BACKGROUND: Community based participation has been advocated by a number of international health organisations including the World Health Organization (WHO) as a solution to the problems of poor patient adherence and default from Directly Observed Treatment Short course [DOTs] programmes for tuberculosis control. OBJECTIVES: To determine the impact of a health educational intervention on the management of tuberculosis in relation to the outcome and adherence to therapy by Tuberculosis patients residing in a densely populated urban slum in Lagos, Nigeria. METHODS: The study was conducted using forty tuberculosis patients (confirmed by acid fast bacilli positive sputum), and selected randomly from those who attend the Mainland Hospital in Lagos. They were divided into two groups of twenty each made up of those to be provided with education intervention at the community level and the control groups followed up at the hospital level only. An initial assessment of the knowledge about tuberculosis management was done through a structured questionnaire for both groups. This was followed by continuous health talks for intervention group in form of neighbourhood self help approach. RESULTS: The results showed that the intervention had a significant impact on the understanding of disease and its management (X(2) =11.842 p<0.05), DOTS and increased awareness (X(2) =17.289 p<0.05, X(2) =10.461 p<0.05), knowing the side effects of anti-TB drugs (X(2) =10.157 p<0.05), the meaning of resistance to anti-Tuberculosis drugs (X(2) =19.798 p<0.05, X(2) =11.192 p<0.05) and importance of contact tracing (X(2) =32.4 p<0.05, X(2) =3.360 p<0.05). CONCLUSION: An effective health education is therefore beneficial for TB control in Nigeria.

Availability of safe blood remains a major challenge for many developing countries. Unnecessary discontinuation of scarce blood is a major conduit of wastage of scarce blood, as well as man hours and funds. Haemovigilance is a national system of surveillance and alarm, from blood collection to the follow-up of the recipients, gathering and analysing all untoward effects of blood transfusion in order to correct their cause and prevent recurrence. A prospective study to audit discontinuation of blood transfusion at the Obafemi Awolowo University Teaching Hospital Ile-Ife over a period of one and half years was done. Simple febrile non-haemolytic transfusion reaction (FNHTR) was the leading indication for such discontinuation (66.7%). More than half of discontinued transfusion due to FNHTR (58%) was successfully completed on review by trained personnel in transfusion medicine. A system of haemovigilance if incorporated into the blood transfusion service will promote effective monitoring of blood transfusion and reduce wastage of scarce blood/blood products.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P>0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB. Ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with a principle of promoting good academic standard.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso, Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P<0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with also operate such system with utmost transparency and with a principle of promoting good academic standard.

OBJECTIVES: To assess the incidence, pattern of presentation and management of complications resulting from unsafe abortion as well as the associated demographic variables at the Lagos Island Maternity Hospital. PATIENTS AND METHODS: A cross sectional survey of all cases with complicated induced abortion was carried out between 1st August 2005 and 31st January 2007. RESULTS: The majority of the patients were young 21.7% were teenagers between 14 and 19 years while 32.6% were in the 20-24 year age group. The majority (64.0%) were single while 30.9% were married, 1.7% were divorced, while 3.4% were separated. Teenagers and single women were more likely to obtain their abortion late (above 12 weeks gestation). 81.2% of the patients knew about modern methods of contraception but only 34.5% had ever used contraception and only 8.6% were using contraception when they became pregnant. Medical doctors were the abortionists in 46.9% of the cases, followed by nurses (17.7%) and traditional practitioners. Retained products of conception was the commonest complication (77.1%) followed by anaemia (48.6%) and sepsis (44.6%). Evacuation of the uterus was the commonest surgical procedure done. There were 16 maternal deaths giving a case fatality rate of 9.14%. Sepsis was the commonest cause of death. CONCLUSION: Unsafe abortion remains a serious concern to the health of women. Efforts need to be maximised at preventing unwanted pregnancy by making contraceptive services easily accessible to women. Effective post abortion care services need to be put in place.

BACKGROUND: Safe driving and road traffic accident prevention could be attained through ensuring good condition of vehicles, the road as well as the physical and mental state of the driver among others OBJECTIVES: To determine the ocular health status of professional drivers of the University of Ibadan, Nigeria METHODS: A cross sectional survey of all drivers in the employment of the University of Ibadan, excluding the College of Medicine, was carried out between March and June 2002 at the University Medical Centre and the eye clinic of the University College Hospital, Ibadan. RESULTS: One hundred and ninety seven all male drivers were screened. Their ages ranged from 31 to 64 years (mean 48.3 +/-5.9yr). Less than satisfactory presenting (functional) binocular visual acuity (< 6/18) was found in 11(5.6%) of the drivers. With refraction no driver had binocular vision of <6/18, but three drivers each had corrected visual acuity in the worse eye of 6/12, 6/18 and 6/36 respectively. The commonest visual problems were presbyopia 100 (50.8%), and refractive errors 38 (19.3%). Other ocular pathologies included pterygium 11 (5.6%), optic atrophy 9 (5.0%), colour vision defects 7 (3.6%) cataract 2 (1.0%), age related macular degeneration 4 (2.0%), glaucoma 3 (1.5%) retinal scar 2 (1.0%), exotropia 1 (0.5%), and pingueculum 1 (0.5%), CONCLUSION: Periodic screening of driver population of any establishment is a worthwhile task that may help to identify potentially blinding or visually impairing conditions such as glaucoma and refractive-error which can be promptly treated.

OBJECTIVES: This is a retrospective study of 1,042 new acceptors of injectable progestogen-only contraceptives at the family planning clinic of the University of Ilorin Teaching Hospital over a five year period from 1st January 2001 to 31st December 2004. The total number of new clients seen during this period was 4,752. 41.1% of these new clients chose condoms as a contraceptive method, 32.2% accepted IUCD, 21.9% accepted injectable progestogen-only contraceptive 08% accepted implants, 3.9% combined oral contraceptive pills and 0.1% bilateral tubal ligation. Of the acceptors of injectable progestogen, 59.5% used depo medroxyprogesterone acetate while 40.5% used norethisterone enanthate. 59.5% of the acceptors belonged to the 30 - 39 years age bracket and 36.2% were grandmultiparous women Injectable progestogen-only contraceptives are among the safest and most effective contraceptive methods available. The two commonly available types are Depot Medroxyprogesterone acetate and Norethisterone enanthate. This study looked at the clinical experience with this form of contraceptive at University of Ilorin Teaching Hospital (UITH). METHOD: The case notes of new clients that accepted injectable progestogen-only contraceptive at the family planning clinic of the UITH between June 2001 and December 2004 were analysed. RESULTS: Injectable progestogen-only contraceptive was the third most commonly accepted method of contraception at UITH during the study period. 59.5% of clients belonged to the 30-39 year age group, 63.5% of them were para 1-4 and 36.2% were grandmultiparous women. 59.8% of the clients were educated up to the secondary level or above. There was no pregnancy reported during the study period. 29.9% of clients experienced various forms of side effects, the commonest of which was menstrual irregularities. CONCLUSION: Injectable progestogen-only contraceptive is widely accepted by women in this centre. Its use cuts across women of all age groups, parities, religion and level of education.

OBJECTIVE: Morphologic changes seen in the endoscopic biopsies are dynamic and could be predictive of more important sequelae of chronic H. pylori gastritis such as gastric carcinoma and lymphoma. The objective of the study was to review the biopsy appearances of endoscopic gastroduodenal biopsies using the updated Sydney System of classification in order to throw some light on the biology of gastroduodenitis. METHODS: A retrospective review of all endoscopic gastroduodenal biopsies received in the department of Morbid Anatomy of Obafemi Awolowo University Teaching Hospitals Complex between 1994 and 2003 was undertaken. Grading of the chronicity, activity, atrophy, H. pylori density and metaplasia were done using the updated Sydney System of classification and grading. RESULTS: A total of 1047 gastric and 47 duodenal biopsies from 1047 patients were reviewed. There was evidence of significant chronic gastritis in 98.1% of the gastric biopsies and in 78.0% of these, H. pylori was the main identifiable aetiological agent. Marked atrophic changes and intestinal metaplasia that are known to predispose to gastric malignances were seen in 4.9% and 9.3% of our cases respectively. Chronic duodenitis was seen in 83% of the duodenal biopsies and in 29.6%, H. pylori was seen on a background of gastric metaplasia. CONCLUSION: The prevalence of H. pylori was high and it was the single most important aetiological factor responsible for the biopsy changes associated with chronic gastroduodenitis.

OBJECTIVES: Acute appendicitis is common. This prospective study of 250 cases of acute appendicitis was performed to critically analyse the pattern of presentation, management, operative findings and treatment outcome. The effect of length and position of the appendix in relationship to acute inflammation was also determined. PATIENTS AND METHODS: Two hundred and fifty cases of acute appendicitis were studied, including those found to have appendicitis at surgery despite other preoperative diagnosis. Patient biodata, clinical signs and symptoms were recorded. Haematological and biochemical parameters were determined after which all patients with a diagnosis of acute appendicitis had appendicectomy under general anaesthesia. All relevant peri-operative data were recorded. Excised appendices were sent for histological examination. RESULTS: There were 133 males and 117 females giving a gender ratio of 1.2:1. The mean age was 25.7 +/- 10.3 years, with majority of cases (42.8%) occurring in the third decade of life. Abdominal pain (100%), fever (48.4%), anorexia (48.0%), vomiting (47.8%) were the common symptoms. Commonly elicited signs included right iliac fossa direct tenderness (74.4%), rebound tenderness (59.2%), localised guarding (42.8%) and right rectal wall tenderness (43.2%). The mean white cell count was not significantly elevated (mean 8538 +/- 4166 per mm3, P > 0.05). Sixty three percent (156/245) of all appendices were retrocaecal in position. Mean length of the appendices was 10.4 +/- 2.9 cm. The length and position of appendices were not significantly different between those who had acutely inflamed and normal appendices (P = 0.923) Two hundred and forty five patients (98%) with a diagnosis of acute appendicitis had appendicectomy. The commonest postoperative complication was wound infection (8%), overall complication rate was 13.5% and negative appendicectomy rate was 13.4%. CONCLUSION: The presentation, management and treatment outcome of acute appendicitis in our centre are similar to those of other centres in our sub-region. Complication rates were low.

A 45 year old trader presented with history of persistent productive cough, progressively increasing dyspnoea, malaise and fever of 6 months prior to presentations. He also complained of severe lower backache and stiffness that radiated to both legs of 5 years duration. Chest radiograph revealed left apical fibrosis, coarse, linear shadows with cavities. There was also super infection with aspergilloma in the left apical region. The sputum AAFB was negative. Despite the fact that the patient complained of lower backache and stiffness, the plain radiograph of the affected spine was not requested for by the attending physician. Rather, the patient was commenced on antituberculous therapy based on pulmonary changes on chest radiograph. But after completing the treatment (nine months regimen), there were no improvement in patient's clinical conditions and pulmonary changes on repeated chest radiograph. The plain radiographs of the lumbosacral spine, pelvis and both hips were suggested by the author (Radiologist) who reviewed the patient's chest radiographs. The radiographs of the lumbosacral spine, as well as pelvis and both hips showed features of ankylosing spondylitis with pulmonary complication. His treatment was later reviewed based on the above new findings. This report highlights the fact that pulmonary manifestation in ankylosing spondylitis, a rare entity in our environment can present the same pattern as pulmonary tuberculosis which is far more common in this environment. A high index of suspicion will enhance early proper diagnosis.