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: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution.

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Background: Pain during childbirth is a well known cause of dissatisfaction amongst women in labor. The use of epidural analgesia in labor is becoming widespread due to its benefit in terms of pain relief. Method: After approval of the local Ethics Committee on Research and obtaining informed written consent, 50 American Society of Anesthesiologists (ASA) class I-II consecutive multiparous women in labor requesting pain relief were enrolled in this prospective study. After providing description of the two options of pain relief available to them, they were allocated into two groups according to their request-to receive either parenteral opioid/sedative or epidural labor analgesia. Both groups received analgesia of choice at 4-cm cervical os dilatation. The epidural group received 0.125% plain bupivacaine, while the other group received pentazocine/promethazine intravenously. The time taken to locate the epidural space, catheter-related complications encountered and the amount of intravenous fluid used were documented. Result: The two groups were comparable in terms of socio-demographic data. The mean duration of the first and second stages of labor, respectively, were significantly shorter in the epidural group when compared with those in the non-epidural group ([ P < 0.01] and [ P < 0.02]). There was no difference in the rate of cesarean delivery between them - epidural analgesia (32% [8/25]) versus parenteral opioid/sedative (44% [11/25]), (OR, 0.60; 95% CI, 0.19-1.90). The maternal blood loss from delivery was minimal, with no statistical difference between the two groups ( P = 0.27). The neonatal outcome was the same in both groups. Closed questionnaire showed that the overall experience of labor was much better (it was also better than expected) in the epidural group when compared with that in the non-epidural group (80% versus 4%). Eighteen (72%) women had inadequate pain relief in the non-epidural group as compared to 2 (8%) women in the epidural group. Conclusion: The study shows that epidural labor analgesia is acceptable to women in our setting. More women in the epidural analgesia group were satisfied with the experience of labor than those who did not receive this form of analgesia than among those who received parenteral opioid/sedative.

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Background/Objective: Circumcision may be associated with complications which are usually minor but could be life threatening on certain occasions. This study determined contributory factors, pattern of presentation, challenges of management and outcome of circumcision mishaps in Benin City, Nigeria. Methods: A retrospective analysis of all male children managed for circumcision mishaps between January 1998 and December 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria. Results: There were 346 male children aged between 6 days and 12 years. Period of presentation to the unit ranged between 1 hour and 12 years. Redundant prepuce, 51 (14.7%); glandulopenile adhesions, 30 (8.7%); implantation cyst, 10 (2.9%); penile chordee, 11 (3.2%); local wound infection, 17 (4.9%); and proximal migration of plastibell ring, 11 (3.2%), were common mishaps treated with good outcome. On the other hand, urethrocutaneous fistula, 73 (21.1%); hemorrhage, 46 (13.3%); glandular amputation, 9 (2.6%); penile tissue avulsion, 24 (7.0%); and transmission of infections, 4 (1.2%), were challenging mishaps to manage. These resulted in 18 children with residual penile deformity and 4 deaths. Challenging mishaps and late referrals were common among children circumcised by traditional circumcisionists ( P < 0.0001). Inadequate training of circumcisionists; circumcision in unhygienic environment; circumcision with unsterilized instruments; circumcision without the use of anesthesia, analgesia and antibiotics - which were compounded by late referrals - influenced the development and final outcome of circumcision mishaps. Conclusion: Circumcision mishaps presenting very late with resultant poor outcome are still common in our setting. Hospital circumcision by experts, health awareness campaigns, adequate training of circumcisionists and early referrals of affected children should be encouraged.

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Background : Acute abdominal conditions are a common reason for emergency admission of children. Little is available in the literature about such conditions in our subregion, especially Ghana. Objective : The aim of this study was to investigate the range of emergency abdominal surgical conditions amongst children in the subregion, with particular reference to Komfo Anokye Teaching Hospital, Kumasi, Ghana. A prospective survey of all children older than 1 year undergoing an emergency abdominal surgery was carried out. Methods : Details of all children (except infants) operated for an acute surgical abdominal condition over a 5-year period were entered into a specially designed form, capturing patient characteristics, surgical causes of the emergency, operative procedure, complications, morbidity and mortality rates. Results : Nine hundred fifty-five children aged > 1 year but < 15 years were enrolled in the study. The mean age was 8.8 ± 3.2 years. The leading causes of surgical abdominal emergencies were typhoid perforation (TP) of the gastrointestinal tract (GIT), 68%; acute appendicitis, 16%; abdominal trauma and intestinal obstruction (including intussusception), 4.7% each; irreducible external hernias, 2.5%; primary peritonitis, 1.0%; gallbladder disease and gastric perforation, 0.8% each. Many children died from the TP group; case fatality for TP alone was 12.6%. The overall mortality was 9.7%. Morbidity was influenced by the presence of major peritoneal contamination, continuing peritonitis and surgical site infections (SSIs), which led to long hospital stay. Conclusions : In our hospital, TP of the GIT, acute appendicitis, intestinal obstruction, irreducible external hernias and primary peritonitis were the most common abdominal emergencies encountered in children after infancy. The high morbidity and mortality in TP is attributable to ignorance, poor sanitation and delay in reporting to hospital for treatment.

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Background: Prevalence of diabetes mellitus (DM) is increasing worldwide, with the major increases expected to occur in developing countries. It has been observed that the pattern of hospital admissions can be used to determine the effectiveness of outpatient care of DM. Objective: This study was aimed to examine diabetes-related admissions to medical wards of a federal medical center in Ekiti, Nigeria. Such data would be useful to determine the burden on health care system and in the planning of appropriate management strategies. Methods: A 5-year retrospective analysis of diabetes-related admissions to the medical wards of Federal Medical Centre, Ido Ekiti, Ekiti State, between 2003 and 2007 was carried out using medical records of the patients. SPSS 13 software was used to analyze data. Results: Of the total 2,696 medical admissions, 118 (4.4%) were diabetes related. The mean age of these patients was 57 ± 16.2 years. Majority (37.29%) of the patients were admitted for diabetic foot ulcer. Other major reasons for admission were severe hypertension (13.56%), uncontrolled hyperglycemia (13.56%), hyperglycemic emergencies (11.86%) and stroke (10.17%). Duration of hospital stay ranged from 1 to 107 days, with a mean duration of 17.5 ± 9.2 days. Mean duration of hospital stay was the longest (25.3 ± 23.9 days) for those admitted for diabetic foot ulcer. Most (74.6%) of the patients were discharged and only 4 (3.4%) died. Majority of those who left against medical advice were admitted for diabetic foot ulcer. Conclusion: There is a need to emphasize foot care as one of the cardinal features of optimal diabetes care. Establishing clinics specializing in treating diabetes and having facilities for treatment of all aspects of diabetes, including diabetic complications, will help in providing better patient care and in minimizing hospital admissions.

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Background: The health care sector depends to a large extent on human labor. Poor worker motivation can greatly affect health outcomes and patient safety. There is little information on the health workers' perceptions of working conditions in resource-poor settings. Method: Three state-owned facilities in each state were selected by simple random sampling technique. The selected facilities were visited on weekdays between 9 and 10 a.m. A self-administered structured questionnaire was given to all health care workers on duty in the facility at the time of visit. Results: A total of 299 questionnaires were returned. The response rate was 85.43%. Two hundred four (68.2%) workers experienced general satisfaction with their current jobs. The relationships between general job satisfaction and presence of conflict at work ( P = 0.001), freedom of expression ( P > 0.001), managerial support for staff welfare ( P > 0.001), managerial support for staff career development ( P > 0.001), availability of tools and consumables in the workplace ( P > 0.001) and progress towards personal professional goals ( P = 0.001) were statistically significant. Conclusion: The level of general job satisfaction was high. Though salaries were important, presence of conflict at work, freedom of expression, managerial support for staff welfare, managerial support for staff career development, availability of tools and consumables in the workplace and progress towards personal professional goals appear to play a role in worker motivation.

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Objective: To estimate the prevalence and predictors of illicit drug use among school-going adolescents in Harare, Zimbabwe. Methods: We used data from the Global School-based Health Survey (GSHS) conducted in 2003 in Harare to obtain frequencies of a selected list of characteristics. We also carried out logistic regression to assess the association between illicit drug use and explanatory variables. For the purpose of this study, illicit drug use was defined as marijuana or glue use. Results: A total of 1984 adolescents participated in the study. Most of the sample were females (50.7%), 15-year- olds (30.3%), nonsmokers and non-alcohol drinkers. Nine percent of the subjects (13.4% males and 4.9% females) reported having ever used marijuana or glue. Males were more likely to have used marijuana or glue than females (OR=2.70; 95% CI [1.47, 4.96]). Marijuana or glue use was positively associated with cigarette smoking (OR=11.17; 95% CI [4.29, 29.08]), alcohol drinking (OR=7.00; 95% CI [3.39, 14.47]) and sexual intercourse (OR=5.17; 95% CI [2.59, 10.29]). Parental supervision was a protective factor for marijuana or glue use (OR=0.31; 95% CI [0.16, 0.61]). Conclusions: Public health intervention aimed to prevent marijuana or glue use among adolescents should be designed with the understanding that illicit drug use may be associated with other behaviors such as teenage sexual activity, cigarette smoking and alcohol use.

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Background: Maternal mortality rates are very high in Nigeria. Increased level of awareness and perception will reduce maternal mortality rates. Objective: The study was aimed at assessing the awareness and perception of maternal mortality among women in the reproductive age group at Ogunu community in Warri South Local Government Area of Delta State. Methodology: This was a descriptive cross-sectional study that was carried out in Ogunu town in Delta State. A simple random sampling technique was used to select 400 women, who gave consent to be enrolled in the study. They were assisted in filling a semi-structured questionnaire containing questions on awareness and perception of maternal mortality among women in the community. Information generated was recorded on a data collection sheet designed for the study. The coded data were fed into the computer using the SPSS program to determine the mean values and frequencies. Results: A total of 400 questionnaires were distributed; of these, 349 were completely filled and returned. The mean age of the study subjects was 31.6 ± 7.7 years. Among these subjects, 54.7% were married, while 32.7%, 28.7% and 26.5% had tertiary, secondary and primary education, respectively. The study revealed that 96.3% of the subjects felt that death can occur from pregnancy-related problems, while 69.1% were aware of maternal mortality. Majority of the subjects agreed that one or more forms of delay could be responsible for their death. This study shows that a good proportion of subjects was aware of maternal mortality and also had a good perception of it. Conclusion: Efforts should be directed towards educating women about the risk of delivering in homes of traditional birth attendants, maternity homes and health centers, and the concept of early referral of women to the hospital should be reinforced. Providing information to women on prevention of maternal mortality and community participation and mobilization will help prevent maternal mortality to some extent in Nigeria.

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Objectives: To evaluate the CD4+ cell counts in adults with human immunodeficiency virus (HIV) infections presenting at the medical department of the Federal Medical Centre, Ido-Ekiti, Nigeria. Methods: This study was carried out at the medical department of the Federal Medical Centre (FMC), Ido-Ekiti, Nigeria, in the period July-December 2006. FMC, Ido, was recently upgraded to serve as the only center for HIV/AIDS referral, diagnosis and treatment in Ekiti State. The center offers free antiretroviral therapy. All patients with a diagnosis of HIV/AIDS, either diagnosed at the center or referred from other hospitals, admitted to the medical department within the study period had their blood sample taken for CD4 cell counts estimation at the first visit to the center, as part of the routine workup to assess their disease status and need for antiretroviral therapy. Results: A total of 87 patients comprising of 54 (62.1%) females and 33 (37.9%) males had their CD4+ T-Lymphocytes cell counts evaluated within their first week of presentation. The total mean age of the population studied was 33.17 ± 7.01 years. The mean age of the females was 31 ± 5.6 years, while that of the males was 36.5 ± 8.2 years. The difference between the mean ages of females and males was statistically significant (P = 0.0004). The female: male ratio was 1.6:1. Out of the 87 patients, 30 were referrals from other hospitals within the state. The total mean CD4+ cell count was 230.7 ± 311.9 cells/µL. The mean CD4 cell count of females was 212.17 ± 264.96 cells/µL, while that of males was 261.0 ± 389.19 cells/µL. This difference was not significant (P = 0.4876). Majority of the patients (75, [86.2%]), had CD4 cell count < 350 cells/µL, comprising of 48 females and 27 males. Of the 75 patients, 57 (76%) had a CD4 cell count < 200 cells/µL (33 females vs. 24 males). Conclusion: At the time of HIV diagnosis, majority of our patients had a CD4+ cell count < 200 cells/µL. This was consistent with a relatively advanced disease. More women than men in the population were found positive for HIV. More sustained and vigorous awareness campaigns need be embarked upon in the HIV propaganda in the Ekiti State on one hand and Nigeria on the other hand to bring down this Hydra-headed monster called HIV/AIDS.

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Background : Tobacco use is the leading cause of noncommunicable disease morbidity and mortality. Most smokers initiate the smoking habit as adolescents or young adults. Methods : Survey data from the 2007 Lusaka (Zambia) Global Youth Tobacco Survey were used to estimate the prevalence of current cigarette smoking and assess whether exposure to pro-tobacco media and perception of the potential harm of secondhand smoke are associated with adolescents' smoking. Logistic regression analysis was used to estimate the associations. Results : Altogether, 2378 students, of whom 56.8% were females, participated in the study. Overall, 10.5% of the students (9.3% among males and 12.1% among females) smoked cigarettes in the 30 days prior to the survey. Students who favored banning smoking in public places were 33% (OR = 0.67; 95% CI [0.47, 0.96]) less likely to smoke cigarettes compared to those who were not in favor of the ban. Seeing actors smoking in TV shows, videos or movies was positively associated with smoking (OR = 1.90; 95% CI [1.26, 2.88]). However, possessing an item with a cigarette brand logo on it, seeing advertisements of cigarettes on billboards and being ever offered a free cigarette by a cigarette sales representative were negatively associated with smoking (OR=0.39, 95% CI [0.26, 0.58]; OR=0.63, 95% CI [0.43, 0.92]; and OR=0.43, 95% CI [0.29, 0.65], respectively). Conclusion : Findings from this study indicate that TV advertisement-promotion-sponsorship was positively associated with smoking, while it was the opposite with other forms of advertisement; there is a need for further studies.

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Background: Nigeria accounts for about 10% of all HIV/AIDS cases in the world. Globally women constitute 48% of adults infected with HIV; in Nigeria, they constitute 57%. There is an increase in the number of children infected with HIV in recent years as the number of HIV-positive women has increased. However, more than 90% of HIV infections in children aged less than 15 years are due to mother-to-child transmission of HIV. Objective: To evaluate the awareness and knowledge of mother-to-child transmission of HIV, HIV/AIDS and the methods to prevent mother-to-child transmission of HIV. Methods: This is a descriptive study. The study was carried out at the pediatric HIV clinic of Aminu Kano Teaching Hospital from 1 ^st July 2006 to 30 ^th December 2006. Mothers included in the study were mothers in first contact with HIV facilities, which was at our center, before any form of counseling. The instrument used was a questionnaire designed to assess awareness of the mothers about HIV/AIDS, evaluate their knowledge of possible routes of transmission and measures to prevent vertical transmission. The questionnaire was then pre-tested for comprehensibility, appropriateness of language, sensitivity of questions and average duration of administration. Results: A total of 164 mothers brought their children for treatment to the pediatric HIV clinic. The level of awareness about HIV/AIDS among mothers was very high (100%), and the main sources of information were radio (48.8%) and television (37.8%). Ninety-one percent of mothers were aware of mother-to-child transmission of HIV. Transplacental route (41%) was the commonly identified route of transmission. The level of knowledge and perceptions of mother-to-child transmission of HIV is inadequate. Conclusion: There is a need to scale up education about mother-to-child transmission of HIV in our health facilities.

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Objective: To know the opinions of trainee ophthalmologists on ways to improve cataract surgical rate (CSR) with a view to having insight into actions that should be of high priority for achieving this improvement. Methods: A survey of 27 trainee ophthalmologists using structured self-administered questionnaire. Results: Most trainees had a positive view about actions towards raising CSR: Structured ophthalmic training- 25 (92.6%), monthly cataract camps by eye departments in teaching hospitals- 21 (77.8%), rural allowance for ophthalmologists- 26 (96.3%) and welfare package for indigent cataract patients- 21 (77.8%). Other actions included local production of cataract consumables- 22 (81.5%), duty-free importation of ophthalmic materials- 23 (85.2%), employment of ophthalmologists in the services of the state governments- 24 (88.9%) and local governments- 20 (74.1%), effective primary eye care- 25 (92.6%) and marketing of cataract surgical services- 23 (85.2%). However, only 16 (59.3%) trainees wanted first ladies (wives of the president, governors and local government chairmen) to adopt cataract elimination as pet projects, and 24 (88.9%) opposed the introduction of cataract surgeons. Conclusion: Most trainees had positive perceptions about most actions that can raise CSR. However, top-priority actions to improve CSR were attractive rural allowance, structured training, resource availability, cost reduction and marketing of cataract surgical services. Multiple actions might be necessary to raise CSR.

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Background: In 2006, a qualitative, cost-free-to-patient eye care program took place in Owo, Nigeria. This study sought to identify factors that are of marketing importance in qualitative cost-free-to-patient eye care program. Methods: A cross-sectional survey of postoperative patients using interviewer-administered questionnaire to probe into patient socio-demographic factors, source of awareness about the eye care program, initial perception of the program, assessment of the performance of eye care personnel and overall assessment of the eye care program was carried out. Comments of patients on problems encountered and suggestions from them for improvement were noted. Results: Ninety-nine patients comprising of 47 men and 52 women, with age range of 24 to 98 years, participated. Factors of marketing importance identified included publicity through people (46.5%), town criers (21.2%), radio (15.2%), churches (8.1%), mosques (5.1%) and banners (4.0%). Patients' assessment of the program was as follows: Service to the community (83%); excellent eye care team performance (80%); and overall program rating as follows: Very satisfactory (76%), satisfactory (22%). The remarkable problem was long waiting period (15.3%). Suggestions of the patients were as follows: Improve program sustainability (10.1%); increase eye care manpower (7.1%); and public support for the sponsor in order to continue with perceived laudable project 4 (4.0%). Conclusion: Adequate publicity, patients' good perception, excellent eye care team performance and patients' overall satisfaction can create awareness about the need to avail of eye care services.

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