The title of the address, clearly suggests that there is something seriously wrong with our health delivery system. What then is wrong with our health care system and how do we set about improving the system?. What role can insurance, especially health insurance, play in solving the problem? These are some of the questions that we will attempt to address in the course of this lecture.

Serum alpha-l-antichymotrypsin (ACT) levels were determined by single radial immunodiffusion in two hundred (200) apparently healthy blood donors and in one hundred patients with the following diseases - nephrotic syndrome 38, multiple myeloma 30, hepatoma 17, prostatic carcinoma 17 and lymphoma 5. The mean and standard deviation obtained were control 156 ± 71.2 ug/ml, nephrotic syndrome 197.6 ± 112.1 ug/ml, multiple myeloma 220.2 ± 162.4 ug/ml, prostatic carcinoma 465.4 ± 138.1 ug/ml, hepatoma 466.1 ± 143.9 ug/ml and lymphoma 331.2 ± 88.5 ug/ml. When compared with the control these figures were found to be statistically significantly higher (p < 0.0001). It is possible that the measurement of this acute phase protein could be of prognostic value.

A 10 year (January 1987 to December 1996) prospective study of pelvi-ureteric junction (PUJ) obstruction in adults at the University of Nigeria Teaching Hospital Enugu is presented. Sixty-eight adult patients with PUJ obstruction were seen (59 males and 9 females). Fifty-two patients ,(46 males and 6 females) underwent surgery, the surgical management depended on the state of the function of the affected kidney at presentation. The procedures adopted were pyeloplasty, nephrectomy and open nephrostomy. The study highlights the need for early diagnosis and prompt treatment of the condition so as to preserve renal function and prevent complications.

A smaple of 365 primary school children in Enugu, Eastern Nigeria, stratified according to social status, was studied with respect to the soil-transmitted intestinal helminths. A questionnaire was aministered to the children and samples of their stool were examined for the presence of the intestinal helminthic ova at the parasitology laboratory of the University of Nigeria Teaching Hospital, Enugu. Certain socioeconomic factors like the area of residence, water supply in the homes of the children and the educational levels attained by the mothers were found to be related to the prevalence of the ova of intestinal helminths. Possible ways of reducing the spread of these parasites are then discussed.

This study focuses on the radiographic findings in paediatric HIV pulmonary disease reviewing the prior observations in literature but trying to analyse and establish the pattern detectable amongst our patient group. Critical radiological analysis of the chest radiographs of these 22 patients revealed that focal infiltrates was the main and most common feature [95%], major lymphadenopathy followed with 26.1%. Prominent hilar and the compound feature of prominent bronchovascular markings [BVM] with focal infiltrates and overaeration were not observed in our sample. Bilaterality of lesions and ‘mottle’ pattern prevailed when focal infiltrates were further analysed. Most of the observed mottle were already coalescing. The right upper zone was the most commonly affected zone. The celebrated reticulonodular pattern was observed in only five cases. Features documented in literature as seen early or late in the disease were characteristically absent in our sample. Present study is of the opinion that these subtle observed variances in our sample are likely subject to a combination of endemic factors of, late presentation and thus malnutrition.

A case-report of the rare phenomenon of spontaneous regression in retinoblastoma which occured in a Nigerian girl at the age of 2 is reported. At birth, the child had divergent squint of the right eye. This was followed by leukocoria and progressive enlargement of the globe 1 and 6 months later respectively. With no history of trauma or any form of treatment, spontaneous involution of the globe occured at about the age of 2. Six months later, leukocoria was again noticed in the left eye. At presentation, a fungating mass was noted. Histopathology report of the left enucleated eyeball confirmed retinoblastoma.

Bone destruction by Histoplasma duboisii infection without other evidence of the disease, is often clinically misdiagnosed as cancer. The diagnostic difficulty of such a case involving the radius, an uncommon site, in a 30 year old woman is described. Controversies surrounding diagnosis, treatment and course of the disease is reviewed. High index of suspicion by practising physicians is strongly recommended.

A review of the current concepts and strategies in the treatment of tuberculosis was carried out. The topics discussed include the World Health Organisation's case definition and classifications of tuberculosis. Also highlighted are drug regimens, monitoring and supervision of therapy with emphasis on the recommendations of our National Tuberculosis and Leprosy Control Programme.

Bronchial asthma is one of the common chronic non-infective diseases in children. The morbidity and mortality from this, disease remain high. Oftentimes, ‘the diagnosis is missed, and where appropriate diagnosis has been made, management may be suboptimal. This paper reviews the aetiopathogenesis and management of bronchial asthma in children. The important role* of inflammation in the pathogenesis of the disease is highlighted while the place of patient education and environmental control in its management emphasized. The major classes of drugs used in the treatment of bronchial asthma are summarised. It is hoped that the aim of this review which is the increased knowledge and understanding of this disease, and improvement in the management of bronchial asthma in children has been achieved.