Clinical microbiology laboratory plays several important roles in the management of bacterial infections. Isolation, identification of pathogenic microorganisms in cultures and subsequent antimicrobial susceptibility testing always assists in selecting appropriate antimicrobial agent and prevention of unnecessary complications. The most important and primary test to perform directly on some special samples such as cerebrospinal fluid and positive cultures is Gram staining which serves as the most rapid and simplest test to characterize microorganisms. It is therefore highly likely that the information provided by the Gram staining will help to assess the adequacy of preliminary diagnosis and antimicrobial therapy selected after collecting culture specimens and before final identification of the microorganism. In recent reports, the impact of Gram staining results on patient mortality has been documented. On the other hand, there remains the possibility that Gram staining results do not match with the final identification of microorganisms. This would carry a risk leading to inadequate antimicrobial therapy and potentially affecting patients' clinical course and mortality. The aim of this mini review is to analyze and discuss the clinical significance and limitations of reporting Gram staining results for sample meant for bacteriological investigations.

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Introduction: The cerebrospinal fluid within the ventricles could be in excess or markedly reduced, and these could be the only sign of an intracranial or intraventricular disease. The linear dimensions of the 3 ^rd and 4 ^th cerebral ventricles are key to some of these findings. The practice of using the reviewer's experience or observing a change in the shape of the ventricles can be very subjective, hence the need for normal values. Objective: To establish linear dimensions of the 3 ^rd and 4 ^th cerebral ventricles among normal adults in Zaria using computer tomography. Materials and Methods: Axial computerized tomographic brain scans of the 488 normal subjects reviewed were acquired during a 3 year period (2009-2012) using a multi-slice GE Sigma excite scanner in our department, and the images were reviewed retrospectively. We obtained the widest linear dimensions of the 3 ^rd and 4 ^th cerebral ventricles using the in-built linear calipers of the computer tomography (CT) scan machine for each patient. Statistical analysis was performed using Sigmastat 2.0 for Windows (Statsoft, San Rafael, CA). The following statistical tests employed: students t-test and analysis of variance, and a probability level of <0.001 taken as statistically significant. Results: The 488 brain CT scans analyzed for this study comprised of 319 (65.36%) males and 169 (34.63%) females. The ages ranged from 18 to 84 years with a mean age of 37.26 years. The age difference between males and females were statistically significant. The mean 3 ^rd ventricular widths were 4.23 ± 1.25 and 3.81 ± 0.87 in males and females respectively, whereas the mean 4 ^th ventricular widths were, 7.87 ± 1.30 and 7.54 ± 1.33, in males and females, respectively. Conclusion: In this study, we have established normal linear values for the 3 ^rd and 4 ^th cerebral ventricles in Zaria using computed tomography. These values could serve as a quick reference for radiologists and neurosurgeons, obviating the need for advanced software packages, which may not be readily available.

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Background: Pediatric testicular volume is an important index in determining the start of puberty, its progress, and/or any subsequent disorder of puberty. It is also important in detecting and monitoring local testicular pathologies. This study is aimed at obtaining reference values for testicular volume measured by ultrasound in normal pediatric age group 0-15 years. Materials and Methods: This cross-sectional study was conducted at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Boys numbering 450 without any evidence of testicular pathology were recruited for this study. The testicular volume was measured by ultrasound (Aloka SSD 3500) utilizing the testicular length, width, and thickness of the ultrasound images. All measurements were analyzed using Statistical Package for Social Sciences (SPSS 17). A P ≤ 0.05 was considered statistically significant. Results: The testicular volume shows no significant increase before the age of 9 years with an average volume of 0.74 ml and then increased to 1.1 ml at 9 years. Afterward, it shows marked increase in volume to reach a value of 8.99 ml at 15 years. Strong correlations were established between the right and left testicular parameters, except for the anteroposterior diameter. However, no statistically significant difference was observed between them, except for length (P = 0.000). Conclusion: The study provides contemporary reference values for testicular volume of the pediatric age group.

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Diabetes is a major cause of morbidity and mortality both in developing and developed countries. The incidence is rising rapidly with sub-Saharan Africa experiencing the largest percentage increase between 2013 and 2035. Nigeria has the largest number of people with the disease, yet information on the diabetes mellitus for policy and programming is fragmentary. Therefore, the purpose of this study to systematically identify population-based studies on diabetes in Nigeria and to determine the prevalence and sex differential. A literature search of the PubMed database was conducted of published research between 1990 and 2013 using the medical subject headings "diabetes mellitus" and "Nigeria." The search was done at the end of 2013 which returned 741 hits. A manual search for additional studies was performed using references cited in the original articles. Some authors were contacted whose full-text publications were not available on the PubMed database or freely on the internet. Twenty population-based studies that had been conducted on the prevalence of diabetes in Nigeria between 1990 and December 2013 that satisfied the inclusion criteria were identified. The prevalence of diabetes ranged from 0.8% to 11% involving both urban and rural populations, with varying sampling schemes, one study reported a traditional population with very low prevalence of diabetes and highly specific populations as well. The review revealed a generally low prevalence (<10%) of diabetes in Nigeria. It also found that there is dearth of literature on diabetes. There is the need to undertake a nationally-representative survey to assess the burden of diabetes in general population.

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Background: Ultrasonographic assessment of fetal growth for the estimation of fetal weight (EFW) is a common obstetrics practice and provides valuable information for planning the mode of delivery. The aim of this study is to determine the accuracy of fetal birth weight estimation and sex determination using ultrasonography from two tertiary institutions of Northwestern Nigeria. Materials and Methods: This was a prospective study involving 109 singleton uncomplicated pregnancies from January 2013 to January 2014. All the patients are booked at the antenatal clinic of two tertiary institutions (Usmanu Danfodiyo University Teaching Hospital [UDUTH] Sokoto and Federal Medical Center Birnin Kebbi). Inclusion criteria in the study were term pregnancy (36-42 weeks), reliable date of last menstrual period, regular menstrual cycle, a close correlation between menstrual age and clinical gestational age measurements. Results: The mean maternal age was 29.01 ΁ standard deviation 4.81 (range: 18-40 years). One hundred and nine term live-born singleton infants delivered at UDUTH and Federal Medical Center Birnin Kebbi during the study period had undergone ultrasound EFW <7 days preceding birth. Twenty-one (19.3%) fetuses were identified as male while 38 (34.9%) was identified as female during the ultrasound examinations. In about 40 (36.7%) of the fetuses, the gender was not seen. Conclusion: There was a significant error while estimating fetal weight by ultrasound and underestimation has the highest percentage. Determination of fetal sex with ultrasound show some degree of accuracy in our study because 21 (19.3%) fetuses were identified as male, while 38 (34.9%) was identified as female during the ultrasound examinations. Hence, it should be recommended only if the mother requested for the gender during the scanning taking into account the social implications.

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Introduction: Neonatal male circumcision is routinely carried out in most places in Nigeria, sub-Saharan Africa. The main reasons why parents bring their sons for circumcision are religious and cultural with a few medical indications like phimosis, paraphimosis and balanitis also being noted. Several techniques of this age long practice have been described and options range from the non-device to device techniques. Circumcision with the Gomco clamp (GC) is not yet as popular in this part of the world even though it has been reported to be safe. Aims and Objectives: To describe our experience and technique using the gomco clamp (GC) for neonatal male circumcision in our environment. Materials and Methods: A retrospective study of 63 newborn boys whose parents gave consent and who were assessed and found fit for circumcision from August 2015 to November 2015 was carried out. They all had circumcision by the same surgeon using gomco clamp at Garki hospital Abuja, Nigeria. Data obtained from patients’ medical records included age, indication, size of gomco clamp and any procedure related complications. They were followed up at 6weeks in the surgical outpatient clinic and then 1year by telephone call to their parents. Results: The average age of the male neonates at circumcision was 10.8 +/- 4.38 days (range from 6 to 26 days) and median age 8days. The indications for circumcision were religion (43, 68%) and cultural (20, 32%). The only early procedure-related complications observed was mild bleeding in two (3.2%) boys and this succumbed to simple pressure. Long term complications included one (1.6%) each penile skin bridge following adhesions between the prepuce and glans and redundant foreskin which were corrected by free hand dorsal and ventral slit circumcision at 8months. Conclusion: Male circumcision can be performed at any age, but there are cost and safety benefits of doing this procedure during the neonatal period. Circumcision using the Gomco clamp (GC) is simple to learn.

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Introduction: Motorcycle injuries, particularly from low income countries like Africa and Asia contribute significantly to road traffic injuries globally, according to recent estimates by the World Health Organization. Objective: To determine the prevalence of visual acuity disorders, knowledge of road safety rules and one-year prevalence of road crashes in male commercial motorcyclists. Methodology: Male commercial motorcyclists numbering 191 were selected from the motorcycles’ parks in Ekpoma, using a multi-staged random sampling technique. Structured interviewer administered questionnaires were used for data collection. Data were analysed using SPSS version 20. Results: A vast majority 189 (99.0%) of respondents had good visual acuity (with visual acuity of between 6/5 and 6/18), Just one percent of the respondents had poor visual acuity (between 6/24 to 6/60). Most respondents 122 (63%) had a good knowledge of road safety rules while 42.9% had been involved in at least a road traffic crash within a year prior to the survey. Knowledge of road safety rules showed a statistically significant association with the educational status of the respondents (P<0.001), but had no association with other socio demographic variables like age (P=0.184), marital status (P=0.298) and religion (P=0.511) in respondents. Conclusion: Majority of the male motorcyclist had visual acuity within the normal range, knowledge of road safety rules was good among respondents with the level of education identified as a significant predictor of knowledge Inclusion of at least primary school educational qualification as criteria for all motorcyclists and a proper medical examination of prospective motorcyclists before issuance of driver licenses.

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Introduction: Perinatal asphyxia is a global neonatal problem which significantly contributes to both morbidity and mortality. It is the fifth largest cause of under-five mortality. This study was aimed to determine the prevalence, risk factors and outcome of perinatal asphyxia in newborns seen in the Special Care Baby Unit. Materials and Methods: A retrospective study of newborns managed for perinatal asphyxia over a 1-year period. All inborn babies with Apgar scores <6 at 5 min and out born babies with no Apgar score but with features of asphyxia were studied. Case files of the patients were retrieved and relevant information was obtained. Results: Of the 223 neonates admitted during the study period, 67 (30.1%) newborns had perinatal asphyxia from our record; but only 47 (70.1%) case files with complete data were retrieved, giving a prevalence of 21.1%. Twenty five (53.2%) of the mothers were primiparous, 31 (66.0%) had no antenatal care and 25 (53.2%) presented with prolonged obstructed labor. Twenty-eight (59.6%) of the newborns were females; 41 (87.2%) were term, 27 (57.4%) of normal birth weight, 42 (89.4%) delivered in the hospital and mostly through an emergency caesarean section. Thirty (63.9%) of the newborns were discharged; while 12 newborns died, giving a case fatality rate of 25.5%. Conclusion: Perinatal asphyxia is a significant cause of morbidity and mortality in Gusau. Health education of pregnant mothers on antenatal care for early detection of high-risk pregnancy is highly recommended in order to reduce the high incidence of this preventable condition.

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Background: Hypertension is the single most important modifiable risk factor for developing stroke and its recurrence. Evidence suggests that antihypertensive treatment rates following stroke remain poor worldwide and non-adherence to secondary preventive medication is a disturbing clinical problem associated with recurrence and poor outcomes. Aim: The aim of this study was to determine the predictors of non-adherence to antihypertensive medications among stroke survivors 3 months after their stroke. Materials and methods: This was a cross-sectional study, involving stroke survivors attending the out-patient neurology clinic at the University of Benin Teaching Hospital, Benin City, 3 months after their stroke. Demographic and clinical characteristic were obtained, with a questionnaire, while medication adherence was measured by pill count method. In the final logistic regression analysis, the independent variables were age, gender, educational status, marital status, modified Rankin scale, polypharmacy, and types of stroke while medication non-adherence was the dependent variable. Results: One hundred and twelve stroke survivors participated. There were 58(51.8%) males and the mean age was 72(12) years. The non-adherence rate in this study was 57.1 %(64/112). The significant predictors of non-adherence to antihypertensive medications were the female gender (P = 0.009), severe disability (P = 0.003), the older participants (P = 0.004), and polypharmacy (P = 0.002). Conclusion: Non-adherence to antihypertensive drugs following stroke was observed in our study, which would affect blood pressure control leading to stroke recurrence. To prevent recurrent strokes, stroke survivors must adhere to their antihypertensive drugs, while involving patient and family members in decision making with regards to treatment plans.

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Street begging is a social challenge that is more rampant in Northern Nigeria than elsewhere in the country. Some poor individuals resort to street begging to sustain their families. Street begging is found more among people living with physical challenges, particularly the blind persons. We reviewed the literature on the causes of blindness and challenges to accessing curative and rehabilitation support services. This is with a view to draw the attention of policy formulators on the appropriate rehabilitation of the visually disabled persons in order to tackle the menace of street begging in Northern Nigeria. A review of the literature was done electronically as well as manually. For electronic search, various scientific journals and web-based search engines were used. The search terms were blind street beggars, visual disability among beggars, avoidable blindness, blindness in northern Nigeria, socioeconomic impact of blindness, psychosocial impact of blindness, challenges of rehabilitation in Nigeria, visual disability in Northern Nigeria, destitution in Nigeria. Cross references of relevant articles were also retrieved. Majority had blindness from avoidable causes (over 75%) and had difficulty in accessing curative and rehabilitation support services. In the light of the avoidable nature of the majority of the causes of blindness among blind beggars in Northern Nigeria, coupled with the existing inadequate modalities for rehabilitating incurably blind, it is recommended that, a comprehensive eye care program on preventive, curative and rehabilitative services with a strong public health education campaign on the avoidable causes of blindness and discouraging street begging should be put in place by relevant stakeholders.

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The sub-Saharan Africa bears the brunt of being the region with the highest burden of both Human Immunodefiency Virus (HIV) infection and of tuberculosis (TB). While only 10% of immunocompetent individuals infected with M.tuberculosis go on to develop active disease in their lifetime, 50% of those co-infected with HIV develop active TB. Qualitative and quantitative defects of CD4+ T-lymphocytes explain the inability of HIV-infected individuals to contain mycobacterial proliferation. Similarly, TB also accelerates the progression of HIV infection. The clinical and radiological presentation of TB in patients infected with the HIV virus may be different and atypical posing significant diagnostic challenges. This is compounded by the dearth of diagnostic facilities in sub-Saharan Africa. The initiation of antiretroviral therapy (ART) during anti-TB therapy (ATT) significantly improves survival of TB/HIV co-infected persons. There are challenges in treatment of HIV associated TB because of overlapping drug toxicities, pill burden and suboptimal adherence, drug-drug interactions between ART and ATT as well as timing of ART. Of particular importance are the immune reconstitution inflammatory syndrome (IRIS) and the emergence of multi-drug resistant (MD-R) and extensively drug resistant (X-DR) TB. Centre's for tuberculosis diagnosis and treatment and for HIV care and treatment need to be integrated. This has not been so successful in sub-Saharan Africa. In spite of sustained support by donor organizations, a substantial number of HIV-TB co-infected individuals remain undiagnosed and are poorly managed. This review focuses on the epidemiology and pathogenesis of HIV-TB co-infection and the special areas of difficulty in the diagnosis and treatment of the dual infection. Emphasis is placed on the peculiarities of management in sub-Saharan Africa, the region with the highest burden of both infections.

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Sickle cell anaemia - the disease that combines molecular biology, clinical features, biochemistry, pathology, natural selection, population genetics, gene expression and genomics - is the world's most common life threatening monogenic disorder. Acute chest syndrome is a common complication of SCA and it has been identified as the most common cause of mortality in adult patients with SCA. In addition to elaboration of pro-inflammatory cytokines and up-regulation of cellular adhesion molecules, interplay among red cell sequestration, fat embolism and pulmonary infection, which are the pertinent pathophysiological phenomena that operate in a vicious cycle, lead to the clinical features of ACS. Chest infection, usually caused by atypical organisms, is a more common trigger in children, while fat embolism is considered as a more common trigger in adults. More common clinical features are cough, fever and chest pain, although the pattern of these symptoms varies between children and adults cohorts. The operational definition of ACS appears to be a bit loose, making it difficult to categorically distinguish from other differential diagnoses like pneumonia, especially in resource-poor areas. However, when ACS is diagnosed, treatment should be aggressive, addressing analgesia, hydration, the use of broad-spectrum antibiotics, inhaled bronchodilators, anticoagulation and blood transfusion if required. Randomized trials on efficacy of novel agents like statins, glycoprotein IIa/IIIb inhibitors and phospholipase inhibitors are still on-going.

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Background: There is a paucity of information on the relationship of renal ultrasound echogenicity and serum creatinine levels to CD4 cell counts in patients with human immunodeficiency virus-associated nephropathy (HIVAN) in our local environment. This necessitated the conduct of this study. Aims and objectives: To establish a relationship between renal ultrasound echogenicity and serum creatinine levels and CD4 cell counts in adult patients with HIVAN. Settings and Design: A cross-sectional study of 100 consecutively confirmed HIV-seropositive patients aged between 19 and 65 years (mean ± standard deviation: 35 ± 10.79) comprising 32 males and 68 females with clinical and laboratory features of HIVAN was conducted at the infectious disease clinic of the University of Maiduguri Teaching Hospital, between April 2011 and September 2012. Materials and Methods: The subjects underwent renal ultrasound scan, and the degree of parenchymal echogenicity was recorded. Serum creatinine levels and CD4 lymphocyte counts were also obtained for all the patients. Statistical Analysis: The data obtained were recorded on Data sheet and analyzed using SPSS for windows version 16. Results: Of the 100 cases studied (i.e., 200 kidneys), ultrasound showed abnormal echogenicity in 192 kidneys (96%) with a grade I echogenicity in 4 patients (4%), grade II echogenicity in 36 patients (36%) and grade III echogenicity in 56 patients (56%). Four patients (4%) had a normal renal echogenicity. Majority of the patients had grade III renal echogenicity. The lower the CD4 count, the higher the degree of the renal echogenicity. Although, the higher the serum creatinine levels, the higher the degree of the renal echogenicity. Conclusion: The degree of the renal echogenicity was found to be inversely proportional to the CD4 cell counts. Prognosis also worsens with higher serum creatinine and lower CD4 cell counts.

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Background: Malaria remains a disease of public health concern in tropical countries. Diagnosis in such countries largely depends on clinical assessment, microscopy (as the gold standard) and recently by rapid diagnostic tests (RDTs). This study was conducted to document common presenting symptoms of malaria, compare microscopy and RDT in the diagnosis of malaria in children in Gusau, Nigeria. Materials and Methods: A cross-sectional, study of children under-five years with presumptive diagnosis of malaria that was managed at the pediatric outpatient department and emergency pediatric unit of Yariman Bakura Specialist Hospital, Gusau. All consecutive children that met the inclusion criteria were recruited over a 4 weeks period. Malaria thick film microscopy and RDTs were carried out on all children. Results: Of the 118 children enrolled, 61 (51.69%) were males while 57 (48.31%) were females. Fever and vomiting were the most common presenting complaints. Microscopy was positive in 55 (46.61%) while RDT was positive in 10 (8.47%) of the children. Only 5 (4.24%) were positive for both microscopy and RDT. Fifty-eight (49.15%) children had negative microscopy and RDT results. There was no significance when positivity of both tests were compared (χ² = 0.050, P = 0.822). RDT had a sensitivity of 9.09%, a specificity of 92.06%, positive predictive value of 50.00%, and a negative predictive value of 53.70%. Conclusion: Our study observed higher positivity rate for microscopy than RDT. We recommend microscopy to be carried out on all patients suspected of having malaria where possible, even in the presence of negative RDT.

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Background: Cervical spondylosis (CS) has received little attention in the Nigerian medical literature even in the present era of magnetic resonance imaging (MRI). Unfortunately, cervical spondylotic myelopathy (CSM) is the most common form of functional debility from spinal cord disease in older adults. Objective: We sought to describe the clinico radiologic findings in CS and CSM with the hope of familiarizing clinicians with this prevalent and potentially devastating disorder. Materials and Methods: This study was a retrospective analysis of 76 patients who underwent cervical MRI examination on account of CS, associated with either radiculopathy, myelopathy, or myelo radiculopathy. The patients comprised of 54 (71.1%) males and 22 (28.9%) females, their ages ranged from 26 to 78 years. Each patient was also scored clinically using the Nurick's classification for cervical myelopathy and scores compared with their MRI examination findings. Results: The condition was commoner in males than females (M:F = 2.5:1). Multi-level disease was seen in almost all patients and the commonest disc levels affected in spondylosis were C4/5, followed by C5/6; while for spondylotic myelopathy, it was C3-4 level. The prevalence of CSM in this study was 42.10%. The patients' clinical scores compared well with their MRI findings. Conclusion: CS should not be dismissed as a mere consequence of aging 'but a disease with possible debilitating outcome and early prevalence due to an interplay of environmental and genetic factors'. On the strength of this, we have presented the MRI and clinical findings in CS and spondylotic myelopathy; and also reviewed previous reports in the light of the current findings in the literature.

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Background: Despite the safety, affordability and widespread use of ultrasound; there is a paucity of literature on ultrasonographic assessment of the portal vein (PV) diameter in adult patients in our local environment. Aims and Objective: The aim of this study was to determine the mean and range of PV diameter in chronic liver disease (CLD) patients in our local environment. Materials and Methods: This cross-sectional prospective study was carried out at the University of Maiduguri Teaching Hospital between January and June, 2013. Two hundred and fifty adult male and female CLD patients and equal number of age and sex matched controls aged 18 years and above had abdominal ultrasonography for measurement of their main, right and left PV diameter in both inspiration and expiration. Transverse and longitudinal measurements were obtained, and the averages of the two measurements were used to determine their final diameter. Results: There were 187 (74.8%) male and 63 (25.2%) female CLD patients aged between 19 and 77 years (mean ± standard deviation [SD], 43.78 ± 12.97 years). The mean diameter of the main PV (±SD) in CLD was 18.68 ± 2.59 mm which is higher than that of the control (10.87 ± 0.81 mm). The mean diameter of the right and left PVs in CLD were 9.04 ± 1.26 mm and 8.58 ± 1.23 mm respectively, which were higher than the respective values of 4.35 ± 0.52 mm and 4.12 ± 0.52 mm in the control. The PV diameter correlated with age and respiratory phases in both CLD and the control group (P < 0.05). There was statistically significant difference in PV diameter between males and females (P < 0.05) with values higher in females. Conclusion: The mean value and range of PV diameter in CLD patients in this environment were statistically and significantly higher than controls. The diameter correlated with age and showed significant difference between the two sexes and respiratory phases.

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Background: The diagnosis of thyrotoxicosis is based on clinical suspicion and confirmed by thyroid function test. In Nigeria, measurements of thyroid function tests are not readily available therefore the need for clinical assessment remains paramount in the diagnosis and management of thyrotoxicosis. Objective: The objective was to determine the relationship between Wayne's score and biochemical indices of thyroid function in Nigerians. Materials and Methods: A total of 30 newly diagnosed patients with thyrotoxicosis referred to the Endocrinology Clinic were recruited for participation in this study. All patients had detailed history taken and thorough physical examinations performed. They were also assessed using the Wayne's score. The patients also had the biochemical evaluation of their thyroid function. The relationship between the Wayne's score values and the biochemical indices were then correlated using the Pearson's correlation coefficient. Results: All the patients with elevated thyroid hormones had elevated Wayne's score. The correlation coefficient between T3 and Wayne's score was 0.79, whereas between T4 and Wayne's score was 0.81. The average Wayne's score was 31.6. There was negative correlation between age and Wayne's score (r = ­0.86). Conclusion: The Wayne's score can be used as a screening tool for thyrotoxicosis in our environment.

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Background: Complications can arise during the postpartum period and if unrecognized can lead to physical discomfort, psychological distress, and a poor quality of life for the mothers. The true burden of postpartum maternal morbidity is still not known. It is estimated to be highest in low- and middle-income countries. Objective: This study was aimed at determining the pattern of postpartum morbidities at Aminu Kano Teaching Hospital and their possible determinants. Methodology: It was a cross-sectional study of women admitted into postnatal ward of Aminu Kano Teaching Hospital, Kano, Nigeria, on account of postpartum morbidities from January 1to December 31, 2016. The admission register of antenatal/postnatal ward was retrieved and only women admitted within the postpartum period were included in the study. Result: There were 3933 deliveries over the studied period and 141 women were admitted for postpartum morbidities. The most common morbidities were anaemia (35.5%), hypertensive disorders (19.6%), and puerperal sepsis (19.6%). Nearly 70% of the patients were unbooked and had spontaneous vaginal delivery. There was a significant association between postpartum morbidities and booking status, level of educational, and mode of delivery. Conclusion: Anaemia, hypertension, and sepsis are the common postpartum morbidities in Kano, north-west Nigeria. Health education on the importance of quality antenatal and intrapartum care will go a long way in reducing these morbidities.

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Introduction: Severe acute malnutrition (SAM) is a disease of the developing world. Poverty and famine have escalated its prevalence. In Nigeria, the Boko Haram menace has resulted in an upsurge of internally displaced persons in need of food and shelter. It is estimated that about 16 million children are affected by malnutrition worldwide and accounts for two million deaths worldwide annually. Evidence suggests incomplete vaccination predisposes to malnutrition and its unwanted sequelae. Anecdotal findings show that most siblings of children with SAM were incompletely vaccinated and hence are at risk of SAM. The study thus aimed at assessing their socio demographic characteristics and immunization to document their vulnerability to development of SAM. Materials and Methods: This was a cross-sectional study of socio-demographic characteristics and immunization status of siblings of children with SAM being rehabilitated in the Paediatric nutrition clinic of Ahmadu Bello University Teaching Hospital Shika Zaria, between March 2009 and September 2014. The information was directly obtained from the mothers of the children as they presented to the clinic and then recorded into a structured questionnaire. Results: The socio-demographic characteristics of 229 parents and immunization status of siblings of children with SAM were reviewed. Most family settings were monogamous (54.2%) and the majority of the fathers were semi-skilled labourers (26.2%). Only 76 (33.2%) of the mothers had some form of formal education while 153 (66.8%) were not formally educated. The majority of the subjects received BCG vaccine but only 56% and 55.5% of the subjects completed their DPT3 and oral polio 3 vaccinations respectively. Conclusion: The study showed that fathers of siblings of children with SAM were semi-skilled labourers while their mothers were predominantly stay at home and not formally educated with limited source of income. Furthermore, BCG vaccination was the most commonly received vaccine and it is recommended that concerted effort should be made towards improving vaccine delivery among siblings of children with SAM. Adult literacy and empowerment of mothers may help achieve improved immunization of siblings of children with SAM.

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Background: The true incidence rate of appendicitis in Nigeria and the magnitude of appendicular fecaliths as a specific causal factor in appendicitis are unknown. Materials and Methods: A retrospective clinicopathologic study was conducted using the medical database of the Ahmadu Bello University teaching hospital, Zaria, northern Nigeria for the decade from 2001 to 2010. The National Population Census in Nigeria 2006 was used to estimate the standardized annual incidence of appendicitis in the locality. Pathologically confirmed specimens of appendicitis were analyzed against demographic data of the patient. Results: During the decade, there were a total of 382 cases with intraoperative diagnosis of appendicitis of which the diagnosis was confirmed pathologically in 373 cases. With a local population whose disease or specimens would most probably end up in this hospital pathology department estimated at 1,423,469 the standardized incidence rate of appendicitis was 2.6 per 100,000 per annum. In 354 (93%) out of the 382 specimens, fecaliths were identified and thought to be causally related to the disease in the individual case. Conclusion: Appendicitis is very uncommon in northern Nigeria and when it occurs, it is almost always caused by fecaliths.

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Aim: Kaplan-Meier estimator provides better estimates to determine the median of the distribution of breast cancer patient's survival times following their recruitment into the study. Materials and Methods: Age, sex, occupation, stage of the disease and results of the treatment of 312 breast cancer patients were the variables used in the study. The mean age of breast cancer patients was found to be 43.39 with a standard deviation of 11.74; the overall median survival time was 10 months. This indicates that 50% of breast cancer patients survived longer than 10 months after being diagnosed with the disease. Results and Discussion: Log-rank test was used to test the significant difference between the survival experiences of the patients. Age group, stage of the breast cancer and results of the treatment, indicated a significant difference, while occupations have not shown any significant difference in the survival of the breast cancer patients.

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Introduction: Anemia is common in pregnancy and iron deficiency is a major cause of anemia in pregnant women in Africa. This is due to increased demands of the fetus, growing uterus, placenta, and poor nutritional habits. Objectives: To determine the prevalence of anemia and the role of iron deficiency in causation of anemia in pregnant women attending the antenatal clinic of the Ahmadu Bello University teaching hospital (ABUTH) in Zaria, Nigeria. Materials and Methods: Ninety (90) consenting pregnant women were entered for this study with an equal number of controls. A structured questionnaire was administered to participants. Full blood count, serum ferritin, urine and stool microscopy for parasites were carried out. Results: The mean hematocrit in the pregnant and non-pregnant subjects was 35% (SD ± 3.8; 95 CI = 34.2-35.8) and 39% L/L (SD ± 3.2; 95% CI = 37.3-38.7) with P < 0.001. In the pregnant subjects 11(12.2%) had anemia while none of the controls was anemic. Mean serum ferritin among the pregnant and non-pregnant subjects was 26.0 μg/L (SD ± 35.2; 95% CI = 18.6-33.4) and 70.3 μg/L (SD ± 106.1; 95% CI 48.1-92.5), respectively, with P-value of <0.001. Even though iron deficiency was observed in 68/90 (75.6%) of pregnant women, it was latent in 61/68(89.7%) of the women while it was frank in 7/68 (10.3%). In the non-pregnant subjects, 23/90 (25.6%) had iron deficiency despite a normal hematocrit. Of the 11/90 (12.2%) of pregnant subjects that had anemia 7/11(63.6%) had frank iron deficiency anemia while 4/11 (36.4) had anemia due to other causes. 2/90 (2.2%) of the pregnant subjects had ova of hookworm in their stool samples and both had iron deficiency anemia. Conclusion: Iron deficiency underlies many cases of anemia in pregnancy, thus justifying the use of iron supplementation in pregnancy as is currently practiced. Latent iron deficiency among non-pregnant controls suggests that iron supplementation may benefit non-pregnant women within the reproductive age group could help to improve their iron stores before the contemplation of pregnancy, thereby, reducing the prevalence of pregnancy related anemia in this environment.

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This work tries to look at how the integration of traditional birth attendants (TBAs) into the health sector in Nigeria can be a strategy for reducing maternal deaths. Skilled birth attendance in Nigeria is below 40% and most deliveries are with unskilled personnel like the TBAs. In the light of current evidence that training of TBAs can have some positive effect on neonatal outcome and with inconclusive evidence on their role in maternal health, this “birthing workforce” can be harnessed by the Nigerian government by re-defining their roles as health promoters with the overall aim of improving skilled attendance at deliveries and the reduction of maternal morbidity and mortality.

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Introduction: Integrated management of childhood illnesses (IMCI) is a holistic approach to reducing under-5 morbidity and mortality, and improving growth and development of children. This study compared key household and community practices in IMCI implementing and non-implementing communities in two local government areas (LGAs) of Kano State, Nigeria. Materials and Methods: A cross-sectional study was employed with multistage cluster sampling selection of caregivers of children 0-59 months of age and their index children (n = 400). The study was conducted from February 2009 through January 2010. Data analysis was performed using EpiInfo ^TM v6.0 and Minitab ^TM software. Results: The adoption of IMCI key household and community practices was generally better in IMCI-implementing communities than in non-IMCI communities. Exclusive breastfeeding (EBF) rate among children under 6 months was higher in IMCI communities than in non-IMCI communities (P = 0.05). Non-IMCI communities also had a greater proportion of low weight-for-age children (42.5%) than IMCI communities. Mothers from IMCI communities (30.5%) were more likely to have antenatal care (ANC) during the first trimester than those from non-IMCI communities (P < 0.05). There was no difference between the study communities with regard to use of insecticide-treated nets (ITN) during pregnancy (P = 0.09), and having skilled attendance during last childbirth (P = 0.23). Conclusion: Mothers in communities implementing IMCI are more likely to adopt EBF and to attend ANC services than their counterparts in communities not implementing IMCI. Expanding IMCI activities to other LGAs in northwest Nigeria will have a positive impact on reducing morbidity from common childhood diseases.

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Background: Sickle cell disease (SCD) is relatively prevalent in Nigeria and it is associated with obstetric complications, especially in unsupervised pregnancies. This study was to determine the prevalence of SCD among pregnant women seen in an antenatal clinic in a tertiary health center in South-South Nigeria. Materials and Methods: This was a 10-year retrospective study of all registered pregnant women seen at the antenatal clinic of Braithwaite Memorial Specialist Hospital (BMSH) (2004-2013). Sociodemographic data and hemoglobin (Hb) electrophoresis were obtained using questionnaires and alkaline cellulose acetate electrophoretic machines (Helena), respectively. Data were analyzed using Epi-info version 7.02 by the WHO, Geneva, Switzerland, and CDC, USA. Results: A total of 35,976 pregnant women were seen at the antenatal clinic of BMSH within the study period, out of which 28,815 (80.09%) were Hb AA, 7,109 (19.77%) were Hb AS, and 52 (0.14%) were SS. The average gestational age of booking was 22.1 weeks. More women with tertiary education registered earlier than those with secondary education. Anemia in pregnancy (Hb <11 g/dl) was found in 94.2% of the pregnant women with Hb SS, while 5.8% was above 11 g/dl (P = 0.001). Conclusion: There is a high prevalence of SCD among pregnant women in this region. Late antenatal booking, anemia, and poor education are the predictive markers of poor pregnancy outcome in this region.

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