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   2004| July-December  | Volume 1 | Issue 1  
    Online since July 2, 2008

 
 
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ORIGINAL ARTICLES
Clean intermittent catheterization: Overview of results in 194 patients with spina bifida
Agnes Jeruto, Dan Poenaru, Richard Bransford
July-December 2004, 1(1):20-23
Background: Clean intermittent catheterization (CIC) is a life-saving procedure in children with spina bifida, but its effectiveness in Kenya has not been previously documented. Patients and Methods: The current study analyzed the application of CIC in a series of 194 patients with spina bifida who fulfilled set criteria for placement on the CIC programme. Caregivers were taught the technique and were provided with the necessary supplies. Results: Leak point pressure (LPP) and post-voiding residual (PVR) data obtained correlated with development of hydronephrosis. Out of 176 children alive on CIC, 74% were continent (20% spontaneously, 37% with CIC, and 17% with CIC and imipramine). 18 children died of disease-related complications. Conclusion: A CIC program is both feasible and effective in Kenya. Economic barriers must be overcome and further parent education is needed in order to offer all Kenyan children with spina bifida a good standard of care.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  2,038 76 1
Acute appendicitis in children in Kumasi, Ghana: Macroscopic findings at laparotomy
FA Abantanga
July-December 2004, 1(1):6-10
Background A lot has been written about acute appendicitis in children in the developed countries but very little is written about this condition among children in the sub Saharan region. It used to be said that acute appendicitis is rare in Africa but this is no longer the case. We are unable to find, in the literature, any reference to acute appendicitis in children in Ghana. We, therefore, reviewed our experience with this pathology, especially the operative findings, in children using the Kumasi metropolitan area. Patients and Methods Ninety-six children admitted and treated for acute appendicitis from January 2001 to December 2003 were considered. The macroscopic findings at laparotomy were meticulously noted down and these form the basis for the analysis. Appendicectomy was carried out in all the 96 children. Results In all there were 67 boys and 29 girls, a boy to girl ratio of 2.2:1. the ages ranged from 1.8 years to 14.0 years with a mean age of 10.1 2.8 years. Macroscopically, simple acute appendicitis (uncomplicated) was found in 13 (13.5%) and obstructive appendicitis (complicated) in 83 (86.5%) children. Postoperative complications consisted of superficial surgical site infection in 4, deep surgical site infection in 3 and incomplete wound dehiscence in 2. there was one death in the series- a mortality rate of 1.0%. Conclusion Acute appendicitis is no more a rarity in the sub-saharan setting as more and more people live affluently and adopt the western style of life. As a result of prehospital delay and also delays in diagnosis, complicated appendicitis was common among our group of patients.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,347 68 1
Postoperative feeding difficulties after repair of congenital diaphragmatic hernia
O Adejuyigbe, RG Buick, P Gornal, JJ Corkery
July-December 2004, 1(1):11-15
Objectives:The study aims to define the incidence, causes and outcome of treatment of feeding difficulties in the immediate post operative period following surgical correction of congenital diaphragmatic hernias {CDH). Methodology: This was a retrospective study. It involved the review of the case notes of all children diagnosed with congenital diaphragmatic hernia at the Birmingham Children's Hospital (BCH) England over a ten year period, 1982-1991. The feeding difficulties and associated problems noticed postoperatively were extracted from the case notes. Results: There were 97 children treated for CDH. Sixty four of these children survived. Of these, 24 (37.5%) developed feeding difficulties in the immediate post operative period. The causes of the feeding difficulties were Gastro-oesophageal reflux (GOR) 9, Recurrent diaphragmatic hernia 8, Adhesive intestinal obstruction 4, Poor intestinal motility 2, Campylobacter enteritis, 1, Hypertrophic pyloric stenosis, 1. Many if the children had more than one cause for their feeding problem. Howevert in 6 of the 24 children no cause could be found. Two of the 24 with feeding difficulties died and 3had lingering feeding difficulties in spite of appropriate surgical and medical treatment.One of these 3 had GOR while the other 2 had adhesive intestinal obstruction in association with recurrence of the diaphragmatic hernia. Conclusions: Feeding difficulties were very common following the repair of congenital diaphragmatic hernias in children at the BCH. They were a cause of considerable postoperative morbidity. The occurrence of adhesive intestinal obstruction with recurrent diaphragmatic hernia in the same patient was associated with a poor prognosis in the children in the series.
[ABSTRACT]   Full text not available  [PDF]
  1,277 70 -
SYMPOSIUM
Pediatric surgical specialty: How relevant to Africa?
Benedict C Nwomeh, Philip M Mshelbwala
July-December 2004, 1(1):36-42
Background The development of pediatric surgical care in Africa has suffered from the neglect of health policy makers, yet surgery remains an essential component of basic healthcare and an important means of providing preventive and curative treatment. The purpose of this report is to highlight the problem of childhood surgical disease in Africa, examine the current state of manpower and ancillary resources, and articulate the need to integrate pediatric surgical care into a comprehensive strategy for reducing the burden of disease. Methods A current literature review of studies relevant to pediatric surgery in Africa was performed using MEDLINE. A thorough search of non-indexed local journals was also undertaken, and critical review of all cited sources was performed. Results We highlighted recent epidemiological studies indicating that childhood surgical diseases constitute a significant healthcare problem in Africa. The leading causes are congenital anomalies, surgical infections, and trauma. The barriers to the development of effective pediatric surgical care are discussed, and strategies for improvement are proposed. Conclusion Childhood surgical disease is an important cause of morbidity and mortality in African children. Specialist pediatric surgical care should be a vital component of a comprehensive strategy to address the endemic health problems facing the continent.
[ABSTRACT]   Full text not available  [PDF]
  1,246 84 -
ORIGINAL ARTICLES
Epidemiology of neural tube defects in North Central Nigeria
AF Uba, ES Isamade, LB Chirdan, ST Edino, ME Ogbe, GO Igun
July-December 2004, 1(1):16-19
Background. Neural tube defects (NTDs) are associated with high childhood morbidity worldwide. We wanted to know the pattern and the possible aetiological factors responsible for this anomaly in northcentral Nigeria. Patients and Methods. The clinical records of all children with NTD admitted at JUTH between 1986 and 2003 were reviewed and the data analyzed for age, gender and antenatal care, incidence, type and location of lesion. Results. There were 284 patients (144 males and 140 females). The incidence of NTD was 0.5/1000 live births and 1.9% of all admissions. The Hausa / Fulani ethnic group constituted the highest proportion. In 165 (58%) patients, the mothers had received antenatal care; however, the antenatal care generally started late in pregnancy. Spina bifida constituted 97% of the total NTDs, 79.6% of which were meningomyeloceles. The sites mostly affected were the lumbosacral and the thoracolumbar regions in 55.8% and 31.9% of cases, respectively. Hydrocephalus was the most common complication occurring in 194 (68.3%) patients. Among those patients presenting with myelomeningocele, 95 (42%) had ruptured sacs, while in 62 (27.4%) the sacs were ulcerated and locally infected; 15 (6.6%) patients had meningitis while 16 (7.1%) had septicemia. Conclusion. The most common type of NTD in this study was lumbosacral myelomeningocele, the majority of which were complicated at presentation. Consanguinity marriage and delayed or absence of antenatal care appear to be important aetiological factors.
[ABSTRACT]   Full text not available  [PDF]
  1,169 102 -
SYMPOSIUM
Challenges of neonatal surgery in Sub-Saharan Africa
Emmanuel A Ameh
July-December 2004, 1(1):43-48
In the last few decades, a better understanding of neonatal physiology and advances in technology and neonatal intensive care have improved the safety and out come of neonatal surgery in developed countries. In sub-Saharan African, however, neonatal surgery is still bedeviled by a myriad of problems, making newborn surgery to be attended by unacceptable morbidity and mortality. The problems range from lack of awareness and late presentation, through shortage of relevant personnel and lack of appropriate equipments and facilities to poor financing for neonatal surgical services. The quality of neonatal surgical service is a measure of the quality of paediatric surgical service provided by any centre. Efforts need to be made by all stakeholders to improve neonatal services in sub-Saharan Africa. Neonates require and certainly deserve the highest level of surgical care.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,153 81 1
CASE REPORTS
Paediatric acquired recto vestibular fistula experience in Accra /Ghana
A Hesse, W Appeadu-Mensah, CE Onuoha
July-December 2004, 1(1):52-54
The association of acquired recto-vaginal fistula (RVF) with the human immunodeficiency virus is increasingly being recognized and reported in the literature Congenital recto - vestibular fistulae associated with imperforate anus is not uncommon, but it is rare to see children with acquired recto - vestibular fistula. From 1997 to 2002, 13 children who presented to the Paediatric Surgical Unit of the Korle-Bu Teaching Hospital with acquired recto - vestibular fistulae were reviewed. The associations of this condition with HIV and management problems are discussed.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,134 61 1
ORIGINAL ARTICLES
Paediatric urolithiasis in Northern Nigeria
AM Abubakar, IA Mungadi, JY Chinda, IO Ntia, I Jalo, SK Obianno
July-December 2004, 1(1):2-5
Background. The incidence of paediatric urolithiasis varies according to geographic areas. In Nigeria, there is paucity of literature on urinary stone diseases in childhood. Materials and Methods. In the period between January 1993 and December 2003, 67 Nigerian children with urinary stones were retrospectively reviewed. Results. There were 63 (94.0%) boys and 4 (6.0%) girls. The mean age at presentation was 6.9 years. Thirty one (46.3%) were in the age group less than 5 years. The commonest presenting symptoms were dysuria 42 (62.7%) and abdominal pain in 30 (44.8%). Pulling on the penis is characteristically present in 26 (38.8%) patients. The stones were located in the lower tract in 57 (85.1%) cases. Anatomic obstruction along the urinary tract was responsible for stone formation in 12 (17.9%) patients. Sixteen (23.9%) patients had associated urinary tract infection. All the stones analyzed were mixed and 75% contained urate. In 7 (10.4%) patients the stones were passed spontaneously. Open surgical technique was employed in the remaining 60 patients. There was no death recorded. Post-operative complications occurred in 15 (25.0%) of the operated patients. The commonest complications were wound infection 3 (5.0%) and vesicocutaneous fistula in 3 (5.0%) patients. The average duration of hospital stay was 16.0 days. Conclusion. In our practice lower tract stones are common and congenital urinary tract obstruction is the commonest identifiable cause for stones. The age and sex distribution and chemical composition are in keeping with historic and endemic stones. Early detection and treatment of urinary tract obstruction will further reduce the durden of stones disease.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,086 78 1
Perspective on paediatric traumatic brain injury
GO Igun, CH Ihezue, OB Lilly-da-tariah, ES Isamade
July-December 2004, 1(1):24-28
Background: Traumatic brain injury is an important aspect of paediatric trauma because of its contribution to mortality ant post trauma seqeulae. Management of traumatic brain injury remains a challenge to surgeons, especially in developing countries. This study aims to determine the pattern of traumatic brain injury among children. Patients and Methods: A retrospective study of a total of 112 children with severe closed head injury was carried out during a fifteen year period at the Jos University Teaching Hospital to comparatively evaluate the epidemiology, clinical presentation and outcome of 42 children aged (4 months to 6 years) in the pre-school age (PSA) versus 70 others aged (6. 13 years) in the school age (SA) bracket. Results: Male to female ratio for PSA was 5:1 versus 4:1 for SA. Road traffic accident (RTA) accounted for a total of 69% of pediatric traumatic brain injury (PTBI). PSA children were less frequently involved in RTA as occupants (15 % versus 56% in SA) but more frequently involved as pedestrians (45% versus 4% respectively). Falls constituted 19% of the total, involving relatively more patients in PSA (36 %t versus 9% in SA). Neck stiffness occurred in a total of 63%, 71% in PSA group versus 59% in SA group. Restlessness was observed in a total of 18%, 29% in PSA compared with 11% in SA. Intracranial hematomas occurred in a total of 29% with sub-dural hematomas predominating in PSA than in SA (32% versus 15%). Coma ranged from 5 weeks in PSA to 3 weeks in SA, with a mean of 4.2 weeks for both groups. A poor outcome (Glasgow outcome score 1, 2,3) was recorded in a total of 20% with a relative majority of patients in PSA (29 % versus 15%). Conclusion: Road traffic accident was responsible for most of the traumatic brain injury in children, especially among the school age group. Traumatic brain injury is associated with high mortality rate in children
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,066 66 1
CLINICAL WATCH
Perineal burns in children
Emmanuel A Ameh
July-December 2004, 1(1):33-35
Perineal burns are not common in childhood but when they occur, they can produce severe complications. Conservative management by open wound care and topical agents is effective in most cases. However, in deep burns and when control of infection proves problematic, diverting colostomy may be necessary to control infection and achieve wound healing and graft take. Burns wound excision and skin grafting may be required in such cases. Contractures of various forms may develop and require plastic procedures for correction.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,020 70 1
ORIGINAL ARTICLES
The management of anorectal injuries in a Nigerian paediatric tertiary centre
Lohfa B Chirdan, Aba F Uba
July-December 2004, 1(1):29-32
Background Anorectal injuries are rare in children. Recently there has been an increasing trend towards primary repair without proximal colostomy. This is a review of our experience with anorectal injuries in children in a paediatric tertiary centre in Nigeria. Patients and Methods All children 15 years or below managed for anorectal injuries in our institution over a 6 year period have been retrospectively reviewed. Results There were 9 children. Five were boys and 4 were girls. Their ages ranged from 4 days - 15 years (median 8 years). Four injuries were due to blunt trauma while 5 were due to penetrating trauma. Road Traffic Accidents (RTAs) and gunshot injuries accounted for 3 each, 1was iatrogenic during Caesarian delivery, while fall from height and cow horn injury accounted for 1 each. Rectal bleeding was the commonest presenting symptom. Only 3 children presented to the hospital within 12 hours of injury. Six had rectal injuries (2 were intraperitoneal and 4 extrperitoneal, 2 of which had associated anal injuries). Three had anal injuries without rectal injuries. Associated injuries were to the colon 2, urethra 2, vagina 2, bone fracture 2, spleen 1, urinary bladder 1 and scrotum 1. Intraperitoneal injuries were treated by repair and colostomy. Extraperitoneal injuries were treated by repair and proximal colostomy in 3; and repair without colostomy in 1. Anal injuries were repaired in 3 children without proximal colostomy after exclusion of proximal injuries. Four children had wound infection (3 without colostomy, 1 had colostomy). One child with intraperitoneal rectal injury associated with colonic and splenic injury died of overwhelming sepsis and multiple organ failure. Faecal continence was achieved in 4 children with anal injuries, while 1 child who had proximal colostomy is awaiting colostomy closure. Conclusion The immediate recognition of anorectal injuries in children is vital to a successful outcome. Though primary repair without proximal colostomy is feasible in selected cases wound complication in this group is high.
[ABSTRACT]   Full text not available  [PDF]
  986 83 -
CASE REPORTS
Cleft of the lower lip: A case report
William Ardill
July-December 2004, 1(1):49-51
Full text not available  [PDF]
  536 59 -
EDITORIAL
African journal of paediatric surgery: A dream come true
Aba Francis Uba
July-December 2004, 1(1):1-1
Full text not available  [PDF]
  407 56 -
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