Oo Chirdan

Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children

BACKGROUND/PURPOSE The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity 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 findings, 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 significantly 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; five (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.

Childhood cancers: challenges and strategies for management in developing countries.

The developing countries bear the greatest burden of childhood cancers as over 90% of the worlds 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.

Supportive supervision: An effective intervention in achieving high quality malaria case management at primary health care level in Jos, Nigeria

BACKGROUND Supportive supervision is a form of supervision that promotes quality at all levels of health system by strengthening relationships within the system through prompt identification and resolution of problems among others. It is an effective intervention in improving health worker performance in low resource settings. Malaria is responsible for majority of outpatient consultations in Nigeria at all levels of care. MATERIALS AND METHODS This was a facility-based interventional study with pre and post-intervention phases conducted among two groups.The study subjects were selected through a multistage sampling technique and data collection was done using both semistructured interviewer administered questionnaire and supervisory checklist. RESULTS The mean knowledge scores of malaria within the intervention group showed an increase from 10.3 ± 1.4 at preintervention to 11.3 ± 1.5 at post-intervention (P < 0.0015). The proportion of respondents who correctly followed malaria management guidelines increased from 32.73% at first supervisory visit to 70.91% by the third supervisory visit (P < 0.001). An analysis of the supervisory checklist showed improvement in performance of healthcare workers with each supportive supervisory visit in most of the variables examined. CONCLUSIONS This study has demonstrated that supportive supervision is a feasible and practicable tool in improving knowledge and practice of malaria case management among PHC workers.

Situational analysis of Orphans and Vulnerable Children in urban and rural communities of Plateau State

BACKGROUND Orphans and Vulnerable Children (OVC) are children affected by HIV and AIDS by virtue of, among others, living in a household where one or more people are ill, dying or deceased, or which fosters orphans, and children whose care givers are too ill or old to continue to care for them. They often have more health needs than their peers. This study was carried out to obtain baseline information on the needs of OVC in North-Central Nigeria as a basis for provision of relief services. METHODS A house to house cross-sectional survey of OVC recruited via a multistage sampling technique was carried out in four LGAs of Plateau State, Nigeria. The Child Status Index (CSI) tool was used to obtain information from the respondents and/or their caregivers. Vulnerability of the children was assessed using a Vulnerability Index (VI) scoring which ranged from 1-21, with 1-9 being vulnerable, 10-14 more vulnerable, and 15-21 being most vulnerable. RESULTS A total of 825 OVC ages ranging from 0-17 years and mean age of 9.8 ± 4.5 years were studied. 432 were males (52.4%) and 393 females (47.6%). 64.8% lived in households headed by women out of which 77.6% were widows. Six hundred and one (72.8%) household heads were farmers. Paternal orphans made up 59.8% of the respondents and 12.1% had lost both parents. Prevalence of abuse/exploitation was 17.7% and 66.7% experienced household food insecurity. Four hundred and seventy-eight (57.9%) OVC lived in households with no source of income. One hundred and fifty-one (18.3%) children (54.9% boys and 45.1% girls) had never been to school. 55.0% had minimal health problems. Majority of them (60.3%) lived in dilapidated shelter and 3.3% were living on the street. CONCLUSION This survey revealed the various needs of OVC. Efforts to care, support and protect vulnerable children should not only focus on their immediate survival needs such as education, shelter and clothing, but also on long-term developmental needs that reduce childrens vulnerability such as life skills, child protection, vocational training, food security and household economic strengthening.

Awareness of occupational hazards and utilization of PPE amongst welders in Jos metropolis, Nigeria

Background: Welding poses a range of both well-known and subtle hazards to health and safety. These hazards can act quickly or may show up only in the long term. They can be rapidly fatal (electric shock or exposure to cadmium fumes) or have delayed effects (lung changes over time). This study aimed to assess the awareness of occupational hazards and utilization of PPE amongst welders in Jos metropolis. Methods: This was a descriptive, cross-sectional study involving 295 welders in Jos metropolis. An intervieweradministered questionnaire was used to collect data which was entered and analyzed using Epi-info version 3.5.4 statistical software. A probability value of p≤0.05 was considered statistically significant. Results: All the respondents were males with a mean age of 24.6±7.7 years. The study revealed that 293 (99.3%) were aware of occupational hazards in welding. In this study, goggles were the most frequently used PPE 98%, then gloves 65.4%, boots 58%, overalls 36.3%, facemask 30.6% and earplugs 12.9%. A statistically significant (p≤0.05) relationship was found between employment pattern as well as working hours per day and the use of safety devices. Conclusions: The study showed that most of the welders had fair knowledge of welding related health problems, hazards and safety devices, and utilization of safety devices was less than optimal. An educational campaign on workplace hazards, types and proper use of different personal protective devices should be instituted for welders on a regular basis by the welders association, local and state government.

Use of community volunteers to improve knowledge and uptake of tuberculosis and human immunodeficiency virus screening services among community members in Qu'an Pan Local Government Area, Plateau State

Background: The global impact of the converging dual epidemics of tuberculosis (TB) and human immunodeficiency virus (HIV) / AIDS is one of the major public health challenges of our time. Ignorance fear stigma and poverty have promoted the course of TB and HIV infections particularly among people residing in the rural areas despite the availability of free diagnostic and treatment services. Community volunteers (CV) have been used successfully to promote and sustain knowledge and utilization of health services in various parts of the world. This study sought to determine the impact of the use of CV on knowledge and uptake of TB / HIV screening services in the study population. Methodology: The study design was a community-based quasi-experimental study. A multistage sampling technique was used to select the study participants. The Primary Health Care (PHC centres offering TB and HIV screening services were the primary sampling units while the communities close to the PHCs were the secondary sampling units. The intervention involved a CV in each community providing education and services on TB and HIV / AIDS infections to the community members. Knowledge and uptake of TB and HIV screening services among the community members were assessed before and after the intervention. Results: A total of 1305 people were recruited into the study and five communities each were selected per PHC. Postintervention there was an increase in the knowledge of the cause mode of transmission symptoms and treatment of TB among community members from a mean score of 2.23 +or- 2.31 to 5.37 +or- 2.64 (P < 0.0001). There was also an increase in the knowledge of the modes of transmission symptoms and prevention of HIV / AIDS among community members from a mean score of 6.66 +or- 2.92 to 8.36 +or- 3.35 (P < 0.0001). Uptake of TB screening rose from 59.4% to 75.0% (P = 0.0161) among community members with a history of chronic cough and uptake of HIV counselling and testing (HCT) also rose from 53.8% to 64.1% (P = 0.0215) among the community members. Conclusion: Community Volunteers were found to improve the people’s knowledge of TB and HIV / AIDS infections as well as uptake of HCT and TB screening services. Their use will help improve TB and HIV collaborative activities and also contribute to the reduction of morbidity and mortality associated with TB and HIV infections.