BACKGROUND: Patients' assessment of quality of health care despite its importance in uptake of available services is not frequently examined in developing countries. METHOD: This descriptive cross-sectional study was conducted at the Eye clinic in a Tertiary health facility to find out patients' perception of quality of care received in the facility. A questionnaire instrument was used, and it included patients' socio-demographic data, patients' perception of waiting time, charges, supportive services such as ease of movement from one service point to the other and pharmacy. Respondents' suggestions on any area of service rendered to them were also captured. RESULT: A total of 124 respondents were interviewed. Majority (89.4%) reported long waiting time particularly for doctors' consultation. Missed clinic appointment was mostly due to health workers strike. Two-thirds of patients procured their prescribed drugs outside the Hospital due to hospital bureaucracy. However, most patients reported having received adequate explanation on their ailment from the health workers. Despite the shortcomings in services received most of the patients expressed satisfaction with the quality of care received. CONCLUSION: There is need to frequently examine the quality of health care received by patients in developing countries with the aim of identifying areas of services that should be improved. Key words: patients' assessment, eye care, quality.

OBJECTIVE: This study was designed to determine the influence of foetal haemoglobin (HbF) concentration on the frequency of painful crisis, blood transfusion and other complications. METHOD: A prospective study of SCA patients in steady state and vaso-occlusive crisis (VOC) seen between August 2001 and July 2002 in 3 centers in Benin City, Nigeria. Two hundred patients (81.3% ) in steady state and forty-six patients (18.7%) in VOC were analysed in the context of gender, age, the frequency of VOC, number of blood transfusions and complications e.g. osteomyelitis, leg ulcer, cholelithiasis etc in the preceding one-year after informed consent. Eighty-four age and sex matched controls were also recruited. Their blood samples were analysed within two hours of collection for HbF using the Betke method and haemoglobin and haematocrit levels using the Automated Coulter Counter. RESULTS: The mean HbF in steady state, VOC and control were 2.17% +/- 1.81, 2.05%+/-1.19 and 1.28%+/-1.04 respectively. There was no significant difference (P>0.05) between HbF values in VOC and steady state periods but they were significantly higher than in control (P<0.01). The mean %HbF was significantly higher in patients who had no painful crisis (2.14% vs 1.55%, P=0.0023), those who had no complications (2.45% vs 1.12%, P<0.0001) and those who did not have blood transfusion (2.41% vs 0.68%, P<0.0001) in the preceding year than those who did. Conclusion-There is no significant difference in foetal haemoglobin values in steady state and vasoocclusive crisis. A higher level of foetal haemoglobin was associated with fewer painful crises, less complications and reduced need for blood transfusion. Key words: foetal haemoglobin, crisis, complications, transfusions.

SUMMARY: This study was carried out with the aim of assessing the plasma status of ascorbic acid and alpha-tocopherol in Nigerian type 2 diabetes mellitus patients It was a cross sectional study, made up of 70 type 2 diabetes mellitus patients and 40 healthy controls. The plasma levels of vitamins C and E were measured, so also were the fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1C). Results showed significantly lower plasma levels of vitamin C and vitamin E in the patients, compared with the controls. The correlation studies between vitamins C and E on the one hand, versus (FPG) and HbA1c on the other hand were not contributory.The conclusion from this study, is that, there is a reduction in plasma levels of anti-oxidant vitamins C and E in type 2 DM but this does not have any particular relationship with the levels of FPG or HbA1C.

BACKGROUND AND OBJECTIVES: Hypertension and hypercholesterolemia are well established independent risk factors of coronary heart disease. Moreover, drug treatment of hypertension also affects lipid metabolism. Recently, body iron status has also been implicated as a risk factor of coronary heart disease. It is not however clear whether hypertension or hypercholesterolaemia directly or indirectly influences body iron status. This study was therefore decided to look at the association between transferrin saturation and hypercholesterolaemia in adult hypertensive Nigerians with high risk Coronary Heart Disease (CHD) lipid fraction. MATERIALS AND METHODS: The study group comprises eighty two adult Nigerians who are known hypertensives with high risk coronary heart disease lipid fraction: that is the ratio of high density lipoprotein cholesterol to total cholesterol (HDL-C/TC) <= 0.13 while the control subjects comprises eighty adult Nigerians who are also known hypertensives with normal HDL-C/TC ratio (>=0.30). RESULTS: The total iron binding capacity is not significantly different between the two groups. Also, serum iron and transferrin saturation were not significantly different in the two groups. Transferrin saturation does not show appreciable correlation with total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels in any of the two groups. CONCLUSION: The association between transferrin saturation and hypercholesterolaemia in hypertensive is not strong enough to possibly suggest that one influences the other. However, the influence of antihypertensive drugs on lipid metabolism cannot be ruled out in this study because subjects and controls were not selected based on type or class of medication.

BACKGROUND: Immunisation injection accounts for less than one-tenth of the global total injections, and it is believed to be safer than therapeutic injections. However, reports have it that about one-third of immunisation injections are unsafe in many countries of the world including Africa. OBJECTIVES: This study was conducted to determine the practice of sage immunisation injection among health workers in static immunisation centres in a urban community in Nigeria with a view to assessing the safety of immunisation injection services in the area. STUDY DESIGN/METHODS: Pre-tested semi-structured questionnaires were administered to 102 consenting staff and observation checklist was completed for each of the 13 fixed immunisation centres in the study area. RESULTS: Most of the subjects 82(80.4%) had poor knowledge of safe immunisation injection and about the same number were not aware of any policy on injection safety. Injection abscess was the main health hazard of unsafe injection reported by majority 71(69.9) of the subjects while as few as 10(9.8%) mentioned needle prick as a health hazard. The common infections associated with unsafe injection listed by the subjects were abscess, HIV and Hepatitis in that order of frequency. Also, most of them 69(67.5%) felt that open burning is the ideal method of disposal of injection waste, while the actual method of disposal practised in most health facilities were mainly open burning (48%) and open dumping into an insecure pit (24%). Up to 83% of the subjects preferred the use of standard disposable syringes and needles for vaccination, but most of them (75(73.5%) confirmed that they use both sterilisable and disposable syringes and needles for vaccination in their health centres. BCG vaccine was exclusively administered using sterilised needles and syringes, while tetanus toxoid was given using disposable syringes and needles in virtually all the centres. Re-use of syringe for vaccine withdrawal and re-capping of used needles before discard were common practices observed while accidental needle stick injury was reported by about half (49%) of the subjects. CONCLUSION: Staff re-training, adequate supplies of injection equipment and provision of appropriate facilities for disposal of injection waste would go a long way to enhance safe immunisation injection practice in the area.

INTRODUCTION: Children are known to be the major reservior of urinary schistosomiasis in endemic communities. This study was conducted to assess the prevalence and intensity of urinary schistosomiasis among school children living along the Bakalori dam. METHODOLOGY: The study was a cross sectional assessment using a pre-tested standardised structured questionnaire interviews. A total of 240 pupils were recruited through a multistage sampling technique. Urine samples from the pupils were examined for the presence of ova of schistosoma haematobium. RESULTS: A total of 125(52.1%) of respondents were 11-12 years old with a mean age of 11.7 +/- 1.4 years. The prevalence of urinary schistosomiasis among school children was found to be 42.1%. The highest age and sex specific prevalence rate was recorded among the 13-14 years age group for both males (43.1%) and females (50.0%). The age, sex, level of school attainment, occupation of respondents' father/guardian and source of water for domestic use were found to have a significant statistical association with the risk of being infected (P<0.05). CONCLUSION: It is concluded that the prevalence and intensity of urinary schistosomiasis is high. To reverse the situation requires mass chemotherapy, community mobilisation and provision of portable water.

INTRODUCTION: The AIDS pandemic has led to the global clamouring for its control. This work was aimed at assessing the level and factors that determine the awareness of undergraduate Students of Usmanu Dandfodiyo University, Sokoto. METHODOLOGY: In a descriptive cross-sectional study, a total of 450 students were recruited by means of multistage and simple random sampling techniques. RESULTS: Overall, there is a knowledge gap on aetiology, mode of transmission and preventive measures with only 40.2% and 38.5% of the respondents having adequate knowledge and indicated their willingness to learn more about AIDs respectively. Age (P<0.05), Sex (P<0.005) and number of years spent in the University (P<0.025) are important determinants of level of AIDS knowledge. CONCLUSION AND RECOMMENDATIONS: This finding could be as a result of strong interactions between the social environment and human sexuality. Hence, student bodies should be involved in reproductive health programmes.

BACKGROUND: Cervical cancer, although largely preventable, remains the most common cause of cancer mortality among women in the developing world. Other members of the community see health care workers as models, therefore their attitudes and actions are predictors of societal health behaviour. OBJECTIVES: We assessed the knowledge, attitude and practice regarding prevention of cervical cancer among female health professionals in a secondary health facility in Kano, Nigeria. METHODS: A structured questionnaire was administered on 230 female respondents in the various health professions including doctors, pharmacists, nurses and laboratory technologists in Murtala Mohammed Specialist hospital, Kano. RESULTS: Over 60% of the respondents were able to correctly identify all the important aetiological factors associated with cervical cancer, while a similar figure knew the important signs and symptoms of the disease. Up to 94.7% of the respondents had a positive attitude towards Pap smear while 8.2% disapproved of it. Only 20.8% of the respondents have had a Pap smear done previously. Married respondents were more than four times likely to have had a previous Pap smear compared to their single counterparts. (X(2) = 13.3 df=1 P = 0.0003)[O.R=4.8, 95% confidence interval= 1.9 -14.4]. In contrast, religion appeared to have no significant influence on the practice (X(2)= 0.87 df=1 P=0.35). CONCLUSIONS: Despite a moderately high level of knowledge of cervical cancer screening and positive attitude towards it, the uptake of Pap smear was low. There is a need for continuing education to improve uptake of these services by health professionals so as to serve as a motivating factor for the public.

Pityriasis versicolor occurs commonly in this environment. It is characterised by fine scaly macular eruption and has a chronic relapsing nature. It is due to infection with malassezia. Recently with the aid of sequencing of the sub-unit rRNA and nuclear DNA complimentary studies, the malassezia species have been classified into seven. Malassezia (M) furfur, M. Symboidalis, M. Obtuse, M. globosa, M. restricta, M. sloofiae and M. pachydermatitis. M. globosa has been linked to development of pityriasis versicolor. Despite extensive work, factors which change the organism from its commensally to its pathogenic state are yet to be identified, although a genetic factor appears to be involved as familial cases occur. However factors such as hyper-hidrosis, depressed immunity, and occlusion of the skin, malnutrition and abuse of corticosteroids have been observed to be contributory. For many years topical therapy was the main stay of treatment that contributed to the high relapse after treatment. Presently management includes the use of both systemic and topical anti-fungals. Prophylactic treatment is now advocated in preventing relapses, which occurs commonly.

AIM: To determine the contribution of glaucoma to ocular morbidity and the different types of glaucoma seen. METHOD: Medical records of all new patients attending the consultant outpatient clinics of the University of Benin Teaching Hospital, Benin city, Nigeria, over a 2-year period were reviewed. Those with a diagnosis of glaucoma were analysed. RESULTS: Of 1,698 new patients, 147 (8.7%) had glaucoma diagnosed. One hundred and thirteen patients (76.9%) had primary open angle glaucoma, 4 patients (2.7%) had primary angle closure glaucoma, one patient (0.7%) had congenital glaucoma, 5 patients (3.4%) had juvenile glaucoma and 24 patients (16.3%) had secondary glaucoma. Among the patients with primary open-angle glaucoma, 19 patients (16.8%) and 47 patients (41.6%) were blind using visual acuity estimation and visual field criteria respectively. CONCLUSION: Glaucoma remains a common cause of ocular morbidity worldwide as in our centre. Primary open-angle glaucoma is the most common type while primary angle-closure glaucoma remains relatively rare.

Labour and delivery result in severe pain for most women. Attention to comfort and analgesia for women in labour is important for physiological reasons and out of compassion. A review of common methods of pain relief of labour was done. Inhalation method as well as intravenous administration of opioids for pain relief in labour is fast giving way to lumbar epidural analgesia. The use of local anaesthetic in labour offers superior pain relief, is effective and safe. The inhalation and parenteral routes seem reserved for patients with contraindication to insertion of epidural. The administration of high volume dilute concentration of local anaesthetic plus lipid soluble opioids, with some level of patient's control, appears to be the current trend in the management of labour pains. There is a body of evidence indicating that Nigerian women may want pain relief in labour. However, there is no organised labour analgesia service in Nigeria. An organised obstetric analgesia service can be developed within the limits of available manpower and technology in an emerging country like Nigeria. This article therefore, focuses on trends in obstetric analgesia and its implications on the development of organised obstetric analgesia services in Nigeria.

OBJECTIVES: To determine types of glaucoma seen and the recent trends applied in treatment, a retrospective non-comparative case-series study was conducted in the Eye Unit of the Royal Victoria Hospital, Banjul, The Gambia. METHODS: The records of the 88 patients(145 eyes) seen during the glaucoma training workshop(organised by Prof.James Standefer, a clinical ophthalmologist from Minneapolis, U.S.A.) which held between 3rd and 14th of September, 2001, were analysed for types of glaucoma and treatment given. All but one patient who was a baby underwent the following tests: visual acuity measurement using the illiterate E-Chart with multiple optotypes; tonometry using the Schiotz tonometer with the 5.5g weight; oblique flashlight test; Van Herrick's estimation of the angle depth; pupillary reactions to light; Slitlamp biomicroscopy; gonioscopy using the 4-mirror pressure gonioprism; fundoscopy using the +78D Volk lens and confrontational visual field analysis. RESULTS: 27 eyes did not have definite glaucoma. Out of the remaining 118 eyes, 65(55.08%) had POAG;17(14.41%)ACG out of which 8 were CACG and 2 acute ACG. 8 eyes had pseudoexfoliation of the lens capsule with or without glaucoma. In the frail and elderly, guttae Timoptol 0.5% was given once daily. 27 eyes had trabeculectomy; all were with releasable sutures and intraoperative application of 5-Fluorouracil. 3 eyes had laser trabeculoplasty and 5, diode laser transscleral cyclophotocoagulation. CONCLUSIONS: POAG was the commonest type of glaucoma seen. Pseudoexfoliation of the lens capsule with or without glaucoma and ACG are not very rare in The Gambia. In the frail and elderly, guttae Timoptol 0.5% was given once daily and none at all in painless glaucoma-blind eyes. Trabeculectomy with releasable sutures and intraoperative application of 5-FU has a very satisfactory pressure-lowering effect.

OBJECTIVE: We present a 13-years retrospective histological study of 444 thyroidectomies received between 1989 and 2001 at the Morbid Anatomy department of the Lagos University Teaching Hospital, Nigeria. The aim of the study is to update the available literature on the frequencies of the common thyroid lesions as well as compare with previous studies. MATERIALS AND METHODS: The materials for this study consist of slides and paraffin embedded blocks of all thyroidectomies received from within and outside the teaching hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms. RESULTS: The male: female ratio is 1: 7. The most common entity was goiter (74%); most of which occurred in the age group 30-39 yrs. Thyroid adenomas (majority; follicular), constituted 10%. There were 29 cases of thyroid carcinoma accounting for 7% of all lesions and occurring more in females than males (17:12). Histologically, follicular carcinoma predominated (48.3%), followed by papillary carcinoma (34.5%) and medullary carcinoma (13.8%). Thyroiditis was uncommon (only 2%). CONCLUSION: Goiter, adenoma and carcinoma remain the commonest pathologic entities of the thyroid gland in Lagos. The age and sex incidences as well as the histological characteristics concur with reports from other parts of Africa and Nigeria. However, unlike many of the Nigerian series except the latest from Ibadan, 4 cases of medullary carcinoma were encountered in this study. The frequencies of toxic hyperplasia and thyroiditis are also lower than those recorded in previous studies.

Diabetic renal disease is a serious problem resulting from microvascular complications in both type 1 and type 2 diabetes mellitus. There is increased mortality from cardiovascular causes in patients with diabetic nephropathy. However, in spite of plethora of studies in recent years on the possible pathogenetic mechanisms involved in diabetic nephropathy, the exact role of each individual mechanism is still inconclusive. Diabetic nephropathy is reviewed in two parts, the first part deals with historical background, pathophysiology and pathogenesis including the roles of chronic hyperglycaemia, renin-angiotensin system and several mediators in the renal changes in diabetes mellitus. While the second part reviews the treatment as well as current theories in treatment and possible intervention strategies of the future. Key words: diabetic nephropathy, microalbuminuria, pathogenesis, renin-angiotensin system, pathophysiology, treatment.

Diabetic renal disease is a serious problem resulting from microvascular complications in both type 1 and type 2 diabetes mellitus. There is increased mortality from cardiovascular causes in patients with diabetic nephropathy. However, in spite of plethora of studies in recent years on the possible pathogenetic mechanisms involved in diabetic nephropathy, the exact role of each individual mechanism is still inconclusive. Diabetic nephropathy is reviewed in two parts, the first part deals with historical background, pathophysiology and pathogenesis including the roles of chronic hyperglycaemia, renin-angiotensin system and several mediators in the renal changes in diabetes mellitus. While the second part reviews the treatment as well as current theories in treatment and possible intervention strategies of the future. Key words: diabetic nephropathy, microalbuminuria, pathogenesis, renin-angiotensin system, pathophysiology, treatment.

SUMMARY: Neurofibromatosis I is a multi systemic genetic and progressive disorder. Malignancy is one of the several complications and frequency of neurofibrosarcoma is significantly higher in NF-I patients. Neurofibromatosis was noted at 2 years after birth and overtime became malignant for which a belowthe knee amputation was done at the age of 29 years. Malignant transformation probably occurred prior to excision of the tumour at 26 years. Recurrence within 18 months is suggestive of inadequate excision and of a slow growing tumour. Diagnosis was missed despite previous presentation to other hospitals. This case presentation and review of literature highlights the need for early diagnosis and follow up, education of the patients and their families and the need for histological diagnosis for lesion removed to achieve overall improvement in morbidity and mortality.

Thromboembolic complications are frequent in patients with peripartum cardiomyopathy (PPCM). Peripheral artery occlusions are however rare. This case report describes a 30-year-old grand multiparous woman with PPCM complicated by acute lower limb ischaemia and gangrene. This followed left intraventricular thrombi despite maintenance of sinus rhythm. We suspect that the thrombosis is caused by the hypercoagulable state of peripartum period, ventricular dilatation and hypokinesis. The impacts of economic and sociocultural factors in the management of this rare complication of PPCM in a resource depleted nation are highlighted.