|Year : 2016 | Volume
| Issue : 2 | Page : 79-83
Analysis of admissions in a West African urology centre: A crux in urologic capacity building
Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||30-Nov-2016|
Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, PMB 3452, Zaria Road, Kano State
Source of Support: None, Conflict of Interest: None
Background: Adequate acquaintance with urologic admissions and interventions offered to patients in a community over a span of time is an invaluable framework for capacity building and health care planning. We undertook a 3-year appraisal of admissions with interventions as a tool for further urologic capacity building at the Abubakar Imam Urology Centre Kano, Nigeria.
Patients and Methods: Records of all the admissions between January 2012 and December 2014 were retrieved. The suitable data were extracted, analyzed, and displayed using the Statistical Package for the Social Sciences version 21.
Results: One thousand five hundred and four patients were admitted and treated; male-to-female ratio was 13:1. The patient's mean age was 50.1 years (±23.3). The most common admitting diagnosis was benign prostatic hyperplasia (BPH) followed by urethral stricture then urolithiasis. Malignancies and congenital anomalies were 4th and 5th, respectively. The mean hospital stay was 9.77 (±6.1) days. Overall mortality recorded was 8.17%.
Conclusion: The study recognized BPH and its complications as the dominating determinants of admissions and mortality, respectively. Heightened health awareness is required to subdue the strain of delayed complicated presentations to the center. The study underscores the need for further capacity building in the center to advance minimal hospital stay, morbidity, and mortality among the inpatients.
Keywords: BPH, urologic admissions, Urologic surgery
|How to cite this article:|
Abdulkadir A. Analysis of admissions in a West African urology centre: A crux in urologic capacity building. Arch Int Surg 2016;6:79-83
| Introduction|| |
A thorough knowledge of the prevalence of disease conditions managed in a population has a principal role in health care capacity building and planning for the designated population. These have a crucial role in the efficient and balanced distribution of medical resources based on the health requirements. This knowledge provides a tool for research and could display changes in the pattern of any given pathology;, it sets the basis of what first comes to physicians' mind when making a diagnosis, which by extension is key to efficient and effective comprehensive care of patients. Nonetheless, community-based records required for strategizing urologic capacity building are frequently not handy for developing communities such as ours owing to the hurdles associated with planning and financing such studies. There are reports on the urologic presentations and outcome of hospitalization from various health institutions that to a certain extent reflect the community prevalence of these urologic ailments.,, These are used as a guide by health care managers and could be the cornerstone for further health care capacity building., In this respect, inpatient data analysis is valuable and worthwhile if utilized well. Notwithstanding, this is the first review on urologic admissions from a government-owned health centre devoted solely to urology problems in Nigeria. The Abubakar Imam Urology Centre, Kano was inaugurated in December 2007 and serves the urologic needs of communities in Kano and neighbouring Jigawa and Katsina States in Nigeria. The centre has 26 inpatient beds, in addition to the dialysis facility. Admissions for the study were through the outpatients and accident and emergency units. This study aimed to retrospectively review the centre's ward admissions, interventions, and outcome of the admissions over a 3-year span as a framework for further urologic capacity building in the institution.
| Patients and Methods|| |
This was a 3-year retrospective review involving all the patients admitted and treated at the Abubakar Imam Urology Center, Kano between January 2012 and December 2014. Ethical clearance from hospital ethics committee was obtained. Hospital notes of the included patients were retrieved from computerized admissions records. Patients not admitted to the ward were excluded from the study. The Information extracted included the patient's biodata, diagnosis, interventions, duration of hospital stay, and outcome. The data were evaluated using the Statistical Package for the Social Sciences version 21.
| Results|| |
A total of 1653 patients were admitted out of the overall 14795 (11.17%) patients seen in the clinic and accident and emergency unit during the study period. Of these 1504 patients were treated and most were followed-up for a variable period. However, 14 patients were referred to other centres because further evaluation revealed nonurologic pathology. Further analysis of those treated and discharge showed that 1394 patients were males, giving a male-to-female ratio of 13:1. The mean age of the study population was 50.1 years (±23.3). The modal age group was 61–70 [Figure 1]. Almost all the inpatients, 1472 (97.9%), were Muslims and the majority 1467 (97.5%) were Hausa or Fulani tribe [Figure 2]. Businessmen represented 29.4% of all the inpatients, followed by those who were not employed and then the Farmers [Figure 3].
|Figure 1: Percentage age (in years) distribution of inpatients 2012 and 2014 at the Abubakar Imam Urology Center. Key: Study period (2012–2014)|
Click here to view
|Figure 2: Pie chart of the tribes managed as inpatients between 2012 and 2014 at the Abubakar Imam Urology Centre|
Click here to view
|Figure 3: Occupation of the inpatients between 2012 and 2014 at the Abubakar Imam Urology Centre|
Click here to view
The most common diagnosis among the inpatients was benign prostatic hyperplasia (BPH) seen in 44.24% of the patients. Urethral stricture was the second most common reason for admission in 9.86% of the patients; it was complicated by bladder stone in one patient and Fournier's gangrene in another. Prevalence of urolithiases, malignancies, upper urinary tract obstructions (other than from calculi), congenital anomalies, inguinoscrotal swellings, and genitourinary traumas are shown in [Table 1]. Of the patients with BPH, 3.6% had complications necessitating an additional procedure are shown in [Table 2]. Other patients presented with rare lesions, and are shown in [Table 3].
|Table 1: Frequency distribution and percentages of the inpatients between 2012 and 2014|
Click here to view
|Table 2: Table of rare cases admitted between 2012 and 2014 at the Abubakar Imam Urology Center|
Click here to view
|Table 3: Complicated BPH patients admitted between 2012 and 2014 at the Abubakar Imam Urology Center|
Click here to view
The mean hospital stay was 9.77 (±6.1) days with a range of 1 to 60 days. Mortality recorded during the study period was 135 (8.17%). The highest proportion of the mortality was from advanced bladder cancer, with case specific death rate of 34%. Mortality in patients admitted with BPH was (7.1%). Most of the mortalities were from renal failure and urosepsis.
| Discussion|| |
This appraisal highlighted inpatient care in a government-owned urologic centre in Kano; the most populous state in Nigeria, as recorded in the 2006 National census. The studied population incorporated communities of comparatively homogeneous sociocultural codes (Hausa and Fulani). The study area is the hub of commerce, and businessmen predominate among inpatients. A large count of the study group who were nor employed is the reflection of the high unemployment rate in typical Nigerian urban and suburban settlements. Many urological ailments are treatable with medications, and multitude of urologic surgical interventions as day cases are the crux of office urology. Consequently, only 11.1% of the overall patients in the centre merited inpatient care. The male-to-female ratio was 13:1, hence, urological ailment were more in males; furthermore, in most African communities, males attend hospital more than females., The mean age of 50 ± 23.3 is the age bracket of common urologic disorders favoring inpatient care such as the prostatic diseases, strictures, and urolithiasis. The study showed that BPH admissions were highest in prevalence, which was the same as conclusions from other reviews.,, These inpatients had transvesical or retropubic prostatectomy; 3.6% of them had complications compelling supplemental surgical interventions. Urethral stricture was second in prevalence; it was complicated by bladder calculus in a patient and Fournier's gangrene in another patient. With the judicious usage of antibiotic, the prevalence of postinfective strictures has been on the decline, however, the reciprocal increase in posttraumatic urethral injuries sustained the prevalence. The number of inpatients treated for urolithiasis was much higher than the preceding 5-year retrospective review from a companion tertiary institution in Kano, probably due to high patient turnover in the centre. Urological malignancies represented 9.59% of the inpatients managed. Several studies have shown that prostate cancer is the most common urologic malignancy, however, in our set up presentation is often delayed. Hence, most patients are seen for the first time with an advanced disease and palliative care is often given on an outpatient basis. Bladder cancer represented 6.4% of all cancers in a study in Kano. The high incidence of bladder cancer, noncalculus upper urinary tract obstruction often caused by ureteral strictures, and bladder neck stenosis in the studies could be the aftermath of urinary schistosomiasis, which is endemic in this area.,, Congenital abnormalities occupied the sixth position among the inpatients; the presentations could, however, be in the adolescent age or at adulthood  unlike in the developed world where prenatal diagnosis prevails. Comparatively less urologic traumas were managed during the study period because isolated urological injuries are not common. In the presence of other systems injuries, the genitourinary injury may be overshadowed; hence, other centers with multispecialist services report higher prevalence., Notwithstanding, male circumcision is a common procedure performed in Nigeria, only six patients who referred with postoperative complication merited inpatient care. Tables 1 and 3 sum up the wide-ranging urological disease managed in the centre. The duration of the hospital stay and mortality could be scaled down with a further capacity building from an average of 9.77 (±6.1) days and 8.1% overall mortality. The high mortality in bladder cancer was because often presentation was with advanced disease, septicemia, and uremia.
The quartet of a pleasant surgical outcome, shorter range of hospital stay, reduced overall cost of health care, and proven patient satisfaction have greater guarantee with minimally invasive interventional procedures., This quartet, therefore, should be the cornerstone of health care capacity building and planning, hence, the minimally invasive interventions should be strengthened. The emphasis should be on the fusion of newer skills of minimally invasive techniques with on-the-job-capacity advancement. The importance of human resource advancement through professional and administrative skills growth concurrently with resource diversification in line with proportionate prevalence cannot be overemphasized. The acquisition and supply of modern equipment to fit in the chart should proceed hand in hand with other facets of capacity building. Interventional strategies and guidelines should be reviewed in line with the assured panorama of priority interventions shown in the study.
The foremost target should be to render technically appropriate, state-of-the-art, high-quality effective and efficient services using the limited available resources. Appropriate linkage with the community, cohorts, and policy-makers could advance the schemes and activities of the centre in its quest towards excellence in urological care. Well-designed prospective reviews with emphasis on detailed epidemiologic, diagnostic, and interventional outcome is required to further unveil the population commonality with others as well as its peculiarities. Both state and nongovernment organization's support are important for extensive analysis. The urologist being an essential team player should “take the bull by the horn.”
| Conclusion|| |
This study recognized BPH and its complications as the dominating indications for admissions and the cause of mortality. The study underscores the need for health capacity building and planning to focus on the gaps in securing pleasant surgical outcome, shorter range of hospital stay, which correlates with reduced overall health care cost along with proven patient satisfaction. Greater guarantee with minimally invasive interventional procedures should secure the priority in the health care capacity building to thwart these gaps. Heightened health education is required to subdue the strain of delayed complicated patient's presentations and sustainability of capacity building.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bernardini DA. Capacity Building: What kind of health care professional is needed. Focus on primary care.
Winter A, Vohmann C, Wawroschek F, Kieschke J. Increase in uro-oncological health care needs due to demographic change: Extrapolation of cancer incidence numbers through 2030 as a basis for directed regional planning. Urologe A 2015;54:1261-8.
Tijani, KH, Adesanya AA, Ogo CN. The new pattern of urethral stricture disease in Lagos, Nigeria. Niger Postgrad Med J 2009;16:162-5.
Minkler M, Wallerstein N, editors. Community-based participatory research for health: From process to outcomes. John Wiley & Sons; 2011.
Mbibu, NH, Nwofor AM, Khalid L. Spectrum of urologic disease in the West African sub region. Ann Afr Med 2002;1:44-52.
Ajape AA, Kuram MM, Ojo EO, Ibrahim AG, Obiano SK. Skills acquisition for trainee urologists: Are the Federal Medical Centers in Nigeria suitable? Ann Afr Med 2012;11:146-51.
Eke N, Sapira MK, Echem RC. Spectrum of urological procedures in University of Port Harcourt teaching hospital, Port Harcourt, Nigeria. Niger J Clin Pract 2007;10:74-8.
Guo KL. A Study of the Skills and Roles of Senior-Level Health Care Managers. Health Care Manag 2003;22:152-8.
IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.
Barau SA. An Account of the High Population in Kano State. Research and Documentation Directorate, Government House, Kano; 2006.
Lucas J. State Capacity and Integrity at the Local Level: A Case Study of Business and Trade Association in Kano, Nigeria. J Afr Policy Stud 1995.
Stober OE. Unemployment Scourge: Rising to the Nigerian Challenge. Romanian Economic Journal 2015;18:181-200.
Ogun SA. Pattern and outcome of medical admissions and deaths in Ogun State Teaching Hospital, Sagamu–A three-year review. West Afr Med J 2000;19:309.
Odenigbo CU, Oguejiofor OC. Pattern of medical admissions at the Federal Medical Centre, Asaba-A two year review. Nigerian J Clin Pract 2009;12:395-7.
Bostwick, David G., Cheng L. Urologic surgical pathology. Elsevier Health Sciences; 2008.
Aji SA, Alhassan SU, Mohammad AM, Mashi SA. Urinary Stone Disease in Kano, North Western Nigeria. Niger Med J 2011;52.
Dawam D, Rafindadi AH, Kalayi GD. Benign prostatic hyperplasia and prostate carcinoma in native Africans. BJU Int 2000;85:1074-7.
Ochicha O, Alhassan S, Mohammed AZ, Edino ST, Nwokedi EE. Bladder cancer in Kano-A histopathological review. West Afr J Med 2004;22:202-4.
Sarkinfada F, Oyebanji AA, Sadiq IA, Ilyasu Z. Urinary schistosomiasis in the Danjarima community in Kano, Nigeria. J Infect Dev Ctries 2009;3:452-7.
Abdullahi MK, Bassey SE, Oyeyi TI. A comprehensive mapping of urinary schistosomiasis using geographic information systems (GIS) in Kano State, Nigeria. Bayero J Pure Appl Sci 2009;2:41-6.
Dawaki S, Al-Mekhlafi HM, Ithoi I, Ibrahim J, Abdulsalam AM, Ahmed A, et al
. The Menace of Schistosomiasis in Nigeria: Knowledge, Attitude, and Practices Regarding Schistosomiasis among Rural Communities in Kano State. PloS One 2015;10:e0143667.
Okeke AA, Okonkwo CC, Osegbe DN. Prevalence of hypospadias, abdominal and peno-scrotal abnormalities among primary school boys in a Nigerian community. Afr J Urol 2003;9:59-64.
Scott JE, Renwick M. Urological anomalies in the Northern Region Fetal Abnormality Survey. Arch Dis Child 1993;68:22-6.
Salako AA, Adisa AO, Eziyi AK, Banjo OO, Badmus TA. Traumatic urologic injuries in Ile-Ife, Nigeria. J Emerg Trauma Shock 2010;3:311-3.
Ahmed A, Mbibu NH. Aetiology and management of injuries to male external genitalia in Nigeria. Injury 2008;39:128-33.
Okeke LI, Asinobi AA, Ikuerowo OS. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 2006;6:21.
Rolle U, Geyer C, Till H. Minimal invasive paediatric urology. Kinder-und Jugendmedizin 2007;7:477-81.
MöHrlen U, Weber D, Gonzalez R, Schmid DM, Sulser T, Gobet R. Robot-assisted minimal invasive pediatric urology. J Pediatr Urol 2009;5:S45-6.
Grol R, Grimshaw J. From best evidence to best practice: Effective implementation of change in patients' care. Lancet 2003;362:1225-30.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]