1
22
defined. Apart from occasional medical audit, studies
focusing on this issue are scarce. Patients’ records are
among the most basic of clinical tools and are involved
in almost all consultations and interactions with patients
at all levels. They are to give a clear and accurate picture
of the patient’s clinical status at birth (the external geni-
talia inclusive). They help doctors to communicate with
other doctors, with other healthcare professionals and
with themselves. Clinical records are essential to ensure
that the individual’s assessed needs are met, comprehen-
sively as well as timely. The record is the clinician’s
main defense, if his assessments or decisions are ever
preterm neonates and neonates delivered outside the
study hospitals were excluded.
The study was approved by the Ethics and Research
Committee of the University of Benin Teaching Hospi-
tal. Permission was obtained from the authorities of the
two hospitals. Consent was obtained for examination of
the newborn infants from their mothers, after informing
them of specific objectives of the study.
A newborn external genitalia examination checklis10t
combining parameters in the Prader Scoring system
11
and External Masculinization Score (EMS) charts was
developed by the researchers to assist in assessing the
reliability of the routine newborn examination in detect-
ing anomalies of the external genitalia. Research assis-
tants (a female nurse and a doctor) were trained for the
study. The research assistant (a medical doctor) was
trained on the “two-handed technique” for the examina-
tion of the testis as well as on the technique for measure-
ment of the penile length. The female nurse was trained
on the method of holding and positioning the newborn
infant for examination of the external genitalia and she
also acted as a chaperone during the newborn physical
examination. The stretched penile length of the infant
was also measured. The rank of the health professional
who performed the routine newborn examination was
also documented.
2
scrutinized. The quality of the case record2 will be as-
sumed to reflect the quality of care received .
An extensive search of the literature did not reveal any
Nigerian study that has examined the quality and docu-
mentation of routine newborn examination and its reli-
ability in detecting anomalies of the external genitalia.
Such documentation has the potential of enhancing col-
lection and gathering of data on anomalies of the exter-
nal genitalia. More importantly, it could contribute to
saving the lives of such neonates which will ultimately
4
reduce infant mortality as envisaged in MDG 4. In de-
veloped countries where healthcare systems are strong,
the standard of record-keeping in health institutions
have been variously criticized by public bodies and offi-
5
-9
cial inquiries into deficiencies of care . Given that
healthcare systems are generally weak in developing
countries, the level of record-keeping in these countries
is likely to be poorer compared with developed coun-
tries. The above factors prompted the present study. The
purpose of this study was to assess the overall frequency
of missed detection of anomalies of external genitalia
following a routine newborn physical examination and
to describe the general pattern of documentation of its
findings.
The researchers assessed the physical examination find-
ings which have been previously documented by the
attending physician/midwife in the case file of each in-
fant and compared these with researchers’ own findings
on direct physical examination of the external genitalia
of the newborn, using the checklist as a guide. The
phrase ‘marked good’ refers to situations where the
symbol “√” was placed beside the area for documenta-
tion of the external genitalia physical examination find-
ing. The attending physicians/midwives were not aware
that the previous documentation in the case file was be-
ing assessed in this study. Before commencement of
data collection, the authors and the assistants practiced
with the checklist until their documentation for each
baby reached agreement. The examination took place in
the labour/postnatal ward at room temperature with the
neonate lying in supine position. The testicular examina-
tion of the infant involved a two-handed technique. The
examining hand is gently swept along the inguinal canal,
starting at the superior-lateral extent of inguinal canal. A
true undescended or inguinal testicle will be felt to
“pop” under the examiner’s fingers during this maneu-
ver. A retractile testicle will be felt by the opposite hand
Subjects and methods
The study was conducted in two hospitals in Benin City,
namely, the University of Benin Teaching Hospital
(
UBTH), a tertiary healthcare level institution and St
Philomena Catholic Hospital (SPCH), a secondary
healthcare level institution. SPCH is located at the cen-
tre of Benin City and ranks second among maternity
units in Benin City. As a policy, in both hospitals,
mothers usually stay for 2-3 days before discharge,
forming the basis for the selection of these two hospitals
for the study. This ensured availability of the newborn
infants for physical examination in the first 72 hours of
life.
1
2
as it is manipulated into the scrotum. The position of
the testis was recorded after its manipulation to the most
distal position along the normal pathway of anatomical
descent without forced traction. In this study, the posi-
tion of the each testis was categorized into two major
group as normal (if they were either normal scrotal or
normal retractile) or undescended. The undescended
group was sub-classified into prescrotal (if they were
high scrotal or suprascrotal), inguinal or non-palpable
Study population
Nine hundred and fifteen (915) consecutively live-born
term neonates aged between 6 and 72 hours whose par-
ents gave consent for the newborn physical examination
and who were delivered in the study hospitals during the
study period were recruited into the study. The case files
1
3
testes. In female newborns, the external genitalia (labia,
clitoris, urethral opening) were inspected as recom-
(
915) were also assessed. All still-born neonates and all