OBJECTIVE: The objective of this study was to evaluate the outcome of a training scheme on data collection, recording, reporting and utilisation practices among primary health care workers in Enugu State. METHODS: This is a "before and after" intervention study conducted among 107 Primary Health Care (PHC) workers in Enugu State. A multistage sampling technique was used. A pre-tested, semi-structured questionnaire and an observation checklist were the instruments used in data collection pre and post-intervention. RESULTS: The workers in this study pre-intervention recorded data using health management information system (HMIS) forms, registers and exercise books. Seven (77.8%) and 6(66.2%) of the study and control health centres respectively kept monthly health center copies of HMIS form 000. These forms and registers were neither completely and correctly filled nor were kept up-to-date. Post-intervention, the reported and observed practices improved significantly (p<0.001) in the study unlike in the control health centress. Pre-intervention, none of the health centres entered data into the register 1-2weeks prior to this study and none remitted same monthly to the monitoring and evaluation units of the LGAs. Post-intervention, early data entry, reporting and local uses of data improved significantly (p<0.001) in the study group unlike in the control group. CONCLUSION: The data management skills of PHC workers studied were generally inadequate pre-intervention. Training greatly enhanced their overall data management skills.

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BACKGROUND: There is a paucity of reports on polycythaemia vera (PV) in Nigeria. The aim of this review is to present the pattern of clinical presentation, method of diagnosis, therapeutic options and treatment outcome in the face of limited facilities. MATERIALS AND METHODS: Case notes of patients with confirmed diagnosis of PV managed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria from 1997 to 2006, were reviewed for clinical and laboratory parameters. The relative proportion of PV to other cases of haematologic cancers seen within the same period was determined. RESULTS: Seven patients, 5 males and 2 females, aged 42-70 years (median, 53 years) were studied. All the patients were symptomatic at diagnosis with the majority presenting with headaches, visual disturbances, and tinnitus. Clinical signs include conjuctival suffusion in all the patients; splenomegaly, hepatomegaly and hypertension in 3 patients (42.8%). Pruritus was uncommon (14.3%). One patient (14.3%) presented with fatal cerebrovacscular accident on admission. The average follow up period was 39.9 months, and 2 patients (28.6%) were followed up for more than 7years. Therapy consisted mainly of regular phlebotomy and low dose aspirin for suppression of thromboxane synthesis and control of thrombocytosis and erythomelalgia. PV accounts for just 0.03% of all the haematologic cancers seen. CONCLUSION: PV has a low incidence in our population and affects significantly the middle age persons. The clinical presentation consisted of headaches, visual disturbance, hypertension, and organomegaly. Treatment outcome are not different from those previously reported. The need for life-long follow up must be emphasised to patients at diagnosis.

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OBJECTIVES: This study was designed to investigate if dietary salt-loading and/or chronic Nitric Oxide Synthase (NOS) inhibition are associated with cardiac hypertrophy and changes in renal mass in the hooded (Aguti) rat. METHODS: Hooded rats 8-10 weeks old were divided into 4 groups viz: control, salt, L-NAME (N?-L-Arginine Methyl Ester) and salt + L-NAME. Control rats were given a normal rat diet and water. Hypertension was induced in hooded rats by giving the following treatments: rats in the salt group were given an 8% NaCl diet and water for 6 weeks; rats in the L-NAME group were fed the normal rat diet and given water containing L-NAME at a dose of 100mg/Kg/day for 4 weeks; rats in the salt + L-NAME group were given both treatments. The rats (n = 8 per group) were anaesthetized and the hearts and kidneys excised. The cardiac weight indices and the kidney weights were measured. RESULTS: The cardiac weight, cardiac weight index, left and right ventricular weight indices and kidney weight showed no significant difference in the test groups compared to control. Kidney weight/body weight (g/100g body weight) increased significantly (P<0.05) in salt+L-NAME rats (0.35 +/- 0.015) compared to control (0.31 +/- 0.013), salt-loaded (0.29 +/- 0.013) and L-NAME rats (0.20 +/- 0.010). CONCLUSIONS: Six weeks of dietary salt-loading and /or four weeks of L-NAME-loading were not associated with cardiac hypertrophy in the hooded rat. However a combination of both manoeuvres resulted in renal hypertrophy.

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BACKGROUND: Painful arthrosis is the commonest indication for ankle arthrodesis. This procedure is infrequently undertaken in our centre - National Orthopaedic Hospital, Igbobi, Lagos (NOHIL), which is the biggest orthopaedic hospital in Nigeria. In order to determine its relevance to orthopaedic practice in Nigeria, we carried out a retrospective study on the indications, complications and functional outcome of ankle arthrodesis at the NOHIL, Nigeria. METHOD: The study was a 15-year retrospective analysis of all cases of ankle arthrodesis undertaken at NOHIL. There were 58 patients that underwent ankle arthrodesis during the period 1989 to 2003. Thirty five of these with complete records and radiographic films were included in the study. Demographic data, indications, surgical techniques, complications and outcome of treatment were analysed using SPSS version 11. RESULTS: There were 37 arthrodeses, involving 18 male and 17 female patients. The mean age was 41.4years with a mean follow-up period of 17months. The main indication for arthrodesis was posttraumatic arthrosis followed by severe acute ankle injuries. AO and Charnley compression techniques were the commonest surgical procedures employed. Eighteen (48.6%) patients had a good outcome, 10 (27.0%) patients had a fair outcome and 5 (13.5%) had a poor outcome. The outcome of the remaining 4 cases could not be ascertained as they were lost to follow up at an average of 4.6 months post surgery. CONCLUSION: The commonest indication for ankle arthrodesis was post-traumatic ankle arthrosis in this study. The use of external fixation technique was the most prevalent method of achieving arthrodesis with a fusion rate of 85%. Post surgical infection was however high but a good outcome was achieved in majority of cases.

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OBJECTIVE: To study the clinicopathological characteristics of Colorectal Cancer (CRC) in the Guinea Savannah region; identify sub site; ascertain any change in the anatomical sub-site between 1981-2005; relate tumour stage/differentiation, to age young =40 years and = 41years old patients Highlight option for diagnosis in the sub region. SETTING : There were 262 patients consisting of 125 retrospective and 137 prospective cases seen in the premier tertiary health institution in Northern Nigeria. RESULTS: The Male:Female ratio = 1.37:1, mean age 39.8 years, cluster age group 3rd-6th decade( 82.1%), patients = 40years constituted 48.2% . Main clinical features present for more than 6 months were bloody mucus discharge (83.5%), palpable rectal mass (67.9%), pain (67%), tenesmus (60.1%). Ignorance of the disease was rife amongst non-specialists, spiritualists and the patients. The left colon was eleven times more commonly affected than the right colon. The rectum was the commonest sub site (74.3%). In 2 out of every 3 patients, the tumour was digitally palpable per rectum. There was no shift in the distribution sub site in (1981-1990), and (1991-2005). 97.2% the tumours were adenocarcinoma. 68.9% patients had advanced disease Duke C or D. 3 out of every 4 patients (= 40 years age group) had advanced disease. Histological prognostic grade of tumour was inversely related to =40 years age group. Routine digital rectal examination as an investigative armamentarium,and public awareness may reduce the prevalence of advanced CRC in the low resource subregion,we advocate their use.

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OBJECTIVES: This study was carried out to determine the prevalence of smoking among secondary school students and identify factors that influence smoking amongst them. METHODS: This descriptive and explorative study was conducted among 1,183 secondary school students, selected by multistage sampling from each of the 6 geopolitical zones in Nigeria. Data was collected by using interviewer administered structured questionnaires. RESULTS: This study recorded a lifetime smoking prevalence of 26.4% and current smoking prevalence of 17.1% among secondary school students in Nigeria. Most (82%) of the students had seen warnings against smoking and most of them were aware that it is possible for cigarette smoking to damage body organs. Unfortunately, however, seeing such warnings had no significant effect on their decision to smoke or not. The students who smoke were introduced to smoking mainly by their friends (67.4 %), and the television (13.4%). Smoking habits of the respondents were influenced by parents' educational status (p<0.05), having friends who smoke (p<0.05) and living with a smoker (p<0.05). CONCLUSION: Over a quarter of secondary school students had ever smoked. Peer pressure was the main reason cited by respondents for initiating smoking. It is suggested that our smoking prevention programmes be reviewed and appropriate health education and smoking cessation programmes be developed and implemented in order to prevent and control smoking among Nigerian students.

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INTRODUCTION: Nigeria recorded its first case of avian flu among birds early in the year 2006 and by the third quarter of the year, about sixteen states of the country had been affected. Finding out the knowledge and practices of persons in close contact with birds as regards the avian flu would help to identify areas in need of focused attention and alert the coordinating agencies of the magnitude and prevalence of practices which may encourage the spread of the disease. METHODOLOGY: This was a descriptive cross-sectional survey of poultry owners and workers in Osogbo, Osun State, southwestern Nigeria. Information was obtained from 65 of the 100 registered members of the poultry association who consented to answering questions on the pre-tested semi-structured questionnaires. RESULT: In this study, 49.1% (28) of the study sample knew of avian flu, and 46.4% (13) of these knew that the disease was present in Nigeria. Only 50% (14) of those who knew about the disease felt it could affect human beings. For those who have heard of the disease before, 85.7% (24) knew it could be transmitted from sick birds to humans. Practices which favour the spread of the virus that were engaged in by the respondents included using bird droppings as manure (71.9%), and feeding fish with intestines of killed chicken (66.7%). CONCLUSION: The study shows a low level of awareness of avian flu among the poultry workers and owners. It is recommended that massive education should be embarked upon for groups occupying strategic positions in disease epidemiology, as well as all stake holders in poultry farming.

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BACKGROUND: Cytomegalovirus, otherwise called human herpes virus type 5, is a transfusion transmissible pathogen responsible for significant morbidity and mortality among various groups of individuals with damaged or impaired host immunity. Although it has a worldwide distribution, the infection is thought to be more widespread in developing countries where certain demographic factors and living conditions are thought to be responsible for the observed increased prevalence of this infection. OBJECTIVES: The aim of this study is to evaluate the effect of living conditions, using certain selected demographic parameters, on CMV seropositivity, among blood donors in Jos. PATIENTS AND METHODS: A total of 200 prospective blood donors who presented for bleeding were recruited consecutively into the study. Questionnaire was used to obtain the personal, educational, social and demographic data of donors. Screening for CMV antibodies was performed on each serum sample using ELISA kit ("DIALAB", Austria) (www.dialab.at). RESULTS: The relationship between the extent of crowding and CMV status of donors was statistically significant, p<0.05. Other studied donor demographic parameters (source of drinking water, place of abode and type of toilet facility) did not statistically influence donor CMV status, p>0.05. CONCLUSION: Our study showed that overcrowding was the most significant factor that statistically influenced donor CMV status in Jos, Nigeria. There is, therefore, an urgent need for concerted effort to handle the problem of overcrowding in developing countries and Nigeria in particular.

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BACKGROUND: Available evidence suggests that most female lower genital tract injuries are primarily of coital origin and may result in death where prompt diagnosis and treatment is not obtained. Yet there is paucity of recent reports on this clinical entity from our setting. METHODS: This was a retrospective study of the service delivery records of patients with coital trauma seen at the University of Benin Teaching Hospital over 5 years. RESULTS: The incidence of coital trauma was 0.7% of the total gynaecological patients (3,300) seen within the study period. Majority (52.2%) of the patients were nulliparous. A significant proportion (73.9%) of the patients were single and 82.2% had primary or no formal education. Coital laceration occurred in sexual intercourse with boyfriends in 39.1% of patients and casual sex partners in 30.4% of cases. Non-consensual sex was reported in 47.8% of the patients and 39.1% had consensual sex. Sex was pre-marital in 65.2% of the cases. Inadequate or lack of foreplay was a significant predisposing circumstance to coital trauma (56.5%). Pain was a presenting symptom in 60.9% of cases, and same proportion of patients had laceration > 4cm. CONCLUSION: The incidence of coitally associated trauma was low. Nulliparity, low levels of education, non-consensual and premarital sex with little or no foreplay were strongly correlated with the risk of coital trauma. Severe forms of intra-peritoneal complications were not documented in this series. Management strategies were quite adequate.

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BACKGROUND: The presence of proteinuria in pregnancy induced hypertension has been shown to increase maternal and perinatal morbidity and mortality. Hence early and accurate screening for proteinuria with prompt management holds one of the keys to reducing the morbidity and mortality associated with the disease. OBJECTIVE : To examine the options for detection of proteinuria in hypertensive pregnancy available to the obstetrician in the light of current evidence in literature. METHOD OF LITERATURE SEARCH: A review of journal articles identified through a search of the following electronic databases: Medline, Cinahl, Biomed Central and Ajol. CONCLUSION: There is overwhelming evidence that urinary dipstick results correlate poorly with 24-hour urinary protein excretion values in pregnant women with hypertension. In the light of current evidence, the random urine protein:creatinine ratio quantitatively or test strips offers the best option for screening for proteinuria in hypertension in pregnancy

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Structural abnormalities of the female genital tract, whether congenital or acquired could result in infertility or reproductive failure. This study retrospectively analysed the structural abnormalities found in patients who had hysterosalpingography in the Lagos State University Teaching Hospital (LASUTH), Ikeja. A descriptive analysis of structural abnormality of the uterine cavity, fallopian tube and the cervical canal in two hundred and fifty patients, who were referred from the gynaecology clinic to the Radiology Department of LASUTH, from January to December 2005, is presented. The commonest abnormality seen was tubal blockage (56.8%) whether unilateral or bilateral. Filling defects (16%) were seen within or outside the uterus, causing irregularity of its wall. These could be due to fibroids, endometrial polyps or fibrous tissue causing adhesions. Cervical canal (19.8%) abnormalities were also noted. Only two cases of congenital anomalies were seen. We found that hysterosalpingography is a relatively cheap and easy mode of diagnosing structural anomalies of the genital tract such as fibroids and tubal pathologies.

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BACKGROUND: Globally, management of gunshot injuries (GSI) encompasses resuscitation, evaluation and treatment. Wound debridement is mandatory, while definitive treatment of any associated fracture varies from one part of the world to another. In developed countries aggressive modalities of early operative fixation of such fractures have produced good results. In the Nigerian environment, the approach to such fractures is controversial and cautious, with secondary operative and even non-operative methods still being predominant. OBJECTIVE: To compare operative versus non-operative methods of treatment of long bone fractures and associated injuries from gunshots in our centre. METHODS: This is a prospective study of long bone fractures and associated injuries from civilian gunshots presenting at Lagos University Teaching Hospital (LUTH), Lagos, Nigeria between 1st January 2000 and 31st December 2003. LUTH, one of the tertiary hospitals in Nigeria receives most of the multi-system trauma referrals in Lagos State, Nigeria. RESULTS: Three hundred and sixty patients with GSI were studied, 322 (89.4%) were males while 38 (10.6%) were females, giving a male: female ratio of 8.5:1. One hundred and thirty-six patients (37.8%) had long bone fractures, 94 (69.1%) on the lower limbs. All wounds were debrided and 198 (55.0%) had serial debridement. Eighty-two (60.3%) of 136 patients with fractures from G.S.I had operative treatment done secondarily and 87.5% of them achieved union. Also 42 (77.8%) of 54 patients treated non-operatively achieved union. Two hundred and thirty-four (65.0%) of the gunshot wounds healed by secondary intention, 81 (22.5%) had split thickness skin grafting and 18 (5.0%) had flap cover. CONCLUSION: This study showed that secondary operative treatment of long bone fractures in GSI produces good outcome.

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PURPOSE: We studied the performance of diagnostic mammography in predicting malignancy among patients presenting with signs and symptoms of malignancy. MATERIALS AND METHODS: 310 patients who presented to the surgical out-patients of the Lagos University Teaching Hospital with signs and symptoms of breast cancer, between January 2002 and December 2003 had mammographic evaluation with a dedicated mammography unit. The mammographic appearances were prospectively classified using the BI-RADS assessment categorisation, and histological confirmation following surgical excision was correlated with mammography. RESULTS: The overall sensitivity of mammography in the study was 82.8% (CI 78.6 - 87%) while specificity, Positive predictive value (PPV) and accuracy were 90.7% (CI 87.5-93.9%), 69.97% (CI 46.6 - 74.8%), and 89% (CI 85.5-92.5%) respectively. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased. CONCLUSION: Diagnostic mammography is useful in characterising breast lesions. This study analyses the performance of mammography and shows that the resultant specificity is high, however it may have to be used in conjunction with needle biopsy to achieve improve sensitivity and avoid unnecessary benign surgical biopsies.

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OBJECTIVES: To ascertain the current pattern of facial fractures presenting in the Obafemi Awolowo University Teaching Hospital (OAUTH) and compare this with two earlier reports from the same institution. PATIENTS AND METHODS: All patients presenting with facial bone fractures at the OAUTH between January 1996 and December 2004 were included in the study. Information obtained were patients' demographics, date, cause, site and type of injury. The interval before presentation in the hospital was documented. Data was analysed and compared with two earlier studies carried out in the same institution. RESULTS: 451 patients (351 males and 100 females) presented with 632 facial bone fractures between January 1996 and December 2004. This shows a greater female involvement compared with earlier studies. Similar to earlier studies, majority of the patients (39.7%) were aged 21-30 years however, more cases occurred in the first decade of life in the present study than in the previous. Road traffic crashes remained the leading cause of fractures (74.7%), followed by fight/assaults (8.0%). There was a significantly higher prevalence of motorcycle related crashes and gunshot injuries. While the incidence of mandibular fractures declined, a statistically significant increase was observed for fractures of the middle face specifically Le Fort 1 and zygomatic complex fractures. CONCLUSIONS: Facial bone fractures appear to be on the increase in the studied location. More females and younger children are involved now. Road traffic crashes accounted for most facial bone fractures but violence related causes are on the increase.

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