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Background: Carrying backpacks is believed to contribute to the musculoskeletal problems in school children. Studies on the use of backpacks by Nigerian school children are scanty. Objectives: To evaluate the use of backpack and associated problems among primary school children. Methods: A cross-sectional descriptive study was carried out on 813 children in six primary schools in Ado-Ekiti. Information about backpack use and associated problems were obtained. Results: 788 (96.9%) children carried backpacks daily. The backpacks were all double strapped and 85% pupils wore them on both shoulders. The backpacks of 64.1% of the pupils contained educational materials. In 79.1% of cases, the backpacks exceeded 10% of their body weights. Pain and loss of sporting time were associated with carrying backpacks in 23.2% and 8.2% respectively, 15.3% took analgesic and 5.5% had medical consultations because of backpack injuries. No pupil missed school and none was hospitalised for backpack injury. Complaint of pain was significantly associated with older subjects, carrying heavier backpack and longer period of carrying packs (p

Ndubuisi OC Onyemaechi,1 Omolade A Lasebikan,2 Itodo C Elachi,3 Sunday O Popoola,4 Kehinde S Oluwadiya4 1Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, 2Department of Orthopaedic Surgery, National Orthopaedic Hospital, Enugu, 3Department of Surgery, Benue State University Teaching Hospital, Makurdi, 4Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria Background: Despite the numerous complications associated with traditional bonesetters’ (TBS) practices, their patronage has remained high in developing countries. The aim was to study the reasons patients seek TBS treatment. Methods: This was a descriptive hospital-based study of 120 patients who were treated by TBS. The sociodemographic profile of the patients, details of injuries sustained, reasons for TBS patronage, duration of TBS treatment, the number of TBS visited, the reason for abandoning TBS treatment, patients’ belief about the TBS practice, and outcome of their treatment were studied. Results: Out of 418 patients who presented with musculoskeletal injuries, 120 patients who had been treated by TBS before presentation met the inclusion criteria. The mean age of the patients was 37.4±10.5 years. Advice of relatives and friends, as seen in 35 (29.2%) patients, was the most common reason for TBS patronage. Other reasons were cheaper cost (number [n]=30; 25%), sociocultural belief (n=17; 14.2%), easy accessibility (n=15; 12.5%), fear of amputation (n=13; 108%), and fear of operation (n=10; 8.3%). There was no correlation between these factors and age, marital status, occupation, and educational status (P=0.41). Forty-two (35%) patients believed TBS were not useful, a nuisance (n=30; 25%), useful (n=38; 31.7%), or indispensable (n=10; 8.3%). The opinion of patients about the outcome of TBS practice was: very satisfactory (n=0; 0%); satisfactory but with deficiencies (n=24; 20%); unsatisfactory (n=80; 66.7%); and no idea (n=16; 13.3%). Conclusion: Advice of relatives and friends was the main reason for patronizing TBS. The majority of patients lost confidence in the TBS practice after patronizing them due to the high complication rate. Keywords: utilization, traditional bonesetters, developing country

The Copenhagen burnout inventory-student survey (CBI-SS) has shown promising psychometric properties in diverse student populations. This study aims to investigate the psychometric properties of the Nigerian version of the CBI-SS. This was a cross-sectional study of 635 students from Ekiti State University, Ado-Ekiti, Nigeria. Confirmatory factor analysis (CFA) was utilized to assess the CBI-SS validity. The reliability score of the CBI-SS was 0.957, ranging from 0.862 to 0.914 for the subscales. Correlation coefficients among the four CBI-SS factors ranged from 0.507 to 0.713. The CFA indicated an adequate goodness-of-fit for the four-factor model of the CBI-SS with the sample data. However, Item 10 was removed due to unacceptably low Average Variance Extracted score. The four factors demonstrated a negative correlation with both General Academic Self-Efficacy Scale and Cumulative Grade Point Average. Furthermore, both self-reported burnout and perceived course stress showed associations with the CBI-SS, where lower levels of burnout corresponded with lower median scores on the CBI-SS scales. This study underscores the significance of the CBI-SS in evaluating student burnout within our student population. The findings indicate that the CBI-SS is a highly reliable and valid instrument for assessing student burnout, suggesting its potential for effective utilization in the Nigerian academic context., (© 2024. The Author(s).)

Background: The Maslach Burnout Inventory (MBI) is the most widely accepted tool for assessing burnout among students worldwide. However, no studies have yet tested the validity of the student version of the MBI in Nigeria. The study aimed to assess the factorial structure and cross-cultural validity of the Maslach Burnout Inventory-Student Version MBI-GS (S) in a Nigerian university., Methodology: An online cross-sectional study was conducted among 536 undergraduate students from three departments in the Faculty of Basic Medical Science at a Nigerian university. Data were collected using MBI-GS (S) and a confirmatory factor analysis was performed to explore its factor structure., Results: The results revealed that the three-factor, 15-item structure of the MBI-GS (S) demonstrated a valid factorial structure among Nigerian undergraduate students, evidenced by the extraction of three components with eigen values exceeding 1, accounting for 73.7% of the variance, in line with the three-factor structure of the original MBI. The internal consistency of the questionnaire was high, with a Cronbach's alpha value of 0.901. The Cronbach's alpha for emotional exhaustion, cynicism, and academic efficacy were 0.901, 0.841, and 0.941, respectively. A weak negative correlation was observed between emotional exhaustion and cynicism, and a moderate negative correlation was found between emotional exhaustion and academic efficacy, and cynicism and academic efficacy., Conclusions: These findings suggest that the MBI-GS (S) is a reliable tool for assessing burnout levels among Nigerian university students. They provide strong evidence for the factorial validity and reliability of the MBI-GS (S), supporting its cross-cultural validation for assessing burnout., (Copyright © 2023 Nigerian Medical Association.)

Introduction: Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State., Materials and Methods: A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis., Results: There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM., Conclusion: The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Oluwadiya et al.)

Background: Globally, the medical and teaching professions are two major professions with the highest prevalence of burnout, and academic physicians bestride the two professions. This study investigated the prevalence and associated factors of burnout among academic physicians working in tertiary hospitals in Nigeria., Methodology: This was a self-administered online survey. Burnout was measured using the Maslach Burnout Inventory for Educators (MBI-ES) on Google Form and sent to 256 academic physicians in tertiary hospitals across Nigeria using the WhatsApp broadcast feature. MBI-ES was categorized into two categories (Burnout and No Burnout), and binary logistic regression was used to test the influence of 13 predictors on the three dimensions of MBI-ES as well as MBI in its entirety., Findings: A total of 155 academic physicians responded, resulting in a response rate of 60.5%. There were 121 (80.7%) males and 29 (19.3%) females (five cases respondents omitted this detail). Eighty-seven respondents exhibited moderate to high burnout in at least one of the dimensions of the MBI, translating to a prevalence rate of 57.7% in our study. Five variables, number of peer reviewed articles published, hours of weekly teaching, enjoyment of academic writing, apathy to teaching and religion were all significantly associated with burnout. Moderate to high emotional exhaustion was reported by 30.8% (45 respondents), moderate to high depersonalization by 5.5% (8 respondents),, and low to moderate personal accomplishment by 43.5% (67 respondents).Eight variables: religion, geopolitical zone of practice, enjoyment of academic writing, apathy toward teaching, university ownership, number of published peer-reviewed articles, salary, and supplementary income were significantly associated with emotional exhaustion, while the number of weeks spent teaching in a year and teaching hours/week were significantly associated with depersonalization and personal accomplishment, respectively. Age (OR 1.302, CI 1.080-1.570), Teaching hours/week (OR 0.924, CI 0.854-0.999), Salary (OR 0.996, CI 0.993-1.0), and supplementary salary (OR 0.996, CI 0.993-0.999) were found to significantly predict emotional exhaustion., Conclusion: The study reveals a high prevalence of burnout (57.7%) among academic physicians in Nigeria, highlighting an urgent need for targeted interventions and policy changes. Given the significant role these professionals play in healthcare and medical education, immediate action is essential to address this issue. Future research should focus on evaluating the effectiveness of preventive measures and exploring the long-term impacts of burnout., (© 2023. The Author(s).)

Background: The impact of artificial intelligence (AI) has been compared to that of the Internet and printing, evoking both apprehension and anticipation in an uncertain world., Objective: This study aimed to explore the perceptions of medical students and faculty members from ten universities across Nigeria regarding AI., Methods: Using Google Forms and WhatsApp, a cross-sectional online survey was administered to clinical year medical students and their lecturers from ten medical schools representing all the six geopolitical zones of Nigeria., Results: The survey received 1003 responses, of which 708 (70.7%) were from students and 294 (29.3%) were from lecturers. Both groups displayed an average level of knowledge, with students (Median:4, range -5 to 12) significantly outperforming lecturers (Median:3, range -5 to 15). Social media (61.2%) was the most common form of first contact with AI. Participants demonstrated a favourable attitude towards AI, with a median score of 6.8 out of 10. Grammar checkers (62.3%) were the most commonly reported AI tool used, while ChatGPT (43.6%) was the most frequently mentioned dedicated AI tool. Students were significantly more likely than lecturers to have used AI tools in the past but <5% of both groups had received prior AI training. Excitement about the potential of AI slightly outweighed concerns regarding future risks. A significantly higher proportion of students compared to lecturers believed that AI could dehumanise health care (70.6% vs. 60.8%), render physicians redundant (57.6% vs. 34.7%), diminish physicians' skills (79.3% vs. 71.3%) and ultimately harm patients (28.6% vs. 20.6%)., Conclusion: The simultaneous fascination and apprehension with AI observed among both lecturers and students in our study mirrors the global trend. This finding was particularly evident in students who, despite possessing greater knowledge of AI compared to their lecturers, did not exhibit a corresponding reduction in their fear of AI.

Purpose: This study evaluated the efficacy of continuous passive motion (CPM) versus conventional physical therapy (CPT) in the early postoperative period following retrograde femoral nailing (RFILN). Based on the principles of operation of CPM, we hypothesized that it would improve knee function and decrease pain after open reduction and internal fixation with a retrograde femoral interlocking nail., Patients and Methods: Eighty-eight patients over the age of 18 years who met the inclusion criteria got randomized into one of two groups. The experimental group had CPM, while the control group had CPT. Postoperative knee functions assessed were the degree of knee stiffness, the total arc of motion, and knee pain. Knee stiffness, defined as the range of motion ≤ 90° assessed one week, two weeks, and six weeks postoperatively, while knee pain was measured using the visual analog scale (VAS) on days one, two, three, four, five, six and seven postoperatively., Results: The CPM group had a significantly lower incidence of knee stiffness at one week, two weeks, and six weeks postoperatively than the CPT group (all p < 0.0001). The VAS scores of the CPM group on days one, two, three, four, five, six and seven were significantly lower than those of the CPT group (p < 0.006 for day one and p < 0.001 for the remaining days). Similarly, the total arc of motion gained postoperatively was significantly greater in the CPM group than in the CPT (all p < 0.001)., Conclusion: The continuous passive motion effectively reduced the number of patients with knee stiffness and knee pain. It increased the total arc of motion in the early postoperative period compared to CPT. Therefore, we recommend CPM for patients undergoing retrograde femoral nailing use in the early postoperative period., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Introduction: orthopedic residency training was established in the West African sub-region a few decades ago, but sub-specialty in arthroscopy has only become established in the last decade. This study was aimed at evaluating available arthroscopy training resources and their impact on skill acquisition by orthopedic residents., Methods: this was a cross-sectional study involving the use of a structured online survey of consultant orthopedic surgeons and orthopedic resident doctors. Details relating to the structure of training and challenges with training and recommendations for improved training were enquired., Results: one hundred and two responses were received. There were 95% males (73) and 5% (4) females among the residents and 92% (23) males and 8% (2) females among the responding consultants. Of the residents, 47% (36) were registrars while 53% (41) were senior registrars. Seventy-six percent (77) were residents and twenty-five (24%) were consultants. Didactic lectures were the most impactful available training adjunct. Only 3% (2) of the residents had access to dry laboratory sessions with no specified number of practice hours attached. There was no computer simulation laboratory or cadaveric laboratory training facility for arthroscopy training in any of the training centres. Ninety-two percent (23) of the responding consultants would prefer a 6-12-month rotation in arthroscopy for residents. Fifty-three percent (41) of the residents had regular opportunities to participate in arthroscopic surgeries., Conclusion: orthopedic residency in arthroscopy in Nigeria is emerging and can be improved upon by increasing the available training resources and trained personnel., Competing Interests: The authors declare no competing interests., (Copyright: Oladimeji Ranti Babalola et al.)

Background: Traumatic injuries are a serious public health problem. The burden of these injuries is increasing globally, and there is evidence that the pattern is changing., Objective: The study had two objectives. The first was to determine the aetiology and clinical spectrum of trauma in a teaching hospital. The second was to determine whether these have changed compared with previous reports from the region., Materials and Methods: Between September 2017 and August 2018, data from injured patients who presented consecutively to the accident and emergency department at the Federal Teaching Hospital Ido-Ekiti, Nigeria, were prospectively collected using a trauma data form and analysed., Results: Road traffic crashes (RTCs) caused 75.6% of the injuries, and motorcycle crashes accounted for more injuries than all the other major causes of injuries combined. Compared with previous studies from the same hospital, assault has risen to the second position, whereas falls have fallen to the third position as causes of traumatic injuries. The Injury Severity Scores (ISS) of the patients ranged from 1 to 75, with a mean score of 7.01. The mortality rate was 2.5%. Time to treatment: odds ratio (OR) = 3.25 (1.1-10.0), ISS: OR = 1.172 (1.07-1.28), age: OR = 1.097 (1.013-1.188), and systolic blood pressure: OR=1.07 (1.106-1.025) were the significant predictors of mortality. No patient was transported to the hospital in an ambulance., Conclusion: The pattern of trauma in the subregion is changing as the proportion secondary to RTCs and motorcycle crashes is higher than previously reported studies from the area. The implication of this finding for the prevention of RTCs is discussed., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of the West African College of Surgeons.)

Background: The advent of COVID-19 pandemic affected education which necessitated rapid adjustments and reorganizations in the approach to learning. This study examined undergraduate students' perception on the pandemic and its effect on medical education., Methods and Materials: A cross-sectional online questionnaire-based survey of students in the College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria. A google form, free open-source software survey tool, was used to collect data on different domains like socio-demographic characteristics, preparedness and disposition to virtual learning in pandemic, risk perception, and knowledge on COVID-19., Results: A total of 568 participants took the survey with 311 (54.8%) females and a median age of 20 (IQR: 18-22) years. Four hundred and eighty-two (84.9%) of the students had regular access to the Internet, 57 (10%) have occasional access while 29 (5.1%) had no access. Three hundred and fifteen (56%) of the students agreed that their digital and online skills will be better after the pandemic. All the students were aware of the pandemic however, 441 (77.6%) students were aware of the pandemic through the social media, 79 (13.9%) through television and newspapers and 32(5.6%) through family and friends while only 4 (0.7%) became aware of the pandemic through healthcare workers. The median risk perception score for COVID-19 was 24 (IQR: 19-29)., Conclusion: The study participants were ill-disposed to virtual learning recommended during the pandemics and had a low-risk perception of COVID-19. Hence, there is an urgent need for continuous education on the benefits of virtual learning beyond the COVID-19 pandemics and the need to adopt proactive measures in anticipation of future outbreaks of other infectious diseases., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Objective: To determine the prevalence of crash and associated factors among commercial motorcyclists in Owo, Ondo State, Nigeria., Methods: This study is a descriptive cross-sectional study. Data was collected by using pre-tested structured questionnaires administered to commercial motorcyclists. Collected information was socio-demographic characteristics of the respondents, riding experience, formal training, possession of valid drivers' licence, motorcycle ownership status, mobile phone usage, history of crash in the previous one year, riding hours per day, helmet use, carrying more than one passenger, riding against traffic and daily income., Results: The study were enrolled 502 individuals with a mean age of 31.5±8.7. The ratio of men to women was 250:1. All respondents who admitted to engage in the study had at least one risky behaviour in the past (95.4% admitted to transporting one passenger more than the legal) and 56.6% admit to a prior history of traffic offences. The crashes' predictive factors include respondent age, cell phone use while riding, prior traffic offences, carrying more than one pillion rider, use of stimulants such as kolanut and bitter kola, alcohol drink riding, and admission of fault in the prior of crashes., Conclusion: Commercial motorcyclists in Owo, Ondo State Nigeria engaged in risky behaviours that raised their likelihood of being involved in crashes. The objectives of public enlightenment and driver education at these behaviours could help to reduce the occurrence of crashes among them., Competing Interests: The authors declare that there is no conflict of interest.

Background: The World Health Organization prioritizes malaria surveillance for accurate tracking of progress of intervention programmes. The malaria parasite rate (PR) and spleen rate (SR) are economical surveillance tools. There has been a global decline in the burden of malaria over the last decade, but most African countries, like Nigeria, have a slow rate of decline. There is a need for adequate malaria surveillance to guide malaria control strategies and policymaking., Methods: A community-based cross-sectional study was conducted among 363 children ages 1-15 y in rural southwest Nigeria. The participants' PR was determined by microscopy and the SR was determined by palpation and ultrasonography. The associations between PR and SR and other covariates were assessed., Results: The PR was 26.7% and the SR was 12.9%. There was no significant association between PR or SR across age groups, but low social class was significantly associated with PR (55 [33.5%], p=0.004) and SR (29 [17.3%], p=0.013). The odds of having splenomegaly doubled with malaria parasitaemia (odds ratio 2.03 [95% confidence interval 1.06 to 3.88)., Conclusions: The PR and SR suggest that the study area is meso-endemic. The PR in the study area was almost equal across age groups; our findings suggest there may be a need for policy review to plan malaria intervention programmes and include older children, not just children <5 y of age. Routine malaria surveillance using simple tools such as the PR and SR are necessary for reviewing malaria control programmes in the community., (© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: HIV/AIDS is a global health challenge with a high burden in sub-Saharan Africa. Long-distance drivers are a high-risk group whose assessment of HIV status, awareness and willingness to undergo HIV self-testing (HIVST) could help prevent the spread of HIV infections., Objective: This study examined the sexual practices, risk perception and HIVST acceptability among long-distance truck drivers in Ekiti State, Nigeria., Methods: A cross-sectional study was conducted among long-distance truck drivers between September 2019 and December 2019. A semi-structured questionnaire was designed to investigate the perceived sexual risk factors and willingness to undergo HIVST., Results: Of the 306 drivers that participated in the study, almost half (49.8%) had their first sexual experience before they turned 18 years. About one-third (38.6%) had multiple sex partners and (34.0%) patronised commercial sex workers in the past 6 months. Consistent use of condoms was reported in a negligible percentage (3.0%), while 7.4% used intravenous drugs. Two-thirds of the respondents were interested in HIVST, while 32.2% knew their HIV status. Significant factors associated with multiple sex partners were the duration of working as a long-distance truck driver and patronage of sex workers., Conclusion: A significant proportion of the long-distance drivers were engaged in unsafe sexual practices and are at risk for HIV transmission. Considering the mobile nature of the long-distance drivers, the risky practices of these workers require intense advocacy, testing and treatment to reduce HIV transmission. Scaling-up testing using HIVST has the potential to bridge the gap in the diagnosis of HIV among long-distance drivers who are willing to be tested., Competing Interests: None

To evaluate the radiographic characteristics and prevalence of fabella and patella variants in an indigenous African population. This retrospective observational study of orthogonal knee radiographs of 377 consecutive subjects was conducted in Lagos, Nigeria, from February 2017 to November 2017. The presence of bipartite/multipartite patella, as well as the presence of fabella were noted. The craniocaudal diameter, anteroposterior diameter, fabello-femoral distance and fabello-tibial distance of the fabella were measured. P ≤0.05 represented a statistically significant result. Three hundred and seventy-seven subjects were enrolled. The average age was 41.22±21.37 years with a range of 3-100 years old. There were 158 male (41.9%) and 219 female (58.1%) subjects. The prevalence of fabella was 11.94%. There was a positive correlation between age <47 and ≥47 and occurrence of fabella, P <0.015. There was no statistically significant difference between the mean male and female measured fabella diameters. The overall prevalence of bipartite and multipartite patella in this study was 2.12%. Among male and female subjects, the difference in prevalence of bi and multipartite patella was statistically significantly, P =0.03. The prevalence of fabella and patella variants was lower in this study compared to the findings in other populations and ethnicities. Sex and age were significantly correlated with fabella prevalence. The results reported in this study will facilitate future studies examining the correlations between fabella and patella variants and various knee pathologies in a population of Black African descent.

This study investigated the spatio-temporal variations in the occurrence of COVID-19 (confirmed cases and deaths) in relation to climate fluctuations in 61 countries, scattered around the world, from December 31, 2019 to May 28, 2020. Logarithm transformation of the count variable (COVID-19 cases) was used in a multiple linear regression model to predict the potential effects of weather variables on the prevalence of the disease. The study revealed strong associations (-0.510 ≤ r ≤ -0.967; 0.519 ≤ r ≤ 0.999) between climatic variables and confirmed cases of COVID-19 in majority (68.85%) of the selected countries. It showed evidences of 1 to 7-day delays in the response of the infection to changes in weather pattern. Model simulations suggested that a unit fall in temperature and humidity could increase (0.04-18.70%) the infection in 19.67% and 16.39% of the countries, respectively, while a general reduction (-0.05 to 9.40%) in infection cases was projected in 14.75% countries with a unit drop in precipitation. In conclusion, the study suggests that effective public health interventions are crucial to containing the projected upsurge in COVID-19 cases during both cold and warm seasons in the southern and northern hemispheres., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The modern arterial tourniquet is an automatic tourniquet system which contains many features that help to minimise complications and improve safety. However, the non-pneumatic tourniquet is still in use, a practice that may be commoner in resource-constrained settings. This study was conducted to investigate the types of tourniquet available and used by orthopaedic surgeons in Nigeria as well as the practical aspects and complications of their use of the tourniquet., Materials and Methods: At an Annual General Meeting/Scientific Conference of Nigerian Orthopaedic Association, a survey was conducted among orthopaedic surgeons using a pre-tested self-administered questionnaire which contained questions on types of tourniquet, practical aspects of the use of tourniquet and complications., Results: The non-pneumatic tourniquet was usually used by 60.2% of the respondents and 58.1% of those who had both pneumatic and non-pneumatic tourniquets used the latter more commonly. In most cases, the tourniquet was applied by surgeons or surgical residents on the arm or thigh. Surgeons who had ever used the tourniquet in diabetic patients were 71.6% while 29.5% had used it in patients with sickle cell disease. Tourniquet duration was usually 1½ h and 2 h in the upper and lower limbs, respectively. The two most common complications were tourniquet palsy and tourniquet pain., Conclusions: The non-pneumatic tourniquet was more commonly used than the pneumatic tourniquet. Application of the tourniquet on sites other than the thigh and the upper arm were uncommon. The most common complication was neurologic injury., Competing Interests: None

Context: Few studies have been conducted to investigate the driving behaviour of drivers in Africa., Aims: This study aims to determine the behavioural risk factors for road crashes among Nigerian drivers., Settings and Design: This is a case-control study. Cases were drivers who were booked for traffic violation or who had been involved in road crashes in the past, while the controls were drivers with no such histories., Subjects and Methods: Both the cases and controls were administered the Driver Behaviour Questionnaire (DBQ). Principal component analysis with varimax rotation was run to examine the factor structure of the scale. Cronbach's alpha was used for assessing the internal consistency of the DBQ, and logistic regression was used to determine risk factors for crash involvement., Results: Six hundred active drivers consisting of 300 cases and 300 controls were selected. The mean scores of all DBQ items, except one, were significantly higher among booked drivers compared to those who had never been booked. Consistent with many previous studies, factor analysis identified three factors in the DBQ (aggressive violation, ordinary violation and error). However, the factors were constructed differently with most ordinary violation items in the original DBQ loading as aggressive violation in the present study. Eight variables were predictive of being booked for traffic offences while only five variables were predictive of self-reported crash involvement., Conclusions: The most important variable associated with previous crash involvement was alcohol use. A major policy implication of this is the need for better attention to anti-drunk driving measures., Competing Interests: None

Background: Surgical checklist was introduced by the World Health Organization to reduce the number of surgical deaths and complications. During a surgical conference on "safety in surgical practice," it was noticed that the awareness and the use of surgical checklist are poor in Nigerian hospitals. This study was aimed at determining the awareness and use of surgical checklist among the theater users in our hospital, factors militating against its implementation, and make recommendations., Methods: This is a prospective study at Ekiti State University Teaching Hospital, Ado-Ekiti; questionnaires were distributed to three groups of theater users - surgeons, anesthetists, and perioperative nurses. The responses were collated by the lead researcher, entered into Microsoft Excel spreadsheet, exported, and analyzed with SPSS., Results: Eighty-five questionnaires were distributed, 70 were returned, and 4 were discarded due to poor filling. The studied 66 comprised 40, 12, and 14 surgeons, anesthetists, and perioperative nurses, respectively. Fifty-five (83.3%) of the responders indicated awareness of the checklist but only 12 (21.8%) correctly stated that the main objective is for patients' safety and for safe surgery. Major barriers to its use include lack of training 58.2%, lack of assertiveness of staff 58.2%, and that its delays operation list 47.2%., Conclusion: The study demonstrated high level of awareness of surgical checklist in our hospital; however, this awareness is based on wrong premises as it is not reflected in the true aim of the checklist. Majority of the responders would want to be trained on the use of checklist despite the highlighted barriers., Competing Interests: There are no conflicts of interest.

Background: Self-discharge by patients without completing their treatment is a problematic issue in healthcare and is strongly associated with readmission and poor treatment outcome., Patients and Methods: A descriptive study of the rate and reasons why patients with limb injuries took self-discharge against medical advice (DAMA) from our facility, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, a tertiary health institution between May 2011 and April 2014., Results: One hundred and thirty-one (16.2%) patients took DAMA out of 810 patients seen with limb injuries. Age ranges from 3 to 95 years with a mean of 36.31 ± 19.34 years. Road traffic crash accounted for 110 (84%) of the injuries. One hundred and sixteen (88.5%) had fractures and 9 (6.9%) had soft tissue injuries. Fifty-eight (44.3%) of the patients were referred cases, 128 (97.7%) signed DAMA form while 3 (2.3%) absconded from the hospital. Reasons for DAMA were mainly; belief more in traditional bone setters (TBSs) (36.6%); pressure from relations (22.9%) and high cost of hospital care (19.8%). One hundred and one (77.1%) of the patients volunteered that they were going to TBS for continued care., Conclusion: High percentage of patients DAMA from our facility and majority of them were in favour of unorthodox form of treatment.

Background: Sub-Saharan Africa has the largest burden and worst outcome of sickle cell disease (SCD). This gloomy outlook has been attributed to the lack of use of simple and cost-effective measures for diagnosis and treatment of the disease. Although haematology analysers are the gold standard for accurate measurement of haemoglobin (Hb) concentration, they are often out of reach of most health facilities in resource-poor settings, thus creating a care gap. We conducted this study to examine the agreement between a point-of-care device and haematology analyser for determining the Hb concentration in children with SCD and its usefulness in resource-poor settings., Methods: Ethylenediaminetetraacetic acid blood samples collected from participants were processed to estimate their Hb concentration using two devices (Sysmex KX21N haematology analyser and portable mission Hb device). The agreement between the two sets of measurements was assessed by the Bland and Altman method., Results: The intraclass and concordance correlation coefficients were 0.854 and 0.936, respectively. Sensitivity and specificity were 84.2% and 98.6%, respectively. The positive and negative predictive values were 94.1% and 96.0%, respectively. The Bland and Altman's limit of agreement was -2.3 to 1.6 and the mean difference was -0.34 with non-significant variability between the two measurements (p  =  0.949)., Conclusion: Hb concentration determined by the portable testing system is comparable with that determined by the haematology analyser. We recommend its use as a point-of-care device for determining Hb concentration of SCD children in resource-poor settings where haematology analysers are not available., (© The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background . Peripheral arterial disease (PAD) is a major risk factor for nonhealing foot ulcers in people with diabetes. A number of traditional risk factors have been reported to be associated with PAD; however, there may be a need to consider nontraditional risk factors especially in some vulnerable populations. This study determined the prevalence and risk factors associated with PAD in diabetics. Methods . One hundred and fifty type 2 diabetics and an equal number of age- and sex-matched apparently healthy controls were studied. Assessment of PAD was made using history, palpation of lower limb vessels, and measurement of ankle-brachial index (ABI). Statistically significant differences between categorical and continuous variables were determined using Chi square ( χ 2 ) and Student t -tests, respectively. Regression analysis was done to determine the associated risk factors for PAD. Results . Prevalence of PAD using ABI was 22.0% and 8.0% among diabetic and nondiabetic populations, respectively. Peripheral arterial disease was associated with age, male gender, waist circumference, and high-sensitivity C-reactive protein. Conclusion . This study highlights the high prevalence of PAD in people with type 2 diabetes mellitus and in apparently healthy controls; age, male gender, abdominal obesity, and high hs-CRP values were the associated risk factors.

In developing countries, most motorcycles are ridden with more than one occupant. The objective of this study was to establish the relative vulnerability of riders and co-riders to injury and determine the injury risk factors in multi-occupant motorcycle crashes. Between January and December 2010, we collected crash and injury data from victims of multi-occupant motorcycle. It is a hospital-based study. The probability of sustaining injuries was similar for co-riders and riders, but co-riders were more likely to sustain severe injuries. Occupants of >2-occupant motorcycles were also more likely to be involved in risky behaviours like not wearing helmet and speeding than those on 2-occupant motorcycles. Occupants of motorcycles on which there were more than two occupants were at an increased risk of sustaining injuries compared with occupants of motorcycles with only two occupants (OR: 2.1, 95% CI: 1.1-4.3). Motorcycle co-riders were more vulnerable to severe injuries than riders. The significance of the study finding to prevention was discussed.

There is paucity of reports describing the pattern of surgical mortality in Nigeria. The aim of this study was to determine the incidence and pattern of mortality associated with surgical care in our hospital and to identify areas of improvement. The records of all patients who died after admission for surgical care at the Federal Medical Centre Makurdi between January 2009 and December 2011 were studied retrospectively. Data extracted were patients' demographics, surgical diagnosis, co-morbidity, surgical procedures performed, duration of hospital admission and outcome of treatment. Data were analyzed with SPSS version 17. There were 2,273 admissions into the surgical wards within the study period. During this period, there were 151 deaths with a crude mortality rate of 6.6 %. Ninety-four (62.3 %) patients were males and 57 (37.7 %) were females (M:F = 1.6:1). The age of the patients ranged from 8 days to 95 years with a mean age of 36.1 ± 20.1 years. Acute abdomen (37, 24.5 %), traumatic brain injury (32, 21.2 %) and malignancy (28, 18.5 %) were the commonest surgical diagnosis. Trauma-related deaths accounted for 48 (31.8 %) of all the deaths. Road traffic crash (89.6 %) was the commonest cause of injury. Surgical operations were performed in 75 (49.7 %) of the patients who died, while 76 (50.3 %) did not have any operative intervention. Mortality in patients admitted into the surgical ward was 6.6 %. Trauma-related death was the commonest. Traumatic brain injury, typhoid perforation of the bowel and malignancy were the leading causes of surgical death in our centre.

Background: Injury threatens children lives worldwide. Most studies from Nigeria have been on accidental injuries in children., Objectives: To study the profile of non-accidental injuries among children receiving care at a tertiary hospital in Nigeria., Methods: Children with non-accidental injuries were serially recruited and studied. The Paediatrics Trauma Score (PTS) was tested against the outcome., Results: Non-accidental injuries accounted for 0.84% of all 5264 patients and 21.3% of the 207 injured. The case fatality rate was 6.8%. Physical abuse, sexual assault, drowning/near drowning, gunshot, poisoning and human bite caused the injuries in 68.2, 13.6, 6.8, 4.5, 4.5 and 2.3%, respectively. One-way analysis of variance and Tukey post hoc analysis showed that the mean PTS score of patients who died was significantly lower than the scores of those who were either discharged home or who discharged against medical advice (p < 0.001)., Conclusion: The burden of non-accidental childhood injuries was high in the study area., (© The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Seat belts are designed to reduce injuries due to road crash among vehicle occupants., Aims: This study aims to determine the availability of seat belt in vehicles and compliance with seat belt use among vehicle occupants., Materials and Methods: This was a 24-h direct observational study of seat belt usage among vehicle occupants in Makurdi, Benue State, Nigeria. By direct surveillance and using a datasheet, we observed 500 vehicles and their occupants for seat belt availability and compliance with its use. Chi-square test was used for test of significance between variables., Results: Twenty-five (5.0%) of the observed 500 vehicles had no seat belt at all. Overall, compliance was 277/486 (57.0%). Use of seat belt was highest in the afternoon with 124/194 (64.4%), followed by 111/188 (59.0%) in the morning and 42/95 (44.2%) at night. Compliance was highest among car occupants [209/308 (67.9%)] and private vehicles, and lowest among commercial vehicle occupants. Compliance among female drivers was 77.1% compared with 51.4% among male drivers. Among drivers, the mean age of seat belt users was 38.4 (7.7) years, which was significantly younger than the 41.3 (8.7) years mean age of non-users. Similar figures were obtained among other vehicle occupants., Conclusions: Compared with previous studies, seat belt usage has improved among Nigerian road users, but there is still room for improvement, especially early in the mornings and at nights. Since these were times when law enforcement agencies were not likely to be on the roads, we advocate for improved coverage by enforcement agents to enforce better compliance.

All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many low-and middle-income countries, the death rates from trauma in the pediatric age group exceed those found in developed countries. Much of this mortality is preventable by developing suitable preventive measures, implementing an effective trauma system and adapting interventions that have been implemented in developed countries that have led to significant reduction in both morbidity and mortality. This review of literature on the subject by pediatric and orthopedic surgeons from different centers in Africa aims to highlight the challenges faced in the care of these patients and proffer solutions to the scourge.

Unlabelled: AIMS AND OBJECTIVES. The objective of this paper is to estimate the prevalence of examination malpractice among medical students; its import on medical education and future doctors., Materials and Methods: Structured questionnaires were administered to consenting medical students of participating four medical colleges in Nigeria. Data was collated and analysed using SPSS version 11., Results: Three hundred and eighty two students responded. There were 210 males and 172 females (M: F-1.2:1); age range 19-45 years, mean 24.86 ± SD. Majority 304(79.6%) were in the 5th and final years. At secondary and tertiary levels, 67(18.1%) and 79(22.2%) were respectively involved in cheating. Mode of cheating included seeking examination materials, 10(2.6%); copying answers between examination rooms, 18(4.8%); copying assignments, 290(77.7%) and copying laboratory results 206(56.6%). Clinical examinations not performed were described as "normal" by 206(56.6%). Motivation for cheating included previous failures and escape punishment in 6(3.3%) and 31(10.4%) respectively. While 46(12.8%) tried to induce lecturers to change grades, 97(25.8%) would not inform the authority if they suspected that examination leaked., Conclusion: Examination malpractice in High schools and Tertiary institutions also includes the medical students. Educating pupils from the elementary schools on effects of cheating, inclusion of this practice in the medical curriculum as part of Medical Ethics and Institutional culture of Integrity among doctors are recommended. Stiffer punishment for offenders would reduce the practice among the students.

HIV infection is rapidly emerging as a predominant cause of morbidity and mortality in children from developing countries. This probably accounts for the many reports that have emanated from resource-limited settings in the last decade. Reports highlighting bone infections and untoward complications in HIV-infected children are rare. This informed our decision to report the case of a 9-month-old HIV-positive Nigerian girl who presented with blistering dactylitis of the right middle finger. Plain radiograph of the right hand showed amputation of the terminal phalanx and changes consistent with osteomyelitis in the middle phalanx of the third finger. The case is discussed with a view of highlighting this rare complication and the challenges associated with management in a resource-limited setting.

Introduction: Brodie's abscess is not a common variant of subacute osteomyelitis; however, when it does occur, the presentation is atypical and usually late. This study aimed to describe the mode of presentation of Brodie's abscess and evaluate the results of surgical treatment in a resource-poor setting., Method: Over a five-year period, we retrospectively reviewed 20 patients who presented to two tertiary health institutions in south western Nigeria with clinical and radiological features of Brodie's abscess., Results: Brodie's abscess accounted for just 2 percent of all patients with osteomyelitis. Most patients were adults (mean age 21.5 +/- 7.8 years) and males (75 percent). In the series, the tibia was involved in 50 percent of the cases, the femur in 30 percent, and the radius and fibula each in 10 percent. The diaphyseal part of the long bones was affected in 65 percent of the patients and the metaphysis, in the remaining patients. The average size of the cavities was 3.0 +/- 0.8 cm. 65 percent of the isolates yielded Staphylococcus aureus. All patients were treated by curettage of the abscess cavities, cancellous bone grafting and antibiotics. All patients had satisfactory outcomes, with complete incorporation of the grafts and new bone formation in the cavities. No patient reported any recurrence., Conclusion: Patients with Brodie's abscess respond well to surgical curettage of the abscess, cancellous bone grafting and antibiotic therapy.

Objective: To identify bacterial isolates from superficial swabs of open fracture wounds at presentation and after infection has been established, and to determine if there are correlations between them., Method: Patients who presented with open fractures at the Wesley Guild Hospital, Ilesa, Nigeria between December 2004 and May 2006 were recruited into this prospective study. Superficial wound swabs were taken at presentation and if patient showed evidence of wound infection., Results: Sixty patients had open fractures. The initial bacteria culture of wound swabs taken on the day of presentation was positive in 41 (68.3%) patients. Of these, 19 (46.3%) yielded one bacteria isolate, 17 (41.5%) yielded two and 5 (12.2%) yielded three, making a total of 68 organisms. The most common organism was Staphylococcus aureus. However, as a group, more aerobic Gram-negative rods were isolated than any other bacteria groups. Eleven (18.3%) patients developed wound infections, all of which were polymicrobial. In 10 (90.9%) of these, the microbial isolate of the final wound swab included at least one organism that was present in the initial wound culture. No patient with an initial negative culture went on to develop a wound infection. The mean presentation interval of patients with wounds that became infected was 15.2 ± 7.9 hours (95% CI 9.8-20.5 hours) compared with 2.9 ± 3.1 hours (95% CI 2.0-3.8 hours) for those who did not develop a wound infection (p>0.01)., Conclusion: In a resource-poor setting, where pre-hospital care is unavailable and patients present late, superficial wound swabs are effective in predicting subsequent organisms that may cause wound infections., Conflict of Interest: None.

Despite being the second most common cause of road traffic injuries (RTIs) in Nigeria, no study had examined the peculiarities of motorcycle crash site characteristics in Nigeria. We examined and interviewed 363 motorcycle RTI patients in three tertiary hospitals in southwest Nigeria. All the motorcycles are small with capacities between 80 and 125cm3. 68.9% of the patients sustained their injuries while working or going to work and 23.4% on their way to school. 176 (48.5%) of the crashes were with moving vehicles and in 83 (22.3%) cases, either the motorcycle or the other vehicle is moving against the traffic. 37.8% of all crashes occurred at junctions with no roundabout versus 5% at junctions with roundabout. Some risky practices of the patient included carrying more than 2 persons (15.02%), travelling without headlight at night (31.7%) and not wearing helmets (96.5%). This study showed that risky behavior among motorcycle riders, chaotic traffic and road design faults accounted for most of the motorcycle crashes. The implications for the prevention and control of motorcycle injuries were discussed.

Objectives: In Nigeria, owners of commercial minibuses commonly modify them by adding an extra row of seats and passengers also seat four abreast rather than the recommended three abreast. The modified minibuses carry nineteen passengers rather than the recommended twelve passengers. One such vehicle was fully occupied and had a head-on collision with a truck. Eight of the nineteen occupants sustained nine posterior dislocations of the hip joint., Methods: We compared the seating space and the leg room of a similarly modified vehicle to an unmodified one., Results: The legroom had been reduced from 120 cm in the unmodified vehicle to between 60 and 70 cm in the modified vehicle. We postulate that the tighter seating space forced the limbs into adduction and the shorter legroom caused the limb to more readily strike the seat in front, causing the hips to dislocate posteriorly., Conclusions: We recommend that the authorities put a stop to uncensored vehicle modifications to reduce hip injuries.

An 8-year-old girl sustained closed fracture of the right ulna 10 weeks prior to presentation. She was taken to a traditional bone setter who applied a tight splint. The patient reported pain, but the splint was not removed. A week after application of the splint, a foul odor was detected and removal of the splint showed extensive exposure of the forearm bones. Above elbow amputation was rejected by the patient's parents when she was taken to hospital, where she was admitted for 8 weeks by a second traditional bone setter. A trained nurse applied herbal concoctions and dressed the wound daily in anticipation that the skin would cover the exposed bone fragments. She was brought to our hospital for wound dressing so that the skin would cover the exposed bones fragments. Examination revealed a grossly shortened right forearm--by 7 cm compared with her left--extensive exposure of both radius and ulna at the anterior aspect of the forearm, and loss of sensation and movement of the fingers. Radiographs showed sequestrated radius and ulna with involucrum around the olecranon process. Above elbow amputation was offered to the patient but the parents again declined. The forearm bones detached while scrubbing the wound for review and removal of the sequestrated bone. The wound healed within one and a half weeks of dressing, resulting in an acquired boneless forearm.

Background: Cancellation of cases on the scheduled day of surgery leads to an inefficient utilisation of scarce hospital and patient's resources. Identifying the causes of such cancellations will assist in taking steps to avoid them., Methods: This is a retrospective study spanning 10 years. Record was taken of all patients who had orthopaedic surgery at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria. The age, sex, type of operation, whether or not the surgery was ever postponed or cancelled, the duration and reasons for such postponements and the duration of admission were collated and analysed., Results: Five hundred and fifty two (40.8%) of the 1,353 orthopaedic patients scheduled for surgery experienced cancellation. The most common reasons were attributable to the hospital (48.7%) mainly due to infrastructural breakdown (28.7%) and procedural lapses by hospital personnel (20.0%). Self cancellation by patient (37.8%) followed and was mainly due to financial constraints (25.6%). Upper respiratory tract infections were responsible for the cancellation in 8.6%. These delays were responsible for more than 30% of the duration of admission in 93 (16.8%) patients., Conclusion: The incidence of postponement of cases on the scheduled day of surgery is still high. Most of the causes are preventable. Better infrastructural facilities, enhanced interdepartmental communication and improved attitude to work would reduce the rate and thus enhance utilisation of theatre space.

Pre-hospital care in developing worlds has been found to be grossly deficient compared to high income countries. The pre-hospital care given to road accident victims attending the casualty departments of four tertiary level hospitals in South Western Nigeria was assessed using a one-page pro-forma. 1996 patients with injuries from road crashes were seen in the hospitals, only 172 had any form of pre-hospital care, just 160 were transported in ambulances and none had any form of organized pre-hospital care. The mean arrival time in the hospital after crashes was 93.6 minutes and there was a high rate (29.5%) of inter-hospital referral. For every Revised Trauma Score (RTS), the Probability of survival (Ps) of the patients was higher than the Ps of patients from high income countries.

Background: Motorcycles have become a very popular means of transportation in Nigeria. This paper is a hospital based study of limb injuries resulting from motorcycle accidents in an urban centre in Nigeria., Method: All patients reporting to the emergency department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with limb injuries resulting from motorcycle accidents between June 1998 and May 1999 were selected for this prospective study., Result: One hundred and fifteen (79.3%) out of the 145 victims of motorcycle accidents that reported to the hospital had injuries involving their limbs. The Male: Female ratio was 2.8:1. The mean age was 31.9 +/- 16.7 (S. D.) years, and 20-29 years; the most commonly involved age group. 42.2% were due to collision with automobiles, 22% pedestrian while 8.7% were collisions between motorcycles. The use of protective/safety devices was practically non-existent. Seventy-six (66.1%) patients had lower limbs injuries, 25 (21.7%) patients had upper limb injuries while the remaining 14 (12.2%) injured both upper and lower limbs. The tibia was the most commonly fractured bone (32 patients, 27.8%) followed by the femur (25 patients, 21.7%). Eighty-six patients (74.8%) with fractures were managed by close reduction and splinting. Eighteen (15.7%) patients had internal fixation., Conclusion: Motorcycle accident is an important cause of limb injuries in the developing worlds. Motorcyclists need to be encouraged to use protective/safety devices.

Background: The pattern of gunshot injury in the Ife-Modakeke communal clash between March 3 and May 23, 1999 was analyzed in this study., Methods: The history was recorded for each patient presenting at the hospital with gunshot injuries from the clash. Each was examined and followed up through subsequent treatment in the wards and clinics., Results: The study included 185 patients. The male-to-female ratio was 22.1 to 1, and 45.9% of the patients ranged in age from 21 to 30 years. The mean age was 28.3 +/- 11.2 years, and the mortality rate was 8.6%. There were 120 warriors and 65 noncombatants. Government workers and students made up most of the noncombatants (42.5%), whereas drivers and farmers constituted the vast majority of the warriors (23.3%). Injury to the lower limbs was the most commonly seen injury (54.6%). Sustained fractures and femoral fractures were the most common fracture (n = 100, 54.1%). Head and colonic injuries were the greatest cause of mortality., Conclusion: For civilian gunshot injuries, morbidity and mortality rates are high in the less developed countries because of inadequate prehospital and hospital care. Efforts should be made to improve these facilities.

This is a retrospective study of limb amputations in Ile-Ife, Nigeria during a thirteen-year period (1987-1999). 82 patients were studied with a mean age of 35 +/- 22 years. 63 of the patients were adults, while 19 patients were children aged 15 years and below. Trauma was indicated as a reason for amputation in 60 patients (73.4%). Road traffic accident with peripheral vascular compromise was the single most common reason for amputation (41.7%). Forty-seven of the 82 patients had lower limb amputations, while the others were in the upper limbs. There was delay in performing amputation in some patients due to refusal to accept the procedure in 10(12.1%), logistics in 5(6.1%) and lack of finance in 3 (3.7%). The average healing time of the amputation stump wounds was 47 +/- 36 days. In 68.3% of cases, there was wound infection and the wound healing time was 63 +/- 45 days, much longer than than the general average. Other complications were flap necrosis, gas gangrene, osteomyelitis of the bony stump, and tetanus. Six patients died from sepsis and one from chronic renal failure, a hospital mortality rate of 8.5%. Prosthesis could not be fitted in any of the patients during the hospital admission and only three of the diabetic patients attended follow up clinic for up to two years; others absconded within 3 months of discharge from hospital. It will be possible to reduce the rate of amputation and improve the quality of life of patients with amputation if more attention is placed on accident prevention and injury control.