Background: Daunting pressure of delivering needed healthcare with limited financial resources, in the face of increasing costs and poor health indices, led the Nigerian government to establish the National Health Insurance Scheme (NHIS). Notwithstanding, public sector participants who fall under the scheme' s Formal Sector Social Health Insurance Programme (FSSHIP), continue to have misconceptions about the programme. Objective: This study assessed client's knowledge, pattern of utilization, patient's satisfaction with the services and perceived barriers to implementation, of the NHIS among staff of a tertiary health institution in South-East Nigeria. Methods: A cross sectional quantitative design was adopted. Three hundred and eighty (380) enrollees insured for more than one year were recruited using a two stage sampling method. Data collection was by means of a validated questionnaire. Data analysis was achieved with Statistical Programme for Social Sciences version (SPSS) 16 using descriptive statistics and logistic regression. Results: While the rate of monthly utilization is high (35%), majority of the respondents (77.4%) were dissatisfied with the services provided under the scheme. The rate of utilization is influenced by sex (p < 0.05) and salary/income level (p < 0.05). Client's knowledge of various aspects of the health insurance scheme and its operations was low. Educational status (p < .05) positively influenced client's satisfaction. The barriers to implementation were diverse and included difficulties in obtaining referral code and medicines out-of-stock syndrome. Conclusion: It is essential to eliminate observed and perceived, bottlenecks impeding effectiveness and efficiency of the programme. Hence, there is need for periodic review of the scheme by government to accommodate legitimate concerns of the consumer

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Background: There is increasing variation in the incidence and distribution of gynaecological cancers. Thus, a study on its trend will help policy makers in appreciating its burden as well as in allocation of the scarce resources. Objective: To determine the trend and pattern of gynecological cancers at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria. Methods: A 10 year retrospective review of case notes of all gynecological malignancies seen in the hospital within the study period. Results: Cervical cancer is the most frequent occurring 57.3% (n=470), followed by Ovarian cancer 20.9 % (n=171) and endometrial cancer 11.8% (n=97). There is a slight reduction in the incidence of cervical cancer over the study period and also when compared with previous studies from the study center. There is increasing incidence of endometrial and vulval cancers while choriocacinoma and ovarian cancers showed a downward trend. Conclusion: Cervical is the most common gynecological cancer in Enugu, Nigeria, however the incidence is currently showing a downward trend. The incidences of endometrial and vulval cancers are on the increase. More efforts and resources are needed in the fight against cervical cancer and other gynaecological malignancies in Nigeria.

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Background: Cytomegalovirus (CMV), a member of the herpes virus family is a known cause of intrauterine infections with attendant sequelae on the newborn. Symptomatic CMV is grossly underdiagnosed and rarely reported in Nigeria and elsewhere. A.O was a 6-week old male with features suggestive of severe CMV infection that was misdiagnosed and managed for bacterial sepsis in another hospital without improvement necessitating referral to our facility. He had generalised “blueberry muffin” skin rashes from birth, respiratory distress, pyrexia,recurrent anemia, severe jaundice with massive hepatosplenomegaly; in addition to symptoms of central nervous system involvement. Serological tests and polymerase chain reaction were positive for Cytomegalovirus. He received intravenous and oral ganciclovir, blood transfusions and intravenous antibiotics for anaemia and bacteria sepsis with satisfactory outcome. This case highlights the need for high index of suspicion, and prompt appropriate intervention in order to minimize morbidity and improve outcome in cases of congenital CMV infection.

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Background: As much as 10 million children die annually from easily preventable causes especially in resource poor countries of sub Saharan Africa. In2016, Nigeria had an U5MR of 104/1,000 live births despite the childhood survival strategies and policies in the past 2 decades. Aim: The aim of this study was to audit the pattern and causes of mortality in children seen at Federal Teaching Hospital, Abakaliki (FETHA). Methods: This was a retrospective cross-sectional study conducted at the Paediatric ward of FETHA over a five year period from January 2013 to December 2017. Case files of all children aged one month to 18 years who died during admission into the paediatric ward were retrieved from the hospital's medical record department and reviewed. Data collected were entered into the data editor of SPSS software package version 20 (IBM SPSS).Descriptive statistics was used todetermine the frequency of cause-specific deaths. Results were presented as percentages, proportions in charts and tables. Results: A total of 2,911 children were admitted into the paediatric ward within the study period. Of this number, 126 died giving a mortality rate of 4.3% and a male: female ratio of 1.29:1.00. Majority (79.3%) of the mortality occurred in the under-five children with over 80% presenting with fever and approximately 72% hospitalised for over 48hours. Sepsis and malaria were commonest causes of death. Conclusion: Mortality rate was high in this study especially among the under-5 children and sepsis and malaria were the commonest causes.

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Background: Symptoms of anxiety disorders vary widely among physically ill patients. Early detection and treatment of anxiety will reduce the economic burden of common medical disorders and provide empirical data for public health educators and policy makers for the development of guidelines for health workers and care givers. Objectives: The objective of the present study was to determine the correlates and predictors of anxiety symptoms based on the Hospital anxiety and depression scores among patients attending medical outpatient clinic in a Tertiary hospital in Enugu South East Nigeria. Methods: This was a cross sectional study conducted at the Medical Outpatient Clinic of Enugu State University Teaching Hospital, Enugu Nigeria. All consecutive consenting patients were recruited. Anxiety symptoms were explored using the Hospital Anxiety Depression Scale. Study duration was 6 months. Statistical analyses were one using SPSS version 22. Results: A total of 512 (males 190(37.1%), females 322 (62.9%)) individuals were recruited. Significant anxiety symptoms (≥ 8) was reported by 16(3.1%) patients; similar in males and females. P=0.51. Anxiety symptoms, negatively correlated with age (r=-0.14, p< 0.01) and positively with use of alternative/herbal medication (r=0.16, p < 0.001), having arthritis (r=0.11, p=0.01), stroke, (r=0.09, p=0.04), chronic headache r=0.11, p=0.01 and peptic ulcer disease (r=0.09, p=0.04). Younger age was a significant predictor of anxiety scores. p=0.03. Conclusion: Several modifiable and non-modifiable factors correlate with anxiety symptoms among out patients in Enugu. There is need to involve mental health practitioners in the education and care of medical outpatients.

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Background: Conventional Galactography is a simple procedure and a cheap tool in evaluating suspicious nipple discharge(SND). It accurately demonstrates the intraductal lesion for confident diagnosis and timely intervention. SND, a common symptom, occurs spontaneously and unilaterally from a single duct. Cancer has been found in some patients with SND. Objective: To examine radiologists' knowledge and practice of galactography in the evaluation of SND and determine if training in performing galactography existed. Methods: A Standardized structured questionnaire with 16 questions was served to radiologists in centres around Nigeria. Descriptive and inferential statistics were done where indicated with SPSS Version 20 (IBM Corp., Armonk NY, USA) and significance levels were set at p<0.05. Results: 58 (64.4%) out of 90 questionnaires were returned. 58% had been in practice for between 11-20 years. 98% worked in departments where breast imaging was available. 26.8% of radiologists reported handling over 10 breast cases/week and SND was reported as a common complaint. Only 8% listed galactography among their department's protocol for managing SND and just 10.5% of respondents had received training to perform it. Only 31% had ever done the procedure. Of those who had performed it, 83% attested that it helped in resolving the cause of the SND. Conclusion: In a resource-poor environment like ours where breast cancer is common and late presentation is the rule, galactography being a cheap tool, it stands to reason that radiologists should widely recommend and use it for early diagnosis. This however does not appear to be the case.

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Background: Hydrocephalus, a common indication for paediatric neuro-imaging, results from any disorder in the formation, circulation and absorption of cerebrospinal fluid. Serious neurological sequelae often result if neglected.Computed Tomography (CT) plays a vital role in revealing the various aetiologies of hydrocephalus in order to guide intervention. Objectives: To retrospectively assess the spectrum of CT findings in children with clinical features of hydrocephalus referred to the CT suite of a tertiary hospital in South-East Nigeria for radiodiagnosis and compare with findings in existing literature Materials and Methods: We evaluated 80children- 32 females and 48 males- over a period of one year. Included also in this study were children with clinical features of hydrocephalus who presented with other findings such as delayed developmental milestones and congenital neural tube defects. Results: The age range was 0.01 to 14 years, a mean of 2.23 years. 56.3% of the cases had CT features consistent with obstructive hydrocephalus- ventriculomegaly proximal to the site of obstruction with normal-sized ventricles distal to the obstruction). The communicating subtype, hydranencephaly and Benign External Hydrocephalus were seen in 36.25%, 6.2% and 1.25% respectively. The level of predilection for ventricular obstruction was the Aqueduct of Sylvius in 75.6%. Secondary causes were demonstrable in 10 of the children with aqueductal stenosis (AS) while 24 had no evident secondary cause. Congenital AS occurred more in males- 17, as against 7 females; however, there was no significant correlation between gender and predisposition for AS (P= 0.546). Conclusion: This study demonstrates the positive yield of computed tomography in the diagnosis of hydrocephalus in children albeit the downside of exposure to ionizing radiation

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Background: Posterior slope of the tibia (PTS) is the posterior-inferior inclination of the tibia plateau relative to the longitudinal axis of the tibia. This slope plays a role in the biomechanics and kinematics of the knee. Aim: The study aims to determine the normal Posterior Tibia Slope Angle (PTSA) in adult Igbos of South East Nigeria population and also identify any laterality and/or correlation of the angle with gender and age. Methods: Normal lateral radiographs of Two Hundred and Sixty Five (265) skeletal matured patients were included in the study. The PTS measurement was done using the Anterior Tibial Cortex method. A two way analysis of variance was conducted on the influence of two independent variables (age, gender) on the PTS measured for the right knee as well as the left knee. Results: The mean normal PTS of the study population was 11.9 ± 3.40. It had no significant association with participants' age or gender (P > 0.05). There was a weak positive correlation between the left and right knee's PTSA (r = 0.33). Conclusion: The mean normal PTSA in adult Igbos of South East Nigeria population is 11.9 ± 3.40. There is no laterality, gender dimorphism or correlation of the angle with gender and age.

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Abstract: Genu recurvatum congenitum (GRC) is a Greek phrase that literally translates to 'backward-bending of the knee that is noticed at birth'. It is a rare condition of unknown aetiology resulting in exaggerated knee hyperextension and marked limitation of flexion. GRC may be unilateral or bilateral. It may occur in isolation or associated with other anomalies such as congenital hip dislocation (CDH) or congenital talipes equinovarus deformity (CTEVD). Though rare, it is easy to diagnose and treatment commonly involves gentle manipulation and serial casting, especially if presentation is early. Unfortunately, late presentation or refusal of treatment is the case in resourcepoor countries such as Nigeria, due mainly to financial constraints and traditional beliefs. We present this rare case of a bilateral GRC in a day old Nigerian female neonate and also highlight the challenges in the management in a resource-poor country

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Background: Anxiety and depression commonly co-exist, and as a consequence entails greater suffering, low quality of life and poor foetal outcome. Not many studies have determined the rate of co-occurrence of anxiety/depression, and the associated risk factors in pregnancy. Methods: It was a cross sectional study of 200 consecutive attendees of antenatal clinic of a tertiary hospital using Sociodemographic, Obstetric questionnaires, Hospital Anxiety Depression Scale, Index of Marital Satisfaction, Big Five Personality Inventory, Brief Coping Scale and Oslo-3 Social Support Scale. Data collected were analyzed with Chi-square and Pearson's correlation and multiple regression tests. Results: Thirty-five (17.5%) out of two hundred participants had anxiety, 21/200 (10.5%) were depressed, while 9/200 (4.5%) were both depressed and anxious. Poor social support was predictive for depression (P=0.03, CI=-.43 to -.02). Poor marital satisfaction (P< 0.001, CI=.04 to .10), neuroticism personality trait (P< 001, CI=.08 to .28) were predictive for both depression and anxiety. Use of problem-based and emotion-based coping skills, positively correlated with having anxiety symptoms (r=0.150, P=0.03; r=0.159, P=0.02 respectively). No association was found between anxiety/depression and parity, unemployment, gestational age, past obstetrics and gynaecology history. Conclusion: Clinicians should evaluate patients further when anxiety or depression is detected in pregnancy. The importance of good interpersonal relationship in the family, extended family and next-door neighbours should be emphasised.

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Background: Vascular thrombotic events complicates uncontrolled type 2 Diabetes Mellitus (T2DM). Antiphospholipid antibodies can cause vascular thrombosis. These present a “double hit” of thrombotic events in T2DM. They also affect disease management and prognosis. Aim: To check serum levels of lupus anti-coagulant (LA) and immunoglobulin Beta - 2 - glycoprotein-1- anticardiolipin antibodies (IgG-B2GPI ACA) in Type 2 DM patients. Methods: This was a cross-sectional analytical study. We recruited 140 Type 2 DM patients and 70 healthy control subjects. The study centre was the diabetic clinic at University of Nigeria Teaching hospital. Assays for serum levels of LA and IgGβ2GPI-ACA in the subjectsweredone. UNTH's institutional ethics committee IEC approved the study. Results: Prevalence of LA in complicated, uncomplicated T2DM and healthy control subjects were 7.1%, 4.3%,43%. The prevalence of IgG-β2GP1-ACA was 4.3% for all the groups. The risk ratio of developing LA & IgG-B2GPI ACA in uncomplicated T2DM patients were 1.3 (95% CI: 0.37- 4.9) and 1.0 (95% CI, 0.20 - 4.78). The RR of complicated T2DM developing LA & IgG-B2GPI ACA 1.67(95% CI: 0.4-6.7) and 1.72 (95% CI: 0.39-7.48). Correlation analysis of LA, IgG-B2GPI-ACA and the presence of vascular complications in T2DM was not significant. P>0.05. Conclusion: There is no causal relationship between APLS antibodies levels and vascular complications in T2DM.

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Background: Information on perception and practice of blood donation among potential donors may help in designing policies for improving services in low income countries. Aim: This study was done to assess the knowledge, attitude and practice of blood donation among medical students in Nigeria. Methods: A descriptive cross sectional study was carried out at two medical schools among different classes in south eastern Nigeria. Socio-demographic characteristics, knowledge, attitude and practice of blood donation of the respondents were sought using a validated questionnaire. Data was analyzed using SPSS version 21 Inc Chicago Illinois, p value of less than 0.05 was considered statistically significant. Results: The age ranged between 19 to 46 (24.2± 3.2) years with 43.7% (n=169) respondents having good knowledge, 47.8% (n=181) corresponding to average knowledge, and 37(9.6%) having poor knowledge of blood donation. There was a strong association between level of knowledge and respondents' year of study (p = 0.001) but no significant association was observed between level of knowledge and practice of blood donation (p = 0.23). The blood donation rate was 31.0%.Whereas about a 40% (10.3%) of blood donors were regular blood donors, 69% had never donated blood. Majority of both the donors (85%) and non-donors (92.1%) opined that blood donation should be voluntary and non-remunerated. Conclusion: Nigerian medical students have reasonable knowledge of blood donation. Their attitude toward blood donation is quite favorable. Policy makers in the health sector can utilize this interesting observation in designing strategies for improving the quantity as well as quality of blood donation in Nigeria.

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Background: Viral hepatitis remain a serious public health issue globally especially in the developing world where occupational health and safety regulations are not properly implemented. Barbers in view of the instruments they use daily and the poor knowledge and practice of occupational health and safety measures are at an increased risk for blood borne diseases like hepatitis B and C. Objectives: To determine the knowledge, attitude and practice of HBV and HCV infections and sterilisation processes among barbers in Sabon Gari LGA, Kaduna state. Methods: It was a cross sectional descriptive study carried out among barbers.Respondents were selected using systematic sampling technique. A pretested interviewer administered questionnaire was used to collect the information from 109 respondents.Knowledge was assessed on a 12 point scale; as poor (0-5), fair (6-8) and good (9-12). Statistical Analysis: Data was analysed using SPSS version 21.Categorical variables were summarized using frequencies and proportions. Chi-square and Fisher's exact test were applied for the comparison of proportions; with level of significance set at p<0.05. Results: The study showed that most of the respondents had low level of knowledge regarding the modes of transmission, complications and treatment of hepatitis. There was a statistically significant relationship between level of education and knowledge of hepatitis B and C (P< 0.0001). The attitude of barbers towards preventing the spread of hepatitis B and C carrying out the work (via disinfection and sterilisation) was good. There was a statistically significantrelationship between the practice of sterilisation and the educational level of the barbers (P=0.000001). Conclusion: The poor knowledge and practice scores shown in this study highlight the need to raise awareness on these diseases and ensure compliance with proper preventive practices.

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