Background: Hepatitis B and C infections occur globally and their coinfection presents a treatment challenge with more severe health problems. Nigeria is endemic for hepatitis B and health workers represent one of the high risk groups. It is therefore imperative for continued surveillance of these infections among health workers to increase and strengthen awareness of preventive measures and treatment options when infected. Objective: The authors set out to determine the prevalence of hepatitis B and C coinfection among health workers in Enugu, Nigeria. Methods: This descriptive cross-sectional study was carried out at the University of Nigeria Teaching Hospital (UNTH) Enugu, between July and August, 2016. Consenting health workers were screened using HBsAg and HCV chromatographic immunoassay rapid test strips. Results: The study included 3132 health workers. The mean (SD) age was 39.4 (9.6) years and ranged. 18 – 75 years with a M:F ratio of 1:2.3. Doctors and nurses constituted 297 (9.5%) and 580 (18.5%) respectively while majority 2,119 (67.6%) were made up of other cadres of health workers. A total of 72 (2.3%) and 28 (0.9%) were positive for hepatitis B and C respectively, but none of the participants was positive for both infections, giving a prevalence of 0.0% for hepatitis B and C coinfection. Conclusion:xs The prevalences of hepatitis B and C coinfection is 0.0% among health workers in Enugu, Nigeria. There is need for sustained awareness creation and health education programmes for prevention and control of hepatitis B and C infections in order to sustain the zero prevalences of coinfection in our setting.

Background: The cost of hydrostatic reduction, the cost of operative treatment of intussusceptions as well as the assessment of the cost-effectiveness of hydrostatic reduction in treating pediatric intussusceptions have not been documented in our environment. Objectives: To estimate the cost of hydrostatic reduction of intussusceptions, the cost of operative treatment of intussusceptions and assess if hydrostatic reduction is cost-effective in management of intussusception. Methods: The medical records of children who were managed for intussusception were reviewed. Micro-costing was used to calculate expenditure on treatment modalities. Decision-analytic Markov model was used to determine the cost-effectiveness of hydrostatic reduction. Results: The average cost of hydrostatic reduction was $116 USD and that of operative treatment was $ 393.62 USD. At the success rate of 44% for hydrostatic reduction, initial attempts at hydrostatic reduction are still cost-effective at the overall cost of $336.6 USD. The expenditure on drugs ($ 68.4 USD) and investigations ($46.58 USD) contributed most to the total cost. Planning hydrostatic reduction to coincide with the initial abdominal ultrasonography will reduce the overall cost by $8.1USD Conclusions: Hydrostatic reduction once indicated should be attempted before operative treatment in any facilities where the success rate of hydrostatic reduction is above 30%. To further reduce cost, the first ultrasonography should be targeted to correspond with the hydrostatic reduction procedure.

Background: The advent of injections and antibiotics into medicine remain laudable landmarks. However, the inappropriate and/or overuse of the same as prescription drugs are recognized public health challenges, globally. Carrying untoward effects on people and health systems, this menace has remained unnoticed at the primary level of healthcare. Objective: To investigate the pattern of antibiotics and injections usage in rural Primary Health Care (PHC) facilities in north-western Nigeria and the profile of health personnel working therein; and recommend strategies for improvement. Methods: A retrospective audit and analysis of prescriptions issued over a three-month period in rural PHC centres with the aid of a checklist developed based on standard indicators for investigating drug use in PHC facilities. The PHC centres used were selected by simple random sampling technique. Results: A total of 4,255 prescriptions issued in the selected rural PHC facilities over a three-month period were studied. About 3,364 of these prescriptions (79.06%) included injections; while 2,790 prescriptions (65.57%) included antibiotics, among other drugs. Most of the personnel serving in these facilities were auxiliary health workers- no physicians or pharmacists were employed in the PHC centres studied. Conclusion: Evidence shows high scale, inappropriate and overuse of injections and antibiotics in rural PHCs; and a paucity of skilled manpower.

Background: Self-medication could be harmful to health even though it has some proven advantages. Medical students are future doctors whose disposition to pharmacotherapy may direct approach to prescription in the future. Objective: To determine factors prevalence and pattern of self-medication among medical students in a Nigerian university. Methods: It was a cross-sectional study of 335 medical students of the University of Nigeria Enugu Campus, Enugu, Nigeria. The students were selected following a stratified probability sampling technique with the various class levels serving as strata. Thereafter, the individual participants were randomly selected from the strata to achieve the required sample size. Results: The prevalence of self -medication was 85.7%. The two commonest reasons for self-medication among the students who practiced it were: ‘prior knowledge about the illness and its treatment’ (67.9%) and ‘illness was mild’ (55.8%). Other reasons included previous successful self-medication (35.9%); too many protocol at the hospital (31.0%); to save time (27.5%); to save money (20.2%); the situation was one of urgency (13.6%); and impoliteness of health care practitioners (3.8%). The common sources of the medications were patent medicine stores (774%), and community pharmacists (21.3%). Conclusions: There is high prevalence of self-medication among medical students in Enugu, Nigeria, and their medications are commonly sourced from patent medical stores. There is thus need for sensitization of medical students on the advantages and disadvantages of self-medication in order to ensure safe and responsible drug use. Policies to control drug dispensation by patent medicine stores are urgently needed in view of the enormous adverse effects of self-medications.

Background: Utilization and quality of services in primary healthcare (PHC) facilities in Nigeria are a source of concern due to the essential role of primary healthcare in providing key health care services and achieving universal health coverage. Objective: This study examined the perception of service users on utilization and quality of services in rural and urban areas of south east Nigeria. Methods: A cross sectional quantitative survey was conducted in one rural and one urban local government area in southeast Nigeria; in eight (8) PHC facilities. A pre-tested interviewer - administered questionnaire was used to collect data on utilization and perceived quality of services. Data was analyzed with SPSS Version 16. Results: Most visits (86.6%) to facilities were for outpatient services. Antenatal care (27.2%) and child health services (23.0%) were the predominant services in urban and rural areas. Educational level, being married, purpose of visit and attending health worker were all associated with utilization while affordability, waiting time, presence of a doctor and laboratory services were positively associated with perception of quality. Conclusion: This study indicates that utilization of healthcare at PHC facilities was sub-optimal for key healthcare services. Underlying health system challenges must be addressed with appropriate recommended reforms if the utilization and quality of services at PHC facilities will be significantly improved.

Background: Accidental poisoning among under-five children remains a recognized cause of morbidity and/or mortality with highest rates in low-income countries. Its prevalence and types vary from place to place with the presenting features ranging from mild to near-fatal symptoms. Aim: To document the frequency and pattern of accidental poisoning among under-five children seen at the Children's Emergency Room of the Federal Medical Center, Umuahia. Methods: This is a retrospective review of the cases of under-fives with accidental poisoning over an eight-year period (January 2009 to December 2016). Information such as age, gender, type of poison, presenting features, type of home remedy and outcome were retrieved. Results: Of the 9,492 under-fives seen during this period, 53 (0.6%) had accidental poisoning. The mean age was 21.2± 10.1 months and male-to-female ratio was 1.8:1. The mean duration from the time of the incident to presentation was two hours. Most common route of poisoning was ingestion (93.4%) and kerosene was the most common substance ingested. Presenting features ranged from mild symptoms such as fever and vomiting, to fatal symptoms such as seizures and coma. Palm oil (83.3%) and coconut water (16.7%) administered orally were the most common forms of home remedies. One of the patients was managed in ICU and there was no documented mortality. Conclusion: Accidental poisoning remains a common paediatric emergency room presentation and kerosene ingestion is the commonest type of presentation. Early presentation and prompt intervention may help to reduce morbidity and/or mortality.

Background: Leprosy is a chronic infectious disease that is associated with serious morbidity and is a disease of public health concern because of the social stigma. Knowledge, attitudes and practices of medical practitioners are very vital in its control. Objective: The aim of the study was to assess the knowledge, attitudes, and practices of medical officers and interns regarding leprosy. Methods: A cross sectional study was conducted among 26 medical officers and 262 interns in two tertiary health facilities in Enugu, South-east Nigeria. Data analysis was both descriptive and inferential using SPSS version 21 at 95% confidence level. Results: Knowledge of the respondents on diagnosis, management, and prevention of leprosy was adequate. However, their overall attitudes and practices towards leprosy were poor. About 50.7% would not eat, 79.9% would not marry, and 34.7% would not be willing to perform cardio-pulmonary resuscitation (CPR) to persons affected by leprosy. The female respondents were significantly more likely than the male respondents to be willing to perform CPR on leprosy patients (73.3% vs. 59.5%; χ² = 13.43; P = 0.001). Similarly, respondents in 30-40 years age category were significantly more likely than those in 40-45 years age category to be willing to perform CPR on leprosy patients (70.0% vs. 58.3%; χ² = 17.11; P = 0.03). Conclusion: There is adequate knowledge among medical officers and interns with regard to leprosy. However, their attitudes and practices were poor. It is recommended that medical students should have training in leprosy as well as adequate exposure including interaction with persons affected by leprosy at the zonal/regional referral centers.

Background: Higher Order multiple pregnancies (HOMP) increase the demand for neonatal intensive care services and knowledge of local prevalences may be useful in planning neonatal intensive care. Objectives: To determine the incidence and feto-maternal outcome of higher order multiple births in university of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria. Methods: It was a retrospective review of all HOMP at the UNTH Ituku/Ozalla Enugu, over a ten year period from June 2006 to May 2016. Results: During the study period, there were 8207 deliveries out of which 23 were higher order multiple (HOM) births; consisting of 19 triplets and 4 quadruplets. The overall incidence of HOM births was 0.28%. This was made up of incidences of triplet and quadruplet births of 0.23% and 0.05% respectively. Ten (43.5%) of the women conceived spontaneously while 8 (34.8%) had ‘artificial reproductive technology’ and the remaining 5 (21.7%) took ovulation inducing agents. The maternal outcome of HOM births was generally good with no record of maternal death. The neonatal complications included: neonatal jaundice (4.5%), birth asphyxia (4.3), conjoined twins (4.3) and neonatal death (13.0%). Conclusions: The incidence of HOMP in UNTH, Ituku/Ozalla, Enugu is much less than 1% and comparable to that in other parts of the world. The overall maternal outcome of HOMP was good. There is however need for improved neonatal care to ensure better fetal outcome of HOMP in our setting.

Objective: The study examined how Lagos state, Nigeria succeeded in increasing her internally generated revenue and the effect on government allocation to health sector in the State. Methods: This study was conducted in Lagos state southwest Nigeria using a mixed methods approach. Audited annual account reports and budget documents of the State (2000-2010) were reviewed with a data abstraction template. Also, nine (9) in-depth interviews (IDIs) were undertaken with purposively selected key informants in the State and analyzed using capacity and policy framework. Trend analysis of government revenue and expenditure were conducted. Results: The findings show that of all the various sources of revenue in Lagos state, internally-generated revenue (IGR) is the major source of revenue, accounting for over 70% of the State revenue. This was due to the introduction of e-payment initiative, tax compliance by the populace and political will of the State government. Federal government allocated revenue to the State and value added tax (VAT) are the next two most important sources of revenue. Lagos state succeeded in raising its IGR up to 2 to 6-fold over the study period. Indeed, the State is the least dependent state on federally allocated funds in Nigeria. Conclusion: The-State government's increased revenue did not translate into increased revenue to health sector although there are increased infrastructural developments in the State. Often health does not seem to be high on the political agenda of most State governments in Nigeria; rather issues that create visibility for government are critical in determining resource allocation. This calls for a rethink as government budget to health shows the priority government gives to health! On the other hand, often, ministries of health lack absorptive capacity and political clout to argue for larger allocations for health due to dearth of evidence to demonstrate improved performance and achievements in service delivery.

Background: Scabies is a common parasitic disease seen in developing countries. It affects families, especially the most vulnerable and has its greatest impact on young children, often resulting in secondary bacterial infection in untreated cases. A study on the disease incidence, pattern and trend will help in designing strategies in controlling the disease prevalence and outbreaks. Methods: The study was a retrospective analysis of skin clinic records of scabies cases seen in three tertiary centers of health care in South-Eastern Nigeria over a five year period from September, 2012 to August, 2017. Generated data was analysed using the statistical package for social sciences (SPSS) for Windows Version 20.0 (SPSS, Inc., Chicago, IL, USA) and patients' age and gender were tabulated, and percentages calculated. Tests of associations and trends in disease presentation were also determined. Results: A total of 13,815 patients were seen in the skin clinic out of which 336 cases were scabies giving an incidence rate of 2.4%. The mean age of the patients seen across the three study centers 20.4 ±14.8years (range 2months-74years) were seen across the three study centers. Majority were males (65.8%) and less than 30 years of age (82.8%). There was a progressive increase in incidence of scabies infection from 0.18% (n=8) in 2012 to 6.67% (n=132) in 2017. Patients' gender and age were significantly associated with family members being infected and the trend showed a gradual increase over the years. Conclusions: There is increasing incidence of scabies in south-east Nigeria and the disease is commoner in males and young individuals. Public health enlightenment campaigns and school/community education programs may help in controlling this emerging epidemic in Nigeria.

Multiple Myeloma (MM) is a monoclonal proliferation of plasma cells in the bone marrow, and secretion of paraprotein into circulation and urine. It is part of the spectrum of plasma cell dyscrasias. Others included in the spectrum are extramedullary myeloma or plasma cell leukaemia. It may be complicated by hyperviscosity, renal impairment, anemia and bone disease. Bone disease is the commonest presentation of MM; presents commonly with usually low back pain. Orofacial presentation is rare. We present a report of 2 cases of MM with uncommon initial presentation as a jaw mass. In both cases a high index of suspicion was entertained after tissue biopsy was done. Aspiration of the tumor mass showed typical plasmacytosis and we suggest that this be done just as in cases of Burkitt's lymphoma.