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IntroductionAs childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).MethodsA multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A pResults1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.ConclusionMortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.

Objective: To document general baseline data on the patterns of childhood malignant tumours at a teaching hospital in south-western Nigeria. Design, setting and participants: A retrospective study of childhood malignancy at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, during an 11-year period, from January 1996 to December 2006. Results: 77 children were diagnosed with malignant tumours (an average of seven diagnoses per year); 46 were boys (60%), giving a male-to-female ratio of 1.5 : 1. The age distribution of patients was 1–18 years. There were 42 diagnoses (55%) in the 1–5-year age group and 68 malignancies (88%) were diagnosed at ages of 12 years or younger. Lymphomas were the most prevalent malignancy identified, accounting for 31 diagnoses (40%). Burkitt’s lymphoma constituted the majority of malignancies (28 cases; 36%), followed by retinoblastoma (16 cases; 21%) and nephroblastoma (11 cases; 14%). Other malignancies included germ cell tumours (6), neuroblastomas (4), osteosarcomas (3), rhabdomyosarcomas (3) and non-Hodgkin’s lymphomas (3). One case each of medullary thyroid carcinoma, adenocarcinoma of the rectum, invasive mucinous carcinoma of the colon were also identified. Conclusion: These data suggest that Burkitt’s lymphoma is the most common childhood malignant tumour in our geographic area of south-western Nigeria. With the rising incidence of childhood malignancy in resource-poor countries, measuring the baseline occurrence of such tumours is imperative to provide

A 23 year old male Nigerian presented to the Nephrology unit of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with features of chronic renal failure secondary to chronic glomerulonephritis. He was referred to the surgical department of the hospital on account of severe torrential uncontrollable bleeding from an infected cannulation site. He was maintained on regular hemodialysis but developed femoral triangle sepsis at the cannulation site and aneurysm of the external iliac artery. The aneurysm later ruptured with severe jet exsanguinations bleeding. Exploration revealed a-4 cm rent in the external iliac artery that was sutured with 6/0 prolene, interrupted, using clamp and suture technique. Perfusion was satisfactory in the immediate post-operative period. The patient was transfused with 11 pints of blood within 12 hours and had an uneventful post-operative period.

The Queen Elizabeth II Hospital is the apex of the health care services in the Kingdom of Lesotho but has no designated burns unit. A review of patients managed during a 5-year period was done to document our experience so as to show what can be achieved even without a standard burns unit. We reviewed the clinical course of children who were admitted for care of acute thermal injuries during a 5-year period, May 1997 to April, 2002 inclusive. All were treated in the children surgical ward in accordance with a protocol of care emphasizing urgent care of shock, accurate fluid therapy, open wound care and early enteral feeding. Ninety-eight children (51 males and 47 females) aged 4 months to 43 months (mean 21.66 +/- 11.30 months) were admitted on account of acute thermal injuries during the study period. The injuries included scalding (46%) involving predominantly the upper part of the body and full thickness burns (87%). Skin grafting was needed in 82% of the patients. The common complications were infection, fluid imbalance, respiratory problems, and contracture deformities. The mean duration of hospital stay was 40 +/- 4.43 days and the case fatality rate was 9%. The case fatality rate in this series is considered high and could be improved if there were a well staffed specialized burns unit.

Objective: To ascertain the diagnostic accuracy and outcome of surgical treatment in Nigerian children referred for paediatric surgical opinion at the Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west Nigeria. Design: A retrospective review of our practice experience over a 15-year period; between January, 1989 and December, 2003. Setting: The Olabisi Onabanjo University Teaching Hospital (OOUTH), serves as a referral centre for other government and private hospitals in and around the Ogun State, South-west Nigeria. The OOUTH, though a tertiary medical centre also receives patients who present directly at the General Out-Patient Clinics and the Emergency Units of the hospital. The catchment population is estimated at 7.5 million. Subjects: The medical records of all patients under 14 years of age with a final diagnosis of femoral hernia who presented between January, 1989 and December, 2003 were reviewed. Methods: The age, sex, mode of presentation, findings at surgery, procedure performed, immediate post-operative and 12 months follow-up details were recorded. Results: Seven of 1,213 (0.58%) patients with groin hernias within the study period had femoral hernias; four (57%) were girls and three (43%) were boys. Age range was 3 to 9 years. The mode of presentation in all the children was recurrent lump in the groin. Five patients (71%) had right sided lump while the lump was on the left side in two of the patients. The duration of symptoms ranged from two years to eight years. The provisional diagnosis by the referring general practitioners and paediatricians were incorrect in all seven patients. Five patients (71%) were correctly diagnosed preoperatively by the attending surgeon while two were thought to be inguinal hernias. Conclusion: The diagnosis of femoral hernia remains a challenging problem in childhood because of its rarity and similar clinical presentation as inguinal hernia. East African Medical Journal Vol.81(9) 2004: 447-449

Background: Fine-Needle Aspiration Biopsy (FNAB) is a diagnostic technique which has achieved widespread use and acceptance. Its clinical use has continued to widen with the availability of more sophisticated methods of imaging. Its minimal invasiveness, cheap cost and easy application make it a technique of choice in investigating swellings even in children. Aims and objectives: To investigate the reliability, safety and diagnostic value of FNAB in superficial masses including lymph nodes in children. Patients and methods: Superficial masses and lymph nodes of twenty consecutive children aged 2-13years were subjected to FNAB. Open biopsies were also performed on them to validate the FNAB. All specimens were subjected to examination by a cytopathologist and a histopathologist. Results: Nine of the patients (45%) had malignant diseases (lymphoma and osteosarcoma); seven had tuberculous lymphadenopathy while four had reactive lymphadenitis. Open biopsies corroborated these findings. There were no false-negative or false-positive cytology results from aspirates. There were no complications related to the procedures. Conclusion: Fine-needle aspiration biopsy is a reliable, safe, less invasive and relatively cheaper alternative method of establishing a pathologic diagnosis, compared to open biopsy, in children. Key Words: Cytology, Children, Fine needle aspiration biopsy. Resume Introduction:- La Biopsie d'aspiration d l'aiguille fine ‘Fine-Needle aspiration Biopsy' (FNAB) est une technique diagnostique l'utisation et acceptabilite de laquelle est largement repandue. Son utilization clinique continue a s'elargir avec la disponibilite de la methode d'imagerie medicale plus sophistiquee. Sa nature invasive minimale, du bon marche et application facile donnent a cette technique de choix dans Ie diagnostic de la tumefaction meme chez des enfants. Buts et Objectifs:- Etudier la fiabilite, Ie sans danger et la valeur diagnostique de FNAB dans des masses superficielle y compris ganglion lymphatique chez des enfants. Patients et Methodes:- Des masses superficielles et des ganglions lymphatiques de vignt enfants consecutifs âges 2 - 13 ans ant subi la FNAB. On avait egalement opere les biopsies couvertes chez des patients afin de confirmer la FNAB. Tous les specimens ont ete exposes a I'examen par un cytopathologiste et un histopathologiste. Resultats:- Neuf d'entre les patients soit 45% etaient atteints des maladies malignes (lymphoma et osteosarcome); sept atteints de la lymphadenopathie reactive tandis que quatre atteints de la tuberculose lymphadenite. Des biopsies ouvertes ont confirme ces resultats. II n'y avait pas de resultats cytologique fausse positive ou fausse negative a partir des aspirers. II n' y avait aucune complication liee aux protocols. Conclusion:- La biopsie de l'aspiration d'aiguille fine est fiable, sans danger, moins invasive et relativement du tres bon marche un autre methode de confirmer un diagnostic pathologique par rapport a la biopsie ouverte chez des enfants. West African Journal of Medicine Vol.23(3) 2004: 221-223

Background: Sacrococcygeal teratomas are derived from embryonic germ cell layers. They present mostly in infancy and are extremely rare in adults; with an associated risk of malignancy. Modern imaging technique may be helpful to delineate the extent of the mass but surgical excision is generally indicated at the time of detection. Patients and methods: A case report is presented with a review of literature utilising MEDLINE, Microsoft Net and Yahoo search engines. Results: A three day old female baby presented with a mature sacrococcygeal teratoma containing well-developed limb buds. She had surgical excision and primary repair with good results. A two-year follow up utilising serial serum alpha-fetoprotein assay and CT Scan revealed no evidence of tumour recurrence. Conclusion: Sacrococcygeal teratoma is a rare tumour that may be benign or malignant. Complete excision is the primary therapy and is adequate if the tumour is benign. Chemotherapy and radiotherapy are however indicated in malignant cases and in recurrence after previous excision. Key Words: Sacrococcygeal teratoma Resume Introduction: Teratome sacrococygeal est d'origine des couches du gamete embroyonnaire. Le plus souvent, il arrive pendant l'enfance et il est extrement rare chez des adultes, avec un risque de la malignite associee. La technique nouvelle d'imagerie pourrait etre utile pour tracer le degre de masse mais l'excision chirurgicale est souvent operee au moment de la detection. Patients et methodes: Il s'agit du rapport d'un cas avec un bilan d'une literature tout en utilisant MEDLINE, Microsoft Net et mecanismes d'operation du Yahoo. Resultats: Un bebe du sexe feminine âgee du trio jours etait atteinte du teratome sacrococcygeal grave qui contient bouton membre bien mur. On l'avait opere a travers l'excision chirurgicale et la chirurgie reparatrice premaire couronnee de success; examens de controles d'une duree de deux ans avec l'utilisation d'un serial serum alpha-fetoprotein essay et CT scanneur n' a indique aucune preuve d'une recurrence de la tumeur. Conclusion: Teratome sacrococcygeal est une tumeur rare qui peut etre benigne ou maligne. L'excision complete est la therapie primaire necessaire si la tumeur est bengine. Toutefois, la chimiotherapie et la radiotherapie sont necessaire pour des cas malins et dans le cas de la recurrence apres une excision precedente. West African Journal of Medicine Vol.23(2) 2004: 176-179

A 1,600 gm baby with sirenomelia (caudal regression syndrome) associated with extensive anomalies in the internal organs occurring in one of a set of monochromic twins delivered at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Shagamu, Nigeria is being reported. The baby lived for approximately twenty hours. The co-twin had no obvious malformation.