Medical education may be classified into 3 sectors viz, (a) basic medical education; (b) postgraduate medical education/Residency Training and (c) continuing professional development (CPD). There are challenges in establishing an ideal medical educational system that educates, develops and enhances the skills and competences of the medical practitioner from graduation till retirement. These challenges are reviewed and it is concluded that the challenges facing medical education emanates from new advances in science and technology, the needs of the society and the influence of the medical profession.

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Introduction: The Nigerian National Health Insurance scheme (NHIS) is planned to attract more resources to the health care sector and improve the level of access and utilization of healthcare services. It is also intended to protect people from the catastrophic financial implications of illnesses. However, whether it will work in practice and whether the present model of the NHIS is appropriate is also a matter of diverse opinions. This article amongst other things outlines the principles and models of health insurance and then examines the equity implications of the NHIS. Methods: A literature review of the principles and models of health insurance and a critical examination of the National Health Insurance Scheme and Community Based Health Insurance (CBHI) were carried out. Grey literature (conference papers, technical reports, dissertations, etc), journal articles, abstracts, relevant books and internet articles were reviewed.The review covered the period 1986 to 2010. The search words used were insurance, health insurance, health insurance models, principles of health insurance, market failure, community based health insurance, Nigerian national health insurance scheme. Results: There are many forms of insurance schemes ranging from Social (compulsory) health insurance to Private (voluntary) health insurance, and both have many different sub-versions. In addition, they all have different modes of operation. These models of health insurance as well as the strengths, weaknesses, opportunities and threats of the NHIS and CBHI are outlined. Conclusion: For any social health insurance scheme to offer full coverage of its citizens the government should not focus on only one type of health insurance scheme. A comprehensive benefit package is needed and thedisconnect between the three tiers of government should be addressed. The different tiers of government should be encouraged to buy into the scheme and avenues for funding through general taxation, donor financing etc should be explored in Nigeria.

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Objective: To ascertain the child gender preferences in an urban and rural community in Enugu State. Materials and Methods: A multistage sampling method was employed to select 245 urban and 243 rural women from households in Enugu State, Eastern Nigeria. A structured questionnaire was used to ascertain child gender preferences in an urban and a rural area. Results: Significant son preference was found in both the urban and rural areas where 74.7 % and 71.6 % of women would prefer to have a male child if they could have only one child(X²=43.835). Considering having many children however a balanced preference more prevalent in the urban area (56.7%) than in the rural area (27.2%) was found. As many as 92.3 % and 84.2 % of the women in the urban area and rural areas with four living males had completed their families compared with 25% and 83.3 % of those with four living females. Conclusion: Son preference exists in the rural and urban community in Enugu State however a balanced preference is also common especially in the urban area. Recommendation: Family education especially on gender equality and sensitivity was recommended.

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Background: Poor posture when maintained for a long period can result in musculoskeletal injuries and deformities. Aims: This study aimed at investigating the knowledge of work ergonomics among bank workers, and the ergonomic compliance of office furniture used in some banks, in Enugu metropolis. Methods: This is a cross-sectional study. 160 tables and computer tables and 180 low back chairs were assesses for their compliance with ergonomic standard while, 300 bank workers were interviewed on their knowledge of work ergonomics using an ergonomic measurement guide. Only low back chairs with arm rest were assessed. The measurements taken include monitor height, keyboard height, seat height (using tape rule) and seat back angle (using goniometer).The seats were also assessed for availability of back support at the lumber region. The data was analyzed descriptively. Results: The results showed that 35% of the monitor heights were normal, all the keyboard heights (100%) normal, all seat heights (low back chair) (100%) normal, 70% of seatback angle normal while, only 18.9% of seats had lumbar support. The knowledge of the bank workers on the work ergonomics showed that none (0%) of the workers knew about the ideal heights of monitor, keyboard, seat, seat back angle, need for lumbar support on seat, the eye distance from monitor and arm angle while operating computer. Only 5% of the workers knew the ideal ergonomic posture. Conclusion: The ergonomic compliance of the office furniture was not optimal while, the ergonomic knowledge of the bank workers was very poor.

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It is proper that as we celebrate 50 years Independence for our beloved nation Nigeria that we also pause to reflect on the state of our children these past fifty years. It is also proper that those who actively witnessed the state of the children these past fifty years volunteer to lead reflections on the state of Nigerian children. I am deeply grateful for being invited to bear this witness. Having said that, let me quickly say that the task is enormous and one has to be imaginative, selective and indeed perspectivistic and even personal to even scratch the surface of the topic in so short a time.

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Objective: To evaluate the maternal and perinatal outcome in patients with Eclampsia at Nnamdi-Azikiwe-University-Teaching-Hospital (NAUTH), Nnewi, Nigeria. Method: A retrospective study of cases of Eclampsia managed at NAUTH over a ten year period — 1^st January, 2000 to 31^st December, 2009. Maternal outcome was measured in terms of complications and maternal death. Foetal outcome was assessed in terms of low birth weight, pre-term births, low apgar score, and perinatal deaths. Results: There were 57 cases of Eclampsia out of a total of 6,262 deliveries within the study period, giving a prevalence of 0.91%. Majority, 71.7%, had Caesarean-section. There were 17.4% maternal deaths mainly from pulmonary oedema, 6 (13.0%), acute renal failure, 4 (8.7%), and coagulopathy, 3 (6.5%). Perinatal deaths were 25.5% as a result of prematurity, 42 (82.4%), and low birth weight, 36 (70.6%). Twenty one (41.2%) of the new born had Apgar score of less than seven at five minutes while 13.0% were severely asphyxiated. Conclusion: Eclampsia was associated with high maternal and perinatal morbidity and mortality in this study. There is need to review existing protocol on Eclampsia management with emphasis on appropriate health education of pregnant mothers, good antenatal care, early diagnosis of pre-eclampsia with prompt treatment.

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Background: The prevalence of hypertension is increasing globally, and is higher in black patients. In Nigeria the estimated prevalence is 17.6% and affects about 21 million people. End organ damage associated with hypertension is more prevalent and more severe in black patients. Adequate control of blood pressure reduces and sometimes prevents the development of end organ damage associated with hypertension. The use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in addition to control of blood pressure delays the development of end organ damage associated with hypertension. This study was undertaken to investigate the efficacy and safety of telmisartan as monotherapy in Nigerian black patients with mild to moderate hypertension. Methods: Adult patients (18 years and above) of both sexes, who were newly diagnosed with mild to moderate hypertension were studied. Results: There was significant reduction in both systolic and diastolic blood pressures at 4 weeks (9 mmHg and 3 mmHg respectively, p < 0.006), and at 12 weeks (7 mmHg and 6 mmHg respectively, p < 0.016). However only 6 out of 19 (32%) patients who completed the study achieved target blood pressure of ≤ 140/90 mmHg (complete responders). At the end of the study there were 10 (53%) systolic responders (Systolic BP <140 mmHg or ≥ 10 mmHg reduction from baseline), and 11 (58%) diastolic responders (Diastolic BP < 90 mmHg or ≥ 10 mmHg reduction from baseline. Majority of the patients required 80 mg telmisartan for significant blood pressure reduction. There were no significant side effects of the drug recorded in this study. Conclusion: It is concluded from this study that telmisartan monotherapy significantly lowers both the systolic and diastolic blood pressures in mild to moderate hypertension in Nigerian black patients. However only about a third of the patient studied achieved target blood pressure of ≤140/90 mmHg with telmisartan monotherapy. Furthermore up to 80% of the patients require 80 mg daily because 40 mg did not control the blood pressure. Telmisartan is safe in Nigerian black patients.

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Background: The Nigerian public health sector, over the years, has been characterised by inadequate funding causing decay in human, material, and services infrastructure. These along with the payment of user-fees have rendered the public health facilities unattractive and therefore poorly patronized by the people. The introduction of the government-community healthcare co-financing scheme in Anambra State of southeastern Nigeria provided additional funds to improve the quality of public health services in the State. The effect of this scheme on the human and material characteristics of primary health care facilities in the State is examined. Methods: The is a descriptive, comparative study of two health centres, one of which had intervention under the State Government-Community health care co-financing scheme. Findings: Physical infrastructure, equipments, drugs and consumables, together with the number and cadre of health providers all showed significant improvement at the intervention health centre following the introduction of the scheme, and also when compared with the control health centre. The result is a significant improvement in the overall utilization of services at the intervention health centre. Conclusions: Community based health insurance, will increase the human and material resources necessary to improve the quality of health care delivery in the community, encourage the utilization of public health facilities within the community and ultimately ensure an overall improvement of health care delivery in the State.

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Objectives: The aim of this study was to evaluate the presence of complications amongst 174 patients that had mandibular fractures and were treated by closed reduction at the University of Calabar Teaching Hospital, Calabar south-south Nigeria. Methods: We carried out a prospective study of 174 patients with mandibular fracture treated by closed reduction technique at the University of Calabar Teaching Hospital, Calabar Nigeria over a 4-year period. The focus was on the complications developed during and after the treatments Results: Of the 174 patients, 36 (20.7%) developed various forms of complications. Amongst the 36 patients, there were 53 different complications. The commonest complication recorded was infection 14 (26.4%) while the least was facial asymmetry and nonunion. According to the duration of onset, more complications were recorded under the intermediate than immediate and late categories. Complications were more common in the third decade of life, but least in the 7^th decade. There were 29 (80.6%) males and 7(19.4%) females with a male to female ratio of 4.1:1. Conclusion: Socioeconomic problems, treatments by quacks and wrong management of patients have been responsible for the occurrence of complications following mandibular fracture. However, the trend of occurrence of complications of mandibular fracture needs comparative analysis with a similar study carried out in the same environment to make a significant conclusion. This result of this study is therefore a baseline report on, which future studies are expected to use as reference point to determine the trends of occurrence in our environment.

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Background: To evaluate the relative frequencies and stage at presentation of the various types of female genital cancers in Enugu and to compare that with other centres both within and outside Nigeria. Methods: This is a retrospective study covering a period of five years from 2005 - 2009. Data on female genital cancers were collected from patients' case notes from the gynaecology ward of University of Nigeria Teaching Hospital Enugu, the cancer registry and histopathology records from morbid anatomy department. The data were analysed using SPSS version 11 Statistical programme. Results: Relative frequency of the female genital tumours shows that cancer of the uterine cervix was the commonest with 77(65.8%). This was followed by ovarian cancer contributing 19(16.2%) , uterine cancer accounted for 15(12.8%), vulval (4.3%) and vaginal cancers(0.9%). The highest parity rate was amongst the women with cervical cancer. Fifty (65%) of the cervical cancer patients were grandmultiparous, 71.4% of cervical cancer patients presented at advanced stage (stages III and IV) while 82% of ovarian cancer patients presented at advanced stages. Conclusion: Cervical cancer is the most common gynaecological cancer seen in University of Nigeria Teaching Hospital and most of them present in advanced stage of the disease with poor outcome. This is worrisome knowing that cancer of the uterine cervix is to some extent potentially preventable and can be diagnosed early with effective screening. There is need to create policies aimed at mandatory and free cervical cancer screening of every sexually active woman from 25years and above.

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Surgical instruments left in the human body after procedures are not uncommon. In this report, we describe the case of surgical gauze left in the abdominal cavity, most probably in the urinary bladder producing massive haematuria 13 years after. This occurred after the patient had received a combination cytotoxic chemotherapy including cyclophosphamide for advanced phase chronic myeloid leukemia. The haematuria was initially assumed to be due to metabolites of cyclophosphamide until gauze was noticed protruding out of her urethra. Following careful removal of the gauze and bladder washout with evacuation of the clots, the haematuria subsequently stopped. This report reinforces the need for surgeons to be extremely vigilant and to be sure that surgical instruments/gauzes used are complete after procedures. It also highlights the need for proper history taking and adequate evaluation of patients.

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