Showing papers in "Nigerian Medical Journal in 2010"

The Evolution of Health Care Systems in Nigeria: Which Way Forward in the Twenty-First Century

Abstract: Correspondence: Prof. A. Scott-Emuakpor Evolution is “change” and one of the most consistent phenomena of life is “change”. Change is to alter, to vary, to substitute, and to mutate. The complexity of life itself is brought about by change. Our individuality is fashioned by change. In the process of gamete formation, the genes within the germ cell undergo a complex rearrangement referred to as “meiosis”. During this event, the chromatids of homologous chromosomes participate in an almost ritualistic exchange of genetic materials called “crossing-over” or “recombination”. At the end of this process, paternal and maternal genes are recombined uniquely to produce an arrangement of genes never before encountered. This ultimate change produces a unique individual generation after generation. Whether you are an “evolutionist” or a “creationist”, change constitutes the main element of the process in which you believe. The entire theory of evolution glorifies “change”. Evolution derives its substance from the theory of “survival of the fittest”. The fittest are fittest because they have undergone change called “mutation”, which confers on them reproductive superiority in a constantly changing environment. Therefore, the “fittest” have a “selective advantage” to deal with a changed environment. The creationist should remember the story of creation very well. It consisted of a series of changes. As the narrative goes, “And the earth was without form, and void; and darkness was upon the face of the deep. And the spirit of God moved upon the face of the waters. And God said, “Let there be light: and there was light” (see Genesis 1:2-3). Light was the very first change God brought to bear in the process of His creation. The story of God's creation becomes even more fascinating as you read the rest of the book of Genesis. It shows how God changed the world and the beauty therein painstakingly. It also shows the changes that were introduced into our very existence when the first Humans disobeyed the instructions of God.

Ectopic pregnancy: A 5 year review of cases at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi

Abstract: Background: Ruptured ectopic pregnancy continues to be a common life threatening emergency in our environment as well as a public health problem. Objective:This is to study the incidence, clinical presentation, risk factors and the management of cases that presented in our centre over a five year period. Methods:This is a retrospective study of cases of ectopic gestations managed in the gynaecological unit of NAUTH Nnewi from January 1 st , 2002 to December 31 st , 2006. Information was obtained from the case notes, theatre and labour ward registers. Results: During the period, a total of 2,746 deliveries were recorded while 556 gynaecological patients were admitted. Thirty six patients had ectopic gestations accounting for 1.3% of all deliveries and 6.5% of all gynaecological admissions. The peak age group was 26-30 years (44.4%); 28(77.7%) were married and 20 (55.6%) attained secondary school as their highest level of education. All 36(100%) of the patients were symptomatic at presentation. Abdominal pain, amenorrhoea and syncopal attack were the most common symptoms at presentation. Also, multiple sexual partners 27(75%), previous abortions 25(69.4%) and previous sexually transmitted infections 10(27.8%) were the most common risk factors present in the patients. Abdominal paracentesis 32(88.9%), ultrasound 8(22.2%) and urine pregnancy tests 7(19.4%) were most commonly utilized for diagnosis. None of the cases was diagnosed before rupture. Open abdominal surgery was the treatment employed in all the patients. Conclusion:Ectopic pregnancy is still a major challenge in gynaecological practice in our centre. Most cases present late making tubal conservation treatment inapplicable. This has far reaching implications in a society where there is high premium on child bearing.

Community based healthcare financing: An untapped option to a more effective healthcare funding in Nigeria

Abstract: Context:The Nigerian health system is characterized by chronic under funding. This has resulted in poor performance of the health sector evident from Nigerian's poor reproductive health indices. Objective: This review evaluates healthcare funding in Nigeria with respect to health budget and health expenditure, appraises the national health insurance scheme, and examines community health care financing as a plausible option to a more effective funding of healthcare in Nigeria. Pattern of health funding in Nigeria: Federal Government budget on health ranged from N 4, 835 million-N 17, 581. 9 million from 1996 to 2000. This amount represented only 2. 7%- 5. 0% of the total Federal Government budget. Nigerian's Total Health Expenditure (THE) as a percentage of Gross Domestic Product (GDP) is low ranging between 4. 3 %- 5. 5 % from 1996- 2005. General Government Health Expenditure (GGHE) as percentage of THE is also low ranging from 21. 8 %- 33. 5 %. Private sector expenditure on health as percentage of THE is high ranging between 66. 5 %- 78. 2 % from 19962005, with private households' out of pocket accounting for 90. 4 %- 95. 0 % over the period. Social security fund had no contribution to the general government expenditure over the 10-year period. The National Health Insurance Scheme (NHIS) currently covers only the formal sector of 4. 5 million people ( 3. 2 %) of the population. Community-based healthcare financing (CBHF): Community-based healthcare financing has been recognized as a community-friendly and community-driven initiative that has a wider reach and coverage of the informal sector especially if well designed. Experience with the Anambra State CBHF scheme, and a few other similar schemes in Nigeria indicate high acceptability of the people to CBHF scheme. Conclusion and Recommendations: Government and non-governmental organizations should collective develop various forms of CBHF to reach out widely to Nigerians.

Implications of low oral health awareness in Nigeria

Abstract: I congratulate the Nigerian Medical Association on this Golden Jubilee celebration. It is my opinion that time is apt for us all to have to reappraisal of health care delivery in Nigeria and fashion a practical and achievable way forward for the betterment of the health of the poor Nigerian. I thank the association for inviting me to participate in this symposium on 50 years of oral health in Nigeria. It is my hope and prayer that deliberations at this meeting would signal the beginning of a well planned and structured oral health care delivery system for Nigeria. My brief is to discuss the implication of low oral health awareness in Nigeria.

Trends in maternal mortality at University of Maiduguri teaching hospital, Maiduguri, Nigeria - A five year review

Abstract: Background:Maternal mortality is on the rise in Nigeria with the North- East having the highest ratio, and Borno state records one of the highest maternal mortality ratios in the country. Objective:To determine the trends in maternal mortality in UMTH, identify the background socio- cultural factors, establish the major causes of deaths and determine avoidable factors. Study design:Retrospective study of maternal deaths. Methods: The case records of all recorded cases of maternal deaths between January 2001 and December 2005 inclusive were retrieved and relevant data obtained and analysed. Results: The maternal mortality ratio (MMR) for the period under review was 430 per 100,000 live births. There were annual fluctuations in MMR. However, there was a consistently rising trend in MMR from 2002-2004 with the highest ratio of 545 per 100,000 live births recorded in the year 2004, with a decline in 2005. Thirty (78.9%) of these deaths occurred among the unbooked patients and more than 90% of this were referred as obstetric emergencies. Age range was 14-39 years with a mean of 26.5years. The highest maternal death occurred at the two extremes of reproductive age group (14-19 years and 35 years and above). Grandmultiparas suffered the highest maternal mortality of 36.8%, followed by teenage mothers. P1-4 contributed the least to maternal mortality. The direct causes of maternal death accounted for 92.1% of the deaths. The major causes of death were eclampsia 34.2%, sepsis 26.3% and prolonged obstructed labour/ruptured uterus 13.2%. Amongst the indirect causes of maternal death, HIV/Tuberculosis was the leading cause accounting for 5.3%. Basic but professional antenatal care, skilled attendance at birth, community mobilization and health education messages for a healthy pregnancy and safe birth will help to reduce the unacceptably high maternal mortality ratio in Borno state and the country at large.

Improving Low Awareness and Inadequate Access to Oral Health Care in Nigeria: The Role of Dentists, the Government & Non- Governmental Agencies.

Abstract: In Nigeria presently, dentistry and oral health issues are not receiving priority attention. There is a general low awareness and inadequate access to oral health care in Nigeria, consequently, the oral health of the populace is getting worse and the morbidity is high. For a broad-based approach to the problems of oral health care in Nigeria there is the need for concerted efforts among the Dentists, the Government and Non-Governmental Organizations.

Universities and medical education in Nigeria

Abstract: Formal attempts at Medical Education in Nigeria began in 1927 with the establishment of an institution in Lagos for training medical manpower to diploma level. They were trained to practice only in Nigeria. The program was not popular and was discontinued. Following the report of the Elliot Commissions on higher education in West Africa it was decided to establish the University of London College at Ibadan, with a Faculty of Medicine as one of the initial faculties. This was realized in 1948. The debate on what type of doctor to produce for Nigeria ended with the decision to produce high caliber doctors of the same standing as British trained doctors. In 1960 the Ashby Commission on Higher Education in Nigeria recommended the establishment of more training institutions, including those for medicine. This led to the establishment of the University of Lagos with the College of Medicine. The three initial regional governments all established their universities with medical faculties. Medical education has expanded rapidly with the expansion of universities, and we now have Federal and State governments as well as other organizations or private individuals owning universities with medical schools. Regulation of undergraduate medical education has continued to be under the dual oversight of the National Universities Commission and the Medical and Dental Council of Nigeria. The main problems of the medical schools have been the shortage of properly trained staff and poor facilities, curriculum stagnation and lack of modern teaching and assessment instruments. To tackle these problems training in educational methods should be mandatory for academic staff; there should be greater synergy between the NUC and MDCN, and curriculums should be reviewed to reflect modern trends.

Malaria Treatment Services in Nigeria: A Review

Abstract: Malaria remains a major Public Health problem in Nigeria and causes death and illness in children and adults, especially pregnant women. Malaria case management remains a vital component of the malaria control strategies. This entails early diagnosis and prompt treatment with effective antimalarial medicines. The objectives of this review is to enable health professionals to understand the magnitude of malaria treatment services in Nigeria, to improve knowledge for rational malaria management within different health system contexts with a view to improving access to malaria treatment. The review therefore looks at the following areas: clinical disease and epidemiology; the burden of malaria in Nigeria; objectives of treatment; antimalarial treatment policy; malaria diagnosis, treatment strategies/ National responses; treatment sources. The review concludes that for improved malaria treatment services in Nigeria, there is an urgent need to develop adequate strategies that will ensure better access to medicines by getting evidence-based and effective medicines to the people who need them, whether by reducing their costs, promoting equity in access, improving their distribution, increasing their efficacy and acceptability, or slowing down the development of antimicrobial resistance.

Hepatitis C virus infection in Nigerians

Abstract: Background:Hepatitis C virus is a chronic lifelong infection in the majority of patients who are infected with the virus. Not much is known and written/published about this virus in Nigeria. Objective: To assess the status of hepatitis C virus infection in Nigeria. Materials and method:Sources of information were mainly from published works in and outside Nigeria. The information was extracted over a period of 12 months from January to December 2009. Results:So far the prevalence of hepatitis C. virus infection is increasing in Nigeria, ranging from 4.7-5% in Ilorin, to 5.3-6.6% in Enugu, to 11% in Ibadan and 20% in Benin. Children and adults are all at risk of being infected especially sickle cell disease patients. Others include those who are exposed to the common risk factors like Blood transfusion, haemodialyisis, recycling of syringes and needles, sexual promiscuity. Conclusion:Reduction in the Hepatitis C virus infection could be achieved by Health education campaign of the general public and by support from government and non-governmental organizations for the to provision of antiviral and immunostimulatory drugs free of charge for those already infected.

Hysterectomy for benign gynaecological conditions at Gombe, north eastern Nigeria

Abstract: Background: Hysterectomy is one of the commonest major gynaecological surgeries performed all over the world. This study is the first audit of hysterectomy in a relatively new centre in the North-eastern part of Nigeria. Aim: To determine the indications and outcome of hysterectomy in Gombe Methods: This is a retrospective study in a tertiary health facility in Gombe, an urban community in north eastern Nigeria. The study is a descriptive analysis of all cases of hysterectomy for benign disease over a 6year period (January 2001-December 2006). Information on socio-demographic characteristics, presenting symptoms, indication for surgery, type of hysterectomy, cadre of surgeon, operative findings, blood transfusion, pre-morbid condition, duration of hospital stay and post-operative morbidity were retrieved and analyzed. Results: Hysterectomy for benign gynaecological conditions accounted for 10.7% of all major gynaecological operations during the study period. The leading indications for hysterectomy were uterine fibroid 36(39.1%), dysfunctional uterine bleeding (DUB) 21(22.8%), and uterovaginal prolapse 19 (20.7%).The mean age and parity were 45.7+11.1years and 5.5+3.7 respectively. Abdominal hysterectomy with either unilateral or bilateral salpingo-oophorectomy accounted for 73(79.3%) and vaginal hysterectomy contributed 19(20.7%) of cases. The majority of the patients 55(59.8%) were not transfused. Thirty four (37%) were found to be hypertensive. The crude morbidity rate was 29 (31.5%) with wound infection 7(24.1%) being the commonest complication. There was no mortality associated with hysterectomy during the period under review. There was no significant difference in blood transfusion rate between abdominal and vaginal hysterectomies (P= 0.168).The cadre of surgeon (consultant or senior registrar) had no significant influence on morbidity rate (P= 0.132) and overall there was no significant difference between route of hysterectomy (abdominal or vaginal) and morbidity rate (P =0.577).The duration of hospital stay was however significantly lower in those who had vaginal hysterectomy (P=0.019) Conclusion: Hysterectomy appears to be a safe procedure but the high morbidity rate is worrisome. There might therefore be the need to review antibiotic prophylaxis and the policy of asepsis and antisepsis during hysterectomies. The shorter duration of hospital stay following vaginal hysterectomy has an economic appeal and therefore should be resorted to whenever feasible. Key words: Indication, hysterectomy, outcome, Gombe

The prevalence of overweight/obesity and dyslipidemia amongst a group of women attending "August" meeting

Abstract: Background: Obesity and dyslipidemia are major risk factors for cardiovascular disease while obesity is a leading determinant for hypertension and diabetes mellitus .The objective of this study was to assess the prevalence of overweight/obesity and dyslipidemia amongst a group of women attending “August” meeting. Methods: A total of 186 women attending the 2006 “August” meeting at Naze, Owerri North Local Government Area, Imo State, were recruited into the study but only 183 had complete data. The Blood Pressure (BP) was measured using a Standard Mercury Sphygmomanometer with appropriate cuff size. BMI was calculated as weight (in kilograms) divided by height (in meters) squared. Based on the WHO classification overweight was defined as BMI between 25 and 29.9kg/m2, and obesity was defined as BMI>30kg/m2. Total serum cholesterol was determined by the method of Trinder 1969 , triglycerides by the method of Jacobs and van Demark 1960 while LDL-C and HDLC were determined by the method of Assmann, Jabs Kohnert et al 1984. Hypercholesterolemia was defined as total cholesterol 6.20mmol/L (240mg/dl), reduced HDL less than 1.29mmol/L (50mg/dl), Hypertriglyceridemia as triglycerides greater than 1.7mmol/L (150mg/dl) . Result: The mean age is 54.84yrs ± 10.76, the mean BMI 26.47 ± 4.50, mean SBP 132.38mmHg ± 21.94, mean DBP 77.07mmHg ± 12.25, mean TC 5.29 mmol/L±1.76, mean HDL 1.14mmol/L ±0.83, mean LDL 1.39mmol/L ± 0.63, mean TG 1.49mmol/L ± 0.63. The prevalence of overweight was 38.5%, obesity 20.7%, hypertriglyceridemia 34.1%, hypercholesterolemia 31.4%, low HDL 37.6%, hypertension 44.3% and dyslipidemia 60.5%. BMI correlated with DBP r=.290, P <.000; TC r=.246, P<.001; LDL r=.172, P=.024 but did not correlate with age SBP, TG and HDL. Age correlated with SBP r=.321, P< .000 and LDL r=.163, P=.031. TC correlated with SBP r=.370, P<.000, DBP r=.274, P<.000, TG r=.441, P<.000 LDL r=.757, P<.000 but did not correlate with HDL. Conclusion: In conclusion this study has shown a high prevalence of Obesity/Overweight, Hypercholesterolemia, Hyperglyceridemia as well as low HDL amongst a group of women attending “August” meeting. Niger Med J. Vol. 51, No. 4,Oct. – Dec., 2010: 155 – 159. Keywords: August Meeting, Obesity, Overweight, Dyslipidemia, Igbo-speaking

Detection of extended spectrum beta-lactamases in gram negative bacilli from clinical specimens in a teaching hospital in South eastern Nigeria

Abstract: Antimicrobial drug resistance seen among many gram-negative bacteria, especially those expressing the extended-spectrum β- lactamase (ESBL) enzymes that hydrolyze the expanded- spectrum cephalosporins has been on the increase. This has compromised treatment options and thus a threat to the containment of bacterial infections. To determine the existence of the extended-spectrum β-lactamase enzymes in Nnewi, 250 clinical isolates of members of the family Enterobacteriaceae and Pseudomonas species from Nnamdi Azikiwe University Teaching Hospital, Nnewi were identified by conventional methods. These include Klebsiella species (96), E. coli (90), Pseudomonas species (37), Enterobacter species (13), Proteus species (6), Citrobacter species (5) and Salmonella species (3). Antimicrobial drug susceptibility testing was carried out on all the isolates by the disc diffusion method. Extended Spectrum Beta- lactamases were detected by the double disc synergy test. High level of antimicrobial resistance was noted in test organisms against some of the antimicrobial drugs: Ampicillin + Cloxacillin (93.2%), Tetracycline (90.8%), Streptomycin (82.4%), and Nalidixic acid (62%), and low level of resistance was observed against Ofloxacin (26.4%), Cefotaxime (28.8%) and Nitrofurantoin (28.8%). One hundred and forty four isolates (57.6%) were suspected ESBL-producers judged by their resistance to any of the third generation cephalosporins used but 40 (16%) actually produced the extended spectrum beta- lactamase enzymes. This shows the existence of Extended Spectrum Beta- Lactamase producing gram negative organisms in Nnewi. Considering the treatment difficulties, as well as the high cost of treatment associated with these organisms, concerted efforts are needed to contain their spread.

Malaria in pregnancy

Abstract: Malaria remains one of the highest contributors to the precarious maternal mortality figures in sub-Saharan Africa. At least 6 million women worldwide are at risk of malaria infection in pregnancy. Malaria contributes to at least 10, 000 maternal deaths and to at least 200, 000 newborn deaths annually. Malaria is a contributor or aetiologic factor in pregnancy complications including anaemia, spontaneous abortion, prematurity and stillbirths. Pregnancy results in increased incidence and severity of malaria. Cerebral malaria, acute renal failure and severe anaemia, rare complications in adults living in malaria endemic areas, may complicate malaria in pregnancy. Research implicate reduced maternal immunity from increased steroid levels in pregnancy, increased attractiveness of pregnant women to mosquito bites and increased adherence of parasitized erythrocytes to Chondroitin sulphate A expressed in the placentae. This is worse in the first and second pregnancies. With infection with the Human Immunodeficiency Virus [HIV], the effects of malaria in pregnancy are even worse. Over the decades, there have been concerted worldwide collaborative efforts, spearheaded by the World Health Organization [WHO] and including governments and allied agencies to tackle the scourge of malaria in pregnancy. The main thrusts of such efforts have been: to increase the use of insecticide treated mosquito bed nets [ITN]; intermittent preventive treatment of malaria [IPT]; and adequate case treatment of acute malaria attacks in pregnancy. While for IPT, Sulfadoxine-Pyrimethamine [SP] combination has been proven to be of benefit in preventing acute and latent malaria in pregnancy and its associated complications, the WHO has introduced the use of Artemisinin-Combination Therapy [ACT] for the first-line treatment of uncomplicated malaria in pregnancy, the need to confirm malaria before treatment and the enforcement of completion of therapy once started. The Roll Back Malaria [RBM] campaign was launched as a strategy to curtail the incidence and scourge of malaria especially in the vulnerable groups including pregnant women. The Millennium Development Goals [MDGs] offer a new hope if adequately pursued to achieving eradication of malaria and its complications in pregnancy. There is need to support research into effectiveness and utilization of established and newer control measures.

Seroprevalence of hepatitis B surface antigen among antenatal clinic attendees in a private specialist hospital in Onitsha, Southeast Nigeria

Abstract: Background and Objective: Hepatitis B virus (HBV) infection is endemic in many regions of the world including Africa, Asia and Western Pacific1, 2. In Southeast Nigeria information on the seroprevalence of HBV infection among pregnant women is limited. This study was carried out to determine the seroprevalence of HBsAg among pregnant women attending antenatal care at an Onitsha specialist (private) hospital Anambra state, Southeast Nigeria. Method: HBsAg was tested for in consenting women who attended antenatal care at Grace Specialist hospital Nkpor, Onitsha. The study women were recruited longitudinally from the hours of 8.00am to 12noon on each antenatal care day which held twice a week. Results: The seropositivity of HbsAg in the pregnant women was 2.2%. There was no significant association between the HBsAg screening result and age or parity. Conclusion: The seroprevalence of HBsAg in the pregnant women was 2.2% irrespective of their age, parity, or sociodemographic or biological factors. There is intermediate endemicity of HBsAg among pregnant women in Onitsha Southeast Nigeria. Niger Med J. Vol. 51, No. 4,Oct. – Dec., 2010: 152– 154. Keywords: Seroprevalence, HBsAg, private hospital, Onitsha

Is the trend of amputation in Nigeria changing? A review of 51 consecutives cases seen at Federal medical centre Ebute Metta, Lagos, Nigeria

Abstract: Introduction: Many previous studies from Nigeria have recognized trauma and complications of management of musculo-skeletal conditions by traditional bone setters (TBS) as the leading cause of amputation in Nigeria However, of recent, a number of the studies are showing that diabetes gangrene which used to be an uncommon indication is becoming an important cause of extremity amputations In view of the effect of amputation on the individual and the society and the success of well designed preventive programs, it is important that the indications for amputation be kept in constant view The objective of this study is to draw attention to the increasing importance of diabetes gangrene as a leading cause of amputation in Nigeria Patient and Methods: This is a three-year prospective study (October 2006 - September 2009) using observer- administered questionnaires after consents were obtained from all patients or proxy during the period of study All recruited patients were followed up and evaluated after surgery to determine the outcome The following data were obtained and analyzed - age, sex, amputation type, indication and use of prosthesis Results:Fifty-one amputations were performed in fifty patients (37 males and 13 females) MF = 28:1, age range 5 - 85 years, mean 476+/- SD 207 Major limb amputations accounted for 35 cases (686 %) with diabetes gangrene accounting for 23 cases (45%) followed by Trauma accounting for 16 cases (31%) Wound infection was the commonest complication occurring in 16 cases (314%), Escherichia coli being the commonest causative organism Only 6 patients (12%) eventually used prosthesis and the mortality in this series was 8 patients (16%) Conclusion:Diabetic gangrene is the leading cause of amputation in this series This is the first study in this environment to the best of the authors' knowledge where diabetes gangrene will emerge the leading indication A number of other reports from Nigeria in the last few years have shown the progressive importance this condition is assuming as a leading cause of amputation [1],[3] This finding therefore calls for more studies in this area and a more proactive approach by caring physicians to limb lesions by their Diabetic patients

Infant Feeding Options, Practices and Determinants of Feeding Practices among HIV Seropositive Mothers in Abuja, Nigeria.

Abstract: Objective: To evaluate infant feeding feeding practices and its determinants among HIV positive mothers in Abuja, the Federal Capital Territory of Nigeria. Materials and Methods: This was a cross-sectional descriptive study conducted among sero-positive women diagnosed during pregnancy and had counseling on infant feeding options. The study was conducted in general hospital Asokoro and Gwagwalada specialist Hospital, both of which offer PMTCT services including free breast milk substitutes (infant formula). Results: A total of fifty HIV-positive pregnant mothers participated in the study. Most of the respondents (63%) were in age range of 21–30years, while that of the spouses were 31– 40years respectively. Forty six percent of respondents had secondary education, while 88% were gainfully employed. Majority of respondents (84%) notified their partners of their sero-status, while 93% of them were counseled along with their spouse/partners (Table 1). All the respondents were counseled on different infant feeding options. Forty percent and 46% of respondents respectively chose exclusive breast milk substitute (EB) and exclusive breastfeeding (EBF) for those who opted for replacement feeding. The main reasons given for the choices were: stigma of HIV status, partner support, availability of supply. Infant feeding choices were significantly related to the level of education and awareness of respondents (x2 = 32.8, df = 16, p = 0.05, x2 = 7.4, df = 2, p = 0.05) Conclusion: Replaccement feeding under the present PMTCT programme seems feasible in urban areas of Nigeria. However, public awareness campaigns are needed for its increased acceptability coupled with adequate support that must be provided for mothers who opted for it. Additional training for counseling in HIV and infant feeding options is recommeded for health care providers. Keywords : HIV sero-positive mothers, infant feeding choices, determinants, Nigeria. Note: there is an erratum at the end of this article

Prematurity in central hospital and GN children's clinic in Warri Niger delta

Abstract: Aim:To determine the pattern of presentation of prematurity in Warri Niger Delta. Materials and Method: Retrieval and analysis of casenotes of all the premature babies seen between 2000 and 2007 at General Hospital Warri, a specialist hospital with referrals from surrounding General Hospitals, and GN Children's Clinic, the two major hospitals for children for Warri and its environs. Results: Of the 639 babies seen, 249 were males and 390 females, giving a ration of 1: 1. 6. The youngest in gestational age was 20weeks and five days while the oldest was 36weeks. The lightest in weight was 600g while the heaviest was 2, 400g. Kangaroo nursing was introduced very early in the management. The weight on discharge ranged from 1200g to 2400g, with very good result. The average weight on discharge was 1500g. The overall mortality was 25. 3%, but was 85. 5% in those less than 28weeks of gestation. Mortality was also higher in males at 38. 6% to 16. 9% for females. Respiratory complications are the commonest cause of death, accounting for 30. 8% of the death rate. Conclusion: Prematurity remains a major cause of morbidity and mortality in the newborn period in developing countries. Early maternal handling and introduction of cup and spoon feeding will reduce the time of hospital stay and also the cost of management.

Universal precautions: awareness and practice of patent medicines vendors in Enugu metropolis, South East Nigeria

Abstract: Aim: To determine patent medicine vendor's awareness and practice of universal precautions. Methodology: This study was a descriptive cross-sectional study carried out in Enugu metropolis, Enugu State, Nigeria in November, 2008. Three hundred and thirty seven patent medicine vendors were studied using semi-structured interviewer administered questionnaires. Information on awareness and practice of universal precautions were obtained. Results: Two hundred and four (60.5%) of the patent medicine vendors had secondary education. Two hundred and sixty three (78%) were not aware of the concept of universal precautions. Of the 74 who had heard of the concept, the mass media was the source of information for 38 (51.4%) of them. Most (67.7%) of patent medicine vendors treat open wounds and administer injections. The proportion who take some precaution or the other (50.7%), is similar to those who do not (49.3%). One hundred and forty four (42.7%) of them, dispose of used sharps inappropriately. Two hundred and twenty three (66.2%) of them are aware of the need for appropriate action after a needle prick; i.e., through accessing HIV screening services or consulting a doctor. Conclusion and recommendation: The patent medicine vendor's awareness and practice of universal precautions is poor. Regular training on universal precautions is recommended. Keywords : Patent medicine vendors, universal precautions, sharps, needle prick.

Incidence and Mode of Delivery of Twin Pregnancies in Uyo, Nigeria

Abstract: SUMMARY Background: Twin pregnancy continues to be a focus of interest the world over due to its increasing incidence and also the high maternal and perinatal mortality and morbidity associated with it. Objective: To determine the incidence and mode of delivery of twin pregnancies at the University of Uyo Teaching Hospital, Uyo. Methodology: A 5-year retrospective review of twin deliveries at the University of Uyo Teaching Hospital. Results: There were 6,344 deliveries out of which 164 were twin deliveries resulting in an incidence of 2.6%. The modal age group of the patients was 20-29 years (66.5%), majority (71.3%) of the patients were multiparous, 79.3% booked and had regular antenatal care in the hospital while 49.4% of the patients delivered at term. Eighty-four patients (51.2%) were delivered by caesarean section and malpresentation of the first twin (18.2%) and hypertensive disorders of pregnancy (10.4%) were the most common indications. The perinatal mortality rate was 207/1000 and there was one maternal death which was from eclampsia. Conclusion: The incidence of twin pregnancy and its attendant perinatal mortality is high in our center. In addition, caesarean section is the most common mode of delivery with malpresentation of the first twin and hypertensive disorders of pregnancy as the most common indications. We advocate widespread public enlightenment on the increased risk associated with twin pregnancy. Community leaders should ensure that women with twin pregnancy should book early and obtain antenatal care in specialized units. Niger Med J. Vol. 51, No. 4,Oct. – Dec., 2010: 170 – 172.

HIV/TB Co-infection in Nigerian children

Abstract: Tuberculosis (TB) is an important cause of childhood morbidity and mortality. The burden of childhood disease is not as well documented as that of adult disease, partly because of the difficulty of confirming the diagnosis. In Africa children have been estimated to account for 20-40% of TB case load. Children infected with M. tuberculosis have a high risk of progression to disease, the younger children being at highest risk. Infected children represent a reservoir of future adult disease. The incidence of childhood TB has increased in developing countries. This resurgence is partly attributed to the coexisting burden of human immunodeficiency virus (HIV) disease, which is most pronounced in Sub-Saharan Africa, Nigeria ranking third highest prevalence. The pattern of childhood HIV and TB infection mirror these epidemics in the adult population. The number of children co-infected with HIV and TB is rising, and so is the incidence of congenital and neonatal TB. In addition the emergence of multi-drug resistance TB and extensively drug-resistant TB has occurred within the context of a high prevalence of HIV and TB. The diagnosis of TB has always been difficult in children and is compounded by HIV co-infection. The clinical symptoms in both diseases are similar, and the radiological changes may be non-specific. Treatment of both conditions in children is a challenge due to drug interactions and problems with adherence. There are few stable syrup formulations of antituberculous and antiretroviral drugs in children, and hence division of tablets gives rise to unpredictable dosing and emergence of resistance. To reduce the morbidity and mortality of TB and HIV, existing childhood TB programs must be strengthened, and antiretroviral drug therapy and prevention of mother-to-child transmission programs scaled up. HIV prevalence in the adult population must also be reduced. An increased emphasis on childhood TB, with early diagnosis and treatment, must be a priority.

Glycaemic Control amongst Persons with Diabetes Mellitus in Benin City

Abstract: Objective: This study set out to find the level of glycaemic control amongst persons with diabetes mellitus in Benin City. Methods: Forty two persons with diabetes had their glycaemic control assessed by measuring the level of their glycated hae­moglobin. Other data collected included age, sex, duration of diabetes, type of diabetes, weight, height, body mass index and waist hip ratio. Results: There were twenty four males and eighteen females in the study population. Thirty one subjects had type 2 diabetes, while eleven had type 1 diabetes. Nineteen subjects (46%), had poor glycaemic control (HbAic > 7%) while twenty three (54%) had good control (HbAic ͳ 7%). Thirteen males (54%) had good control while ten females (53%) had good control and this was not statistically significant (p>0.05). Eighteen of the thirty-one type 2 DM subjects (58%) had good glycaemic control, while five persons out of eleven with type 1 DM (45%) had good glycaemic control and this was not statistically significant (p>0.05). Conclusion: This study has shown that poor glycaemic control is common amongst persons with diabetes mellitus in Benin City. Studies have shown that good glycaemic control prevents and delays the complications of diabetes mellitus. We therefore recommend that health education on the benefits of good glycaemic control should be given in diabetes clinics, and ef­forts intensified to achieve target glycated haemoglobin levels to prevent diabetes complications.

The pattern of male breast cancer in eastern Nigeria: A 12 year review

Abstract: Background:There is at present a high interest in breast cancer but there is still lack of adequate knowledge on male breast cancer. There is no prospective study on male breast cancer, in our environment. Objective: To determine the epidemiology, pathological types, clinical features, management and outcome of male breast cancer in Eastern Nigeria Materials and methods: Folders of all patients with breast cancer, that attended University of Nigeria Teaching Hospital (U.N.T.H.) Enugu, a major referral centre in South Eastern Nigeria from 1995 to 2006 were pooled from the medical record. The number of female and male breast cancer patients were noted. Other relevant facts like age at presentation, duration of illness before presentation, mean age at presentation, pathological types, stage at presentation, treatment received and follow up care were also obtained. Results: Out of 1313 cases of breast cancer that presented over the period, 26 were males giving male percentage to be 2%. The peak incidence of occurrence was between 60-69 years with a mean of 60.5 years. The age range of the patients were 25 to 84 years. Invasive ductal carcinoma accounted for 65% of the cases managed. 58% of the cases presented at stage III. Eleven of the patients were followed up for 5 years, only 1 was alive, giving 5 year survival of 9.1%. Conclusion: Male breast cancer cases contributes to 2% of all breast cancer cases seen at U.N.T.H., Enugu, a major referral centre in Eastern Nigeria . Most of the patients presented late making outcome to be poor. There is need for increased public awareness of this disease. Key words: Male breast cancer, invasive ductal carcinoma, lobular carcinoma.

Pathomorphology of molar gestation in Zaria

Abstract: Background: Molar gestations are a source of significant morbidity with increased risk of mortality from their complications if not identified and treated early enough Objective: This study aims at histologically reviewing and analyzing all cases of molar gestations seen in the Histopathology Department of Ahmadu Bello University Zaria between January 1995 and December 2004, and comparing the findings with other studies done elsewhere Methods: Cases for this study were identified from the departmental bench book The relevant request forms, slides and in some cases, tissue paraffin blocks for the study period were retrieved All cases were stained with Haematoxylin and Eosin The slides were reviewed based on the histological criteria published by Gehrig and Van-Lee Main findings: Seventy three cases of molar gestations were seen out of which 17 were excluded and 56 were analyzed as follows: Complete hydatidiform mole, 34; Partial hydatidiform mole, 20; Invasive mole, 2 There were 43 cases of choriocarcinoma making 37% of gestational trophoblastic diseases (GTDs) and were exempted from this study The frequency of Hydatidiform mole was 1: 612 deliveries The mean age of the patients was 257 years and their leading mode of presentation was vaginal bleeding between 11-18 weeks of gestation Conclusions: Hydatidiform mole was found to be a common problem and the complete type occurred more frequently than the partial type Niger Med J Vol 51, No 1, Jan – Mar, 2010: 1 – 4 Key words : Complete Hydatidiform Mole; Partial Hydatidiform Mole; Zaria

Malaria parasitaemia and household use of insecticide treated bed nets: A cross-sectional survey of under-fives in Jos, Nigeria

Abstract: Background: In spite of enormous investments in Malaria control programme, malaria is still a major cause of morbidity and mortality among under-fives. Objective: The objective of this study was to determine malaria parasitaemia in under-fives and to relate it to household use of Insecticide Treated Bed Nets (ITBNs) in Jos - a malaria endemic setting. Methodology: A cross-sectional study was carried out in a selected settlement in Jos North Local Government Area (LGA) in September 2007 towards the end of the rainy season. All households with children less than 5 years of age in the selected settlement were listed and then 150 of the households were selected using systematic sampling technique. In each selected household one under five was selected and where there were more than one under five only one was selected by balloting. The selected 150 under-fives were then studied using thumb prick blood smear to determine the presence of malaria parasite in their peripheral blood and a semi structured interviewer administered questionnaire to obtain information on household use of ITBNs in the community. Result: Malaria parasitaemia was found in 57 (38.0%) of the children and the highest age specific prevalence of 46.4% was among the 36-47 months age group. The females were more (46.6%) infected than their male counterparts (29.9%) p=0.035. Eighty three (55.3%) mothers owned ITBNs but only 61(40.7%) used them for their children. Children who slept under ITBNs were less likely to have malaria parasites in their blood compared with those who did not (p=0.000..). Mothers’ age and education were among other factors that positively influenced the use of ITBNs. Conclusion: Malaria parasitaemia is high in this community and sleeping under ITBN has been found to significantly reduce the prevalence of parasitaemia in the children studied. It is therefore recommended that the ITBNs campaign should be intensified so that the ITBN use can cover all the under-fives. Key words : Malaria; Insecticide; bed nets; under-fives,

Spontaneous rupture of gravid horn of bicornuate uterus at term - A case report

Abstract: Uterine structural abnormalities are known causes of recurrent pregnancy losses occurring especially within the second trimester However, recent reports show that the rate of pregnancy losses caused by uterine anomalies may not be as high as previously feared We report a case of a 28 year old secondigravida with uterus bicornis unicollis who had spontaneous rupture of one of the uteri in pregnancy, had excision of one horn of the double uterus and was able to carry a subsequent pregnancy to term and achieve a live birth The literature on double uterus was also reviewed

Socio-demographic Factors associated with Asymptomatic Bacteriuria in Children with Sickle Cell Anemia in a Tertiary Health Facility in South Eastern, Nigeria.

Abstract: Background: Urinary tract infection (UTI) is a common cause of chronic kidney disease in children. It is second only to respiratory tract infection in developed countries as a cause of morbidity and mortality arising from microbial infections. It is also common in a developing country like Nigeria and is the commonest cause of renal disorders in Port Harcourt, South South, Nigeria. UTI can be symptomatic or asymptomatic (asymptomatic bacteriuria). Asymptomatic bacteriuria is said to be more common in school aged girls and children of low socio-economic class. It has also been documented to be more common in children with sickle cell anaemia. Objectives: To determine the relationship between asymptomatic bacteriuria and age, sex and socio-economic status of children with sickle cell anaemia. Methods: One hundred children with sickle cell anaemia in stable state were screened for asymptomatic bacteriuria using midstream urine samples. The age, sex and social class of the children were obtained through a structured questionnaire administered to the parents/care-givers. The relationship between age, sex and social class with asymptomatic bacteriuria in these children was analyzed using SPSS software. Results: The age of the children ranged from 2-12 years. Six of the 100 children were noted to have asymptomatic bacteriuria and five of the six children were females (p=0.04).Five (83.3%) of the six children were five years and above. There was a predominance of positive cases (66.7%) in the higher socioeconomic class (p=0.03). Conclusion: Asymptomatic bacteriuria is commoner in school aged female sickle cell anaemia children of higher socioeconomic class. However, we suggest that further studies be done to confirm this finding especially with regards to the socioeconomic status of these children. Niger Med J. Vol. 51, No. 4,Oct. – Dec., 2010: 137 – 140. Keywords: Asymptomatic, Bacteriuria, Sickle cell anaemia, Socio-demographic.

The point prevalence and cost of wound management in a Nigerian teaching hospital

Abstract: Background: Chronic wounds as a cause of patient morbidity represent a major health burden and drains on resources. There is paucity of information on the actual cost of wound management in Nigeria. Studies have calculated the cost of wounds to the NHS in United Kingdom to be about £1bn a year. Objective: This study was conducted to provide data on the point prevalence of wounds in a Nigeria Teaching Hospital, the aetiology and the cost implication of managing the wound. Methods: The study was carried out on a Sunday morning to minimize disruption to patient care. Data on all in patients with chronic wounds were documented in a designed proforma. Results: Two-hundred and six patients were on admission on the day of study out of which sixty-five patients (31.55%) were being managed for one type of wound or the other. There were thirty-six males and twenty-nine females with a male to female ratio of 1.1:1. Twenty-four patients (36.9%) had surgical wounds of different aetiology which seventeen patients (26.2%) were being managed for traumatic ulcer. Twenty-nine patients (44.6%) spent between one hundred Naira to five hundred Naira on wound dressing per week. The costs of care of these patients were being settled by their relation in fifty-one patients (78.5%). Conclusion: Wound management is a significant clinical and economic problem. The cost to the health system can be very significant, this is particularly so in a developing country like Nigeria. Our study showed that majority of our patients are petty traders and the cost of wound care was borne mainly by their relatives. The money being spent in a week on wound dressing alone is a bit high for an average Nigerian. Key words: point prevalence, wound, cost, hospital.

Performance of Medical Graduates Within and Outside Nigeria

Abstract: The objective of this report is to provide a summary of the outcome of Nigerian Medical Graduates globally. Since the establishment of the first medical school at the University College Hospital, Ibadan, at least four generations of medical schools have been created. With approximately 306 health training institutions and ~ 26 medical schools, www.who.int/hrh/wdms/ media/Nigeria.pdf, Nigeria graduates approximately 2300 medical doctors each year. Nigeria has one of the largest stocks of human resources for health in Africa comparable only to Egypt and South Africa. In 2005, there were about 39, 210 doctors and 124, 629 nurses registered in the country, which translates into about 39 doctors and 124 nurses per 100, 000 populations as compared to the Sub-Sahara African average of 15 doctors and 72 nurses per 100, 000 populations[2]. Between 2005 and 2007 requests for certificate of good standing (a surrogate for migration), were 2, 341, 2, 989 and 3, 567 respectively. While many graduates remain in-country, migration occurs in a significant percentage. Based on one study, the most common country of migration is the U.S.A ( 20%), United Kingdom ( 9%) and Ireland ( 5%). In the U.S. most Nigerian physicians in clinical practice, are in a private practice, whereas a small minority is engaged in academic medicine. Curriculum reform in medical schools will be important to adequately prepare medical graduates for practice within and outside Nigeria.

Neurosurgery in Nigeria II – Evaluation of the Perceptions of Health Personnel after the Commencement of Services in a new Centre

Abstract: Background: Prior to the commencement of neurosurgical services in our new centre, in 2006, the awareness of and perceptions about this specialty amongst the health workers were studied. One year after, having experienced first-hand the activities of the unit, these perceptions were again re-evaluated amongst the same workers to determine the impact of the unit on the opinions about the specialty. Methods and Materials: This study was carried out with a questionnaire designed with the 5-point Likert scale, and the respondents comprised of doctors, nurses, students, paramedics and administrators, randomly selected. The same questionnaire was used in the first study but was slightly modified for the present study. Results: Out of 400 questionnaires distributed randomly, 342 were completed and returned. Most of the respondents 282 [82.5%] were aged 20 – 30years, mostly students 220 [64.3%], and majority 318 [93%] have heard of neurosurgery prior to the establishment of our unit. The service need was rated very necessary by most 286[83.6%], availability of services in Nigeria rated inadequate by 177 [51.8%], and the quality of services rated fair 155[45.3%]. The services in our centre were rated fair 138 [40.4%] and lack of equipment/facilities was adjudged the greatest hindrance to practice 216 [63.2%], and majority 289 [84.5%] strongly recommended that services continue. Conclusion: Neurosurgical services are still significantly inadequate in Nigeria, and though the establishment of new units has positively changed the perception of health workers about the specialty, provision of more manpower and modern facilities remains the major challenge. Niger Med J. Vol. 51, No. 4,Oct. – Dec., 2010: 177 – 179. Keywords : neurosurgery, evaluation, perception, health personnel

Effects of nutrition on oral health

Abstract: Nutrition represents a summation of intake, absorption, storage and utilization of foods by the tissues. Oral tissues are one of the most sensitive indicators of nutritional state of the body. Nutritional deficiencies are associated with changes in the integrity (health and appearance) of the oral structures/ tissues and these changes are frequently the first clinical signs of deficiency. Nutrition affects oral health and oral health affects nutrition. The effects of malnutrition can be seen in the oral structures in all stages of human growth and development from conception to old age. The consequence of certain oral diseases may compromise the nutrition by affecting the intake and mastication particularly in some vulnerable groups like people with severe caries, severe oral ulceration, advanced periodontal disease and the resulting edentulousness. The HIV pandemic has added another dimension to the issue of nutrition and oral health. Oral lesions are some of the earliest lesions seen in HIV/AIDS and 90% of HIV/AIDS patients will have oral lesions at a point in the course of the disease. These oral lesions are painful; disturb food intake and mastication thereby further compromising the nutrition of the affected individuals. In Africa, particularly the Sub-Saharan Africa, the burden of poverty, economic downturn and the HIV pandemic have added another dimension to the issue of food availability and nutrition. Malnutrition is a real problem in this area. This paper will examine the effects of compromised nutrition on oral health and the reverse.