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   2010| July-September  | Volume 9 | Issue 3  
    Online since August 11, 2010

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Premenstrual dysphoric disorder among medical students of a Nigerian university
Baba A Issa, Abdullah D Yussuf, Abdul Waheed O. Olatinwo, Martin Ighodalo
July-September 2010, 9(3):118-122
DOI:10.4103/1596-3519.68354  PMID:20710100
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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An overview of cancer of the prostate diagnosis and management in Nigeria: The experience in a Nigerian tertiary hospital
Abdulwahab A Ajape, Kazeem O. O. Ibrahim, John A Fakeye, Olusegun O Abiola
July-September 2010, 9(3):113-117
DOI:10.4103/1596-3519.68353  PMID:20710099
Objective: To review our experience with cancer of prostate management, highlighting the mode of presentation, method of diagnosis, and the treatment outcome. Methods: Medical records of patients managed for cancer of prostate were retrospectively reviewed over a 10-year period. Relevant information which included the year of diagnosis, age at presentation, mode of presentation, digital rectal examination (DRE) findings, ultrasound (USS) assessment of the prostate, the prostate-specific antigen (PSA) value, the histology report, treatment offered and the outcome were extracted. Data were analyzed with SPSS version 11 software. Results: A total of 192 patients were managed for cancer of prostate within the study period but only 90 case notes were available for analysis. There was a 7.7 fold increase in the incidence of cancer of prostate. The mean age (±SD) at presentation was 68.4 (±10.1) years with an age range of 47-91 years and the peak incidence occurred in the seventh and eighth decades of life. The mean duration of symptoms prior to presentation was 10.3 (±17.1) months. A total of 66.7% of cases presented within 6 months of the onset of symptoms as against 14.4% of cases presented after a year. Majority of cases (88.9%) presented as locally advanced or metastatic disease and only 4.4% of cases were found incidentally. Only 38.9% had histologic confirmation of the diagnosis before management was instituted. DRE gave a false negative finding in 28.6% in this study. The sensitivity and false negative value of USS was 50% each and 3.3% had PSA within normal value. Bilateral orchidectomy was offered to 64 of 90 (71.1%) and the cancer related death (CRD) was 15.6%. The maximum follow-up period was 36 months in this study and 36.9% are still attending follow-up clinic. Conclusion: There was an apparent increase in the incidence of cancer of prostate from the present study with majority still presenting with advanced disease. The sensitivity of DRE was high; this probably accounted for the treatment without establishing the histologic diagnosis in majority of the cases. Such a practice of clinical diagnosis alone should be discouraged.
  19 5,892 113
Pattern of prescription drug use in Nigerian army hospitals
ET Adebayo, NA Hussain
July-September 2010, 9(3):152-158
DOI:10.4103/1596-3519.68366  PMID:20710106
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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Prevalence of intestinal parasitic infestation in HIV seropositive and seronegative patients in Ilorin, Nigeria
SK Babatunde, AK Salami, JP Fabiyi, OO Agbede, OO Desalu
July-September 2010, 9(3):123-128
DOI:10.4103/1596-3519.68356  PMID:20710101
Objective: To determine the prevalence, severity and pattern of intestinal parasitic infestation in HIV-seropositive patients. Methods: A Cross-sectional study from January 2007 to December 2008.Patients were recruited from the HIV clinics of the hospital. Paired blood and single stool specimens were collected from each patient. The stool sample was investigated for intestinal parasites while the blood sample was tested for antibodies to HIV-1 and 2. HIV-seropositive subjects also had CD4 + cells count done. Result: Ninety each of stool and blood samples were collected from HIV-seropositive and HIV-seronegative patients. Four species each of helminthes and protozoan parasites and three species of coccidian parasites were isolated from the stool of both HIV-seropositive and seronegative subjects. The prevalence of these parasites was two and a halve times higher among the HIV seropositive patients than the seronegative ones. The range of CD4 cells count was 20-680 cells/΅l with a median of 259 cells/΅l. Patients with CD4 + count <200/΅l had more coccidian parasites in their stool and also had higher prevalence of intestinal polyparasitism ranging from 2 to 4 different species per stool sample. Conclusion: The frequency of both AIDS defining and non- AIDS defining intestinal parasitic infestation was higher among the HIV infected patients. Patients' CD4 + cells count was an important determinant of the rate and number of parasitic infestation.
  16 7,265 106
Correlation of oxidative stress and inflammatory markers with the severity of sickle cell nephropathy
MA Emokpae, PO Uadia, AA Gadzama
July-September 2010, 9(3):141-146
DOI:10.4103/1596-3519.68363  PMID:20710104
Background: Reactive oxygen species have been shown to mediate inflammatory process and may be involved in lipid peroxidation. Methods: This study evaluates superoxide dismutase, glutathione peroxidase, catalase, malondialdehyde, C- reactive protein and fibrinogen in the serum of patients with sickle cell disease and their correlation with renal insufficiency. Superoxide dismutase, glutathione peroxides and C - reactive protein were assayed using sandwich ELISA technique while malondialdehyde and fibrinogen were determined using thiobarbituric reactive substance and turbidometric technique, respectively. Results: The study group consisted of 40 patients with sickle cell disease along with macroalbuminuria, 16 with chronic kidney disease and 144 sickle cell disease controls. Superoxide dismutase, glutathione peroxidase and catalase were decreased while malondialdehyde, C-reactive protein and fibrinogen were increased in patients with sickle cell disease along with renal insufficiency. These parameters correlated with the severity of renal disease. Conclusion: Oxidative stress and inflammatory parameters correlate with sickle cell disease nephropathy.
  15 6,036 84
Social consequences of epilepsy: A study of 231 Nigerian patients
Folorunsho T Nuhu, Joseph O Fawole, Obafemi J Babalola, Olaniyi O Ayilara, Zainab T Sulaiman
July-September 2010, 9(3):170-175
DOI:10.4103/1596-3519.68360  PMID:20710109
Background: Epilepsy is the commonest neurological disorder and majority of the sufferers are found in the developing countries. It is associated with psychological and social problems. The aim of this study was to determine the social difficulties experienced by epileptic patients and the factors that are associated with these difficulties. Methods: Two hundred and thirty-one consecutive epileptic patients who were of age 10 years and above, and who had no co-morbid major psychiatric disorder, seen over a 6-month period at the outpatient clinic of Federal Neuro-psychiatric Hospital, Kaduna, were interviewed. We used an instrument designed for the purpose of this study, which focused on people's attitudes to epilepsy, relationship/marital, employment and academic problems. Results: The mean age of the subjects was 28 ± 13.2 years; 59.3% were males; 44.6% said people make negative remarks about their illness; 14.1% have been denied leadership role; 36.4% were irregular at work; 37.3% performed poorly at work; 22.5% have had their marriage proposals rejected; 19.5% have been abandoned by spouse. At least 39.4% had poor academic performance while 19.5% were withdrawn from school because of epilepsy. Short seizure-free period, long duration of seizure disorder and family history of epilepsy were significantly associated with social problems. Conclusion: Social difficulties are common among epileptics. Effort should be made to educate the society about epilepsy, and physicians treating patients with epilepsy should aim at achieving a good seizure control.
  15 7,534 49
Malaria among antenatal clients attending primary health care facilities in Kano state, Nigeria
AU Gajida, Z Iliyasu, AI Zoakah
July-September 2010, 9(3):188-193
DOI:10.4103/1596-3519.68352  PMID:20710113
Background: Malaria in pregnancy remains a major public health problem especially in sub-Saharan Africa. However, the prevalence of clinical and asymptomatic infection among antenatal client (ANC) attendees is largely unknown, especially at primary health care (PHC) level in northern Nigeria. This study assessed the prevalence of fever, malarial parasitemia and anemia among pregnant women attending PHC facilities in Kano, northern Nigeria. Methods: A cross-sectional descriptive study was conducted among 360 ANCs attending PHC facilities in two Local Government Areas (LGAs) in Kano state. Data were collected using a pre-tested semi-structured interviewer administered questionnaire. Blood samples were also obtained for thin blood smear for malaria parasite using Giemsa staining technique. Hemoglobin was estimated from the Packed Cell Volume (PCV) determined using hematocrit. Results: Age of the subjects ranged from 15 to 42 years with a mean ± SD of 24.0 ± 6.0. Up to 39.2% (n = 141) (95% Confi dence Interval = 34.1-44.4%) of the subjects were found to have malarial parasitemia. Exactly 36.2% (n = 51) of those with parasitemia had fever (temperature ≥ 37.5oC) while 63.8% (n = 90) of them were asymptomatic. Anemia, (hemoglobin of ≤11 g/dl) was found in 48.1% (n = 173) of the respondents. A higher proportion of primigravid and secondigravid clients (61% vs. 39%) and younger pregnant women (54.6% vs. 45.4%) had malarial parasitemia compared to multigravid and older women, respectively. Similarly, a signifi cantly higher proportion (67.6%) of anemic ANC clients had malarial parasitemia. (χ2 = 113.25, df = 1, P < 0.05). Conclusion: Malarial infection is common among the ANC clients attending PHC facilities in Kano state and the infection is commonly associated with anemia. Intermittent Preventive Treatment (IPT) should be provided especially among primigravid, secondigravid and younger mothers at PHC centres.
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Jaundice in typhoid patients: Differentiation from other common causes of fever and jaundice in the tropics
A Ahmed, B Ahmed
July-September 2010, 9(3):135-140
DOI:10.4103/1596-3519.68361  PMID:20710103
Background: While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics. Materials and Methods: This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters. Results: Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6 ± 9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38 - 165 umol/l with mean of 117 ± 14SD. Conjugated bilirubin ranged 31-150 umol/l with mean of 95 ± 8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients. Conclusion: Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.
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Pilot study on multidrug resistant tuberculosis in Nigeria
L Lawson, AG Habib, MI Okobi, D Idiong, I Olajide, N Emenyonu, N Onuoha, LE Cuevas, SO Ogiri
July-September 2010, 9(3):184-187
DOI:10.4103/1596-3519.68355  PMID:20710112
Background: Drug resistant tuberculosis (TB) has lately emerged and it represents a serious public health problem. We set out to determine drug resistance among TB patients. Methods: Using automated BACTEC cultures, multidrug resistant-tuberculosis (MDR-TB) was investigated in 117 diagnosed cases in Abuja, Nigeria. Results: Ten (31%) of 32 culture-positive patients were resistant to at least one and four (13%) to all of the four drugs tested. No association between drug resistance and human immunodeficiency virus (HIV) infection was found. Conclusions: MDR-TB is present in Nigeria and larger studies are urgently required. TB clinical management and control efforts should be improved.
  10 7,720 93
Awareness and perception toward referral in health care: A study of adult residents in Ilorin, Nigeria
OL Abodunrin, TM Akande, GK Osagbemi
July-September 2010, 9(3):176-180
DOI:10.4103/1596-3519.68359  PMID:20710110
Background and Objective: The Nigeria Health System operates three levels of health care, which correspond to the tiers of government and interacts through a referral system. The national health policy recommends the Primary Health Care (PHC) as the entry point to health care system. However, these facilities are poorly managed leading to underutilization. Therefore, people usually attend any facility that will meet their needs, not considering the appropriateness of the level of care. This study is to determine the awareness and perception of adult residents in Ilorin toward referral in health care. Methods: A cross-sectional descriptive survey was conducted among 366 adult residents in Ilorin, selected by multi-stage sampling technique. Data were obtained using a semi-structured questionnaire, appropriately scored and analyzed with Epi-Info 2005 computer software. Results: Only 22 (6.0%) respondents knew that PHC is supposed to be the fi rst point of call when ill and 25 (6.8%) were aware that referral hospitals have the right to reject patients without referral. More than two third, 256 (69.9%) of the respondents felt it will be unreasonable for any hospital to reject patients on the basis of not being referred. The level of education was signifi cantly associated with the knowledge and perception of referral in the health care. Conclusion: There is low awareness and poor perception of referral protocol in the health care system among the people of Ilorin. The higher the level of education, the more knowledge the respondents have about referral in the health system and the more likely they have correct perception of referral in health care. The Nigeria health care system policy on referral and appropriate hospital utilization could be more effective if public awareness is created about it via the media while making effort to improve the credibility of the PHC.
  6 7,573 56
An overview of the diagnosis and management of prostate cancer in Nigeria: Experience from a north-central state of Nigeria
Kasonde Bowa
July-September 2010, 9(3):111-112
DOI:10.4103/1596-3519.68350  PMID:20710098
  4 5,758 102
Prevalence of cervical intraepithelial neoplasia in Zaria
Oguntayo O Adekunle, Modupeola O.A Samaila
July-September 2010, 9(3):194-194
DOI:10.4103/1596-3519.68351  PMID:20710114
  4 4,099 46
Rectal cancer: Pattern and outcome of management in University of Ilorin teaching hospital, Ilorin, Nigeria
GA Rahman
July-September 2010, 9(3):164-169
DOI:10.4103/1596-3519.68362  PMID:20710108
Background: Cancer of the colon and rectum was considered to be rare in Africa three to four decades ago. This is no longer true though it is not as common as in Western Europe and North America. The aim of this study is to determine the incidence of rectal cancer, its pattern of presentation, diagnosis, treatment and outcome of treatment at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. Methods: This is a prospective study of all the patients with rectal cancer seen at the UITH from January 1998 to December 2002. Clinical and radiologic findings as well as findings at surgery were recorded and evaluated. They were all histologically confirmed. The data were analyzed using SPSS 10.0. Results: Thirty-six patients with rectal cancer were seen during the period. The male to female ratio was 1:1. Fourteen (38.9%) of the patients were younger than 40 years. Only three (8.3%) patients presented as emergency. Eighteen patients had resectable lesions at presentation. Ten had abdomino-perineal (A-P) resection and eight had anterior resection. Operative mortality was 5.9%. Ten (60%) of the patients who had A-P resection were alive at 5 years and 62.5% of those who had anterior resection were alive at 5 years. None of the patients who had unresectable tumors was alive at 5 years. Conclusion: Rectal cancer is not rare in Africans. Surgical therapy still remains as the main treatment. When patients present early, outcome is satisfactory. Since most cases in this environment are accessible to digital rectal examination (DRE), the need for this procedure in patients with lower gastrointestinal symptoms cannot be overemphasized.
  3 4,985 62
Priapism resulting from sertralinerisperidone combination in a 30-year-old Nigerian man with schizophrenia
FK Salawu, H Mustapha, A Danburam
July-September 2010, 9(3):195-195
DOI:10.4103/1596-3519.68349  PMID:20710115
  2 3,550 61
The reported preparedness and disposition by students in a Nigerian university towards the use of information technology for medical education
A Fadeyi, OO Desalu, A Ameen, AN Muhammed Adeboye
July-September 2010, 9(3):129-134
DOI:10.4103/1596-3519.68358  PMID:20710102
Background: The computer and information technology (IT) revolution have transformed modern health care systems in the areas of communication, storage, retrieval of medical information and teaching, but little is known about IT skill and use in most developing nations. Objectives: The aim of this study has been to evaluate the reported preparedness and disposition by medical students in a Nigerian university toward the use of IT for medical education. Methods: A self-administered structured questionnaire containing 24 items was used to obtain information from medical students in the University of Ilorin, Nigeria on their level of computer usage, knowledge of computer software and hardware, availability and access to computer, possession of personal computer and e-mail address, preferred method of medical education and the use of computer as a supplement to medical education. Results: Out of 479 medical students, 179 (37.4%) had basic computer skills, 209 (43.6%) had intermediate skills and 58(12.1%) had advanced computer skills. Three hundred and thirty (68.9%) have access to computer and 451(94.2%) have e-mail addresses. For medical teaching, majority (83.09%), preferred live lecture, 56.78% lecture videos, 35.1% lecture handout on web site and 410 (85.6%) wants computer as a supplement to live lectures. Less than half (39.5%) wants laptop acquisition to be mandatory. Students with advanced computer skills were well prepared and disposed to IT than those with basic computer skill. Conclusion: The findings revealed that the medical students with advanced computer skills were well prepared and disposed to IT based medical education. Therefore, high level of computer skill is required for them to be prepared and favorably disposed to IT based medical education.
  2 4,493 63
An audit of spirometry at the University of Ilorin Teaching Hospital, Ilorin, Nigeria (2002-2009)
Olufemi O Desalu, Alakija K Salami, Ademola E Fawibe, Patrick O Oluboyo
July-September 2010, 9(3):147-151
DOI:10.4103/1596-3519.68365  PMID:20710105
Background: Spirometry is a noninvasive and cost-effective physiologic test that greatly complements other investigative procedures in evaluation of respiratory conditions. This study was aimed at auditing the spirometry performed at the University of Ilorin Teaching Hospital (UITH) Ilorin, Nigeria, and highlighting some of the challenges associated with the procedure. Methods: We reviewed and analyzed the record of spirometry performed at the cardiopulmonary unit of the hospital from June 2002 to December 2009. Results: A total of 119 patients had spirometry tests from 2002 to 2009 and their age ranged from 15 to 85 years with a mean of 47.6 ± 14.8 years. There were 69 (58%) males and the male:female ratio was 1.4:1. More than half (65%) of the tests were in patients <50 years old. The rate of spirometry performed annually increased from 12 (10.1%) in 2002 to 31 (26.1%) in year 2009. Evaluation of bronchial asthma was the most common indication for spirometry (43 patients; 36.1%). Majority of the requests (84 patients; 70.6%) were from adult respiratory physicians. The identified challenges were lack of awareness of the range of diseases that could be investigated by spirometry, lack of skills in interpreting the results, lack of time and delays in replacing exhausted consumables and faulty components of spirometer. Conclusion: Gradually, the trend of spirometry request is increasing in UITH; however, a wider acceptability could be achieved for this test by raising the level of awareness and improving the skills of all doctors on the usefulness and interpretation of spirometry.
  2 4,987 55
Pediatric ophthalmic indications for examination under anesthesia in Ilorin, Nigeria
Abdulraheem Olarongbe Mahmoud, Abdulkabir Ayansiji Ayanniyi, Olanrewaju Olubukola Oyedepo
July-September 2010, 9(3):181-183
DOI:10.4103/1596-3519.68357  PMID:20710111
Objective: To determine the ophthalmic indications and challenges for pediatric ocular examination under anesthesia (EUA). Methods: The surgical register and patients' records of children who underwent EUA between 1990 and 2007 were examined to document patients' bio data, diagnoses and details of procedures and anesthesia. Results: Thirty-nine children underwent EUA during the 18-year period. The indications included congenital glaucoma (20 cases, 21.3%) and congenital cataract (5 cases, 12.8%). There were two cases each (5.1%) of microphthalmia, megalocornea, and squint. A case each of other indications constituted the remaining 10.3%. Conclusion: The commonest ophthalmic indication for EUA among children is congenital glaucoma. Most of the children (36, 92.3%) had inhalational anesthesia administered by anesthetists at great cost to their parents. We recommend the use of ketamine anesthesia administered by nonanesthetist with some training in anesthetic resuscitation procedure, for short pediatric procedure such as EUA in resource-challenged settings.
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Contact tracing / pre-employment screening for pulmonary tuberculosis: Should positive mantoux test necessitates routine chest X-ray?
AA Adeyekun, EE Egbagbe, OA Oni
July-September 2010, 9(3):159-163
DOI:10.4103/1596-3519.68364  PMID:20710107
Background: Pulmonary tuberculosis (PTB) remains a scourge in most developing countries. Mantoux skin test and more commonly chest radiography are some of the methods of diagnosing the disease, especially with regard to contact tracing and pre-employment screening. Regular use of radiography has both safety and cost implications. This study aimed at establishing if any justification exists in requesting for chest radiographs in asymptomatic subjects with a positive Mantoux skin test reaction. Methods: 174 adults comprising PTB contacts and newly employed/admitted university staff/students were recruited into the study. They were 89 males (51.1%) and 85 females (48.9%). All subjects had Mantoux test (using purified protein derivative, PPD). Patients who had positive Mantoux reaction subsequently were subjected to posteroanterior chest radiographic examination. Mantoux test and chest radiographic findings were then correlated with each other. Results: 102 subjects (59.2%) had positive Mantoux reactions, while 27 subjects (31.1%) had abnormal chest radiographs. There was no significant correlation between Mantoux readings and chest radiographic findings (P=0.106). Conclusion: It is concluded that other ancillary tests like sputum examination and/or, where available, Interferon and ESAT tests should be carried out before chest radiograph is requested in subjects with positive Mantoux reaction.
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