BackgroundOverweight and obesity have been identified as independent risk factors for musculoskeletal disorders. However, the association between obesity and low back pain remains controversial. Little is known about the effects of overweight and obesity on the angles of the lumbosacral spine. The objective of this study was to evaluate the effects of body mass index (BMI) and waist–hip ratio (WHR) on lumbosacral angles.MethodsThe effects of BMI and WHR on the lumbar lordosis angle (LLA), lumbosacral angle (LSA), sacral inclination angle (°°), and lumbosacral disc angle (LSDA) of 174 overweight and obese subjects (test group) and 126 underweight and normal-weight subjects (control group) were analyzed.ResultsThe test group had a significantly higher mean LSA, LLA, sacral inclination angle (SIA), and LSDA (P=0.001). A significant correlation was noted between BMI and LSA (P=0.001), LLA (P=0.001), SIA (P=0.001), and LSDA (P=0.03). There was also a positive relationship between WHR and LSA (P=0.012), LLA (P=0.009), SIA (P=0.02), and LSDA (P=0.01).ConclusionThere was an increase in lumbosacral angles in individuals with raised BMI and WHR. This may result in biomechanical changes in the lumbosacral spine, which increase the incidence of low back pain.

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Public health experts worldwide concede that there is a global epidemic of road traffic accidents (RTA). Globally, RTA is the leading cause of injury-related deaths. In Nigeria, injuries and deaths resulting from RTA are on the rise and are Nigeria's third-leading cause of overall deaths, the leading cause of trauma-related deaths and the most common cause of disability. Do RTA constitute a public health problem in Nigeria? If so, is there a pragmatic approach to combat this problem? A systematic literature search using the advanced features of various databases such as PubMed, Scopus, Embase, Google, and directory of open access journals was carried out using the key words “ RTA, public health problem, government response, Nigeria.” Out of initial 850 articles retrieved from the search 15 articles that suited the study were included in this review. There is need to view RTA s as an issue of urgent national importance that needs urgent attention aimed at reducing the health, social, and economic impact. Policy makers at the various levels of government need to recognize this growing problem as a public health crisis and design appropriate policy responses that will back up with meticulous implementation.

Background: Traditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other lowand middle-income countries (LMICs). They are widely patronized and their services are commonly associated with complications. The aim of the study was to establish the feasibility of formal training of TBS and subsequent integration into the healthcare system.Methods: Two focus group discussions were conducted involving five TBS and eight orthopaedic surgeons in Enugu Nigeria. Audio-recordings made during the focus groups were transcribed verbatim and analysed using a thematic analysis method.Results: Four themes were identified: Training of TBS, their experiences and challenges; perception of traditional bonesetting by orthopaedic surgeons; need for formal training TBS and willingness to offer and accept formal training to improve TBS practice. Participants (TBS group) acquired their skills through informal training by apprenticeship from relatives and family members. They recognized the need to formalize their training and were willing to accept training support from orthopaedists. The orthopaedists recognized that the TBS play a vital role in filling the gap created by shortage of orthopaedic surgeons and are willing to provide training support to them. Conclusion: This study demonstrates the feasibility of providing formal training to TBS by orthopaedic surgeons to improve the quality of services and outcomes of TBS treatment. This is critical for integration of TBS into the primary healthcare system as orthopaedic technicians. Undoubtedly, this will transform the trauma system in Nigeria and other LMICs where TBS are widely patronized.

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There is paucity of reports describing the pattern of surgical mortality in Nigeria. The aim of this study was to determine the incidence and pattern of mortality associated with surgical care in our hospital and to identify areas of improvement. The records of all patients who died after admission for surgical care at the Federal Medical Centre Makurdi between January 2009 and December 2011 were studied retrospectively. Data extracted were patients' demographics, surgical diagnosis, co-morbidity, surgical procedures performed, duration of hospital admission and outcome of treatment. Data were analyzed with SPSS version 17. There were 2,273 admissions into the surgical wards within the study period. During this period, there were 151 deaths with a crude mortality rate of 6.6 %. Ninety-four (62.3 %) patients were males and 57 (37.7 %) were females (M:F=1.6:1). The age of the patients ranged from 8 days to 95 years with a mean age of 36.1±20.1 years. Acute abdomen (37, 24.5 %), traumatic brain injury (32, 21.2 %) and malignancy (28, 18.5 %) were the commonest surgical diagnosis. Trauma-related deaths accounted for 48 (31.8 %) of all the deaths. Road traffic crash (89.6 %) was the commonest cause of injury. Surgical operations were performed in 75 (49.7 %) of the patients who died, while 76 (50.3 %) did not have any operative intervention. Mortality in patients admitted into the surgical ward was 6.6 %. Trauma-related death was the commonest. Traumatic brain injury, typhoid perforation of the bowel and malignancy were the leading causes of surgical death in our centre.

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