Background: Contrary to reports from developed countries, operative treatment of pediatric intussusceptions by either manual reduction or bowel resection still constitute the major treatment modality in our environment. Comparative analysis of pre-operative and post-operative indices of the patients treated by the two methods may help decision making in some critical clinical situations. Objective: To compare clinical indices between children who had manual reduction and bowel resection for intussusception. Materials and Methods: Retrospective analysis of all children who had operative treatment for intussusceptions at the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2015. The patients were divided into two groups: manual reduction (MR) and bowel resection (BR). Data including patient demographics, weight, duration of symptoms, presence of fever, need for re-laparotomy, and duration of hospital stay, post-operative complications and mortality rates were compared between the two groups. Results: Sixty-four patients were analyzed. Twenty-six patients (41%) had manual reduction (MR) and 38 patients (59%) had bowel resection (BR). Mean duration of symptoms for manual reduction was 4.0±3.16 days and 4.8±3.04 days for bowel resection (p=0.28). All patients had fever. Palpation of intussusceptum per rectum in manual reduction was 42% and 36% in bowel resection (p=0.80). Average length of hospital stay for manual reduction was 9.1±4.20days and 14.3±8.24 days in bowel resection (P < 0.01). Duration of hospital stay in 26% of manual reduction and 75% of bowel resection was up to 10 days (P < 0.001). Two patients died after bowel resection and one after manual reduction. There were no recurrences. Conclusions: Average length of hospital stay is significantly higher in bowel resection manual reduction. Those with bowel resection are more likely to spend beyond 10 days in hospital. There were more post-operative complications and reoperation in bowel resection. There was no significant difference in sex, age, duration of symptoms and mortality between the two groups.

Objective: To determine the factors associated with perception of maternal death and the referral practices of traditional birth attendants in Enugu, Nigeria. Methods: This was a questionnaire-based cross-sectional study of traditional birth attendants who attended a training workshop in Enugu held between March 15-18^th 2014. Statistical analysis involved descriptive and inferential statistics performed with SPSS statistical software version 17.0 for Windows. Tests of association were done with the chi-square test. P values ≤ 0.05 were considered significant. Results: A total of 105 unskilled birth attendants participated in the workshop out of which 100 consented to participate in the study. Of these, 85 returned their questionnaires and were used for analysis. This gave a response rate of 85%. All the participants were females. Approximately 57.6% (49/85) of respondent's perceived maternal death as resulting from superstitious reasons (patients' sins, witchcraft or God's wish etc.). Perception of maternal death was associated with age (P <0.001), educational level of traditional birth attendants TBAs (P <0.001), duration of practice (P = 0.03) and previous witnessing of maternal death (P=0.02). Approximately 80% (67/85) would not refer high-risk pregnancy or labour to a health facility. The referral practices of traditional birth attendants were associated with their perception of maternal death (P <0.001). Conclusion: Perception of the cause of maternal death may influence the referral practices of traditional birth attendants. In addition to imparting skills for detecting complicated pregnancies and labour, training programs for traditional birth attendants in this area may need to include aspects that will address superstitious perception of maternal death.

Background: The current trend in global modernization has enabled consumers to turn to the internet via electronic devices to gain information on many issues including health. There is scarcity of literature on the awareness and use of e-health services in low income countries such as Nigeria. Aim: This study explored the knowledge, use and factors that affect the use of e-health amongst undergraduates of non-health related courses and the influence of use on health-seeking behavior.Materials and Methods: A cross-sectional descriptive study of three tertiary institutions of learning in Enugu state, Nigeria. Respondents from the institutions were selected by Multistage Sampling. Data analysis was both descriptive and inferential at 95% confidence level. A p value ≤ 0.05 was considered statistically significant. Results: Respondents were mostly young (15-20 years, 42.2% and 21-25years, 42.5%); there were more males than females (58% vs 42%) while almost all (96.6%) of them were single. The result showed that almost all (379, 93%) respondents knew they could access the internet for health information. 244/379 (64.4%) reported good knowledge of e-health, while knowledge was poor in 135/379 (35.6%) of the respondents. E-health awareness was not significantly associated with age, sex, marital status, course of study or monthly allowance. Availability of data for browsing was the greatest factor reported by half (52%) of the respondents to affect their use of e-health services. A good number (61.2%) felt that e-health usage had gotten them more informed on health while 67.3% of them agreed that e-health information had increased their eagerness to seek health care. Conclusions: Awareness of e-health is high among undergraduates and e-health usage may have a positive effect on health seeking behavior.

Background: Cesarean delivery is an essential component of comprehensive emergency obstetric care, an intervention that saves the life of pregnant women. Although the cesarean section (C/S) rate varies from one region to the other, there is generally a rising trend in the C/S rate globally with its associated benefits and attendant challenges. Objective: The study aimed to determine the C/S rate and its outcome at the University of Nigeria teaching hospital, Enugu. Methods: All pregnant women undergoing C/S during the 12 months study period from 1st January to 31st December 2012 at UNTH, Enugu, South east Nigeria were consecutively recruited. Cesarean delivery group were compared with vaginal delivery group using maternal mortality ratio (MMR) and perinatal mortality rate (PMR) as outcome measures. Relevant data were obtained and analyzed using Epi info statistical software. Results: There were 256 C/S and 998 total deliveries, giving a C/S rate of 25.7%.The maternal mortality rate (MMR) in the C/S group was significantly higher than the vaginal delivery group (MMR= 1619 vs 139/ 100 000 livebirths, p value = 0.02. RR= 11.46, 95% CI (1.29, 102.04). The perinatal mortality rate in the two groups was not statistically different, (53.6 v 54.9/ 1000 live births, p value=0.93, RR =0.97, 95% CI (0.54, 1.77), however un-booked status was a predisposing factor for maternal and perinatal deaths. Conclusion: The C/S rate from the study was high, although with good outcome. However, MMR was significant higher in the Cesarean group compared with those that had vaginal delivery.

Background: Factors such as race, poverty, nutrition and chronic diseases have been shown to influence the age of attaining menarche in girls. HIV is one of the most prevalent chronic diseases among young girls living in sub-Saharan Africa. This study compares the age at onset of menarche between HIV-infected girls and un-infected controls matched for age and socio-economic status. Materials and Methods: A cross sectional study involving 100 HIV-infected girls aged 8-17 years and 100 un-infected counterparts matched for age and social class. Questionnaire was administered to study participants after obtaining consent from their caregivers. Age at attainment of menarche was obtained using recall method. Data analysis was done with SPSS version 20 (Chicago IL). Significant levels were assumed at p-values less than 0.05. Results: Eighty-seven subjects and controls respectively (87%) were within the age range of achieving menarche. Among them, 19 subjects (22%) and 31 controls (36%) had attained menarche ((OR= 0.505, CI= 0.258-0.988, p =0.046). Menarche occurred at a mean age of 12.84 ± 1.30 years among the subjects and 12.32 ± 0.79 years among the controls (p=0.085).Conclusions: A significant proportion of subjects compared to controls had achieved menarche.

Background: Globally, every minute, at least one woman dies from complications related to pregnancy or childbirth. Knowing the obstetric danger signs helps in avoiding the first delay. This is because early recognition of complications is a critical determinant of timely decision-making. Objectives: This study was conducted to assess the knowledge of obstetric danger signs (ODS) and its determinants among women of reproductive age in a rural community in north-western Nigeria. Methods: A cross-sectional, community based descriptive study was conducted in Kwaba as part of a Community Diagnosis field practical experience for final year medical students of Ahmadu Bello University, Zaria, from 19^th September to 14^th October 2016. An interviewer- administered questionnaire was used to collect data from 395 women of reproductive age in the community. Data was analyzed using SPSS version 20. Results: Among the 395 respondents, 373 (94.4%) were married and prolonged labor was the most known ODS (316/395, 80%). A majority of the respondents, 286 (72.4%), had good knowledge of ODS. Determinants of having a good knowledge of ODS were: petty trading profession (OR= 1.65, 95% C.I: 1.04 – 2.64, P=0.03); formal education (OR=1.97, 95% CI: 1.24-3.01, P=0.01) and ever been pregnant (OR=4.23, 95% CI: 1.90 - 9.42, P < 0.01). Conclusions: Formal education, ever been pregnant and petty trading profession were determinants of having a good knowledge of ODS among respondents. Increased enrolment of children into formal education; increased antenatal care attendance and health education of both men and women on ODS in the study area is recommended. This may help in avoiding delay in seeking for emergency obstetric care services and may reduce maternal mortality in the community.

Background: There is a constant presence of occupational hazards as health care workers carry out their various clinical activities in hospitals and other medical facilities. More than 90% of the occupational infections occur in developing countries like Nigeria. Following repeated outbreaks of infectious diseases in the country only consistent practice of universal precautions will prevent disease transmission within health facilities and onward into communities. Aim: The aim of this study was to assess practice of these precautions among health workers and identify what factors influence them. Materials and Methods: Using a multistage sampling technique, a questionnaire-based cross-sectional study was carried out in January 2016 among 304 health workers at the Federal Medical Center, Owerri, Nigeria. Chi square analysis was used to identify factors associated with good levels of practice and logistic regression to ascertain the determinants of universal precaution practice. Statistical significant was set at P ≤ 0.05. Results: There was a good level of practice of precautions; 253/304 (83.2%) with strong association observed with level of education (P<0.001), department (P=0.01), occupation (P<0.001), knowledge (P=0.000), education on precautions (P<0.01) and how recently training had occurred (P<0.001). The department in which one worked was identified as a determinant of universal precaution practice (P=0.05). Conclusions: Health workers need to be educated regularly on these precautions and discouraged from assuming patients to be of low risk and recapping needles before disposal. Auxiliary nurses who had the lowest levels of knowledge and practice require particular attention in educative programs.

Background: The existing data suggests increase in prevalence of pre-hypertension and hypertension in developing countries. The percentage of awareness of hypertension and its treatment is unacceptably low in the Indian adult population. Objectives: Prevalence, awareness and adequate treatment of hypertension amongst adults in rural and urban areas of District Lucknow was studied. Methods: The community based cross sectional study involved a survey of 337 male and 416 female respondents, aged 18 years and above using stratified random sampling and Probability Proportionate to Size technique. A structured pretested schedule was used to collect data regarding demographic characteristics, awareness and treatment of hypertension. Chi- square test, Gaussian test, Students t test and ANOVA were used to analyze data. Results: The prevalence of hypertension was found to be higher in urban areas (30.8%) than rural areas (20.9%). One hundred and three (52.82%) of 195 hypertensives knew of their hypertensive status and 26 (13.33%) hypertensives were taking adequate treatment/advice. The mean systolic as well as diastolic blood pressure patterns were found to be higher in urban respondents, female gender and with increase in age. Conclusions: Early detection of hypertension can be facilitated by periodic screening of the people regularly. Counseling of the hypertensives on life style modification and its role in controlling hypertension should be emphasized.

A rare case of bident shaped barbed spear injury to the cranial base in a 14year old male with a rare mechanism of injury, which was treated operatively with good recovery. Clinical and imagery review of a cranial penetrating trauma resulting from a bi-prong barbed spear which pierced the cranium, dura mater and frontal lobe parenchyma traversing the orbital cavity without injury to the globe or critical neurovascular structures. The patient underwent bifrontal craniotomy to remove the bident shaped barbed metallic spear head complex. This was done retrograde to its route of entry. He was hospitalized 2 weeks post-surgery and discharged. During outpatient follow up he manifested no neurologic deficits. Transorbital intracranial injuries are rare lesions more so, non-assault related bilateral transorbital injury from a bi-prong barbed spear. Maximal injury occurs when barbed spears are retrieved by retracing their route of entry. In this case however, retrograde retrieval was adjudged the safest route after a bifrontal craniotomy flap was turned. There was no morbidity.

Spinal arachnoid cysts (SAC) are rare cause of spinal cord compression in children. This paper reports thoracic anterior intradural spinal arachnoid cyst as a rare cause of myelopathy in toddlers. A two-year-old Nigerian male who presented with weakness of both lower limbs which progressed to paraplegia nine days prior to presentation, bi-sphincteric dysfunction and sensory in the trunk and both lower limbs. Examination revealed spastic paraplegia, grade 4 deep tendon reflexes in both lower limbs, with T6 sensory level. MRI showed Th4-Th7 anterior intradural cyst with significant thoracic cord compression. He had microscope-assisted Th4–Th6 laminoplasty and cyst wall excision through left posterolateral approach. Histology confirmed spinal arachnoid cyst. He made good clinical improvement at one year follow up. Anterior thoracic intradural arachnoid cyst may be a rare cause of paraplegia in toddlers. High index of suspicion and early neuroimaging are needed to avoid missed diagnosis. Careful microscope-assisted surgery ensures good outcome.