Aims and Objectives: This study assessed the level of awareness and perception of women of child bearing age to tetanus immunisation and determines the cover- age rate in Ojodu Local Council Development Area (LCDA) of Lagos State, Nige- ria. Subjects and Methods: This is a descriptive cross-sectional study of 288 women of childbearing age selected using multistage sampling technique. Information was obtained using structured close-ended questionnaire. Data analysis was done using Epi-InfoTM software, version 3.5.1. Results:There was high level of awareness of tetanus immunisation among re- spondents (89%) and as a method of prevention of tetanus (76%). There was a positive association between the level of awareness and respondents' educa- tional level and occupation (p < 0.05). However, there is a low level of awareness regarding the number of doses of the vaccine required in pregnancy (14.4%) and for life protection (19.5%). Those who ever received the vaccine, got it post-injury (48.9%) and in pregnancy (45.2%). Age, occupation and parity were positively associated with receiving the vaccine (p < 0.05), while parity and marital status were positively associated with number of dose of vaccine received (p < 0.05). Only about 20% of the respondents had received two or more doses of the vaccine. Conclusion: This study concludes that despite the high level of awareness about tetanus and tetanus immunisation, there is a low coverage rate of tetanus immunisation among women of childbearing age in Ojodu LCDA of Lagos State. Women of child bearing age should also be targeted at the community level in tetanus immunisation campaign programme.

Aims and objectives: The objective of this study was to determine an algorithm for malaria diagnosis using presenting signs and symptoms of children (aged 0-13years) with uncomplicated malaria in Gwagwalada Area Council of Abuja, Nigeria. Materials and Methods: A validated questionnaire was used to obtain relevant data from 400 children diagnosed presumptively of simple malaria by clinicians and 400 other children of similar sex and age considered as not having malaria. Giemsa-stained thick blood films were used to determine parasitaemia. Data obtained was analysed using Epi-Info version 3.3.2. Results: Thirty-eight per cent of children with presumptive diagnosis of malaria had parasitaemia. Fever, rigor, vomiting, jaundice, pallor and spleen enlargement had significant statistical relationship with parasitaemia on bivariate analysis, but only fever (p=0.00), rigor (p=0.00), vomiting (p=0.00), and pallor (p=0.00) maintained the relationship when subjected to logistic regression analysis. But these symptoms individually had low sensitivity and/or specificity. Candidate algorithms (combinations of symptoms) were then successively subjected to bivariate, logistic and validity analyses. Fever with vomiting gave the highest sensitivity (56.2%), specificity (76.4%) and PPV (60.0%) and were therefore adopted as the algorithm of choice. Conclusion and recommendations: Children presenting with fever and vomiting without any other obvious cause in health facilities without laboratory support in the research area should receive antimalarial treatment, to help reduce the malaria scourge. This algorithm should be field-tested and if found reliable should be adopted to ease the problem of malaria diagnosis in peripheral health facilities.

Aims and Objectives : This study was conducted to assess the effect of a community based sexuality education programme on the sexual health knowledge and practices of out of school female adolescents. Subjects and methods: This Intervention study was conducted in two markets within Lagos, Nigeria. Representative samples of adolescents were interviewed on their sexual health knowledge and practices. An Education- entertainment programme provided sexuality education to adolescents in Mushin market only (intervention group) followed by post intervention surveys in Mushin market and Sangrouse market (control group). The pre and post intervention surveys were compared 6 months post intervention to detect any changes. Results: Sexual health knowledge and behaviour was similar among respondents in both markets pre intervention. Post intervention, the sexual health knowledge of the respondents in the intervention site improved significantly. (p<0.05) Fewer adolescents initiated sex in the intervention site than in the control site and contraceptive use increased. However among the sexually active, there was no significant change in their condom use and number of sexual partners. Conclusion: Community based health education programmes can be used to provide effective sexuality education for out of school adolescents. Provision should be made by government and non-governmental organisations during adolescent reproductive health programming for sexuality education targeted at out of school adolescents.

This study aimed to assess the effect of a short school-based anti-smoking program on the knowledge, attitude and practice of cigarette smoking among students in secondary schools in Lagos State. Subjects and methods: A non-randomized, controlled intervention study was done among respondents selected using multi-stage sampling. Baseline data was collected using self-administered questionnaires. An anti-smoking awareness programme was carried out among students in the intervention group using health talks, information leaflets and posters. Post-intervention data collection took place three months later. Results : There were significant increments in the mean knowledge and attitude scores after the intervention. There was however no statistically significant change in the current smoking habits of respondents (4% vs. 3%; p=0.41) in the intervention group. Nevertheless, in the intervention group, the number of never- smokers who reported that they were likely to initiate cigarette smoking within the next year significantly reduced. There was also a significant increase in the proportion of current smokers who desired to quit smoking. Conclusion:Even brief anti-smoking programs of this nature are effective at improving the knowledge and modifying the attitude of the respondents but do not improve smoking habits. It however motivated the desire to quit among current smokers. Health education sessions and periodic anti-smoking programmes should be introduced into the secondary school curriculum. More intensive approaches may be needed to influence the smoking behaviour of adolescent smokers.

Aims and objectives: Hypertension remains a significant risk factor in cardiovascular morbidity and mortality. The purpose of the present study was to investigate the effects of 8 weeks interval training programme on blood pressure, aerobic capacity (VO max), indices of adiposity and marker of inflammation in black African men with essential hypertension. Patients and methods: Two hundred and forty five (245) male subjects with stage 1 and 2 (systolic blood pressure [SBP] between 140-179 & diastolic blood pressure [DBP] between 90-109 mmHg) essential hypertension were age matched and grouped into experimental and control groups. The experimental (n=140; 58.90 ± 7.35 years) group involved in an 8 weeks interval training (60-79% HRmax) programme of between 45 and 60 minutes, while age-matched control hypertensive (n=105; 58.27± 6.24 years) group remain sedentary during this period. All subjects in both groups were on antihypertensive drugs throughout the study period. Cardiovascular parameters (SBP, DBP) & VO max and percent body fat [%BF], waist to hip ratio [WHR] and C-reactive protein [CRP] were assessed. Independent t-test and Pearson correlation test were used in data analysis. Results: Findings of the study revealed significant decreased effects of interval training programme on SBP, DBP, %BF, WHR and CRP and significant increased effect on VO max at p< 0.05. Also, changes in CRP as a result of exercise training significantly and positively correlated with changes in SBP, DBP, %BF, WHR, CRP and negatively correlated with VO max at p< 0.05 Conclusion: It was concluded that interval exercise training is an effective adjunct in the management of essential hypertension.

Aims and Objectives: This study is aimed at determining how much knowledge of glaucoma the non-ophthalmic medical doctors still possess and their personal attitudes toward glaucoma. Patients and Methods: Self- administered questionnaires were randomly distributed to the non-ophthalmic medical doctors in two specialist hospitals in south eastern Nigeria: The data obtained were the age, sex, professional and number of years of practice of the participants, their knowledge of the symptoms/ aetiology/risk factors, examination/investigation, treatment of glaucoma as well as their personal attitude towards glaucoma. Results: There were two hundred respondents; one hundred and forty two males and fifty eight females (M:F=2.4:1); comprising 82.5% Resident doctors; 51% of whom had been in practice for less than 5 years. All the doctors had heard of glaucoma; approximately seventy two per cent (72.5%) had a good knowledge of glaucoma symptoms and 52.0% of these had been in practice for only 5 years or less. Similarly, of the 83% of the doctors who correctly answered the questions on the aetiology of glaucoma, majority (84.3%) had been in practice for 5 years or less. Only 24.5% and 38.5% respectively of the doctors had a good knowledge of the basic examination and treatment required for the management of glaucoma. There was no statistically significant relationship between most variables tested. Only the relationship between the knowledge of the symptoms of glaucoma and the duration of practice of the doctors was statistically significant (p< 0.005). Conclusion: Most of the non-ophthalmic medical doctors have a basic knowledge of glaucoma and how to investigate it but showed a poor knowledge of examination and treatment modalities. They also acknowledged the importance of regular eye checks but only very few had had their eyes examined.

Aim and Objective: To determine changes in malondialdehyde (product of lipid peroxidation) and antioxidant enzymes (Superoxide Dismutase, Glutathione Per- oxidase) levels in pre-eclamptic Nigerian women Patients and Methods: A Total of 100 subjects each for pre-eclamptic, apparently normal and non pregnant women were recruited into the study. Venous blood samples were taken from the participants during second and third trimesters of pregnancy and at the point of contact for non pregnant women. Malondialdehyde, glutathione peroxidase and superoxide dismutase were measured accordingly from plasma and haemolysate prepared from whole blood. Variables were analysed using SPSS ver- sion 16, taking level of significance to be 0.05 Results: Plasma malondialdehyde in the third trimester (3.13±0.61μmol/l) of pre- eclamptic subjects was higher than in the second trimester (3.00±1.21μmol/l). Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71μmol/l) was also found to be significantly higher than in the second trimester (1.65±0.62μmol/ l)(p<0.0001). Glutathione peroxidase in pre-eclamptic subjects was significantly higher in the third trimester (2804.11±1573.00U/L) as compared to the second tri- mester (2655.00±1751.30U/L), p= 0.0001. Glutathione peroxidase activity in the third trimester of normal pregnancy (3339.50±1733.80U/L) was also found to be higher than in the second trimester (3023.50±1115.90U/L)(p=0.131). Superoxide dismutase activity was significantly lower in the third trimester of pre-eclamptic pregnancy when compared to second trimester (110.40±59.47 Vs 118.01±64.41 U/ ml)(p<0.039) .Similarly, superoxide dismutase activity was significantly lower in the third trimester of normal pregnancy (110.40±59.47U/ml) than in the second trimester (153.01±71.85U/ml)(p<0.0001). Conclusion: There was an increased level of lipid peroxidation products, malondialdehyde in subjects with pre-eclampsia. This was more in the third trimes- ter. There was an increased oxidative stress in pre-eclampsia as evidenced also by low serum level of superoxide dismutase in the third trimester. Diet rich in antioxi- dant enzyme might be beneficial

Aims and Objectives: To determine the prevalence of sleep disorders in a population of Nigerian women during pregnancy and to evaluate the frequency of these sleep disorders according to the three trimesters of pregnancy. Subjects and Methods: A prospective cross-sectional design. Participants' were interviewed at the antenatal clinic with a questionnaire to evaluate their sleep during and before pregnancy and to appraise disturbance in their sleep according to the trimester. Results: Two hundred and three pregnant women participated in the survey and were evaluated at one of three points in pregnancy: 1st trimester (n=57), 2nd trimester (n=71) and 3rd trimester (n=75). Overall, the prevalence of sleep disorder in the population surveyed was 35.5% (72/203), more women experienced sleep disturbances in the first (42.1%) and third (40%) trimester of pregnancy compared to the second (25.3%). In terms of types of sleep disorders; 96(47.3%) reported insomnia, 32(15.8%) sleep breathing disorders, 86(42.4%) excessive daytime sleepiness, 172(84.7%) mild sleepiness and 64(31.5%) significant specific awakenings. The most common reason for specific awakening was frequent urination (78.6%). These sleep disorders were more common in the third trimester of pregnancy but only insomnia and specific awakenings showed statistical significance, p=0.007 and 0.031 respectively. Logistic regression model showed that nulliparity, increased BMI and previous adverse obstetric events had significant independent associations with sleep disorders. Conclusion: Sleep disorders are common in pregnancy, notably in the first and third trimesters.

Aims and objectives: This study set out to assess the quality-of-life of school-age children in relation to their level of asthma control. Patients and methods: A cross-sectional descriptive study of children with asthma using the Paediatric Asthma Quality of Life questionnaire (PAQLQ) and the Asthma Therapy Assessment Questionnaire (ATAQ) to respectively assess the health-re- lated quality of life and the level of asthma control. Results: Ninety children with mean age of 11.8(SD, 2.8; 95% CI, 11.2 to 12.4) years, were enrolled. Fifteen children (16.7%) were well-controlled, 17 (18.9%) were partly-controlled while 58 (64.4%) had uncontrolled asthma. The mean asthma control score for all participants was 3.2 (95% CI, 2.8 to 3.7). The mean quality-of-life score was 5.3 (SD, 1.2; 95% CI, 4.9 to 5.5). The lowest score was in the symptom domain: 5.1 (SD, 1.4; 95% CI, 4.9 to 5.5), and among the14-17 year age group (4.5 SD, 1.5; MD=1.1; p=0.002). The emotional domain was the least affected 5.4 (SD, 1.3; 95% CI, 5.1 to 5.7). Children with well-controlled asthma had the best quality-of-life scores in symptom domains: 5.6 (SD, 1.3; 95% CI, MD=0.6, p=0.63). Quality of life scores were not significant in determining asthma control (MD=0.1, p=0.98). Age was noted as the strongest quality-of-life predic- tor (ί=-0.2, p=0.002). Conclusions:QOL scores are better in children with well-controlled asthma. Adolescent age group marks a period of both poor asthma control and quality of life in children with asthma.

Aims and Objectives: To determine spleen size using abdominal ultrasonography and haematological parameters in steady state children with sickle cell anaemia (SCA). Subjects and Methods: An analytical case control study of 150 children with SCA in steady state aged 6 months to 15 years was undertaken. Children with HbAA matched for sex and age were used as controls. The spleen sizes of children with SCA and the controls were determined using abdominal ultrasonography. Haematological parameters (RBC, Hb, MCV, MCH, MCHC, WBC, Platelet and Reticulocyte counts) were also assessed. Results:Fifty three children (35.3%) with SCA against 19 children (12.7%) with HbAA had splenomegaly defined as spleen index > 31cm΂. among the children with SCA who had splenomegaly, 17 (11.3%) were older than 10 years. None of those above 10 years with HbAA had splenomegaly. The mean values of RBC, Hb, MCV and MCH were significantly lower in children with SCA compared to age- sex matched HbAA controls (p = 0.001, 0.001, 0.15 and 0.016 respectively), while the mean values of MCHC, WBC, platelet and reticulocyte counts were significantly higher in children with SCA than in the HbAA controls (p = 0.022, 0.001, 0.013 and 0.001) respectively. Among the SCA subjects, as spleen index increased from grade II through grade V, the mean values of RBC, Hb, WBC and platelet count significantly decreased (p = 0.001, 0.001, 0.032 and 0.007), while the mean value of reticulocyte count significantly increased (p = 0.001). However, with increasing spleen index from grade II to grade V, the mean values of MCV, MCH and MCHC were not significantly different (p = 0.077, 0.741 and 0.995). Conclusion: Splenomegaly persists in much older age group in children with SCA and is associated with mild cytopaenia. Spleen size in children with SCA should be assessed using a more sensitive and reliable method of ultrasonography.

Aims and Objectives : The aim of this study was to determine the nature and extent of elder abuse and neglect among community dwelling elderly in Zaria, Nigeria. Subjects and Methods : Community dwelling elderly in Zaria city North-western Nigeria were interviewed;. they were interviewed using a data collecting sheet designed to obtain socio-demographic data and an instrument designed to detect abuse and neglect in the elderly. The data obtained was analysed using Statistical Package for Social Sciences Version 13 for Windows. Results: Three hundred and fifty one elderly people participated in the study out of which 211(60.1%) were females. The mean age of the participants was 73.90years (95%CI=.72.96-74.84 years) There was no case of physical, financial or psychological abuse. However, 125(35.6%) participants suffered possible neglect in terms of personal care and hygiene. Increasing age, lack of formal education, receiving pension, not having a spouse and self reported poor health status were significantly associated with elder possible neglect in this community. Conclusion : Elder abuse was uncommon in this community like in other communities in the developing countries. However, possible neglect of personal care and hygiene of the elderly was common and that might be due to poor economic status of both the elderly and his or her caregiver.

Aims and objectives: This research aims to establish the usefulness of timed over- night (8 hours) Urine Albumin(microalbumin) Excretion (UAE), in monitoring therapy in Nigerian patients with benign essential hypertension. Subjects and Methods: The study population comprised 40 normotensives/con- trols, (23 males and 17 females) aged between 20-70 years, with a mean blood pressure 116/75mmHg, 30 well-controlled hypertensive patients, diastolic BP < 100mmHg or MAP (mean arterial pressure) = 110mmHg and 30 poorly con- trolled hypertensive patients, diastolic blood pressure > 100mmHg or MAP > 110mmHg. albumin(microalbumin) was determined on the 8 hours overnight urine samples by ELISA method using kit from Randox Laboratories Limited, N. Ireland Cat No. MA 1410. UAE was calculated from the urine albumin concentration, urine volume and collection time. The intra assay precision was determined by running 20 replicates of two kit controls in a single batch. The coefficient of variation was 6.6% at 10.70mg/L and 4.3% at 51.20mg/L. Results: The average UAE in the three groups were as follows: 12:22 +/- 4.65μg/ min, 21.50 +/- 10.5μg/min and 30.10 +/- 24.25 μg/min in the control, well con- trolled and poorly controlled groups respectively, 12.5% of normotensive sub- jects, 40% of well controlled and 56.7% of poorly controlled patients were found to have microalbuminuria. The UAE increased significantly with the severity of hypertension (r = 0.32, p<0.001 for control) r = 0.38, p<0.05 for controlled and r = 0.49 p<0.05 for poorly controlled. Conclusion:A timed overnight (8 hours) Urinary UAE is a preferred alternative to cumbersome 24 hours urine collection for monitoring response to treatment in Nigerian patients with benign essential hypertension.

Aims and Objectives: This included determining aetiology of failure and comparing the failure rate in implant fixations using solid intramedullary nail and DCP. Patients and methods: A retrospective study conducted at the Orthopaedic Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Records of all operated cases of lower limb long bone diaphyseal fractures including those with failed fixations from August 2006-July 2011 were reviewed. Data retrieved included type of implant used, aetiology and characteristics of Implant failure. Data were analysed using SPSS version 16. Frequency distribution of the variables of interest was done. Difference in failure rate of intramedullary nail versus DCP was tested using chi-square. Statistical significance was inferred at p<0.05. Results: A total of 280 patients were studied out of which two hundred and twenty-one patients had long bone diaphyseal fractures and met inclusion criteria, of which 135 had intramedullary nail fixation and 86 had DCP. The rate of implant failure in intramedullary nail was 1.5% while it was 5.8% in patients with DCP (p=0.113; 0R=4.10; 95% CI=0.65- 43.77). Implant fracture was the commonest type of failure seen (100% versus 60%) and non union was the commonest cause of failure seen (50% versus 40%) in the intramedullary nailing and DCP groups respectively. Conclusion:The likelihood of a failed implant is higher in fixations done with DCP compared with intramedullary nail though the difference was not statistically significant. Commonest reason for failure in both groups was non-union. Findings from this study may guide surgeons in choice of implant in the management of long bone fractures.

Onychomycosis is a fungal infection which affects the nail unit. It was previously thought to be just a cosmetic problem, but presently, it is regarded as a major public health issue because of the impact on the quality of life of the patients. Aetiologic factors identified in onychomycosis include increasing age, immunosuppression, occupation and genetics. Management of onychomycosis is both pharmacological and non pharmacological. Pretreatment counseling is important in patients with fungal nail infections and this should include probable length of therapy, possible side effects of treatment and the expenses involved. Patients should be educated on proper nail care and the fact that no treatment is 100% effective. Presently, combination therapy is advocated for the management of onychomycosis. This is a review of the epidemiology, clinical types, investigations and current considerations in the management of onychomycosis.

Aims and objectives : Foreign body impaction in the upper aero-digestive tract is relatively common in Otorhinolaryngological practice. The aim is to present a case of an unusual impacted foreign body (ear ring), in the pharynx of a child, that was confirmed by plain radiographs. Case report : An 8-month old male baby presented in emergency paediatric unit (EPU) of our hospital with a history of ingestion of an empty paracetamol satchet. Plain X-ray soft tissue of the neck however revealed a big metallic ear ring that impacted in the upper aerodigestive tract. It was removed successfully under general anaesthesia. The possible delay in diagnosis and various complications of pharyngeal foreign bodies were highlighted /reviewed. Conclusion:In conclusion foreign body impaction is common in the paediatric age group. Effort should be made by the attending physician to inquire into details of event relating to ingestion of foreign body in order to arrive at early and timely diagnosis and treatment so as to prevent complications.

Pityriasis amiantacea (PA) is a papulosquamous condition of the scalp, characterized by asbestos - like thick scales attached to the hair shaft. It is thought to represent a reaction pattern to inflammatory skin disorders like psoriasis, seborrhoeic dermatitis, tinea capitis, atopic dermatitis and lichen planus, rather than a distinctive disease. The scaling may be localised or generalised, depending on the underlying condition and its duration. This report highlights the clinical features of pityriasis amiantacea secondary to atopic dermatitis and the differential features of other papulo-squamous scalp disorders such as scalp psoriasis, seborrhoeic dermatitis and lichen planus. Scalp psoriasis and seborrhoeic dermatitis are the commonest causes of PA as well as the closest differentials hence should be excluded in all cases. The long term sequelae of PA include scalp fibrosis and permanent hair loss hence should be identified and treated promptly. The management modalities of PA will also be discussed.

Aims and Objectives: Casualties following inhalation of carbon monoxide in fumes produced from incomplete oxidation of hydrocarbon in gasoline-powered engines such as generator is common especially in developing countries. These are two case reports managed at University of Benin Teaching Hospital (UBTH) and their outcomes. Case summary: The first patient was a 17 year old female with 12 hour history of breathlessness, restlessness and unconsciousness following inhalation of fumes produced by an electric generator that was put in a confined area. She also presented with convulsion, sphincteric incontinence and foaming in the mouth. Pulse oximetery showed desaturation. She was placed on mechanical ventilation, mannitol, phenytoin infusion and intravenous vitamin C. She was weaned off the ventilator on the fourth day in the Intensive Care Unit (ICU) and discharged from ICU on the 6th day. The second patient was a 78 year old man with 18 hour history of unconsciousness and breathlessness following carbon monoxide poisoning. Pulse oximetry showed desaturation. He was placed on mechanical ventilation but died one hour and 30 minutes later probably due to advanced age and delayed presentation at the hospital. Conclusion:The cases reported highlight the risk of prolonged exposure to carbon monoxide and protracted delay in instituting oxygen therapy. Early referral of victims of carbon monoxide poisoning to a hospital with adequate intensive care facilities may improve survival. There should be regular public education on safe use of electric generating sets.

Aims and Objectives: The objective of this article is to report a rarely encountered case of haemophilic arthropathy which should be considered in the differential diagnosis of knee swelling. Patients and methods: The history, physical findings and results of investigations of a patient presenting with haemophilic arthropathy and the past medical records of the patient were reviewed with relevant literature. Results: This is a report of the existence of this condition in this environment and the management of this rarely encountered condition in a 10year old boy, known haemophiliac who presented at the orthopaedic clinic with features of right knee arthropathy. He was co - managed with the haematologist with the available Fresh frozen plasma and physical therapist with good response. Conclusion: Haemophilia is rare in this environment. Haemophilic arthropathy is rarely considered a differential diagnosis of knee swelling. There is little experience with the presentation and the mangement of this condition.