Modelos de análisis textual

30 years. Patients in this age group constituted 29.8% of the study population and were closely followed by the 31-40 years age group (22.8%) and the 41-50 years age group (21.1%). People in these age groups are more active and mobile than other age groups. They engage in economic, academic, sporting and adventurous activities.

They are more prone to trauma.

In Australia, 70% of ulcers occur in individuals aged over 70 years ¹⁶⁵. CLU affects approximately 1-2% of the population aged over 65 years in the industrialized nations United States of America, United Kingdom, Europe and Australia 17,18, 19,18, 19, 20, 2201. In these countries, it is a commonm recurrent problem in the elderly population and is likely to increase as the population grows older ²⁰²¹. A Swedish study reported that 4%-5% of people over the age of 80 years sought medical treatmentadvice for a leg ulcer ²⁴³. The observation in this study shows that the young are more affected by CLU than other age groups. The difference in the age incidence observed in this study and that in the above countries may in part be due to the wide difference in life expectancy between Nigeria and the other countries. Nigeria has a life expectancy of 47.56 years. is the life expectancy in Nigeria. The life expectancy in the United States of America (USA), United Kingdom (UK) and Australia are 78.3 years, 80.05 years, and 81.81 years respectively ⁸⁰⁹². These countries in contrast to Nigeria have elderly populations.

The difference between the age incidence of CLU in this study and that in the USA, UKk, Europe and Australia mMay also be related to the aetiologies of the CLU observed in this study in contrast to the aetiologies in thoese countries. Trauma and sickle cell disease were the most common causes of CLU in the patients studied.

Venous insufficiency ranked third in the aetiology. Young people are prone to trauma Trauma alone accounted for 28.1% of the CLU in this study and another 8.8%, 3,5%,

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and 1.8% in association with venous insufficiency, sickle cell disease and diabetes mellitus respectively. Trauma affects young patients ⁸¹ more than other age groups.

This may be related to their higher engagement in trauma prone activities such as contact sports, industrial and economic activities. probably because of adventure and their engagement in economic social and sporting activities.

Sickle cell disease (SCD) alone was responsible for 22.8% of the CLU studied and another 10.5% and 3.5% in association with venous insufficiency and trauma respectively. SCD as the second most common cause of CLU in this study may be related to the high incidence and prevalence of the disease in Nigeria. In Nigeria, 1-2% of the population have SCD (1-2 million) and about 1 in 4 people is a carrier (25 million); 100,000 affected babies are born annually. ^{93. 94}1-2% of the population have SCD (1-2 million) and about 1 in 4 people is a carrier (25 million) ^{85, 86}. There has been improved survival of the survival of the patients into adolescence and adulthood because of increase in the awareness of parents of SCD patients as well as improved health services. Moreover, there is also a high incidence of CLU among SCD patients.

Durosinmi et al ²⁶ reported a CLUn incidence of 7.5% in Hb SS patients and 1.7% in Hb SC patients in Ibadan, Nigeria²⁴. 36.8% of the patients in this study had homozygous sickle haemoglobin (Hb SS), 50.9% were Hb AA and 12.3% were Hb AS.

Venous insufficiency alone was the third most common cause of CLU in this study. Alone, it was responsible for 17.5% of the CLU studied and another 8.8% and 10.5% in association with trauma and SCD. On the contrary, it is the leading cause of all lower extremity ulcers in Australia accounting for 45-90% of the cases ¹⁵⁵. Venous leg ulcers occur in 0.3% of the adult population in western countries ²⁷⁸. Venous insufficiency affects 5% of Americans ⁸⁹⁵³.

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The disparity in the contribution of venous insufficiency to leg ulceration in this study compared to that in western countries may truly reflect a low prevalence of venous insufficiency in our society or must have been relegated by the high incidence of trauma and high prevalence of SCD in our society. It may also be age related as we have a young population while the developed nations have an elderly population.

Korber et al ²⁷⁷ reported venous disease (15%), arterio-venous disease (15%) and vasculitis (13%) to be the leading causes of leg ulcers in a dermatologic wound care centre in Germany.

Similar to the findings in this study, Rahman et al ⁹¹ at the University of Ilorin teaching hospital reported trauma as the commonest cause of CLU accounting for 56.7% of the cases ⁸². This was closely followed by infection which was responsible for 31.7% of the cases. Only 1 of 60 patients in that study (1.7%) had sickle cell disease.

Infection and lymphedema were responsible for 5.3% and 1.8% (1 patient) of the CLU in this study. The reason for the low contribution of infection as a cause of CLU in this study is not clear because infection is rife in a developing tropical country like ours. Infection is expected to contribute significantly to the aetiology of CLU in this study which was carried out in a developing country. The reason for its low contribution in this study would require further investigation to elucidate. However if similar findings are made in other hospitals in Lagos, it may then be the pattern in Lagos. Though, infection was not a primary cause of CLU it must have been a major factor in tipping traumatic wounds to a state of chronicity.

The Majority (43.9%) of the patients in this study had only secondary school andeducation, 31.6% had primary school education, 21% had tertiary and postgraduate education while a few 3.5% had no education. So 79% of the patients

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had secondary school education or less. The implicationortance of this is that most patients lies in their low socioeconomic classstatus, havetheir low health seeking behaviour and more likely to be their unableinability to afford requisite health care.

Most (28%) of the patients treated were traders,. 21.1% were artisans, 17.5%

were students while 12.3% and low level 8.8% were private company and low level government workers respectively. The distribution of the patients’ occupations is a reflection of their educational attainment which impacted on their socioeconomic level.

Christians constituted 87.7% of the study population while muslims constituted 12.3% of the population. There is no clear reason or explanation for this wide difference. 91.2% of patients treated were resident in Lagos while 8.8% resided outside Lagos, mostly in the neighbouring towns of Ogun State.

Most patients91.2% of the patients in this study presented with unilateral CLU while 8.8% had bilateral CLU. The ulcers were located on and the left leg/ and ffoot in 49.1% of the patients and onwas more affected than the right leg/foot and foot in 42.1% of the patients. Similarly Rahman et al ⁹¹ observed that more than 90% of the CLU at The University of Ilorin Teaching Hospital werewas unilateral ⁸². In contrast they recorded equal affectations of the right and left legs by CLU. Idaewor et al at the University of Benin Teaching hospital found that the left leg was more affected by CLU, a similar finding as in this study ⁸⁴.

A higher proportion ofMost patients in this study (68.4%) presented with one ulcer, 17.5% had two ulcers12.3% had three ulcers and 1.8% had more than three ulcers. This revealed that while multiple ulcers were encountered in 31.6% of the patients., though 8.8% of them had bilateral leg ulcers. Multiple ulcers and bilateral ulcers adds to the intricacy and burden of wound care.

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Most patients in this study presented for treatment within 12 months of the onset of their CLU45.6% of the patients in this study presented within six weeks to six months of the onset of their leg ulcers. 19.3% had had their ulcers for between seven months and twelve months before their presentation. 17.5% of the patients had an ulcer lasting more than 48months before they presented to our health facility. Long duration of ulcers was also observed in Australia ¹⁶⁵ where 50%-75% of patients had their ulcers present for up to nine months, 50%-72% for up to one year, 13%-29% for over two years and 30%-45% for more than ten years.

The chronicity of the ulcers is a testimony to difficulty with healing. Patients blame the persistence of their ulcers on spiritual causation or attacks from malicious human enemies. Patients are perplexed and desperate for cure. Many patients seek orthodox or traditional treatment or a combination of both often at more than one health facility before presentation. Majority of the patients73.7% of the patients in this study had had some form of orthodox treatment before presenting to our health facility. Others3.5% of them had traditional treatment while 22.8% of them had or a combination of orthodox and traditional treatment.

AdegbehingbeOginni et al ³¹³ noted that in view of the chronicity and indolence of these ulcers, various methods, orthodox and non-orthodox are often employed in Nigeria as in most other black African countries. Patient education about pathology of their condition should constitute an important part of the treatment in a bid to solicit their cooperation. They will appreciate the natural course of their pathology and the expected outcome of their management. This will prevent unrealistic expectationssequence of events in their management and prevent unrealistic expectations.

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Large surface area ulcers were the majority encountered in this study. 40.4%

of patients with unilateral leg ulcer in this study (91.2% had unilateral CLU) presented with ulcers of greater than 30 cm² in surface area. 15.4% of them had ulcers of 1-5 cm² in surface area, 13.5% of them had ulcers of 6-10cm² in surface areas, 11.5% of the patients had ulcers of 11-15 cm² in surface area. In all, In all, 69.2% of patients with unilateral leg ulcer presented with ulcers greater than 10cm², the index surface area beyond which patients fell into the operative treatment group. These large surface area ulcers tasks both human and material resources in their care.

NearlyMore than half of the patients in this study (49.1%) had had previous leg ulceration. InOf thisat group, 88% of them5.7% had the ulceration on the same site as the index ulcer they presented with (figures 4.13 and 4.14 respectively). This is an indication of a recurrent ulceration. So 42.1% of the entire study population presented with a recurrent chronic leg ulcer. More than half of the patients 53.6% of the patients who had previous leg ulceration had had previous ulcer surgery (figure 4.15). The recurrence rate of 42.1% among patients who presented with CLU is high but compares well with the recurrencet rate of 26%-69% reported in Australia ¹⁷⁵. The high rate of recurrence adds to the agony of CLU patients who are depressed with an on-going ulcer and become anxious about a possible recurrence after healing.

Recurrence was also high among patients who had had previous ulcer surgery (53.6%). This shows that management coverage of ulcer by surgery does not prevent recurrence.