed tomography cystoscopy in bladder pathologies
    (International Braz J Urol, 2006-04-02) Arslan Halil; Ceylan Kadir; Harman Mustafa; Yilmaz Yuksel; Temizoz Osman; Can Saban
    Assessed the usefulness of virtual cystoscopy performed with multidetector computed tomography (CT) in patients with different urinary bladder pathologies compared to the conventional cystoscopy.Eighteen patients with different bladder pathologies, which consisted of 11 tumors, 3 diverticula, 2 trabecular changes and 2 stones, were assessed with conventional cystoscopy and virtual CT cystoscopy. The results of virtual CT cystoscopy were compared with the findings of conventional cystoscopy. We determined the detection rate and positive predictive value of CT imaging based virtual cystoscopy in the diagnosis of urinary bladder lesions.CT scanning was well tolerated by all patients, and no complications occurred. Images in 16 (88%) of the 18 virtual cystoscopic examinations were either of excellent or good quality. All tumors except one, 2 trabecular changes and 2 stones were characterized with similar findings in the both of methods. The masses ranged from 0.4 to 7.0 cm in diameter. While conventional cystoscopy could not evaluate interior part of the diverticulum, virtual CT cystoscopy could demonstrate clearly within it. There were no false-positive findings in our series.Virtual CT cystoscopy is a promising technique to be used in the detection of bladder lesions. It should be considered especially at the evaluation of bladder diverticula. In the future, it may be possible or even advantageous to incorporate into the imaging algorithm for evaluation of bladder lesion.
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    Incidence of Renal Insufficiency in Cancer Patients
    (Health Communications Inc, 2005-02-02) Dogan Ekrem; Izmirli Mustafa; Ceylan Kadir; Erkoc Reha; Sayarlioglu Hayriye; Begenik Huseyin; Alici Suleyman; Yil Yuzuncu
    The frequency of chronic renal insufficiency among cancer patients is unclear. The aim of this study was to determine the frequency of impaired renal function within a population of cancer patients. One thousand two hundred seventeen patients (563 women, 654 men) with cancer underwent serum creatinine concentration and glomerular filtration rate (GFR) evaluations. The Cockcroft-Gault formula was used to estimate the GFR from the creatinine clearance (Clcr). Renal insufficiency was defined as a GFR ≤90 mL/min. Among this population, 72 (5.9%) demonstrated an abnormal serum creatinine concentration (>1.2 mg/dL). According to the Cockcroft-Gault formula evaluations, however, 330 (27.1%) of the patients had an estimated GFR <90 mL/min. Among these, the Clcrwas between 60 and 89 mL/min in 241 patients (19.8%); 30 and 59 mL/min in 75 patients (6.2%); and 15 and 29 mL/min in 7 patients (0.6%); 7 patients (6%) had a Clcr <15 mL/min. As a result, 21.2% of patients demonstrating a normal serum creatinine level had abnormal renal function. Renal function should be evaluated in all cancer patients, regardless of their serum creatinine level, before any drug regimen is administered. The Cockcroft-Gault formula appears to be more accurate than serum creatinine concentration for diagnosing renal insufficiency in patients with cancer, but more prospective studies in this population will be necessary to confirm this finding.