The Burden, Challenges, and Prospects of Hand Surgery Practice in South Eastern Nigeria.

Abstract

Background: Hand injuries sometimes cause significant loss of function with psychological and functional consequences. The national status on dedicated specialised hand surgery units, hand surgery fellowship programmes, and outcome of operative hand surgery cases is generally lacking.

Aims: To determine the current state of hand surgery practice in south eastern Nigeria and identify the major challenges to its practice and proffer realistic solutions.

Methods: This was a prospective and cross-sectional study conducted amongst accredited hospitals for plastic surgery training in south eastern Nigeria amongst plastic surgery senior residents. Data were collected using a well-structured online questionnaire validated by a panel of investigators created as a Google form. Data analysis was carried out using Statistical package for Social Sciences by IBM, version 22. Ethical approval was obtained from the health, research, and ethical committee of the University of Enugu Teaching Hospital, Enugu, Nigeria.

Results: There was a 70.59% response rate with 24 residents filling and submitting the questionnaire. Lack of fellowship training opportunities in hand surgery represents the most important challenge of hand surgery practice, followed by lack of appropriate facilities in government institutions in contrast to a lack of funding in private ones. Other major challenges include lack of adequate funding, lack of facilities, late presentation of cases, and lack of appropriate follow-up physiotherapy protocol. Availability of competent hand surgery specialists was significantly correlated with the frequency of hand surgery cases in the facilities (P = 0.000; χ² = 20.400).

Conclusion/recommendation: The current state of hand surgery practice in south eastern Nigeria is not yet optimal. The creation of more hand fellowship trainings and courses bagged first place in recommended solutions by nearly half of the respondents. Provision of modern facilities, creation of dedicated hand surgical units, and better funding to the specialty were other suggestions.