East and Central African Journal of Surgery

Abstracts of the College of Surgeons of East, Central and Southern Africa (COSECSA) 24th Annual Scientific Conference: 4th to 6th December 2024: Harare, Zimbabwe

The College of Surgeons of East, Central and Southern Africa (COSECSA) — Tue, 31 Dec 2024 00:00:00 +0000

Is Uroflowmetry a Valuable Tool for Posterior Urethral Valve Ablation Follow-Up? A Single Centre Study in Africa on Voiding Patterns and Outcomes

Sarah Okebe, Francis Osawa, Peter Mwika, Timothy Jumbi — Tue, 31 Dec 2024 00:00:00 +0000

Background

In newborn males, posterior urethral valves are a common cause of lower urinary tract obstruction causing long-term urological problems despite prompt endoscopic valve ablation. Uroflowmetry is an inexpensive, simple, and non-invasive follow-up urodynamic test that can evaluate the bladder and urethra’s functionality post-valve ablation. This study sought to establish uroflowmetry as a valuable tool for patient follow-up by describing its patterns post-valve ablation at Kenyatta National Hospital.

Methods

A cross-sectional study was conducted on participants who underwent valve ablation from January 2014 to December 2020 at Kenyatta National Hospital and had completed toilet training. The uroflowmetry test was conducted according to the International Children’s Continence Society standards for uroflowmetry. Data on demographics, voided volume, Q max, flow curve pattern, and post-void residual urine were analyzed with SPSS Version 26.0. Continuous data were presented as means and medians, while categorical data were shown as frequencies and percentages. Relationships and differences were explored using chi-square and paired sample t-tests.

Results

Out of 59 patients, 24 completed the uroflowmetry test, with a mean age of 6.6 years. There was a significant difference between the mean voided volume (139.08 mL (SD = 90.028) and mean expected bladder capacity (257.08 mL (SD = 98.576) (p < 0.001) post valve ablation, but no significant difference between observed (11.72 mL/s) and expected Q max (11.26 mL/s) (p = .596). Significant post-void residual was observed in 19 boys (79%).

Conclusions

Incorporation of uroflowmetry as a routine follow-up metric in LMIC protocols is valuable as it can provide useful adjuncts in detecting bladder dysfunction after valve ablation.

Determinants of Abdominal Wound Dehiscence: A Case-Control Study

Tue, 31 Dec 2024 00:00:00 +0000

Background

Abdominal wound dehiscence (AWD) is a serious postoperative complication. It is a mechanical failure of a healing abdominal surgical wound. The incidence of abdominal wound dehiscence ranges from 0.4 to 3.5%, and it can reach 10% in the elderly. Despite advances made over the past decades in perioperative care and suture materials, incidence and mortality rates of abdominal wound dehiscence have not changed markedly.

Objectives

The purpose of this investigation was to determine the magnitude and predictors of abdominal wound dehiscence in patients who underwent laparotomy at two hospitals in Sidama regional state, Ethiopia, in 2023.

Methods

We employed a case-control study design to determine the magnitude and implicated risk factors of abdominal wound dehiscence among pediatric and adult patients who underwent laparotomy for various indications between April 1, 2018 and January 31, 2023 at Hawassa University Comprehensive Specialized Hospital and Yirgalem hospital medical college. We analyzed a sample size of 196 patients (63 cases and 133 controls). Using the Kobo toolbox, data were captured from the operation theater log book and chart review and exported to SPSS version 26 for analysis. The results of descriptive and analytical analyses were presented using tables, graphs, and charts.

Results

The extent of abdominal wound dehiscence was determined to be 1.66%. Place of residence, AOR = 13.94 (95% CI: 3.57-54.45), post-operative complications, AOR = 20.40 (95% CI:6.79-61.25), anemia, AOR = 4.01 (95% CI: 1.32-12.17), and emergency surgery, AOR = 10.17 (95% CI:2.28-45.25), were all statistically significant

Conclusion

We propose that special attention be paid to those from rural areas and those who undergo emergency surgery. Preventing postoperative complications and addressing the root cause of anemia as much as possible is critical.

Patterns Of Orthopedic Injuries among Motorcycle Trauma Patients in Malawi

Mackson Mwaungulu, Patrick Noah, Godfrey Sama Philipo, Chikumbutso Clara Mpanga — Tue, 31 Dec 2024 00:00:00 +0000

Background

Worldwide, road traffic accidents are on the rise. Motorcycle users are highly vulnerable to accidents, resulting in rising orthopedic related morbidity and mortality. In Malawi, the surge in motorbike taxi services has led to a notable increase in motorbike-related road accidents.

Objectives

This study aimed to assess the pattern of orthopedic injuries, examine demographic characteristics, and analyze the mechanisms of injuries among motorcycle trauma patients admitted at Queen Elizabeth Central Hospital.

Methods

A retrospective study was conducted at Queen Elizabeth Central Hospital in Malawi. We included all orthopedic surgery data from ward admissions records from January to December 2021. Data were extracted from patients’ files and stored on REDCap and analyzed using SPSS version 27.

Results

A total of 502 motorbike and non-motorbike road traffic trauma patients were recorded in the inpatient orthopedic trauma database. Of these, 453 patients’ files were identified and analyzed, while 9.7% (49/502) files were missing. Amongst the 453 patients’ files identified, those that suffered motorcycle injuries were 63.4% (287/453) of all road traffic accidents. Most of these accidents occurred in urban areas 64.1% (168/266). The age range was 8 to 78 years with most falling within age group of between 21 and 40, 53.7% (154/287). The majority, 78.7% (226/287), were male. Collisions between motorcycles and cars were the most common mechanism of injury 41.6% (119/286). Motorcycle drivers constituted the largest group of victims 42.8% (118/276) and majority of victims did not use helmets 83.1% (74/89). The most frequent orthopedic injury pattern was fractures of the tibia and fibula accounting for 44.6% (128/287) of injured patients, with highest likelihood of being open 57.8% (59/102). Greater number of orthopedic injuries, 70.1% (199/284), were treated surgically. The commonest duration of hospital stay was ranging from 1 week to 1 month with most being discharged within 14 days, 43.9% (125/285).

Conclusion

Motorcycle related accidents is public health challenge in Malawi and similar LMICs, leading to a high burden of morbidity and mortality, primarily affecting the productive age group with long impact on health system to spend long time in hospital, requiring surgical provision. Policymakers should consider preventive measures, as the treatment of these injuries strains already limited hospital resources and contributes to poor patient outcomes.

Closing the gap towards a successful referral system, a case study of a tertiary teaching and referral hospital, Kenya: pre-post intervention study design

Maxwell P. Omondi — Tue, 31 Dec 2024 00:00:00 +0000

Background

Inappropriate utilization of higher level health facilities and ineffective management of the referral processes is characterized by self-referrals and frequent bypassing of nearest health facilities coupled with low formal referral mechanisms. This leads to unnecessary congestion at a high-cost health facility and compromises the ability and capacity of Kenyatta National Hospital to function as a referral facility as envisioned by Kenya Health Sector Referral Implementation Guidelines of 2014, Kenya 201 constitution and Kenyatta National Hospital legal statue of 1987. The purpose of this study was to analyse the effect of enforcement of national referral guidelines on health facility referrals to Kenyatta National Hospital.

Methods

This was a pre-post intervention test study design. The study was conducted amongst the orthopedic health facility referrals in 2021 with 222 and 246 before and after enforcement of the national referral guidelines respectively. This was done in Orthopedic Department at Kenyatta National Hospital. The variables collected were the healthy facility, location of health facility, health facility tier, type of health facility (government or private) and facility related factors associated with healthy facility orthopedic referrals to Kenyatta National Hospital. Data collection was done through data abstraction. Data was analyzed using frequency distribution, pearson chi-square test and logistic regression.

Results

Nairobi County and its environs constituted over four-fifth of all health facility referrals to Kenyatta National Hospital. Enforcement of the national referral guidelines was significant reduction in health facilities levels 2 and 3 referring patients directly to Kenyatta National Hospital after enforcement of national referral guidelines (p=0.002). About 43 health facilities ceased referring patients to Kenyatta National Hospital with over two-thirds of these health facilities being private facilities. The major facility and patient factors that were associated with health facility referrals to Kenyatta National Hospital were human resource capacity and availability and patient’s preference.

Conclusion

Enforcement of the national referral guidelines significantly reduced the lower tiers health facilities referring to Kenyatta National Hospital. We recommend having written standard operating procedures on referrals based on the national referral guidelines with continued enforcement of the same to sustain the gains made.

Pitfalls and Trade-offs in the Use of Artificial Intelligence in Surgical Research: Current and Future Perspectives

Larry Onyango Akoko, Vincent Kipkorir, Abebe Bekele — Tue, 31 Dec 2024 00:00:00 +0000