Showing papers in "Nigerian Hospital Practice in 2012"

Proximate determinants of antenatal care utilization among women in southeastern Nigeria.

Abstract: BACKGROUND: In order to scale up Antenatal services there is need to determine the factors that deter women from accessing antenatal care. AIM: To determine the proximate factors that affect utilization of antenatal care among market women in Nnewi southeastern Nigeria. MATERIALS/METHOD: A cross sectional survey of 400 market women using semi structured questionnaires and focus group discussions. RESULT: Out of the 398 studied women 97.2% attended antenatal care in their last pregnancy. Most (64.5%) of them booked after the third trimester and majority of the women received antenatal care from the private specialist hospitals (37.4%) followed by the private general practice hospitals (34.7%) and government hospitals (17.8%). The main reasons for choosing antenatal care facilities were the perceived friendliness of the staff (33.9%) availability of staff always (27.4%) and proximity of the facility (17.4%). Financial considerations accounted for 4.5% of the reasons for the choice of facility. There was no significant influence of age parity and religion on the utilization of antenatal care. However the likelihood of ANC attendance was significantly lower among the house wives (x2 = 14.2; p = 0.0). There was no association between choice of facility for ANC and age parity occupation or religion. The main reasons identified by the FGD discussants for preferring the private hospitals were more friendly and available staff. Also late booking was mainly attributed to wrong advice from friends and husbands refusal to provide money. Antenatal care attendance rate was high among the studied women and most of the women utilize private hospitals for care. Staff friendliness and availability at all times were the main reasons for choice of ANC facilities. There is the need to address the negative attitudes of the staff in government hospitals.

Pattern of contraception among HIV positive women in Jos University Teaching Hospital.

Abstract: Background: Prevention of unintended pregnancies among HIV positive women is a key strategy in preventing the spread of the disease. Contraception is crucial to achieving this and consistent use of condom provides the dual advantage of prevention of pregnancy and re-infection with HIV and other sexually transmitted infections. The purpose of the study is to determine the contraceptive awareness among these women, the types of contraception being used as well as the prevalence and compliance with barrier contraception. Method: A cross-sectional survey using an interviewer-administered proforma among HIV positive women within the reproductive age group receiving prevention of mother to child transmission (PMTCT) in Jos University Teaching Hospital. Result: A total of 140 questionnaires were administered and retrieved. One hundred and thirty nine women (99.3%) had contraceptive awareness. Ninety eight of them (70%) were using contraception, among which 95(96.9% of contraceptive use) were using condom. The condom prevalence rate in the whole population was 67.8% The pattern of contraception showed that 46(46.9%) used condom alone, 49(50%) used condom with other methods; among which condom and injectables constituted the largest group (41 women, 41.8%). Out of those using condom, 43(43.2%) were using it consistently. Conclusion: The prevalence of contraception, the use of barrier contraceptive and the rate of the combined use of condom with other contraceptive method, underscores the contraceptive awareness of these women as a means of preventing unplanned pregnancies and prevention of re-infection with HIV and other sexually transmitted infections. Keywords: Pattern, Contraception, HIV, Positive, Women, Jos

Knowledge and practice of contraception among pregnant women attending the antenatal clinic in Lagos University Teaching Hospital.

Abstract: BACKGROUND: Preconception prenatal and postnatal care forms a continuum. Family planning is one of the important aspects of the spectrum. Contraceptive options are available but the uptake has been poor. Ante natal clinic attendees represent a major target population for well designed /appropriate post partum contraceptive counseling and care. OBJECTIVES: The study examined the sociodemographic data of antenatal clinic attendees at the Lagos University Teaching Hospital (LUTH) their knowledge about contraceptive methods previous contraceptive practice and anticipated pattern of post partum contraceptive uptake. METHOD: A Semi-structured questionnaire was administered to 151 pregnant women attending the antenatal clinic in LUTH to collect data on their sociodemographic characteristics knowledge of family planning methods pre-pregnancy contraceptive use and their anticipated post-partum contraceptive choices. RESULTS: The mean age of the women was 29.9 years and the mean Parity was 1.1. Majority (90.7%) of the women were married. Ten women (6.6%) felt that they had poor knowledge about contraception while the rest had fair to excellent knowledge. The prevalence of contraceptive use before current pregnancy was 57.6% and the male condom was the method used in 56 cases (64.4%). Their major (54%) source of contraceptive commodity was the chemist/pharmacy. Sixty (69%) women stopped using contraceptive because they wanted to get pregnant. Sixty-eight (45.0%) women planned to use contraceptives after delivery and the male condom (55.9%) was the most preferred method of post-partum contraception. There is no statistical association between age religion parity and educational attainment and desire for post-partum contraception. CONCLUSION: Antenatal women in LUTH appeared quite knowledgeable about contraception but majority had no plan for contraceptive use post delivery. Information dissemination about benefits of child spacing and provision of incentives for easy uptake of post partum contraception would help to correct this imbalance.

Total abdominal hysterectomy for benign gynaecological conditions at a University Teaching Hospital in Nigeria.

Abstract: BACKGROUND Hysterectomy is one of the most commonly performed major gynaecological procedures in women. Total abdominal hysterectomy (TAH) for benign disorders is commonly performed in Jos University Teaching Hospital and this study aimed at ascertaining its frequency in relation to other major gynaecological operations, demographic features of the patients, indications and safety of the procedure in this institution. MATERIALS AND METHODS A retrospective descriptive study of consecutive patients who had elective total abdominal hysterectomy performed for various benign indications during the study period from January 2001 to December 2008 was conducted. Data extracted from the case files included age, parity, presenting symptoms, indications for the surgery, intraoperative findings and post-operative complications. Data was analysed with 2008 EPI-info version 3.5.1. RESULTS Total abdominal hysterectomy accounted for 18.2% of all major gynaecological operations. Majority of the women were in their fifth decade of life (65.9%) and parity of five and above (46.4%). The most common indications were uterine fibroid with or without menorrhagia (60.6%) and cervical intraepithelial neoplasia (27.0%). Post-operative morbidity was recorded in 40 (17.7%) of cases. Post-operative wound infection (52.5%) and fever (30.0%) accounted for the majority of the complications. There was no mortality. CONCLUSIONS Total abdominal hysterectomy for benign conditions is relatively common and safe in this centre. The review of the antibiotic regimes for chemoprophylaxis may help in reducing the post-operative infection rate associated with the operation.

Assessment of pattern of cigarette smoking and associated factors among male students in public secondary schools in Anambra State, Nigeria.

Abstract: Background: The WHO has estimated that there are about 1,300 million smokers globally and about 75% of these are in the developing countries. It is also predicted that if the current pattern of smoking continues, by 2020, there will be 10 million tobacco-related deaths annually worldwide and seven million (70%) of these deaths will occur in the developing countries. The objective of the study was to assess the cigarette smoking pattern and associated factors among male students in public secondary schools in Anambra State. Methods: The setting was public secondary schools in Anambra State. The study was in April 2008. It was a cross-sectional survey involving six schools, selected by multistage sampling technique. Eight hundred and fifty male students participated in the study. A semi-structured self-administered questionnaire was used. Qualitative data were collected using Focus group discussion (FGD). Results: The mean age of respondents was 16±2.1 years. The ever-smoked and current smoking prevalence were 13.1% and 8.7% respectively. Mean age of commencement of cigarette smoking was 13.7±2.6 years. Among smokers, 37.8% were daily smokers. Television (40.7%) and radio (33.3%) were the main sources of advertisement. Peer influence (34.2%) was the main reason for uptake of cigarette smoking. Major reason for not smoking among non-smokers was health concerns (57.9%). There were significant associations between smoking status and age of respondents ( 2 =25.08; P= <0.05), father's smoking status ( 2 =158.77, P < 0.05), awareness of health hazards of smoking ( 2 = 5.13, P = 0.023) and advertisement on television ( 2 = 4.05, P = 0.044) and billboards ( 2 = 44.39, P<0.05). Conclusion: Cigarette smoking prevalence among secondary school boys in Anambra State is high. Health education and strict implementation of anti-smoking policies of the Federal Government of Nigeria is recommended. Keywords: Cigarette smoking, Anambra state, male students, health education, smoking prevalence

Visual disability in newly diagnosed primary open angle glaucoma (POAG) patients in a tertiary hospital in Nigeria.

Abstract: Background: Glaucoma remains the second leading cause of blindness worldwide and the highest cause of irreversible blindness worldwide. In Nigeria, Glaucoma accounts for 16% of blindness and primary open angle glaucoma is the most prevalent clinical type. Aim: The aim of this study is to assess the visual disability resulting from glaucoma in newly diagnosed POAG patients in University of Port Harcourt Teaching Hospital. Materials/Method: This is a retrospective study of newly diagnosed glaucoma patients referred from the general ophthalmology clinic to the glaucoma clinic over a 12 month period (January-December 2010). All patients had a glaucoma workup including Snellen distant visual acuity, slit lamp examination, Goldman applanation tonometry, gonioscopy, dilated fundoscopy with +78 diopter lens as well as perimetry. All examinations were carried out by both authors. Patients with other co-morbidities such as cataract and retinal/macular pathologies were excluded from the study. Results: A total of 98 patients were reviewed. There were 34 males and 27 females, giving a male to female ratio of 1.3:1.The average age was 54.2 years and most patients (>80%) were in the 40-59 year age group. Of the 98 patients reviewed, 62.2%had POAG. 30 patients were blind by distant visual acuity criteria while 45 patients were blind by central visual field criteria. Conclusion: POAG is the most prevalent clinical subtype of glaucoma in Nigeria and sub-Saharan Africa. Paucity of symptoms in early stages of the disease and late presentation is a characteristic finding in our clinical environment. Our study showed that POAG in our environment is associated with marked visual disability at the time of presentation. Keywords: Visual disability, POAG, Tertiary Hospital, Nigeria

HIV sero-prevalence among pregnant women in a resource constrained setting, South East Nigeria.

Abstract: INTRODUCTION : HIV infection and AIDS is a public health problem worldwide, particularly affecting the populace in resource constrained settings like in sub-Saharan Africa. Women of reproductive age are most affected and infected with the disease. METHODOLOGY : A descriptive study of pregnant women presenting for the first time at the obstetrics booking clinic of ESUTTH, Parklane from 1st April, st2009 to 31 March, 2010. Socio-demographic characteristics, sexual behavior, pregnancy history and STI related symptoms were obtained using already prepared proforma. HIV Screening test was conducted in a serial two step approach using Determine HIV test kits and Stat- Pak HIV kits after obtaining an informed consent. Discordant results were subjected to Western blot for confirmation. Data were entered and analyzed using Epi-info statistical software. P Value <0.05 were assessed as statistically significant at 95% confidence interval. RESULT : A total of 1306 women were recruited, 66 women were HIV positive, giving a prevalence rate of 5.1%. Their mean age was 28.79 ± 5.06 years. Majority of them were married (9%).The mean gestational age at booking was 26.2 ± 6.8 weeks. Alcohol intake, history of 3 or more sexual partner in the last 5 years, abnormal vaginal discharge in the last 12 months, history of genital ulcer in last 12 month, had a statistically significant association with prevalence of HIV infection (p value<0.005) CONCLUSION : HIV infection prevalence rate in among antenatal attendants in Enugu is still high. A multi-sectoral approach is required for effective prevention and control of the disease to ensure achievement of Millennium development Goals 5&6 KEY WORDS : HIV in Pregnancy, booking visit, low resource setting, Nigeria

A Comparative Study of School Based Violence and Strategies for Control in Public and Private Secondary Schools in Osun State

Abstract: Background: Violence is universal; it occurs in schools (both public and private). The study aim was to assess the rates of violence as well as existing violence prevention strategies in public and private schools in Osun state. Methodology: A cross sectional study was conducted among 800 secondary school students (599 in public and 201 in private schools) selected by multi­stage sampling technique using quantitative and qualitative methods of data collection. Results: The mean age for all the respondents was 14.26 years ±2.00. Males make up about 51% of the respondents in both public and private schools. Respondents from public schools assaulted other students and staff with a weapon more than their colleagues in private schools (24.7% and 9.7% against 12.9% and 6.5% respectively). The commonest violence 'prevention' strategy in both schools was punishment for violent acts (>90%). Conclusion: Respondents in public schools perpetrated and experienced virtually all forms of school-related violence more than those in private schools. There were mild differences in existing violence prevention strategies in both schools. School connectedness seems to be a major factor in the differential rates of violence between both groups of schools. Keywords: School, violence, public, private, prevention

Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in a low resource setting

Abstract: Retained placenta membranes and tissue are responsible for 5% to 10% of postpartum hemorrhage. Placenta accreta occurs in approximately 1 in 2500 pregnancies of which placenta percreta constitutes about 5% of placenta accreta. This portends the rarity of placenta percreta especially in a 32 year old woman with minimal risk factors. Our patient was a G4P3(+0) woman with 2 living male children who presented at 39 weeks plus 2 days gestation in latent phase of labour and transverse lie. She had emergency caesarean hysterectomy due to primary postpartum haemorrhage secondary to placenta percreta. There should be a high index of suspicion of placenta percreta in women with the risk factors and whoever does caesarean section should have the skills for hysterectomy in case of any encounter with placenta percreta not amenable to conservative management.

Determinants of subjective health status of HIV positive mothers in NAUTH Nnewi.

Abstract: BACKGROUND : Acquired immune deficiency syndrome (AIDS) caused by human immune deficiency virus (HIV), once dominated by infected males has become feminized especially in sub-Saharan Africa where the majority of adults living with the condition are females. Positive life styles, belonging to social support groups and stigma-free HIV services by providers may have good impact on the quality of life of HIV-positive mothers. This study was aimed at assessing the determinants of subjective health status of HIV-positive mothers accessing prevention-of-mother-to-child-transmission (PMTCT) of HIV services in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. METHODS : This is a descriptive study in which 288 consenting HIV positive mothers were selected using the systematic sampling technique. Data on demographics, life style, social support, contraceptive use and subjective feeling about current health status were collected from the subjects using a pre-tested, structured, interviewer-administered questionnaire. RESULTS : The mean age of the respondents was 30.46+4.86 years. Majority (89.2%) of them were married while 55.2% were traders. A significantly higher proportion of the mothers on highly active anti retroviral therapy (HAART) (70.8%) than non users (29.2%) described their current health status as 'excellent' (p<0.001). Also a significantly higher proportion of condom users (99%) than pill users (1%) described their health status as 'excellent' (p<0.02). The same significantly higher proportions of 'excellent' response were given by subjects who engage in social support activities (p<0.001), who practice good feeding (p<0.01) and personal hygiene (p<0.01). CONCLUSION : Access to family planning services and HAART, participation in support group activities and positive lifestyle practices tend to improve subjective health status and should be comprehensively encouraged among the HIV positive mothers. KEY WORDS : Determinants, health status, HIV positive mothers.

Premarital sexual experience and preferred sources of reproductive health information among young men in Kumbotso, northern Nigeria.

Abstract: BACKGROUND: Despite well known risks associated with unprotected premarital sex this phenomenon has not been well explored among young men in rural northern Nigeria. We studied the predictors of premarital sex and preferred sources of sexual and reproductive health information among young unmarried men in Kumbotso northern Nigeria. METHOD: A cross section of 400 young men were interviewed using structured questionnaires with mostly closed ended questions. RESULTS: Of the 385 respondents 39 (10.1%) were sexually experienced. Less than half of respondents (48.7%) used a condom at sexual debut and an equal proportion reported having multiple sex partners. Only 41.0% of sexually experienced respondents reported subsequent consistent condom use Age (adjusted odds ratio [AOR] = 4.12; 95% confidence interval (CI): 2.24-5.20 and educational attainment [AOR = 3.57; 95% CI (1.49-9.10)] were significant predictors of sexual experience. The current versus preferred sources of sexual and reproductive health information included friends (51.3% vs. 93.3%) Islamic school teachers (41.0% vs. 72.7%) and school teachers (8.8% vs. 15.1%). CONCLUSION: Although the prevalence of premarital sex among young men in this community in northern Nigeria as low those that did engage in such activity were likely to not use condoms and to have multiple partners. Preferred and trusted sources of information included peers and religious leaders. The findings in this study could be used to develop innovative strategies for reaching young men with accurate sexual and reproductive health information.

The impact of health education on the awareness and acceptability of strategies for preventing mother to child transmission of HIV in Enugu, Nigeria.

Abstract: BACKGROUND : Majority of Paediatric HIV/AIDS are from infected mothers and adequate prevention of mother to child transmission (PMTCT) of HIV is a critical factor in the control of paediatric HIV/AIDS. Success of PMTCT strategies will require a high level of acceptability of these strategies by pregnant women. METHODS : A cross sectional descriptive study of the impact of health education on the awareness of strategies for PMTCT was undertaken using interviewer administered questionnaire on antenatal women recruited from three health institutions in Enugu. RESULTS : A total of 150 antenatal clients were studied. Their mean age was 29.9 + 4.0. Ninety four point seven percent (94.7%) were married and 60% of them had post secondary education. There was high level of awareness and acceptability of PMTCT measures amongst the respondents. Out of the 150 respondents, 123 (82.0%) identified correctly the meaning of HIV, 140 (93.3%) were aware it can affect the newborn, 105 (75%) knew how it is transmitted and 135 (90.0%) had awareness that we can prevent mother to child transmission of HIV. 130 (86.6%) of the respondents would accept some measures for PMTCT. Awareness that HIV can affect new born increased from 140 (93.3%) to 145 (96.7%) following health education while those who would accept PMTCT measures increased from 130(86.6%) to 146 (97.3%). These increases were statistically significant (P<0.05). CONCLUSION : Health education has a positive and significant impact on the awareness and acceptability of Prevention of Mother to Child transmission of HIV amongst antenatal clients in Enugu. KEYWORDS : Health education, mother to child transmission, HIV, Enugu.

Childhood Acute Bacterial Meningitis in Benin City, Nigeria

Abstract: Childhood acute bacterial meningitis (ABM) is a leading cause of morbidity and mortality in Nigeria. The usual practice of commencing antibiotic therapy before the complete laboratory result is available necessitates the knowledge of the current most frequent aetiologic agents of meningitis and the antibiogram in the local population.This study was undertaken to prospectively investigate childhood acute bacterial meningitis in patients attending the children emergency unit at the University of Benin Teaching Hospital. One hundred and fifty CSF specimens obtained from children suspected to have acute bacterial meningitis were analyzed using microscopy, culture, biochemical tests and latex agglutination tests. A total of 23 (15.3%) out of 150 were confirmed bacterial meningitis. Eleven (47.8%) out of the 23 cases were caused by Streptococcus pneumoniae, 7 (30.4%) Haemophilus influenzae type b, 3 (13.0%) Neisseria meningitidis and 2 (8.7%) for others comprising of Staphylocuccus aureus and Klebssiella pneumoniae. No statistically significant association was established between ABM and variables like age 0.05). Penicillin and ampicillin resistances were established among 16.7% and 11.1% of Haemophilus influenzae and Streptococcus pneumoniae isolates respectively. There is need for periodic surveillance of prevalence, aetiology and antibiotic resistance pattern of childhood bacterial meningitis in order to optimize antibiotics management.

Akinosi (tuberosity) technique: a verity but under-utilised mandibular nerve block technique.

Abstract: Background: Profound local anaesthesia is a desired clinical condition in surgical treatment of lesions in the oral cavity This is because patients' cooperation is better assured with a pain-free field of operation In dentistry this is usually achieved by either infiltration or block anaesthesia The inferior alveolar nerve (IAN) block is the main block anaesthesia employed in dentistry, particularly for mandibular procedures Different techniques of achieving this block anaesthesia have been described The two commonly used of these techniques are standard technique (ST) and Akinosi technique (AT) The objectives of this study were to determine the more commonly used IAN block technique and the success rate in a self-referral dental clinic Patients and Method: This was a retrospective study that included patients treated between January, 1993 and December, 1995 Records of the patients treated within this period were examined to determine which of the two anaesthetic nerve block techniques was more frequently used in achieving deep analgesia for their mandibular procedures Results: Of the 480 patients that were treated with block anaesthesia, 392 (817% ) were treated with standaard technique while 88 ( 183% ) were treated with Akinosi technique Conclusion: Dental Surgeons in the clinic utilised standard nerve block technique more frequently than the Akinosi technique in their mandibular procedures inspite of the reported higher merits of Akinosi techniques

Knowledge of HIV prevention and willingness to collaborate in vaginal microbicides trials-survey of Nigerian gynecologists.

Abstract: BACKGROUND: Gynecologists being the primary care physicians and advocates for women sexual and reproductive health are critical in delivering messages on effective intervention to prevent heterosexual HIV transmission. Their knowledge and opinions on the effectiveness of HIV prevention technologies may influence the acceptance and use of these technologies among women at risk. METHODS: A cross sectional survey was self-administered to Nigerian gynecologist attending an Annual Scientific conference; "Kanon Dabo" between November 17 and 21 2009 in Kano Nigeria. Their opinions on various HIV prevention strategies as well as their willingness to collaborate on vaginal microbicides trials were assessed on a Likert scale. The mean scores of the responses were tested using students T-test. Statistical analyses were done with STATA version 11 College Station Texas USA. RESULTS: Of the 100 questionnaires distributed to the participants at the conference we had a survey response rate of 74.0%. The mean age of the participants was 42.38 +/- 6.67 years with range 30-58 years. Male participants constituted 84.9% and Female participants 15.1%. Twenty five percent (25%) of the surveyed participants were aware of vaginal microbicides and only 3% correctly mentioned an example of a vaginal microbicide for HIV prevention. The willingness of the participants to collaborate on vaginal microbicides trials was not significantly related to their knowledge on vaginal microbicides (p = 0.475). CONCLUSION: We concluded that the current knowledge of Nigerian gynecologist on vaginal microbicides is poor. Efforts to create awareness among these women advocates on recent HIV prevention technology particularly vaginal microbicides are required.

Pattern of clinical presentation of eclampsia at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeastern Nigeria.

Abstract: BACKGROUND: Eclampsia contributes significantly to maternal and perinatal mortalities globally. The objective of this study is to review the pattern of Eclampsia in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi Nigeria. METHOD: A retrospective study that reviewed records from labour ward and the Medical Records Department of cases of Eclampsia managed at NAUTH over a ten year period 1st January-31st December 2009. RESULTS: There were 57 cases of Eclampsia out of a total of 6262 deliveries within the study period giving a prevalence of 0.91%. The highest prevalence of 0.24% occurred in 2009. It was most common 14 (30.4%) in the 25-29 year age group. The nulliparous women 28 (61%) were more commonly affected. The prevalence was higher in the un-booked patients (89%) and antepartum Eclampsia was the commonest type (76%). Twenty one (45.7%) patients had three or more convulsions prior to the institution of therapy. Headache oedema and blurring of vision were the commonest symptoms 74% 71% and 65% respectively. CONCLUSION: Eclampsia occurred mainly in un-booked and primigravid patients in this study. Early registration of pregnant women especially primigravid in health facilities for effective antenatal care and supervised hospital delivery will significantly reduce the prevalence and complications of Eclampsia.

Stereological quantification of Leydig and Sertoli cells: technique of assessing antifertility potentials of metronidazole.

Abstract: Changes in the numbers or volume of the different cell types in the testis have been widely used to ascertain the effects of environmental and chemical agents on the testis. This study is designed to investigate the direct effects of metronidazole on the testicular cells by quantifying the number of Sertoli and Leydig cells. A total of 105 adult male and 50 female wistar rats weighing 170±10g (70-90 day old) were used for the experiment. The rats were randomly divided into a control and experimental groups. There were four major groups with 5 subgroups consisting of 5 rats each. Varying doses of metronidazole were used depending on the experiment. Experiment 1; animals were fed with 15mg/kg of metronidazole, experiment 2; fed with 30mg/kg of metronidazole, experiment 3; administered with 200mg/kg of metronidazole and experiment 4; fed with 400mg/kg of metronidazole. Each experimental has 5 sub-groups; A control, B; group fed with the experimental dose, C; experimental dose with vitamin E, D; experimental dose with testosterone, E; fed with experimental dose, vitamin E and testosterone and sub­group F, a reversal group which was left for 8weeks after cessation of treatment. At the end of the experiment, animals were scarified and the antioxidant effects of metronidazole were investigated using malonildialdehyde concentration and catalase activity. Results showed that metronidazole at the therapeutic dose of 15mg/kg and 30mg/kg did not have significant negative effect on the testicular cell number. At the dose of 200mg/kg and 400mg/kg, there was a marked increase in number of Sertoli and Leydig cells. The results of this study indicate that metronidazole administration (200mg/kg or 400 mg/kg), for 8weeks, caused a reduction in the total number of Sertoli and Leydig cells of the testis and this effect was reversible after 8weeks of abstinence. Keywords : stereology, Leydig cells, Sertoli cells

A reduction in radiographic exposure and image quality in film screen postero-anterior chest radiography.

Abstract: Purpose: To develop a protocol for the optimization of diagnostic chest radiography examination, the effect of radiographic exposure reduction on image quality is investigated. Procedure: Fourty-eight adult patients presenting for posterior-anterior (PA) chest radiography in a tertiary health care centre were categorized into 3 groups to assess the effects of exposure (tube current/time mAs) reduction on clinical image quality using in film screen (FS) chest radiography. Images were obtained at existing departmental exposure protocol (T1) while a record of the exposure factors was made. Test exposures obtained by reducing average mAs values by 20% (T2) and 50% (T3) were used to obtain radiographic images of patients following normal ethically based clinical practice. To make up for the reduction in mAs, a 4% increase in the T1 kVp was used. The quality of images obtained with each exposure protocol was studied by two Consultant Radiologists, using the image quality criteria of the Commission of European Communities (CEC). Assessors used the method of ranked scoring and worked independently. Results: Results showed no change in image quality following the 20% exposure (mAs) reduction. However, there was a significant change in image quality at 50% reduction of mAs values (P < 0.05) with higher image quality scores suggesting improved perceptibility of all assessed criteria among the observers. Conclusion: Improving radiation protection of the patient while maintaining diagnostic quality of the radiographic image at reduced exposures is a clinically desirable development. This study will find application in current efforts at optimization of radiography procedures in the area of study. Keywords: Radiography, exposure reduction, image quality, chest, quality control.

Case Report: Profile of Paediatric Umbilical Hernias Managed at Federal Medical Centre Umuahia

Abstract: BACKGROUND : Umbilical hernias are common in children but many resolve spontaneously within the first five years of life .Most umbilical herniorrhaphies in our environment are due to symptomatic hernias which constitute a small percentage of all umbilical hernias . PATIENTS AND METHODS :A retrospective review of all pediatric patients with UH treated at Federal Medical Centre Umuahia ,Abia State from February 2001 to February 2011. RESULTS : There were 22 patients but only 20 of the folders were found and analyzed .They were made up of 11males and 9females with a mean age of 6.19±0.83years and median age of 6years.Nine(7 males and 2 females) had acute incarcerations ,nine(3 males and 6 females) had recurrent umbilical pains without incarceration and two(1 male and 1 female) had recurrent incarcerations .Age range for acute incarceration was 2-8years(mean:4.69years,median :4years);recurrent umbilical pains was 4months-15 years(mean:7.7years,median:8years) and for recurrent incarceration 2-10years(mean:6years).All had standard umbilical hernia repairs except one whose parents declined surgery after reduction of acute incarceration .One patient with acute incarceration had gangrenous bowel with hernia sac abscess and was offered bowel resection with end-to-end anastomosis .On short-term follow-up ,the symptoms resolved in all the patients following surgery .Five patients had six complications:1 exuberant granulation tissue,2 stitch reactions,2 superficial wound dehiscence and one superficial wound infection .There were no mortalities and no recurrence on short-term follow-up .Only one patient(5%)registered under the National Health Insurance Scheme(NHIS). CONCLUSIONS : Active observation of all umbilical hernias at all ages will ensure early detection of complications and prompt treatment .Elective repair of umbilical hernias in patients above five years with fascia defect greater than 1.5cm is encouraged .Comprehensive NHIS will ensure early presentation and reduced complications. KEY WORDS : Pediatric ;Umbilical ;Hernia

Patterns of Voluntary Counselling and Testing among Undergraduate University Students in Lagos, Nigeria

Abstract: It is critically important for individuals to learn about their HIV status and make informed decisions about their future. The study aimed at determining the patterns of voluntary counselling and testing among undergraduate university students in Lagos, Nigeria. The study was conducted in May 2010 among students recruited from seven faculties within two of the campuses of Lagos State University, Ojo and Ikeja campuses. A total of 200 respondents were recruited using systematic random sampling method and surveyed with the aid of structured questionnaire. A high percentage of respondents (54.0%) had not performed HIV counselling and testing before the survey interview. 54.1% and 53.8% of male and female respondents, respectively, had not performed HIV counselling and testing before the survey. The commonest reasons given for not doing HIV counselling and testing is that respondents are too busy which accounted for 35.1% of total respondents. Ahigh percentage of respondents (65.5%) are aware of location of HIV counselling and testing centre within their institution. Students are not particularly interested in HIV counselling despite the high awareness of availability of HIV counselling and testing centre located within their educational institution; they invest their time and interest more in academics.

Traditional birth attendants issue: a menace in developing countries.

Abstract: BACKGROUND: A significant proportion of births in Nigeria still occur at homes of traditional birth attendant. Traditional birth attendants are popular in developing and low resource countries. They lack no formal education or medical training and their clients end up with obstetric complications which lead to severe morbidity and mortality. CASE SUMMARY: Two cases of pregnant women that engaged the services of traditional birth attendants (TBA) before presenting at a health facility are presented. They ended up with severe morbidity and mortalities. A 29 year old gravida 3 + para 2+0 woman with two previous caesarean section(C/S) was counselled for elective c/s but declined. She presented at the home of a TBA had spontaneous vagina deliver collapsed one hour after delivery and was dead by the time she was brought to the hospital. A 30 year old gravida 10 para 7 + 3 presented in hospital after being in labour at the home of a TBA for three days. On presentation in hospital there was absent foetal heart sound. At surgery there was ruptured uterus and subtotal hysterectomy was done. CONCLUSION: To improve the situation better access to optimal antenatal care and intrapartum care together with early referral of high-risk patients must be facilitated. Increased community awareness promotion of appropriate technology for effective health care planning strategy from the grassroots level to tertiary centres is important in the reduction of obstructed labour. One of the most effective means of reducing maternal mortality is the provision of caesarean section for all women who need it.

Letter to the Editor: Burn Disaster Acute Care Management in a Nigerian Hospital: Any change 10 years after?

Abstract: This study is derived from retrospective data from the management of a fire disaster involving nine students managed in the institution following a fire disaster at the female students' hostel.The average length of stay was 19 days. The total cost was $47.74 per day per patient. KEY WORDS : Burn care costs, injury, Nigeria

Feasibility of early diagnosis and treatment of acute chest syndrome in sickle cell anaemia--a case report.

Abstract: Acute chest syndrome is a serious complication and one of the causes of mortality in sickle cell disease. Twenty eight year old male was admitted in our hospital with fever, severe chest pain and haemolytic crisis. He was treated with intravenous antibiotics, fluids, parenteral analgesics and blood transfusion. Severe hypoxemia developed after 72 hours of hospitalization. The patient was transferred to the intensive care unit of our hospital. Oxygen therapy and ionotropic support were initiated. Vital parameters and organ functions returned to normal after treatment. KEYWORDS : Acute chest syndrome, Sickle cell anaemia