African Referral Center Research Articles

Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center.

Study Design:Retrospective cost-effectiveness analysis.Objectives:While the incidence of traumatic spine injury (TSI) is high in low-middle income countries (LMICs), surgery is rarely possible due to cost-prohibitive implants. The objective of this study was to conduct a preliminary cost-effectiveness analysis of operative treatment of TSI patients in a LMIC setting.Methods:At a tertiary hospital in Tanzania from September 2016 to May 2019, a retrospective analysis was conducted to estimate the cost-effectiveness of operative versus nonoperative treatment of TSI. Operative treatment included decompression/stabilization. Nonoperative treatment meant 3 months of bed rest. Direct costs included imaging, operating fees, surgical implants, and length of stay. Four patient scenarios were chosen to represent the heterogeneity of spine trauma: Quadriplegic, paraplegic, neurologic improvement, and neurologically intact. Disability-adjusted-life-years (DALYs) and incremental-cost-effectiveness ratios were calculated to determine the cost per unit benefit of operative versus nonoperative treatment. Cost/DALY averted was the primary outcome (i.e., the amount of money required to avoid losing 1 year of healthy life).Results:A total of 270 TSI patients were included (125 operative; 145 nonoperative). Operative treatment averaged $731/patient. Nonoperative care averaged $212/patient. Comparing operative versus nonoperative treatment, the incremental cost/DALY averted for each patient outcome was: quadriplegic ($112-$158/DALY averted), paraplegic ($47-$67/DALY averted), neurologic improvement ($50-$71/DALY averted), neurologically intact ($41-$58/DALY averted). Sensitivity analysis confirmed these findings without major differences.Conclusions:This preliminary cost-effectiveness analysis suggests that the upfront costs of spine trauma surgery may be offset by a reduction in disability. LMIC governments should consider conducting more spine trauma cost-effectiveness analyses and including spine trauma surgery in universal health care.

Postmortem Examinations on Deceased Neonates: A Rarely Utilized Procedure in an African Referral Center

Postmortem examination remains the gold standard for the correct diagnosis of many diseases and for unraveling unexplained causes of death. This paper reports on the poor utilization of autopsy services and encourages parents/caregivers and practitioners to perform postmortem examinations on deceased neonates in sub-Saharan Africa. In a retrospective study, the records of 1093 neonates (653 males and 440 females, ratio 1.5∶1) who died at the University of Benin Teaching Hospital and who were brought to the mortuary between 2006 and 2010 were reviewed to determine the utilization of and factors influencing postmortem examination. Sixty-two percent of the neonates died within the 1st week of life, and only 9 (0.8%) underwent a postmortem examination. Findings in the 9 postmortem studies performed on 7 males and 2 females provided additional information on the causes of death. The religious beliefs that neonates should not be subjected to postmortem study and beliefs that dead neonates are taboo and a punishment by the gods for past wrongdoings influenced 511 (46.8%) parents/caregivers to refuse postmortem analysis. The practitioners did not request postmortem study in 281 (25.7%) of the cases. The utilization of postmortem examination was marginal in this setting. We advocate the need for public enlightenment campaigns to modify the attitudes of parents/caregivers toward the postmortem study of deceased neonates. Policies should be formulated to mandate postmortem examinations of deceased neonates to enhance insight into neonatal disease, unravel unexplained causes of death, and improve the standard of neonatal care in this subregion.

The prevalence and challenges of abandoned dead neonates in an African referral center

Background Dead neonates are often preserved in the mortuary pending until parents/caregivers’ collect them for formal burial. This study reports the prevalence and challenges of abandoned dead neonates in an African referral center. Materials and methods The clinical and mortuary records of all dead neonates at the University of Benin Teaching Hospital between January 2006 and December 2010 were retrospectively reviewed to determine the prevalence, influencing factors, and challenges of abandoned dead neonates. Results A total of 1093 (22.9%) mortalities were recorded among 4781 neonates. The prevalence of abandoned dead neonates was 77.2% as 844 of the 1093 dead neonates were abandoned to the hospital and given mass burial by an assigned government agency after at least 3 months of abandonment. This was challenging as an average of 85 dead neonates were given mass burial every 6 months to decongest the mortuary. Of 618 illiterate parents/caregivers of low socioeconomic class, 520 (84.1%) abandoned their dead babies. This was extremely significant statistically when compared with 324 (68.2%) bodies abandoned by 475 literate parents/caregivers in upper/middle class (P < 0.0001). Surgical neonates, neonates with obvious congenital anomalies, and babies from the third birth positions onward were mostly abandoned. Conclusion We advocate the need for public enlightenment campaign to modify present parents/caregivers’ attitudes toward dead neonates. Hospital-based postbereavement programs should be organized to help parents/caregivers adjust appropriately to neonatal deaths. Those with dead neonates should be exempted from paying hospital bills. Keywords : abandonment, challenges, dead neonates, prevalence