Background : Cancer of the cervix is the most common cancer of the female genital tract and accounts for about two hundred and fifty thousand deaths yearly most of which occur in the developing countries. It has assumed greater prominence with the decrease in deaths due to infective causes and the increase in the incidence of HIV/AIDS which is a predisposing factor. A significant drop in its incidence has been recorded in the developed countries as a result of intensive program of cervical screening. This study determines the level of awareness and uptake of cervical screening in Owerri, South Eastern part of Nigeria. Method : This is a cross sectional study in which self administered questionnaires returned by eight hundred and forty six respondents were analysed using simple percentages. Results : The level of awareness of cervical screening was 52.8 %( 447), while 7.1 %( 60) had ever done the test. The major sources of information about cervical smear were hospital /health facilities (31.3%) and friends (30.9%).The most common reasons given for not doing the test were lack of awareness 390(46.1%),no need for it 106( 12.5%) and fear of a bad result 98(11.6%). Conclusion : The level of awareness of cervical screening is low and worse still, is the level of uptake at the present level of uptake no significant impact will be made on the incidence of cervical cancer which needs to be reduced. A national cervical smear screening policy is advocated but in the interim, greater public education and the greater use of opportunistic screening by physicians should be vigorously pursued.

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Background : Intestinal parasites are very common in developing countries including Nigeria. There are diverse ways of their transmission; the study attempts to determine the level of intestinal parasitic contamination on vegetables sold in Jos. Methods : Sample of 200 each of Tomatoes (Lycopersium sativus), Letus (Loctus satival) Carrot (Davcus carota L) Cabbage (Brassica Denceal) and Green leafy vegetables were analyzed using standardized Centrifugal-floatation technique methods. Results : Of the 1250 samples of vegetables examined, 450 (36.0%) were positive for intestinal parasites, cabbage recorded the highest prevalence of 64% while tomatoes had the least prevalence of 20%. Conclusion : Vegetables in Jos are heavily contaminated with intestinal parasites and there is need for public enlightenment campaign on the danger of consuming inadequately washed and prepared vegetables.

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Background : Despite the growing research interest in self-medication, little information has been available about its major determinants especially in developing countries. This informed the conduct of this study to determine the major factors that influence the pattern of self medication in a population of market women in Ifako-Ijaiye area of Lagos, Nigeria. Methods : Interviewer administered pretested semistructured questionnaire was used to collect data from 205 market women selected by multistage sampling technique. Results : The patent medicine dealers were the commonest source of information on medications (31.4%) and where they were obtained (52.2%). The exceptions were the educated (62.5%) respondents who obtained theirs from hospitals and pharmacies. Trade and generic names (61.1%) were common means of drug recognition especially among the educated respondents (P<.05). Education of the respondents was the major factor influencing the practice of self-medication though the pattern was descriptively associated with the marital status and educational level of the respondents (P<.05). Benefits of the practice includes in the order: curing of ailments (58.0%), saving time and money (32.0%) and independence of care (7.0%). Conclusion : Literacy and public health education were the major factors influencing the pattern of self-medication among market women. Recommendations on the role of education of market women, patent medicine dealers and the importance of community pharmacy were suggested.

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Background: Clinical depression is a common problem among patients who seek medical care, and diabetic patients with comorbid depression tend to have higher health care cost. A dearth of literature exists on depression among diabetics in Nigeria. The objectives of the study were to determine the prevalence of depression among diabetic patients and to determine the sociodemographic correlates of depression among diabetics. Methods: A cross-sectional descriptive study was conducted between December 2005 and April 2006 among patients who attend the diabetes clinic of Jos University Teaching Hospital (JUTH) with a laboratory and clinical evidence of diabetes mellitus. A semi-structured questionnaire was used to record the sociodemographic data of each consecutive patient followed by an interview by psychiatrists using the depression module of the Structured Clinical Interview for DSM-I V axis I disorder (SCID). Subsequently, the Hamilton Rating Scale for Depression (HDRS) was used to determine the severity of symptoms among subjects diagnosed with depression according to DSM-I V criteria. Results: Thirty-one of the 160 subjects fulfilled the DSM-IV criteria for the diagnosis of a major depressive episode giving a 1-year prevalence rate of 19.4%. Depression was significantly correlated with sex (P=0.001) with a female-to-male ratio of 3:1 and was also significantly associated with unmarried diabetics (P=0.002) and those who had a poor relationship with their partners (P=0.04). No significant association was found between depression and the respondents' age (P=0.216), educational qualifications (P=0.268), employment status (P=0.84), place of residence (P=0.80), household composition (P=0.77), and monthly income (P=0.110). Conclusion: Depression is a common psychiatric disorder among diabetic subjects in this environment. It was suggested that diabetic patients be screened for depression to allow for early detection and treatment.

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Background : Carcinoma of the breast is an important public health problem in Nigeria and studies have reported low levels of awareness and practice of breast self examination as an important method of prevention. Breast self examination is a cost-effective method of early detection of cancer of the breast especially in resource poor countries. We assessed knowledge and practice of breast-self examination (BSE) among female undergraduate students of Ahmadu Bello University Zaria, Nigeria. Method : In this study, knowledge and practice of BSE were examined among 221 female students aged 16 - 28 years old studying at Ahmadu Bello University Zaria using self administered questionnaires. Results : It was found that despite nearly three quarter of the respondents (87.7%) had heard of BSE, only 19.0% of them were performing this examination monthly. Regarding the sources of information about BSE among respondents, media was found to be most common followed by health workers accounting for 45.5% and 32.2% respectively. Regular performance of BSE was significantly correlated with duration of stay in the University (X² = 81.9, df = 3, P < .05) and family history of breast cancer (X² = 17.4, df = 2, P < .05). Conclusion : We observed a disparity between high levels of knowledge of BSE compared to a low level of practice. Public health education using the media could significantly reduce the knowledge- practice gap and early detection of breast lump.

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Objective : To determine the trend and indications for the use of caesarean delivery in our environment. Method : A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. Results : During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically significant (c^[2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. Conclusion : Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate.

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Aim: With increasing urbanization of lifestyle, cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. Materials and Methods: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have hypertension. Each participant's blood pressure was measured and any value ≥140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m ² ; BMI ≥30 Kg/m ² was referred to as global obesity. Their waist circumferences (WC) were also measured and any value ≥102 cm for males and ≥88 cm for females was regarded as abdominal obesity. Results: The general prevalence of HBP in the rural community was 44.5%. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2%). Females were more aware than the males. The prevalence of HBP was higher in males (49.3%) compared with their female counterparts (42.3%), whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2%, global: 14.8%) compared with the males (abdominal: 14.5%, global: 10.1%). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. Conclusion: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus, the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP.

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Background : Pre-eclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. There is need to provide the most effective management to pre-eclamptic and eclamptic patients. There is now evidence that magnesium sulphate is the most effective anticonvulsant. Method : In this article , a literature review was made on the contribution of pre-eclampsia and eclampsia to maternal mortality and how it can be curtailed by the use of magnesium sulphate. Results : The drug is administered by the Pritchard or Zuspan regimen, although modifications in the two protocols have been reported. Conclusion : A Nigerian national protocol has been developed on its use. There is need for further training of health workers on how to use this important drug.

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Background : Seasonal variation in hospitalization for cardiovascular disease has been described in the temperate regions of the world as well as in Northern Nigeria. Increase admission rates during the cold seasons have been reported in these areas. No studies have been done in Southern Nigeria. This study is thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolled hypertension and hypertension related-stroke in Southern Nigeria. Methods : Hospital records of patients admitted to the medical wards of the University of Uyo Hospital (UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension&#8211; related stroke (Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-Info 2002 software was used to analyze data. Results : Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heart failure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The mean age of patients was 52±12.8 years. The average monthly admission was eleven (11). More admissions were recorded in the rainy (cold) season than in the dry (hot) season. The observed difference was however statistically significant only for heart failure and uncontrolled hypertension (P<.05). Conclusion : Admissions for heart failure and uncontrolled hypertension are therefore more during the wet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visit in this season when agricultural activity is intense and less attention given to medical care. This leads to poor compliance to medications and clinical deterioration. The already bad road network both in rural and urban centers also become worse at this time making access to medical care difficult. Facilities and measures should thus be put in place to provide adequate medical care for these patients during that period of the year.

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Objective: To look at the trends in maternal mortality in our institution over 5 years. Methods: Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. Results: There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (χ²=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with χ²=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (χ²=64.69, P =0.00000; and χ²=18.52, P =0.0000168, respectively). Conclusion: In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR.

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Background : In the last decade the number of elderly citizens in Nigeria has increased and their health needs are becoming popularly recognized. A number of factors have also been recognized to determine health care seeking behaviour in these elderly. Methods : The sample consisted of 756 households that had at least one resident who was aged 60 years and above (35% of 2160 households). Multistage and proportionate sampling techniques were employed to select the study subjects. Structured interview were conducted to elicit information on health needs and determinants of health care seeking behaviour of household members aged 60 years and above. Results : The most frequently reported illnesses were body pain (89.5%), joint pain (86.4%), generalized body weakness and fatigue (81.5%), poor sight (78.2%), fever (71.3%) %), irritability, anger, and nervous tension (70 %), %), listlessness, depression, and headaches (60 %),and decreased mobility (65.8%). More than two-thirds (68.8%) of respondents had never visited health facilities in the last one year even for ordinary medical check-up. Family care/Family consultation was the first choice (44. 6%) of treatment for the most frequently reported illnesses irrespective of age group and sex.Less than one-third (28.7%) of the subjects were aware of their health needs. Receiving treatment when sick was the health needs mentioned by the majority (89.4%) of the elderly. Poverty emerged as a major (50.3%) determinant of health care seeking behaviour followed by nature of illness (28.5%). The odds ratio that elderly from poor households will seek health care from unqualified health care practitioners was 0.7 (95% confidence interval (CI) = 0.38-0.67); while the odds ratio that elderly from poor households will seek health care from qualified health care practitionerswas 0.8 (95% CI = 0.57-0.89). Self treatment had odds ratio of 1.7 (95% CI= 0.38-0.67). After controlling the household's poverty status, there was still a significance difference (P<0.05) in age group and gender in terms of health care seeking behaviour. Conclusion : Socio-economic indicators and nature of illness were the most pervasive determinants of health care seeking behaviour among the elderly, overriding age and sex, and in terms of health-care expenditure, the nature of illness and quality of service provided ranked the major determinants.

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A 10-year-old girl presented with an episode of seizure following osteomyelitis of the frontal bone and subperiosteal abscess due to frontal sinusitis. CT scan confirmed osteomeyelitis of the frontal bone and subperiosteal abscess. At surgery, the subperiosteal abscess and contiguous subdural abscess was drained and sequestrectomy of the affected frontal bone done. Broad spectrum antibiotics and anticonvulsant were given for 4 weeks. The patient recovered without residual problems and has remained well at 5 years of follow up. Pott's puffy tumor is now relatively uncommon and associated seizure is unusual. Early diagnosis and prompt treatment is necessary to avoid severe neurological complications and sequelae.

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Background: Acute sigmoid volvulus is one of the commonest causes of benign large-bowel obstruction. Its incidence varies considerably from one geographic area to another. This study reviews its management in a relatively high-prevalence area. Materials and Methods: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH), Banjul, between September 2000 and January 2005 were retrospectively studied. Demographic data, clinical features, resuscitative measures, results of investigations, findings at surgery and postoperative course, and complications were retrieved from the patients' clinical records and analyzed. Results: A total of 48 patients, 45 (93.8%) males and 3 (6.3%) females, with a male: female ratio of 14.3:1, age range of 19 to 78 years and mean age of 45.8 ± 17.6 years underwent treatment for acute sigmoid volvulus. Twenty-one (43.8%) of the patients were aged 40 to 49 years. Two (4.2%) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission, while 24 (50%) had emergency laparotomy, at which bowel decompression, one-stage resection and primary anastomosis without on-table lavage were done. The rest of the patients, 22 (45.8%), had gangrenous sigmoid colons at laparotomy and consequently underwent resection and Hartmann's procedure. Fourteen (29.1%) patients developed wound infection; and 5 (10.4%) had prolonged ileus, which was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were 5 deaths, giving a mortality rate of 10.4%. Conclusion: Acute sigmoid volvulus in The Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage.

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Background : Welders are exposed to a variety of occupational hazards with untoward health effects. However, little is known of welders' awareness of health hazards and their adherence to safety precautions in developing countries. This study assessed the awareness of occupational hazards and adherence to safety measures among welders in Kaduna metropolis in northern Nigeria. Methods : A structured questionnaire was administered on a cross-section of 330 welders in Kaduna metropolis in northern Nigeria. Information was sought on their socio-demographic characteristics, their awareness of occupational hazards and adherence to safety measures. Results : All welders were males with a mean age of 35.7 ± 8.4 years. The illiteracy rate was 7.6%. Overall, 257 (77.9%) of the welders were aware of one or more workplace hazards. This was positively influenced by educational attainment, age, nature of training and work experience. Of the 330 respondents, 282 (85.3%) had experienced one or more work-related accidents in the preceding year. The most common injuries sustained were cut/injuries to the hands and fingers (38.0%), back/waist pain (19%), arc eye injuries/foreign bodies (17.0%), burns (14.0%), hearing impairment (7.0%), fractures (4.0%) and amputation (1.0%). Only 113 (34.2%) welders used one or more types of protective device with eye goggles (60.9%), hand gloves (50.3%) and boots (34.5%) being more frequently used. Regular use of safety device, shorter working hours and increasing experience were protective of occupational accidents. Conclusions : The level of awareness of occupational hazards was high with sub optimal utilization of protective measures against the hazards. There is therefore need for health and safety education of these workers for health and increased productivity.

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Background/Objective: This study aimed at estimating the prevalence and associated factors of premenstrual dysphoric disorder (PMDD) among medical students in a University in the North-Central State of Nigeria. PMDD is the severest form of premenstrual symptoms and is associated with impairment of social and role functioning. Methods: A cross-sectional study of female medical students of the University of Ilorin College of Health Sciences (n=208), which involves completing a questionnaire to elicit socio-demographic and gynecological information as well as the GHQ-12 questionnaires. They were later interviewed with DSM-IV PMDD instrument. Results: Seventy-five (36.1%) of the respondents met the criteria for the diagnosis of PMDD. Sixty-five (%) of the PMDD cases reported having pain during menses among whom 14 (21.5%) reported mild, 32 (49.2%) moderate and 19 (29.2%) severe form of menstrual pain. Forty-two persons (20.2%) were categorized as having probable psychiatric morbidity using a cut-off of ≥ 3 on GHQ 12. There was neither a causal relationship between psychiatric morbidity (≥ 3 score), and PMDD, nor any association between gynecological factors and PMDD. However, menstrual pain was significantly associated with PMDD (P=0.019). Conclusion: The rate of PMDD in this study is high. Dysmenorrhoea of moderate/severe intensity correlated significantly with the possibility of having PMDD. Efforts should therefore be made to alleviate the pain associated with menses. In addition, the College's health-care providers should take into account the issues of dysmenorrhoea and its management more seriously by intensifying health education on dysmenorrhoea and PMDD in order to improve the quality of life of the students.

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Objective: The main objectives of the study were to determine the relationship between social network and pathway to service utilization among psychotic patients. Materials and Methods: This descriptive study was carried out in a psychiatric unit in a general hospital in South West Nigeria. Using structured questionnaires, primary data were collected from 652 psychotic patients on their social network, health behaviors and pathway to current service use. Logistic regression analysis was used to assess the effect of social network on patients' use of services, controlling for sociodemographics, health and functional status. Results: Mean age of the respondents was 29.0 ± 7.5 years, range 14-58 years, males constituted 52.6%. Regarding pathway to services, alternative sources of care such as priests, spiritualists, natural therapists, herbalists, was the first port of call for 78.9% of respondents. Family dominated the social network in 51.1% of patients. The presence of some social network and social support structures were significantly associated with the use of general medical and specialty psychiatric services for patients with schizophrenia (P = 0.03), schizoaffective disorder (P = 0.02), bipolar I disorder (P = 0.01), but not with major depression and symptoms of psychological distress. Conclusions: Findings indicate that social support and social network enhanced utilization of mental health services for psychiatric patients except for those with psychotic depression or those with symptoms of psychological distress. In addition, alternative sources of care are still relevant in mental health service delivery in South West Nigeria.

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Background / Objective : To determine the pattern of eclampsia and its contribution to maternal mortality at the Federal Medical Centre, Birnin Kudu, Jigawa State in Northern Nigeria. Method : A 4-year retrospective review of the case records of all women who presented with eclampsia at the center. All the case records were retrieved from the medical record department and analyzed. Results : There were 207 cases of eclampsia out of 2197 deliveries during the period giving an incidence of 9.42%. 171(82.6%) of the patients were unbooked. Majority (58.5%) of the patients were aged less than 20 years. The highest frequency (78.3%) was recorded in the primigravida. Delay before reaching the hospital was established in 116(56%) of patients. The condition was antepartum in 68(32.9%), intrapartum in 112(54.1%) and postpartum in 27(13%). 107(51.7%) of the patients were delivered by cesarean section. Twenty two (10.6%) of the mothers died. Eclampsia was the commonest cause of maternal mortality and contributed 43.1% of all maternal deaths. 180(87%) of the babies were delivered alive while 27(13%) died. Conclusion : Eclampsia is a major cause of maternal mortality. There is need for health education on the need for patients to avail themselves of antenatal care.

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Background / Objectives : Expenditures due to irrational use of drugs have been a strain on the meagre health budgets of several developing countries and inappropriate prescribing has been identified in many health facilities in developing countries. This study examines the prescription pattern in a secondary health facility. Method : A descriptive cross-sectional survey was used in this study. Three hundred and three randomly selected prescriptions issued to patients attending out-patients' clinics in the facility over a period of three months were examined. Data obtained was analyzed using EPI-INFO 2000 computer software. Results : Mean number of drugs per prescription in the health facility is 3.99 ± 1.55. At least 4 drugs were prescribed in 61.6% of the prescriptions. Generic prescribing was generally low. Out of a total of 1219 drugs prescribed 511 (41.9%) were prescribed in generic names. Analgesics, antimalarials, antibiotics and antihypertensives accounted for 19.7%, 10.2%, 13.0% and 4.9% of the drugs prescribed respectively. Only 124 (40.9%) of the prescriptions had all drugs prescribed available in the health facility. Conclusion : This study found practice of polypharmacy prevalent as found in other studies in developing countries among prescribers and prescription in generic names is low. Regular orientation and re-orientation of prescribers on rational drug prescription and prescription in generic names in conformity with national drug policies is necessary.

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Background: Most health expenditure of developing countries is on drugs and medical sundries but inappropriate use of such resources is common. To our knowledge, only few studies have been done in Africa on this issue , with inadequate consideration of the sociological context of the knowledge, attitude and practice of the prescribers especially doctors. This study presents the pooled data of the pattern of prescription drug use from three Nigerian Army hospitals using some WHO criteria, and the knowledge and attitude underlying doctors' prescribing practices in these hospitals. Methods: Retrospective cross-sectional survey of one year (March 2006-February 2007). Systematic random sample of general out patient case notes from three hospitals were collected using WHO criteria. The knowledge, attitude and practice survey of doctors at each study site towards the concept of rational drug use (RDU) were assessed using a self-administered questionnaire. Results: Data collected from 660 case notes showed that average number of drugs per encounter was 2.8 while 49.3% of drugs were prescribed in the generic form. An average of 28.1% of patients encountered antibiotics. From the knowledge, attitude and practice survey, it is evident that 90.5% of 74 prescribers were aware of the existence of national essential drugs list but 58.1% of them did not use it as basis of prescriptions. In describing types of medicines preferred, 56.7% of prescribers claimed they prescribed a mixture of generic and branded drugs. Only 12.1% of prescribers could accurately detail the 5 steps of rational prescribing. Conclusion: The pattern of prescription drug use in Nigerian Army hospitals is unsatisfactory. It is characterised by high number of drugs per prescription, high rate of antibiotic usage and unscientific prescription by doctors. There is a need for further education and research on rational drug use among prescribers in Nigerian military health facilities.

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An up-to-date review on human paragonimiasis in Africa was carried out to determine the current geographical distribution of human cases and analyze the animal reservoir, snails and crustaceans which intervene in the local life cycle of Paragonimus species. Two countries, i.e., Cameroon and Nigeria, were mainly affected by this disease, while the distribution of human cases in the other eight states of the intertropical zone was scattered. Infected patients were currently few in number and two Paragonimus species: P. africanus and P. uterobilateralis, were found. The animal reservoir is mainly constituted by crab-eating mammals. The identity of the host snail remains doubtful and was either a prosobranch, or a land snail. Seven crab species belonging to Callinectes, Liberonautes and Sudanonautes genera are able to harbour paragonimid metacercariae. Due to the current low prevalence of human paragonimiasis recorded in Africa and the high cost of wide-scale screenings for this disease, training of technicians in anti-tuberculosis centers would be the most realistic attitude to detect mycobacteria and/or Paragonimus eggs during the same sputum examination.

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Objective : To evaluate patterns of morbidity and mortality among bike riders and pillion seat passengers involved in road traffic accidents in Benin-City Nigeria between August 2003-July 2004. Methods : A total of Fifty-one bike riders and pillion seat passengers, who participated in this study were part of a larger study, involved in a road traffic accident and were brought to the accident and emergency unit of either the University of Benin Teaching Hospital (UBTH) or the State Specialist Hospital between August 2002-July2003.The injured ones were examined and dead patients had an autopsy done on them Results : A total of 51 cases of bikes riders/pillion seat passenger accidents were recorded representing 18% of total accidents. 35 motorbike riders/pillion seat passengers were struck down by cars (68.6%). Seven bike riders/pillion seat passengers (13.5%) were struck by articulated vehicles. 7 bike riders/pillion seat passengers representing 13.5% of cases were stuck by buses, 2 (3.9%) pillion seat passengers fell of bikes from epilepsies and sustained secondary injuries. Males were more in number with a ratio of 2.5; 1. One hundred percent (100%) or all motorcyclist and their passengers did not use helmets. Conclusion : Cars struck down most bike riders and their pillion seat passengers. Males were more than females in number. The commonest autopsy findings as cause of death was intra-cranial hemorrhage preventable by the use of crash helmets.

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Objective : To assess treatment outcomes and determinants of outcome among tuberculosis patients. Design : A longitudinal study design involving a cohort of sputum smear-positive pulmonary tuberculosis patients at initiation of therapy, who were followed up to the end of treatment at eighth month. Setting : Tuberculosis treatment centers in Ibadan, Nigeria Results : A total of 1,254 patients were followed up with a mean age of 35.0±3.3 years. The percentages of patients with treatment outcomes assessed in the study were as follows: cure (76.6%), failure (8.1%), default (6.6%), transferred out (4.8%), and death (1.9%). The cure rate varied significantly between treatment centers from 40 to 94.4% (P<0.05). The treatment centers located within the specialist health centers at Jericho and the University College Hospital had 50 and 75% cure rates, respectively. The mean age of cured patients was 31.2±3.1 years, which was significantly lower than the mean age of those with poor treatment outcomes (36.7±3.5 years; P<0.05). Males had a higher risk of a poor treatment outcome (RR=1.8; 95% CI: 1.02-1.94) than females. Also, patients with a poor knowledge of tuberculosis had a higher risk of having a poor treatment outcome (RR=1.35; 95% CI: 1.25-1.62) compared to those with a good knowledge. Conclusion : Variations in health center treatment outcomes and poor knowledge of tuberculosis among patients suggest that poor program implementation quality may be a major modifiable determinant of treatment outcomes in our environment.

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Objective : To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. Methodology : Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis. Results : Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age group <20, 20-29 and above 30 all had similar case fatality rate of 22.1%, 23.8% and 26.7%, respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5% of the case fatality in that category. As expected, unbooked had higher case fatality of 24.0% compared to 15% among booked cases, while those with no formal education also had more death (22.3% case fatality) as compared to 3.3% among those who had some form of formal education. Antepartum eclampsia was the cause in 50% of the death, 11(21.2%) of the pregnancies were not delivered before their death, while 18 (34.6%) were stillbirth. Conclusion : Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery.

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Although Parkinson's disease (PD) is still incurable, a large number of different treatments have become available to improve the quality of life and physical and psychological morbidity, and its early treatment is of prime importance. This article reviews the current situation of PD. This review was based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. The subject headings and keywords used were Parkinson's disease and therapeutic advances. Only articles written in English were included.The management of PD has evolved rapidly over the last 10 years with the advent of new drugs and new classes of drugs, but the currently available treatment methods are all symptomatic ones. However, some of these may have marginal disease-modifying effects. Progress in manufacture of newer drugs has markedly improved the treatment of early PD; however, the management of advanced Parkinson's symptoms remains a challenge. Currently no treatment has been proven to slow the progression of PD. Although symptomatic therapy can provide benefit for many years, PD will eventually result in significant morbidity.

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Background : Tuberculosis (TB) is an important cause of mortality and morbidity in human immunodeficiency virus (HIV) infection in Africa. The interaction between TB and HIV infections is reviewed. Methods : Literature on TB, HIV and their co-infection, especially in sub-Saharan Africa, including Nigeria, is reviewed. Results : Burden of TB is fueled by the HIV epidemic, and clinical presentation of TB may be atypical with co-infection. Recommendations on drugs and timing of antiretroviral therapy (ART) initiation are discussed. Use of cotrimoxazole prophylaxis (CPT) in co-infected patients reduces morbidity and mortality, while the principles of TB prevention in HIV infection can be summarized with the three I's: intensive TB case finding and surveillance, isoniazid preventive therapy (IPT) and infection-control measures; to these can be added a fourth 'I,' viz., instituting ART. Clinical complications like drug resistance, toxicity and drug interactions; and immune reconstitution inflammatory syndrome (IRIS) with CPT, IPT and ART are highlighted. Emergence of drug-resistant- and nosocomial- TB in HIV infection poses serious challenges and potential consequences in Africa, and appropriate measures are recommended. Conclusions : Many barriers exist for optimizing the care of the two diseases, but the aim should be strengthening capacities, collaborations, linkages and eventually integrating the services. Interventions for TB prevention in HIV infection should be widely implemented.

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