Aim: To determine the knowledge of certain University of Nigeria Teaching Hospital, (UNTH) staff about ARI case management and the impact of ARI case management training on their knowledge. Materials and Methods: This was done during two three-day training courses, which were based on the National Acute Respiratory Infections Programme (NARIP) adaptation of the WHO standard case management module. Pre- and post- (training) tests were done and were marked by the same person. Results: The general mean±S.D pre- and post-test scores were 38.68± 10.22% and 73.44±18.35% respectively (P<0.001). However, there were obvious differences between the groups. Conclusion: This study highlights the deficiency in the knowledge of some of the staff, the need for further staff training and the potential impact of case management training on health workers' knowledge.

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Gastric leiomyosarcoma, a rare malignant tumour, is usually not diagnosed pre-operatively. Even at operation, the correct diagnosis is often missed. Thus, the intimidating presence of a left hypochondrial mass in a middle aged Yoruba soldier mimicked tropical splenomegaly syndrome. This was unmasked at laparotomy, which exposed a giant gastric growth that was subjected to wide surgical excision. Thereafter, histological examination revealed the presence of leiomyosarcoma. Therefore, the case is documented here on account of its rarity, the mimicry of splenomegaly and survival for over 2 years.

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Objective: To examine the knowledge, attitude and practice of adoption among unmarried adolescent expectant mothers. Method: A questionnaire survey of unmarried adolescent expectant mothers seen during antenatal booking within a 2-year period. Results: A total of one hundred and thirty (65.7%) adolescent mothers have heard of adoption but only seventy (35.4%) knew the correct meaning. The more educated patients had better knowledge of adoption. Twenty-three (11.6%) of the adolescents chose the option of adoption and the educational status did not affect their choice. Lack of financial support, erroneous cultural belief and ignorance contributed to the attitude of these adolescents and their decision about adoption. Conclusion: Provision of financial, social and emotional support for the young adolescent mothers as well as public enlightenment on adoption as a better option to unsafe clandestine abortion and street abandonment of babies should be embarked upon rigorously in our environment.

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Aim: To assess the efficacy of dexamethasone in relieving acute lower ureteric obstruction by carcinoma of prostate. Patients and Methods: Over a four year period, 23 patients who presented with renal failure secondary to bilateral obstruction of the lower ureters by carcinoma of prostate, and with no significant bladder outlet obstruction, were treated, with dexamethasone for six weeks in addition to orchidectomy. The final outcome was retrospectively compared with that of 23 patients with similar condition managed in the unit within the past 15 years preceding the study, managed with only orchidectomy and no other specific treatment for carcinoma of the prostate or renal failure during the admission. Results: The 23 patients in the prospective study were aged between 58 and 82 years (mean 68 years). There was improvement in renal function in 21 patients within the first week of treatment, and this improvement was maintained in 20 of them even after discontinuation of dexamethasone therapy, and they survived for between 5 and 29 months (mean 15 months). One of the patients that initially responded, died 20 days after stopping the steroid therapy. In the remaining 2 patients, renal function rapidly deteriorated while on steroid therapy and they died 15 and 21 days respectively, after admission. In the retrospective study, six patients died within 10 days of admission and 17 survived for between 6 weeks and 9 months (mean 4.7 months). Conclusion: Dexamethasone in combination with orchidectomy seems to be more effective in the relief of acute obstructive nephropathy associated with lower ureteric obstruction by carcinoma of prostate than orchidectomy alone. It obviates the necessity for urinary diversion in such acutely ill patients.

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Camphor (Naphthalene) gastrointestinal poisoning is an unusual toxicity. A 39-year-old Nigerian male patient is hereby presented with camphor poisoning. The case is presented for purposes of documentation since it is an unusual occurrence in this environment.

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Aim: To establish the relationship between packed cell volume (PCV), fasting plasma glucose (FPG) and malaria parasite counts (PC), sex and age of children, living in a malaria endemic area. Materials and Methods: Sixty four (64) untreated malaria patients, aged 0-9 years and 40 age-matched apparently healthy children brought for haemoglobin genotyping in UNTH Enugu were studied. FPG was estimated by the glucose oxidase method while PC was done by the thick blood film stained by the Giemsa method. Results: Mean PCV of patients, 32% (19-43) differed significantly (<0.05) from that of control, 39% (36-45). This was not the case with the mean FPG of patients 4.9 (3.8-6.3) and control, 5.0 (4.8-6.3) mmol/L (P>0.05). Female patients had significantly higher mean PC than their male counterparts, 8.4 and 7.1 × 10³/ml blood respectively (P<0.05). There were no sex differences in PCV and FPG. PC, (range 1,760-18,630/ul blood) did not correlate significantly with either PCV or FPG. Highest PC were recorded for the age range 1-5 years. Conclusions: The parasitaemia encountered affected the PCV but not the FPG. The sex difference in PC deserves further investigations with a larger number of samples.

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Aim: To evaluate our experience with Norplant implant in UNTH Enugu. Materials and Methods: This retrospective study was carried out between January 1992 and December 1997. During this period, 3615 new clients accepted various contraceptive methods at UNTH Enugu. Two hundred and four of these chose Norplant. One hundred and ninety cases with complete records were analysed with respect to age, parity, educational status, complications associated with insertion and removal of norplant, side effects and reasons for removal of implants, duration of use before removal and failure of method. Results: Completed family size (50.5%) was the commonest reason for seeking family planning and majority of the clients were grand-multiparous women (67.9%). The mean age and parity were 31.7 years and 5.5 respectively. Formal education was recorded in 73.1% and health workers were the commonest source of information about norplant (58.9%). Complications occured in 4.7% of cases and consisted of post-insertion pain, infection, and dermatitis. Menstrual disturbances are the commonest side effects with menorrhagia being the most frequent reason for discontinuation. One client got pregnant with the Norplant in situ giving a failure rate of 0.5% Conclusion: Narplant implant system has come to stay as an effective, low risk hormonal contraceptive. Increasing cost and non-availability may hinder further progress in norplant acceptance.

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Aim: To identify clinical parameters other than respiratory rate which are simple and equally predictive of pneumonia in under five children. Patients and Method: One hundred and one children with respiratory symptoms ≤ 28 days were studied. Detailed history, physical examination and chest radiography were done on each child. Data was analyzed using the EPI-INFO version 5 software. Results: A combination of history of difficult breathing and/or observation of chest in-drawing was the best predictor of pneumonia in all age groups studied (75% sensitivity, 80% positive predictive value). Conclusion: We suggest that the current WHO guideline on the use of respiratory rate to predict pneumonia be expanded to include history of difficult breathing and/or observation of chest in-drawing as major criteria for predicting pneumonia in under five children.

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Aim and Objective: To assess the knowledge, attitude and practice of Enugu female medical doctors and nurses to cancer screening. Materials and Methods: A cross-sectional study of 156 female doctors and nurses was carried out at the University of Nigeria Teaching Hospital making use of a self-administered structured questionnaire. Results: The ages of the respondents ranged from 20 to 59 years (mean = 36.4 with standard deviation 9.7). One hundred and fifty three (98.1%) were aware of cancer screening and 87.2% had correct knowledge of cancers routinely screened for in women. Professional training was the commonest source of information. Regular cancer screening was considered essential by 64.1% of the respondents; 20(12.8%) had ever practiced cancer self-screening. Five (3.2%) had undergone self-screening in the previous year. Professional training, marital status, advancing age and long service in the teaching hospital significantly improved the conduct of cancer self-screening. Conclusion: As the prevalence of the practice of cancer self-screening by female doctors and nurses at UNTH Enugu was very low, retraining, mobilization and persistent counseling through a well-articulated and funded National Cancer Control Programme, are suggested.

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Aims and Objectives: To assess the influence of maternal hygiene practices, educational level and socio-economic status on the occurrence of childhood diarrhoea in Enugu. Materials and Methods: A cross-sectional study of 364 women who brought their children for routine immunization to 4 health institutions in Enugu, was carried out with the help of a self-administered structured questionnaire and guided oral interviews. Results: The ages of the subjects ranged from 17 to 40 years (mean = 26.9 years with standard deviation 4.6). Sixty-seven children aged below 5 years of the 364 women had at least one episode of diarrhoea in the last 24 hours, given a prevalence of 18.4%. More episodes of diarrhoea (20.3%) were recorded in children whose mothers irregularly washed their hands before preparing food, compared with those whose mothers always did so (18.9%). The rate of diarrhoea was also higher (19.5%) in the children of mothers that did not always wash their hands after going to the toilet, compared with those who regularly did so (18.3%). The highest rate of diarrhoea (25.0%) was recorded in children whose mothers had no formal education while the least rate (16.3%) was observed in those whose mothers attained post-secondary education. More cases of diarrhoea (19.5%) were also noted in children of low socio-economic class compared with the others. Conclusion: Health education interventions and mass literacy campaigns are advocated in order to improve maternal hygiene behaviour.

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Aim: To highlight the health hazards associated with ingestion of the readily available but relatively worthless Nigerian coin by children. Methods: Medical records of cases of impacted oesophageal foreign bodies occurring in childhood over a seven year period were retrospectively analysed. Results: The Nigerian coins were implicated in 14 cases. In 57.2% retention occurred at the upper third of the oesophagus while the middle was affected in 6 (42.8%) cases. Mean (±SEM) age was 4.60±0.60 years while the modal age bracket was 3.0-6.0 years. About 60.0% of those affected were males. Removal of coins was achieved in 13 (92.9%) children through oesophagoscopy while case fatality rate was 14.3%. Mean hospital stay, post-op, was 14.4 ± 9.9 days. Conclusions: As a result of the health hazards, prohibitive cost of care for such patients, unwarranted disruption in the social life of the family of the affected child vis a vis the relative economic worthlessness of the Nigerian coin today, it is suggested that they be withdrawn from circulation.

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Aim: To analyse the resesults of clinical pelvimetry in relation to labour outcome so as to determine the ability of clinical pelvimetry to predict insurmountable disproportion. Patients and Methods: A retrospective analysis of the results of clinical pelvimetry in relation to labour outcome in 209 primigravidea at the University of Nigeria Teaching Hospital, Enugu, Nigeria was undertaken. A positive test was defined as any case with borderline or contracted pelvis. Results: A significantly greater proportipn of those with a positive result underwent caesarean section than those with a negative result. Despite this, the sensitivity of clinical pelvimetry in identifying women with insurmountable disproportion was 34.1% with a specificity of 83.2%, a positive predictive value of 41.7% and a negative predictive value of 83.2%. The relative risk of undergoing caesarean section by those with borderline or contracted pelves was 3.36 times that of those with clinically normal pelves. Conclusion: In areas such as the developing countries where quick intervention is not normally feasible because of logistic reasons, clinical pelvimetry may forewarn of an increased risk of caesarean delivery so that early measures can be commenced to shorten the decision-intervention interval.

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Aim: To evaluate the clinical features and management of malignant tumors of the periampullary region at the University of Benin Teaching Hospital from January 1980 to December 1999. Methods: The case files of the patients were retrieved from the medical records library. All clinico-demographic data relating to age, sex, clinical symptoms and signs, investigations, operative findings and procedures and postoperative care were obtained. Additional information was obtained from the records of the ooperating theatres and surgical wards of the hospital. Results: A total of 36 patients were seen but the case files of 29 patients comprising 20 males and 9 females were available for study. Thirteen of these tumors were histologically confirmed adnocarcinoma of the pancreas. All of these patients had explorlatory laparotomy and various operative procedures were carried out in 24 patients. Five patients had only biopsy as by-pass procedures were not possible due to huge tumor mass. There was prompt relief of jaundice and pruritus in the immediate postoperative period in those patients that had by-pass procedures. The average survival was nine months. Conclusions: Periampullary tumors appear to be less common in our environment compared with Europe and North America. Although by-pass procedures resulted in prompt relief of symptoms, the disease was associated with high mortality.

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Objective: To determine the attitude of medical doctors in Enugu to the liberalization of the abortion law and the factors influencing this attitude. Method: A cross-sectional study of medical doctors in hospitals and clinics in Enugu urban was carried out. A self-administered, semi-structured questionnaire was used. The questionnaire covered biostatistical data, knowledge of the abortion law, attitude towards the liberalization of the abortion law and reasons for such attitude and the practice of induced abortion. Results: Up to 26.9% of the respondents supported the liberalization of the abortion law. Religious background, moral perception of abortion and previous practice of induced abortion significantly affected their attitude to the abortion law (P<0.05). The law had it's strongest advocates amongst gynaecologists and the least support amongst general surgeons. Conclusion: Religion and morality rather than medical consideration motivated the opposition of most medical doctors in Enugu to the liberalization of the abortion law. Morally and religiously acceptable methods of preventing unwanted pregnancies in order to reduce the complications of abortion are suggested.

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Background: There has been persistent report of increasing rate of chloroquine resistance in Plasmodium faciparum malaria in Nigeria. The present study is aimed at assessing the current level of chloroquine resistance among under five children in Ugwogo-Nike, Enugu East Local Government Area Enugu State. Materials and Methods: One hundred and five under-five children with microscopically confirmed falciparum malaria were given the standard oral chloroquine therapy (l0mg/kg days 1 and 2; 5mg/kg day 3). Using the 14-day WHO protocol, they were followed up. Results: Treatment failure was recorded in 33% of the cases, 20% of which were early treatment failure, the remaining 13% being late treatment failure. Conclusion: We conclude that the clinical efficacy of chloroquine as a first line therapy in this environment is low.

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Aim: To determine the rate of detection of depression in general outpatient clinic attenders by General Medical Practitioners (GPs). Methods: The study was carried out in the General Out Patient Clinic of the University of Nigeria Teaching Hospital, Enugu. The Zung self-rating Depression Scale (SDS) was used to screen the Patients for depressive symptoms. The diagnosis of depressive disorder was established via a clinical psychiatric interview given to a systematic sample of 80 patients scoring in the morbidity range of the SDS. Results: Out of a consecutive sample of 300 patients aged 18 years and above, 165 (55%) scored within the morbidity range of the SDS. Sixty percent (48) of the 80 patients subjected to clinical psychiatric interview met the ICD-10 criteria for depressive disorder Twenty five percent had other psychiatric diagnosis while fifteen percent had no psychiatric disorders. The GPs were able to recognize only twelve percent of those who scored within the morbidity range of the SDS as depressed. Sociodemographic characteristics neither differentiated low scorers from high scorers nor did they differentiate recognized depressed patients from unrecognized ones. Conclusions: There is the need to sensitise Gps to recognize and treat patients suffering from depressive disorder.

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Objective: To identify the symptoms and signs predictive of appendicitis in patients with abdominal pain. Materials and Methods: We present a case of acute abdomen in a 25-year-old male patient with symptoms suggestive of appendicitis. An evaluation of the operating characteristics of the most useful elements of the history and physical examination for the diagnosis of appendicitis, and a literature review of the predictive symptoms and signs of appendicitis, are presented. Results: The presence of a positive psoas sign, fever and migratory pain to the right iliac quadrant suggests an increased likelihood of appendicitis. Conversely, the presence of vomiting before abdominal pain makes appendicitis unlikely. The lack of the classical migration of pain, right lower quadrant pain, guarding or fever makes appendicitis less likely. Conclusion: A rapid and accurate clinical diagnosis must be made when the patient presents with a questionable acute appendicitis. Once the diagnosis is confirmed to a reasonable degree of certainty, surgical intervention is indicated.

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