Introduction: In most countries health care reform is aimed at improving the efficiency, equity and effectiveness of the health sector. Documentation of health sector reform experiences has focused primarily on efficiency and design of reforms, largely neglecting equity and the frequent experience that reforms are not fully implemented. The reasons why implementation stalls remain rarely explored in the health sector. This review assesses the factors that have enabled or constrained health sector reforms in Enugu and Anambra states of Nigeria. Methods: A systematic search of literature published from 1990-2008 was conducted. Grey literature (conference papers, technical reports, dissertations, etc), journal articles, abstracts, relevant books and internet articles were reviewed. Results: The results show that the following reforms have been attempted in Enugu and Anambra states of Nigeria in the past two decades: The Bamako initiative program and drug revolving funds with user fees and exemption system, reproductive health reform, integrated management of childhood illnesses (IMCI), district health system, community-based health insurance ,immunization and disease- specific programs. Only a small number of core articles focus on these reforms and their impact on equity. Some of the key factors which have determined whether these reforms preferentially benefit the poorest have also been outlined and they range from institutional, political, managerial to contextual factors. Conclusions: Some of the key factors which have determined whether reforms preferentially benefit the poorest have been outlined. If the enabling factors are enforced and the deterring factors corrected, the chances of achieving the MDGs goals through these health reforms will be strengthened.

Cervical cancer is to a large extent preventable by effective screening. The effectiveness of such screening depends on the knowledge and attitude of the women. Objectives: To ascertain the knowledge of the certified nurses in a teaching hospital in Nigeria to cervical cancer, their attitude to cervical cancer screening and factors hindering their uptake of available screening services (pap smear test). Methods: Structured questionnaires were self administered to the consenting certified nurses working at University of Nigeria Teaching Hospital Enugu, in South Eastern Nigeria. Results: Showed that 92.2% of the nurses were aware of cervical cancer screening. Fifty three percent of the respondents attributed the cause of cancer of the cervix to sexually transmitted infection and 2.2% of them identified human papilloma virus as a factor. Only 28 (12.2%) of the respondents have ever done pap smear test. The commonest reason given by the nurses who had never been screened was that they did not have any complaint and hence not at risk of having cervical cancer. Years of practice has a significant influence on the knowledge of cervical screening and screening procedures. Conclusion: The nurses have good knowledge of cervical cancer screening but very low uptake of Pap smear test. There is a great need for continuous education of the nurses on the need to change attitude that will ensure improved uptake of cervical cancer screening (Pap smear test).

Background: School children sometimes exhibit a range of deviant behaviour which could serve as a source of stress to the families and society. Objective: To determine the prevalence and pattern of deviant behavour in urban school children in Enugu and factors that may be associated with it. Methods: Two schools were randomly selected from the urban school population. Pupils with normal Intelligent Quotient (IQ) were selected by systematic sampling method. Rutter's behavioural scale for teachers (B) and parents (A₂) were completed by their teachers .and parents (A₂) respectively. Socio-demographic characteristics of the children were also obtained.Student t-test and Kruskal-Wallis test were used to determine differences between means and Chi² test for differences between proportions. Multiple linear regression analysis was used to ascertain the predictive determinants for deviance. p<0.05 was considered significant. Result: The prevalence of deviant behaviour was 16.3% on the Teachers' scale and and 13.9% on the Parents' scale. The difference was statistically significant (p=0.001). Males were significantly more deviant, scoring higher than the females on both scales. Antisocial behaviour was more common than neurotic on both scales. Gender and family size were significantly associated with high scoring on the teacher's scale. Conclusion: Significant number of schoolchidren in Enugu had deviant behaviour with predominance of antisocial behaviour for both sexes. This study serves as a baseline for a more recent study to monitor the prevalence of deviant behaviour and associated factors in our environment. Adequate attention should be given to this aspect of child health as teachers and parents could be experiencing difficulties in coping with such problems.

Aim: The study aimed at determining the tooth cleaning devices, reasons influencing the choice of such devices, which tooth cleaning device gave the best oral hygiene and to ascertain the oral health status of the community. Methods: This cross sectional study involved 147 participants resident in Isu Awaa, in Enugu state, Nigeria, who were present for an oral health educational activity. Data collection was done using a structured pre-tested questionnaire administered by the dental team. Data obtained were on the participants' demographic details, tooth cleaning devices used, and reasons for their choices. The caries status was measured using modified DMFT index, the periodontal treatment needs by CPITN and the Oral hygiene status by Simplified OHI. The data collected were analyzed using SPSS version 15. Results: The choice of toothbrush was mostly attributed to “good result” while choice of chewing stick was hinged on availability and traditional beliefs. The mean DMFT and OHI-Scores were 2.0 ± 2.82 and 2.46 ± 0.93 respectively, while 105 (71.4%) participants needed deep scaling and curettage. Conclusion: The use of chewing stick in this community is still very popular, although the participants believed that better results were obtained by using toothbrush. To help improve and maintain good oral hygiene, routine community based oral health education on proper use of either the chewing stick or tooth brush is highly recommended.

Background/Objective: Chronic hepatitis B or C affects one out of every twelve persons globally. As part of the global campaign against hepatitis, the authors seized the opportunity of the 2010 World Hepatitis Day to undertake a Hepatitis C screening exercise for civil servants of Enugu State of Nigeria. Method: Civil servants of Enugu State attached to the Government House, Enugu were screened for anti-HCV antibody using a third generation enzyme linked immunosorbent assay (ELISA). Risk factors for Hepatitis C Virus (HCV) infection were also determined using a structured questionnaire. Results: Four hundred and one (401) civil servants were screened during the exercise (211 males or 52.6% and 190 females or 47.6%). Seven (7) of them were anti-HCV seropositive (1.75%). Among the putative risk factors for HCV infection, none was significantly more frequent in the anti-HCV seropositive subjects compared to their anti-HCV seronegative counterparts. Conclusion: The sero-prevalence of anti-HCV antibody in civil servants of Enugu State of Nigeria is 1.75%. Seropositive subjects had a higher frequency of past history of jaundice. There is an urgent need to intensify preventive measures to ensure that the sero-prevalence remains low or even lower in the community in order not to add to the burden of Hepatitis B Virus (HBV) infection.

Background: A mother's knowledge and perception of fever may determine the degree of her anxiety and fear, and reflect on the way the fever is managed at home. This study was carried out to determine the knowledge, perception and practice towards childhood fevers among mothers at the University of Nigeria Teaching Hospital, Enugu. Methods: A cross-sectional descriptive study was carried out over a 6 week period. Data were collected from 179 mothers using a semi structured interviewer administered questionnaire. Results: The mean age of the respondents was 32.9 ± 7.1 years and majority were multiparous mothers. Seventy-seven percent had either secondary or tertiary education. Majority (74%) reported malaria as a common cause of fever while some reported teething (80%), witchcraft (26%), ‘ntiwa-isi’(widened anterior fontanelle-56%), spiritual attack (34%) and ‘nta’(marasmus-52%). Eighty percent knew fever could cause convulsion while others thought it could lead to blindness, anaemia, weakness, brain damage and death. Most of the mothers used cold water bath and exposure on their febrile children while others applied coverings and ointments. Majority gave drugs inappropriately and none had knowledge of the temperature that indicates fever. Conclusion: Understanding mothers' perception may help Paediatric care providers to identify wrong practices towards fever and promote a more appropriate fever management.

Background/ aim: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Despite the high prevalence of this disease, it is not known how frequently this diagnosis is made by physicians in Nigeria. The purpose of the study was to determine the frequency with which the diagnosis of IBS is made by physicians in Nigeria and the symptoms used. Methods: Self-administered questionnaires addressing frequency of IBS diagnosis and the symptoms used were distributed to consultant physicians attending a meeting of the West African College of Physicians, Nigeria chapter. Results: Fifty (50) questionnaires were distributed with 43 physicians (38 males and five females) returning completed forms giving a response rate of 86%. A total of 30 physicians (69.8%) had ever made a diagnosis of IBS. Of these, 25 (83.3%) make the diagnosis of IBS “rarely”; four (13.3%) make the diagnosis “often enough” and only one (3.3%) make the diagnosis “commonly”. The symptom complexes of abdominal pain relieved by defecation, abdominal pain associated with diarrhoea and abdominal pain associated with constipation in the absence of any known cause that usually prompt the diagnosis of IBS were correctly indentified by 22 (51.2%), 32 (74.4% ) and 19 (44.2%) physicians respectively . Conclusion: This study demonstrates the rarity with which the diagnosis of IBS is made by physicians as a result of the low index of suspicion for this condition. There is the need for continuing medical education as this is likely to increase physician awareness of this illness.

Aim: The study determined the prevalence and factors associated with Schistosomiasis infection among primary school pupils in Agulu community in Anambra state Nigeria as it is important to identify communities at high risk of infection and assess effectiveness of control programs. Methods: Using a questionnaire, information on history of passing bloody urine and known risk factors associated with infection was collected from 984 pupils. Their urine and stool samples were also examined for S. hematobium and mansoni eggs. Results: More than half (57.1%) of the pupils were males and a majority of them belong to the age group of 8-13 years. While 14.5% of them have noticed snails in their popular stream, 21.3%, 6.9% and 20.3% have had pains while urinating, passed blood in urine and passed blood in stool respectively. Schistosome hematobium eggs were found in the urine of 16.4% of the pupils . Prevalence in schools ranged from 0.0% to 25.6%. The prevalence of soil transmitted helminths (STH) were 10.9%, 2.4%, 0.8% and 0.1% for Hook worm, Ascaris, Trichuris trichuria and Enterobius vermicularis respectively. Gender, source of water in school and at home, bathing/playing in the stream were significantly associated with S. hematobium infection. There is also mixed infections with soil transmitted helminthes (STH) Conclusions: The prevalence of S. hematobium infection is still high in the study area and there is also mixed infections with STH. This local estimate of the prevalence is likely to be more useful than national estimates in planning and implementation of control interventions at community level.

Background/Objective: Cancers remain a major cause of morbidity and mortality globally. Tumor markers provide a minimally invasive, cost-effective source of data valuable for monitoring disease course, determining prognosis and aiding in treatment planning. This review examines the extent to which some of the common tumor markers in clinical use have met these needs. Method: Publications from local and international journals on tumor markers were accessed by means of a MEDLINE search using PubMed. References from key journal articles were also accessed and critically reviewed. Results: The number of tumor markers in clinical use continues to increase. Their potential applications include screening in asymptomatic individuals, confirming a suspected disease, assisting in tumor classification and staging, estimating prognosis, monitoring treatment response, surveillance for residual disease, and early detection of recurrent disease. To date, only prostate specific antigen in conjunction with digital rectal examination has proved effective in screening asymptomatic individuals for prostatic cancer. Conclusion: Tumor markers are important adjuncts in the diagnosis and management of malignant diseases but several factors influence the clinical utility of any potential tumor marker.

Background: The burden and magnitude of chronic kidney disease (CKD) are enormous. The incidence and prevalence of chronic kidney disease are rising all over the world. Thus, there is the urgent and pressing need for methods of early detection of CKD, to be included in guidelines for management of noncommunicable diseases, to help stem the tide. Method: This paper reviewed various articles on guidelines for management of CKD including KDOQI and UK guidelines. Result: There is consensus in literature about the increasing incidence of CKD worldwide and the emergence of CKD as a disease of public health concern. Most guidelines advocate inclusion of estimation glomerular filtration rate (eGFR) in laboratory requests for serum creatinine using the Modification of Diet in Renal Disease or the Cockroft and Gault formulae. Conclusion: We therefore conclude that inclusion of methods of early detection of CKD in the national guidelines for non-communicable disease is a necessity. Equally necessary is the inclusion of eGFR in laboratory requests for serum creatinine.

Survey of the world literature indicates that the sermon preached to surgeons over the years kept on reminding them to be aware that prostatic carcinoma can invade the rectum. In sharp contrast, Igbo surgeons in both urban and rural practices have readily been recognizing this phenomenon throughout a period of 30 years.