The first epidemic of Ebola haemorrhagic disease in West Africa is the largest and longest Ebola epidemic till date, where the outbreak notably involved three countries with distant spread to other countries. It has caused significant mortality, with reported case fatality rates of up to 70%. Data and relevant information were extracted from the review of majorly relevant publications/papers about the Ebola epidemic in West Africa and other previous outbreaks of Ebola virus (EBOV). As of 2016, with the epidemic under control, the World Health Organization has warned that flare-ups of the disease are likely to continue for some time as recently occurred in Sierra Leone and the on-going in Guinea. As this may not be the last outbreak of Ebola virus disease (EVD) in West Africa, there is a need to focus on diagnostic and research capacity required to curtail EVD with adequate measures for emergency preparedness and policies for innovative treatment strategies.

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Spontaneous heterotopic pregnancy (HP) is a very rare and fatal condition that could result in significant maternal morbidity and mortality if prompt diagnosis and appropriate interventions are not instituted at the right time. Unfortunately, this life-threatening condition may be easily misdiagnosed in early pregnancy due to its rarity, vague clinical presentation and the presence of an intrauterine pregnancy which may confuse an inexperienced clinician. The aim of management is to excise the ectopic gestation while preserving the intrauterine pregnancy, if alive. We present a case of spontaneous HP that had complete excision of the ectopic gestation and a live delivery of the intrauterine pregnancy at term.

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Background: A descriptive cross-sectional survey was conducted among healthcare workers offering immunisation services in primary healthcare facilities in Alimosho Local Government Area, Lagos, Nigeria, on knowledge and reporting practices of healthcare workers on adverse events following immunisations (AEFIs). Materials and Methods: A pre-tested, close-ended, self-administered questionnaire was used to assess knowledge and reporting practices on AEFI. Data were analysed using Statistical Package for Social Sciences (SPSS) version 16. Knowledge of healthcare workers was scored and graded as <50% - poor, 50–74% - fair and ≥75% - good. Reporting practices on AEFI was classified as good if it was reported within 24 h of seeing one.P= 0.05 was considered statistically significant. Results: One hundred and sixty-four healthcare workers duly completed and returned their questionnaires. The mean age was 39.5 ± 2.64 years and mean post-qualification experience was 12.2 ± 2.33 years. Over 80% of the healthcare workers knew that fever, pain, redness and swelling at injection site were clinical signs and symptoms of AEFI, and 93% knew about filling an adverse event form to report an AEFI. Overall, nearly 80% of respondents had fair/good knowledge on AEFI. Fifty-five (33.5%) healthcare workers had encountered an AEFI and 31 (56.4%) reported such within 24 h. There was a significant relationship between being younger healthcare workers and knowledge on AEFIs (P = 0.029). No healthcare worker characteristics were significantly associated with good reporting practices on AEFI. Conclusion: Respondents' knowledge and reporting practices on AEFI were average.

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Context: Perception of one's physical appearance is important in the development of the concept of body image. Desire to achieve the unrealistic image of 'physical perfection' often make adolescents feel discontented; thus leading to mental health problems. Aims: To assess body image perception (BIP) and its relationship with mental health of secondary school adolescents in Benin City, Nigeria. Settings and Designs: The study was cross-sectional and descriptive, conducted in senior secondary schools in Benin City. Subjects and Methods: Six hundred randomly selected subjects completed the 28-item General Health Questionnaire, the appearance evaluation (AE) and body areas satisfaction (BAS) subscales of the Multidimensional Body-Self Relations Questionnaire (MBSRQ), and a sociodemographic data collection sheet. Cross tabulation of categorical variables and correlation analysis was performed by means of SPSS version 19.0, with level of significance set atP= 0.05. Results: Two hundred and twenty three (36.7%) and 46.2% of the respondents were dissatisfied with their appearance and discrete aspects of their bodies, respectively. The prevalence of probable psychiatric morbidity was 35.4%. AE and BAS subscales of the MBSRQ had significant but weak negative correlation with psychiatric morbidity (r = −0.195,P= 0.000; r = −0.097,P= 0.018, respectively). Conclusion: BIP was significantly associated with psychiatric morbidity. Subjects who were less satisfied with their general appearance and discrete aspects of their body screened positive for general psychiatric morbidity.

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Background: Determination of normal reference values for penile dimension may prevent overdiagnosis of micropenis and hence reduce unnecessary investigation and parental anxiety. Only a few data exist on the subject in Nigeria. Objectives: The study set out to document the stretched penile length (SPL) and penile diameter (PD) of male newborns in Port Harcourt, Nigeria. Methodology: Four hundred and eleven consecutively delivered male newborns were recruited for this study. SPL and PD were measured using the standard methods with a digital metal caliper. The mean values were determined and compared with other anthropometric parameters. Results: The mean (standard deviation) SPL from this study was 3.17 ± 0.5 cm and mean PD was 1.07 ± 0.17 cm. There was no significant correlation of the SPL with any of the studied anthropometric parameters, but the PD showed weak positive correlation with estimated gestational age (r = 0.104,P= 0.036), birth weight (r = 0.169,P= 0.001), birth length (r = 0.139,P= 0.006), and head circumference (r = 0.111,P= 0.025). The PD increased significantly across the different weight categories. The third and tenth percentiles for the SPL were 2.3 cm and 2.5 cm. Conclusion: It is concluded that the mean SPL and PD of newborns in Port Harcourt are 3.17 cm and 1.07 cm, respectively. A PL of <2.3 cm should be taken as representing micropenis.

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Context: The benefit of malaria prophylaxis in pregnancy is threatened by emergence of Plasmodium falciparum resistance to antimalarial agents for chemoprophylaxis and treatment. Aim: This study aimed to compare the effectiveness of azithromycin (AZ) with sulphadoxine-pyrimethamine (SP) for malaria prevention. Settings and Design: A prospective comparative study of antenatal clinic attendees at the University College Hospital, Ibadan, Nigeria. Participants were randomised to receive SP or AZ. Subjects and Methods: The subjects were antenatal attendees and Samples for malaria parasitaemia were collected and repeated at follow-up visits; maternal peripheral blood film, placental and cord blood samples were collected at delivery. Statistical Analysis Used: Chi-square test and t-test in a per-protocol analysis. Results: Of 200 participants (100 in each group), 166 (83.0%) completed the study: 86 (86.0%) of SP and 80 (80.0%) of AZ groups, respectively (P = 0.26). Four (4.7%) participants who had SP compared to five (6.2%) in AZ group developed malaria at mean gestational ages of 30.3 ± 1.56 and 33.0 ± 8.6, respectively (P = 0.56). Positive peripheral, placental and cord blood parasitaemia were found in ≤2% of the participants. Drug tolerability and foetal outcomes were comparable for both groups. Conclusion: AZ was comparable to SP for prevention of malaria in pregnancy and may be used in patients who do not tolerate SP.

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Aim: The aim was to determine the prevalence and pattern of congenital colour vision deficiency among secondary school students in Ibadan, Nigeria. Subjects and Methods: A descriptive cross-sectional study was conducted among students from three public secondary schools through a multi-staged sampling method. Ocular examination including visual acuity assessment and colour vision test with the Ishihara plate was performed for all students. Further assessment with the Farnsworth-Munsell D-15 panel was performed for those who failed the Ishihara test. Results: One thousand six hundred and thirty-five students participated in the study. There were 769 (47.0%) males with mean age of 13.9 ± 1.9 years. The overall prevalence of congenital colour vision deficiency was 2.3% with prevalence of 3.8% and 0.9% in males and females, respectively, which was statistically significant (P = 0.00112), and equal proportion of deutans 11 (32.0%) and protans 12 (35.0%) ratio of 1:1.1. Conclusion: The prevalence of congenital colour vision deficiency among public secondary school students in Ibadan is comparable to findings in other parts of the country.

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The development of open-heart surgery (OHS) programme in Nigeria has followed the different economic phases. Starting from the oil boom era in the 70s to 80s when indigenous efforts led to the successful performance of the first set of OHS to the period of depressed economy in the 80s to 90s that witnessed a lull in the programme, the revamping of the programme that started in the mid-90s following intense collaboration with foreign groups is gradually being sustained. The aim of this article was to examine the current efforts at sustaining the development of OHS programme in Nigeria with a view to identifying various challenges and how such can be addressed.

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Background: Peripartum hysterectomy is life-saving and a life-threatening criterion of the World Health Organization (WHO) maternal near-miss concept. The maternal severity index (MSI) model was developed to assess the outcome of severe maternal morbidities. This study assessed severe maternal outcomes of peripartum hysterectomy using the MSI model and related maternal severity score with mortality. Subjects and Methods: Records of women with peripartum hysterectomy over a 20-year period were retrieved and the documented WHO life-threatening conditions (severity markers) extracted. Severity markers were related with booking status, the level of specialist care and mortality. Comparison of dichotomous variables was done with Mantel–Haenszel statistics, and with one-tailed Fisher's exact test when the variable was <5, at 95% confidence interval andP< 0.05. Results: There were 30,553 deliveries and 145 women had a peripartum hysterectomy with an incidence of 4.8/1000 deliveries. Fifty women (50/116; 43%) had no associated severity markers. Fifty-eight (58/116; 50%) and 5% (6/116) women, respectively, had one and five severity markers. All women without a severity marker survived, but there was an exponential increase in mortality to 20.7% (12/58) in women with massive blood transfusion (MBT) and 66.7% (12/18) in women with both MBT and disseminated intravascular coagulopathy. Overall, peripartum hysterectomy case fatality was 13.8%. Other morbidities were anaemia (100%), febrile morbidities (55.2%), urinary tract infection (20.7%) and ureteric injuries (5.1%). Conclusion: The onset of severity markers was positively related to mortality. There should be early intervention to improve survival when an indication for peripartum hysterectomy occurs.

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Complex craniofacial defects often create a reconstructive challenge in our region. We highlight two cases that demonstrate this problem and highlight the role of microvascular free flaps in covering these defects. The evolution of head and neck reconstruction as well as the peculiarities of these types of reconstruction in our environment are discussed.

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Background: The optimum management of patients with abdominal stab wounds (ASWs) is yet to be fully elucidated. Aims and Objectives: To evaluate the pattern of injury, treatment offered and outcome in patients with ASWs seen at our tertiary hospital. Patients and Methods: This was a retrospective descriptive study of patients who sustained ASWs seen from January 2011 to December 2015. Information obtained from case notes were analysed on a personal computer using SPSS version 22 (SPSS Inc., Chicago, IL, USA).P<0.05 was considered statistically significant. Results: Fifty patients who sustained ASWs were included in the study. Forty-four (88%) were males, mean age was 27 years and 50% were between the ages of 21 and 30 years. The wounding weapon in patients was the knife in 26 (52%) and broken bottle in 14 (28%). Our patients presented at the hospital about 3 h after abdominal stabs and surgical intervention time was uniformly prolonged. Forty-eight (96%) patients had emergency laparotomy, whereas two (4%) patients with omental evisceration were treated using the policy of selective non-operative management. The commonly injured organs were stomach (22.9%), small bowel (20.8%), omentum (18.8%), colon (18.8%) and liver (14.6%). The negative laparotomy rate was 31.3%. The knife was a more lethal weapon than broken bottle in our patients (P<0.05). Seven (14%) patients suffered serious post-operative complications and two (4%) died. Conclusion: The high therapeutic laparotomy rates observed in our patients who had generalised peritonitis, evisceration and shock, support the fact that these findings should be indications for immediate laparotomy.

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