Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 182

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Advertise Contacts Login 
     

ARTICLE
Year : 2010  |  Volume : 51  |  Issue : 1  |  Page : 23-25 Table of Contents     

The point prevalence and cost of wound management in a Nigerian teaching hospital


1 Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
2 Division of General Surgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria

Date of Web Publication27-Nov-2010

Correspondence Address:
I A Adigun
Department of Surgery, University of Ilorin Teaching Hospital P.M.B 1459, Ilorin, Kwara State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and Permissions
   Abstract 

Background: Chronic wounds as a cause of patient morbidity represent a major health burden and drains on resources. There is paucity of information on the actual cost of wound management in Nigeria. Studies have calculated the cost of wounds to the NHS in United Kingdom to be about £ 1bn a year.
Objective: This study was conducted to provide data on the point prevalence of wounds in a Nigeria Teaching Hospital, the aetiology and the cost implication of managing the wound.
Methods: The study was carried out on a Sunday morning to minimize disruption to patient care. Data on all in patients with chronic wounds were documented in a designed proforma.
Results:Two-hundred and six patients were on admission on the day of study out of which sixty-five patients ( 31. 55%) were being managed for one type of wound or the other. There were thirty-six males and twenty-nine females with a male to female ratio of 1. 1: 1. Twenty-four patients ( 36. 9%) had surgical wounds of different aetiology which seventeen patients ( 26. 2%) were being managed for traumatic ulcer. Twenty-nine patients ( 44. 6%) spent between one hundred Naira to five hundred Naira on wound dressing per week. The costs of care of these patients were being settled by their relation in fifty-one patients ( 78. 5%).
Conclusion:Wound management is a significant clinical and economic problem. The cost to the health system can be very significant, this is particularly so in a developing country like Nigeria. Our study showed that majority of our patients are petty traders and the cost of wound care was borne mainly by their relatives. The money being spent in a week on wound dressing alone is a bit high for an average Nigerian.

Keywords: point prevalence, wound, cost, hospital


How to cite this article:
Adigun I A, Rahman G A, Yusuf I F, Ofoegbu C. The point prevalence and cost of wound management in a Nigerian teaching hospital. Niger Med J 2010;51:23-5

How to cite this URL:
Adigun I A, Rahman G A, Yusuf I F, Ofoegbu C. The point prevalence and cost of wound management in a Nigerian teaching hospital. Niger Med J [serial online] 2010 [cited 2021 May 14];51:23-5. Available from: https://www.nigeriamedj.com/text.asp?2010/51/1/23/70987


   Introduction Top


Simple surgical and traumatic wounds require simple, low-cost dressings since healing is likely to be rapid and uncomplicated. Normal wound healing in an acute wound is highly coordinated with movement of specific cell populations occurring as the wound progresses from injury through repair, and remodeling to healing. This process is however impaired in chronic wounds. Chronic wounds as a cause of patient morbidity represent a major health burden and drains on resources. There is a paucity of information on the actual cost of wound management in Nigeria. Studies have calculated the cost of wounds to the NHS in United Kingdom to be about one billion BP a year[1]. Also in the United Kingdom, around 24000 admissions a year are patients with diabetic foot ulceration. The cost of this to the NHS is seventeen million BP[2]. A major part of this sum are for dressing and community nurse visits. The sum shows only the direct costs and does not include loss of income, loss of man hours and reduced quality of life of the patients. The aim of this study is to provide data on the point prevalence of wounds in a Nigerian Teaching Hospital, the aetiology, care given and the cost implication of wound management.


   Methods Top


The study was carried out in a tertiary hospital located in Kwara state in the north central zone of Nigeria. This institution is the only tertiary institution that caters for patients in the state and the surrounding states such as Niger, Benue and Kogi with a total population of about 8, 928, 280 from the National population censors of 1991. It also functions as a secondary health institution because of the unavailability of a functional secondary health centre. The hospital consists of two sections, the General wing and the Maternity wing. This study was conducted in the General hospital wing which consists of 8 wards, adult and paediatric emergency units.

The study date was on Sunday morning to minimize disruption to patients care. The study was carried out on 08/ 02/ 09. The data was collected by 5 observers who are experienced in wound evaluation and wound care. Data was collected and entered into a proforma. The informations collected are aetiology of wound, age, sex, type of wound, weekly cost and mode of wound dressing. This was entered into SPSS version 9 for analysis. The data was presented as percentages, proportions, means and standard deviations.


   Results Top


A total number of two-hundred and six patients were on admission. Sixty five patients were being managed for one type of wound or the other, this constitute about 31. 55% of the total patients in the hospital. The age distribution is as shown in [Figure 1] with the majority of the patients in their third to fifth decades of life. The mean age 34. 51(SD- 17. 99). There were thirty-six males and twenty-one females with a male to female ratio of ( 1. 7: 1). Twenty six patients ( 40%) were traders, twelve patients ( 18. 5%) were civil servants and fifteen ( 23. 1%) of our patients were students. For the purpose of this study, wounds that were being managed were classified into six types as shown in [Figure 2]. Twenty four patients ( 36. 9%) had surgical wounds of different aetiology while seventeen patients ( 26. 2%) were being managed for ulcers resulting from poorly managed traumatic wound. There were six patients ( 9. 2%) with pressure sores while four patients ( 6. 2%) were being managed for chronic leg ulcer from other causes apart from trauma such as sickle cell disease, varicose vein and diabetic foot. Burn wounds were classified under others.
Figure 1: Age distribution

Click here to view
Figure 2: Type of wounds

Click here to view


[Table 1] shows the cost of care for wound dressing per patient per week in the ward. Twenty nine patients ( 44. 6%) spent between one hundred to five hundred Naira on wound dressing alone per week. Twenty one patients ( 32. 3%) spent between five hundred Naira to one-thousand Naira on wound dressing per week while ten patients ( 15. 4%) spent between one-thousand and one Naira to one thousand and five-hundred Naira on wound dressing per week. The result also showed that the costs of care of these patients was borne by relations in fifty-one patients ( 78. 5%). Eleven patients ( 16. 9%) were self-financed while only two patients ( 3. 1%) have their employers taking care of their cost.
Table 1: Cost of Care

Click here to view


Frequency of the dressing revealed that 43 patients ( 66. 2%) have daily wound dressing, 9 patients ( 13. 8%) have alternate day wound dressing and 13 patients ( 20%) dress their wound twice in a week. Thirty seven patients ( 56. 9%) will require wound cover in form of skin grafting or flap surgery for the final care of their wounds.


   Discussion Top


Wound management is a significant clinical and economic problem[3]. It is likely to be worse in developing countries than in developed nations of the world. Our study revealed that 31.55% of the total hospital patients were been managed for wounds. Though the authors could not lay their hands on a local comparative data, this figure was on a high side. National Health Insurance has taken off, but coverage is limited to those employed in the formal sector. Hence most of our patients are not covered by the NHIS and where the Gross per Capital (GP) of an average Nigerian is US $915 and the expenditure as percentage of GP is 3.4%, the brunt of the cost of care of these patients will probably fall on the patients and their relatives. Majority of our patients (40%) are petty traders and in fifty one patients (78.5%), the cost of care was borne by their relatives. Twenty nine patients (44.6%) spent an average of one-hundred Naira to five hundred Naira in a week on wound dressing excluding the costs of drug treatment, investigations, hospital bed fee, physiotherapy and feeding. We think this is a bit high for an average Nigeria. Twenty four patients (36.9%) had surgical wounds of different aetiology such as wound dehiscence resulting from laparatomy done for patients with typhoid perforation; ruptured appendice. It also include wound of feacal fistula, complicating a major abdominal surgery. Seventeen patients (26.2%) were also being managed for traumatic ulcers, resulting from poorly managed traumatic wounds. Forty three patients (66.2%) had daily wound dressing, while 37 patients (56.9%) will require wound cover in form of autologous skin grafting or flap surgery.

All chronic wounds harbor bacteria. However, while some wounds are contaminated, others are colonized and some are infected. A bacterial load of 105 and 106 organism per gram in a wound bed, irrespective of the organism will adversely affect wound healing[4],[5],[6]. We did wound biopsy and not wound swab to confirm infection. Chronic wounds with necrotic tissue when surgically debrided accelerates the rate of wound healing[7],[8],[9]. In addition to surgical debridements we make use of honey for wound dressing in our centre which is a good non-surgical debriding agent. We mostly use gamgee instead of gauze to cover our large wounds which serves as a good absorbent dressings. In the presence of clean healthy looking granulation tissue, healing can be disturbed if exudate is not controlled[10].

We recommend that patients should be educated on the need to present early to hospital with traumatic wounds so that, adequate and proper care can be instituted. Primary attending Physician and private hospitals should refer cases that are meant for the specialists early enough, they should not hold on unnecessarily to the patient for personal or financial gain. The Physician at tertiary level should ensure adequate and proper care of patients to minimize post-operative complications such as wound dehiscence and feacal fistula.


   Conclusion Top


Government hospitals should subsidize treatment of patients with chronic wounds by providing dressing materials at a highly subsidized rate, and some of them may be exempted from paying. When the NHIS is fully implemented in Nigeria it will remove the burden of cost of care away from the less privilege people.

 
   References Top

1.Harding K. G. The future of wound healing. In: Leaper D. J., Harding K. J., eds. Wounds: biology and management. Oxford:Oxford University Press, 1998: Page 191.  Back to cited text no. 1
    
2.Currie C. J. Morgan C. L., Peter JR. The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy and ulceration in diabetes. Diabetes care 1998; 21: 42- 48.  Back to cited text no. 2
    
3.Majno G. The healing hand: man and wound in the ancient world. Cambridge, Massachusett: Harvard University Press, 1991.  Back to cited text no. 3
    
4.Dow G., Browne A., Sibbald R. G. Infection in chronic wounds: Controversies in diagnosis and treatment. Ostomy WoundManage. 1999; 45: 23- 27, 29- 40.  Back to cited text no. 4
    
5.Sibbald R. G., Williamson D., Orsted H. L., Campbell K., Keast D., Krasner D., Sibbald D. Preparing the wound bed debridement, bacterial balance and moisture balance. OstomyWound Manage. 2000; 46: 14- 35.  Back to cited text no. 5
    
6.Sibbald R. G. What is the bacterial burden of the wound bed and does it matter? In: Cherry G. W., Harday K. G., Ryan T. J., editors. Wound Bed Preparation. London; Royal Society of Medicine Press Ltd, 2001; 41- 50.  Back to cited text no. 6
    
7.Steed D. L., Donohoe D., Webster M. W., Lindsley L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg 1996; 183: 61- 64.  Back to cited text no. 7
    
8.Vowden K. R., Voroden P. Wound debridement, Part 2: Sharp techniques. J Wound Care 1999; 8: 291- 294.  Back to cited text no. 8
    
9.Vowden KR, Vowden P. Wound debridement, Part 1: Non-sharp technique. J Wound Care 1999; 8: 237- 240.  Back to cited text no. 9
    
10.Falanga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen 2000; 8: 347-352.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Methods
    Results
    Discussion
    Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed4589    
    Printed165    
    Emailed0    
    PDF Downloaded208    
    Comments [Add]    

Recommend this journal