2. CHALLENGES IN AFRICA
COMMUNITY
Ignorance of problem
Lack of acceptance by parents
Stigmatization by community
Witchcraft suspicion
Ignorance of available medical help
Poor/unhygienic enviroments
Financial constraints
Late presentation
3. CHALLENGES IN AFRICA
MEDICAL CHALLENGES
Lack of knowledge/understanding of problem
Fear of likely poor outcomes and suspected poor
QOL
Lack of surgical expertise to manage SB/H
Lack of facilities
No ultrasound facilities for antenatal diagnosis
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9. CHALLENGES
In the third world, we still have a long way to go before
we can manage SB/H properly
The biggest challenge is knowledge and
understanding of the condition of SB/H
There is lack of emphasis in training of medical
personnel at all levels: TBA, nurses, CO and even
doctors. This must change
There are no facilities for ante-natal diagnosis, so we
are not prepared for such a birth
Most of these children are born in unhygienic
conditions and are exposed to unhygienic practices
such as applying cow-dung to the lesion
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11. COUNSELLING FOR FAMILY
Inform/educate family about condition and prevention
Create realistic hope
Parents don’t know what has hit them. Take time to
explain the condition of the child and how to prevent
recurrency
Tell them: treatment will help the baby but not cure.
Child may need other operations(VP shunt, correction
of limb deformities etc)
Child will need CIC management
Give info in leaflet
12. ON ADMISSION
Assess general condition of the patient:
The majority of patients present late
They are not ready for surgery
They are septic, dehydrated and with very dirty
wounds
Some are anemic
13. Pre-op assessment
CLINICAL EXAMINATION:
Head circumference/start chart
Brain ultrasound if need be
Body temperature
Nutritional status, weight, hydration
Other deformities: weak limbs, club feet, open
anus
General condition of baby
14. Pre-op management
Rehydrate the patient
Workup the patient for sepsis and anemia
Do pus swab of the lesion for M/C/S
FBC
If Hb is low, either transfuse pre-op or cross-match
to transfuse on the day of surgery
If the child is septic, start on broad spectrum
antibiotics until sensitivity results are ready
In case of severe sepsis, there may be need for
debridement before closure can be contemplated
15. Pre-op management
WOUND CARE:
Keep baby in prone position(on tummy) to avoid
pressure on the wound and to prevent stool coming
onto wound and avoid the pain
keep the lesion clean
use normal saline for cleaning open wounds
cover with sterile dressings
Only give antibiotics when signs of sepsis appear
