Background and Objective: The Emergency Department is of significance and is the vital entry points of patients into the healthcare facility of the hospital all around the world. This study aims to assess the knowledge, attitude and practices of emergency personnel at two tertiary hospitals in Lagos as regards emergency management and preparedness. Aims: This study aims to assess the knowledge, attitude, and practices of emergency personnel at two tertiary hospitals in Lagos with regard to emergency management and preparedness. Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: A convenient recruitment was made of eligible and consenting individuals at both hospitals until the required sample size was reached. Statistical Analysis Used: The data obtained were analyzed using Epi Info statistical software version 3.5.1. Results: The majority (93.2%) of the participants were clinicians. It was discovered that less than half or 98 (47.8%) of the participants had good knowledge of emergency preparedness and planning, 76 (37.1%) had a fair knowledge, while 31 (15.1%) had poor knowledge. The respondents' attitude toward emergency preparedness was generally positive, as most of them, that is, 191 (93.2%) believed that they needed to know about emergency planning. Only a minority, that is, 72 (35.1%) of the respondents knew that emergency drills are done in their respective hospitals. Conclusions: There was an overall deficiency in the respondents' knowledge of emergency preparedness. Their attitude was good and acceptable, but their practices in terms of the frequency of emergency drills and the frequency of regularly updating the emergency plans were grossly inadequate.

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Background: Children with neurodevelopmental disorders (CNDs) are a group requiring more attention as their care is often challenging, particularly for parents with primary caregiving roles in resource-restricted settings. This study had set out to investigate the burden and psychological distress among caregivers of children with neurodevelopmental delays. Materials and Methods: A total of 68 caregivers were recruited during the 2013 annual autism health program organized by the College of Medicine, University of Lagos in collaboration with Guaranty Trust Bank, Nigeria and Blazing Trails, USA. Of these caregivers, 60 respondents (caregivers and children) were included in the final analyses due to poorly completed questionnaires. The Zarit Caregivers Burden Scale (ZCBS) and General Health Questionnaire version 12 (GHQ-12) were administered to elicit caregivers' experience with respect to burden and psychological distress, respectively. Results: Of the 60 participants included in the final analyses, the majority constituted parents (96.3%) with mothers accounting for 71.7%; 28 (46.7%) participants were government workers and 3 (5%) were full-time housewives. The mean age of CNDs was 6.8 (±3.2) years, and 33 (55.0%) were males. Delivery by cesarian section was reported in 19 (31.8%). The common presenting complaints by caregivers were inability to walk (32.7%), repetitive behavior (25.5%), difficulty with verbal communication (10.9%), nonsocialization (9.1%), seizures (9.1%), and hyperactivity (3.6%). Problems were noticed at ≤ 1 year in 46.7% while they were noticed after 2 years in more than half the children, and a little above one-eighth (14%) had siblings with similar problems. On the ZCBS, nine (15.0%) caregivers reported a significant burden. In addition, 23 (38.3%) caregivers had psychological distress. Caregivers' burden was significantly related to the report of psychological distress in caregivers (P < 0.001) and there was a trend toward the presence of psychological distress in almost all caregivers with children experiencing seizures. Conclusions: The findings in this study underscore the need for counseling and psychosocial support for caregivers of CNDs. Further research on the emotional experience of caregivers is also warranted.

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Background: There are pointers in existing literature to the stressful nature of residency program, thereby placing training physicians at increased risk of psychological distress. Objectives: The study identified perceived stress, its sources, training satisfaction, and the associated sociodemographic characteristics among resident doctors. Materials and Methods: A total of 405 self-administered questionnaires were given to all attendees of the National Postgraduate Medical College Revision Course. The questionnaires sought information on sociodemographic variables, sources of stress, and training satisfaction. Only 20 questionnaires were not returned. Data were collated and analyzed. Results: A majority of the respondents were male (69.1%), mostly between 31 and 35 years of age. Most (80%) of the respondents were married while 51.4% had over 4 dependents. All the respondents reported a significant level of stress, and different sources of stress were identified. Only 12 (3.1%) of the respondents were satisfied with the quality of training being received in their institutions. Conclusion: Our study found residency training to be stressful for doctors and often compounded by identifiable variables as shown in this study. Such stressful experience can, in turn, have negative impacts on their physical along with mental well-being and the patient care. Thus, there is a need for relevant stakeholders to review the structure of residency program with the view of addressing “modifiable risks” of stress among would-be specialists.

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Background: The mutagenic and teratogenic effects of chemotherapeutic agents from repeated exposure during care are well documented. Nurses are among the healthcare professionals who constantly handle these agents, therefore their knowledge and pattern of occupational safety is a concern. This study sought to determine knowledge of chemotherapy and occupational safety measures of nurses in oncology units in the University College hospital, Ibadan. Materials and Methods: A cross sectional descriptive study design, based on Protection Motivation theory was conducted among 100 purposively selected nurses from oncology unit of the hospital. Data were collected using a 54-item validated questionnaire. Descriptive and inferential statistics at 0.05 level of significance was used. Results: Respondents were within 35.4 ± 5.1 years. More than half of the respondents had over 3 years practice in the oncology unit (mean 2.62, ± 1.1). Knowledge of chemotherapy among the cohort was high; mean 13.9 ± 2.2, 70 % understood the use of gloves and gowns as part of safety guidelines. On handling patients' clothes, only 57% understood that such should not be washed by hand or with other clothes. Cumulatively, 79.2% of the respondents knew about the safety guidelines, 4.7% had no knowledge while 16.1% were not sure of the correct guidelines for administering chemotherapy. Respondents' level of education was significantly associated with knowledge of chemotherapy, P<0.05; practice score was also significantly associated with respondents' cadre; P<0.05. Conclusion: Periodic and consistent update of nurses' knowledge supported by policies to enforce guidelines implementation is recommended.

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Background: One of the components of health care for every woman of reproductive age is preconception care (PCC). The adoption of this care will assist the healthcare system to shift from the delivery of procedure-based acute care to the provision of counseling-based preventive care. Aims: The aim of this study is to determine the level of awareness, knowledge, and the practice of our women on PCC. Settings and Design: A descriptive cross-sectional study was carried out on 50 consenting pregnant women at the antenatal outpatient clinic. Subjects and Methods: All pregnant women who booked for antenatal care during the period of data collection were consecutively recruited through convenient sampling technique. Data were collected using pretested, semi-structured questionnaires to provide answers to the objectives of the study. Statistical Analysis Used: Data obtained were analyzed using SPSS software version 22 and expressed as frequency and percentages. The Chi-square was used to test for association with a value of P < 0.05 indicating statistical significance. Results: The mean age was 31.5 ± 3.8 years and majority (80%) had tertiary education. There is high level of awareness of PCC (76%); however, awareness of its practice in Nigeria is very low (34.2%). Only 34.2% had received PCC before index pregnancy. There is, therefore, a huge disconnection between their level of awareness and practice. Conclusions: There is the need to arm our women with detailed and accurate information on PCC, establish functional clinics with availability of evidence-based guidelines to improve uptake and pregnancy outcome.

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Background: Postoperative pain has a negative effect on the process of recovery. There is paucity of literature on the postoperative pain management practice in children in developing countries. We sought to determine the current practice of postoperative pain management in children among pediatric surgeons in Nigeria. Methods: A cohort of 43 pediatric surgeons/trainees attending two annual meetings of Association of Paediatric Surgeons of Nigeria (2011 and 2013) were surveyed with a questionnaire enquiring about the practice of postoperative pain management in children and their perceptions. Results: Thirty-seven respondents had completed the survey (86% response rate). Of these respondents, 27 (73.0%) were consultants and 10 (27.0%) were trainees. Only 2 (5.4%) respondents used any guidelines, and 8 (21.6%) respondents had an established institutional protocol for the pediatric postoperative pain management. Almost half of the respondents (18, 48.6%) used clinical judgments for assessing postoperative pain, followed by crying, requires oxygen to maintain saturation > 95%, increased vital signs, expressions, and sleeplessness scale (13, 35.1%); alertness, calmness, respiratory response/crying, physical movement, muscle tone, and facial tension behavioral scale (11, 29.7%); and verbal rating (10, 27.0%). In neonates, 89% of the respondents used paracetamol and 32% used pentazocine for routine postoperative analgesia. None of the respondents used morphine for neonatal postoperative analgesia. In older children, commonly used analgesics include paracetamol (35, 94.6%), pentazocine (30, 81.1%), and nonsteroidal anti-inflammatory drugs (28, 75.7%). More than half of the respondents (20, 54.1%) were not satisfied with their current practice of postoperative pain management. Conclusion: Pain was infrequently assessed, and analgesic therapy though multimodal was largely not protocol based and therefore subject to inadequate pain relief. Postoperative pain should be more visible in our hospitals, and efforts should be made to improve its assessment and management.

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Background: Family planning programs, researches, and studies have focused mainly on women with little attention to men's role in the contraceptive choices by the couple. Men's exclusion from these programs has serious implications on the acceptance and use of contraceptives by the couple. Objective: To determine the influence of male partners on contraceptive use of their spouses. Subjects and Methods: This was a cross-sectional descriptive study at a Tertiary Care Centre in Lagos, Nigeria. It was conducted from January 1 to April 30, 2010, where all consecutive consenting pregnant women were given structured questionnaires to give to their partners so as to evaluate the contribution of the male partners to contraceptives use in their spouses as well as assess their awareness and knowledge of contraception. Categorical variables were analyzed using Chi-square test or Fisher's exact test as appropriate while continuous variables by t-test. P < 0.05 was considered significant. Results: Of the 370 respondents, only 51.9% (192) knew about female contraceptive methods, while 50% (185) were willing to allow their wives to use contraception. Barrier method (17.3%) and periodic abstinence (15.7%) were the leading preferred choice for their wives. However, bilateral tubal ligation was the least preferred method (1.6%). Previous counseling of male partner significantly influenced their decision to allow their wives to use contraceptives (P = 0.001). Conclusion: Involving the male partner in family planning counseling plays an important role in increasing the acceptance and use of contraceptives by the couple.

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Background and Objectives: Psoriasis is a chronic, papulosquamous disorder of the skin with variable morphology, characterized by periods of remission and reactivity. Psoriasis is less common in the tropics and in dark-skinned persons. Prevalence in West Africans has been noted to be similar to that of the African-Americans suggesting a similarity in genetic ancestry. This study aimed to describe the clinical characteristics of psoriasis and precipitating factors in Nigerian patients. Materials and Methods: This is a retrospective study of all dermatology patients with features of psoriasis who attended the dermatology outpatient clinic of the hospital between January 2007 and May 2012. Data were obtained from the patients' clinic notes and protocol for psoriasis, which documented patients' demographic data, clinical presentations, and precipitating factors. Results: Psoriasis was found in 1.13% (124/11,015) of the study population. There was a male preponderance with a male to female ratio of 1.34:1. The majority of patients seen were in the fourth decade of life. Stress, alcohol, and drugs were the most reported predisposing factors to psoriasis. All types of psoriasis were found, and plaque psoriasis was the most common. Conclusion: This study confirms the increasing frequency of psoriasis among dermatology patients in Nigeria, which may either be due to an increased proficiency in diagnosing the condition by physicians or increase prevalence of environmental factors. The current trend in the management of psoriasis is focused on treating the inflammatory process as well as managing the modifiable environmental triggers.

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Background: Uterine rupture remains a major life-threatening obstetric disaster encountered in many developing countries and is associated with a high maternal and perinatal mortality and morbidity. Objectives: The objective of this study was to determine the incidence, associated risk factors, trend, clinical presentation, management as well as maternal and fetal outcome of uterine rupture at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Materials and Methods: This was a retrospective study of patients with uterine rupture at the LUTH, Idi-Araba, Lagos, Nigeria, from June 1, 2005 to May 31, 2013. The case records of patients in this period were retrieved from the medical health records department. The relevant data of sociodemographic characteristics, clinical presentation, management as well as maternal and perinatal outcome were collated using a structured questionnaire. Results: Of the 13,138 deliveries during the study period, there were eighty cases of uterine rupture giving a hospital incidence of 6.1/1000 deliveries. Patients with parities of 1 (28.36%) and 2 (38.81%) were identified to be at higher risk of uterine rupture. Previous caesarean section (46.28%), obstructed labor (26.87%), and injudicious use of oxytocin (16.42%) were the common associated factors. Rupture along previous anterior scar was the most common site affected in 32.84%; repair with bilateral tubal ligation was the surgical procedure in most of the cases (47.76%). The case fatality rate for ruptured uterus was 11.94% for the mothers and the perinatal mortality rate of 791/1000 babies. Conclusion: Uterine rupture is a major cause of maternal and perinatal death in Lagos, Nigeria.

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Background: The incidence of noncommunicable diseases (NCDs) is increasing in developing countries, largely due to lifestyle and dietary changes. Adolescents are a nutritionally vulnerable age group; however, poor eating habits are often observed in adolescents. It has been observed that individuals who develop healthy eating habits early on in life are more likely to maintain them into adulthood and have a reduced risk of developing NCDs. This study aimed to assess the knowledge and consumption pattern of fruits and vegetables among junior secondary school students. Materials and Methods: This was a cross-sectional descriptive study of 220 respondents selected using a multistage sampling technique. An interviewer-administered questionnaire was used to collect data, which was analyzed using Epi Info Version 7 statistical software. Results obtained were presented with the use of frequency tables. Results: Results from this study revealed that 84.99% of the respondents displayed good knowledge of the nutritional and health values of fruits and vegetables; however, the consumption of fruits and vegetables was appropriate in only 5.48% of the respondents, having five portions of fruits and vegetables daily. Parental intake, encouragement, and supervision as well as availability and accessibility to fruits and vegetables at home were motivators for appropriate consumption. Conclusion: This study has revealed that the students of Obele Community Junior High School, Surulere, have good knowledge of the nutritional and health values of fruits and vegetables. However, the students have inappropriate daily consumption, as their consumption falls below the World Health Organization recommended five portions daily. Efforts should be made by the students themselves, the family, the School, all and sundry in the community to effect change soonest, so that these adolescents maintain healthy eating habits into adulthood, and hence prevent the occurrence of nutrition-related NCDs later on in life.

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Background and Purpose: Anxiety disorders impact negatively on morbidity and mortality poststroke. Few studies have, however, been done on poststroke anxiety disorders (PSAD), particularly in Africa. The study aims to determine the prevalence, associated clinicodemographic factors, and impact of PSAD on quality of life (QoL) among outpatients at a tertiary hospital in Nigeria. Methods: Seventy stroke survivors attending Outpatient Clinics at Lagos University Teaching Hospital, Nigeria, were recruited into the study. Participants were assessed using sociodemographic/clinical questionnaire, the modified Mini–Mental State Examination, the Modified Rankin Scale, the Schedule for Clinical Assessment in Neuropsychiatry, and the World Health Organization-QoL-Bref. Data collection took 5 months and analyzed using the Statistical Package for the Social Sciences (SPSS^®) software version 17.0. Results: The mean age of respondents was 57.43 (±9.67) years and 38 respondents (54%) were male. Majority of the stroke survivors had infarctive stroke 55 (78.6%), right hemispheric lesions 37 (52.9%), and significant poststroke disabilities 57 (81.4%). The prevalence of PSAD was 10% and agoraphobia with panic attacks was elicited in 42.8% of those diagnosed with PSAD. Participants with PSAD were significantly more likely to be unemployed (P = 0.01) and pay more than ₦10,000 ($62.50 at December 2013) monthly for health care. The mean QoL scores were lower in participants with PSAD across all QoL spheres, and significantly so for overall health (P = 0.04), health satisfaction (P = 0.02), and physical health (P = 0.01) domains. Conclusion: PSAD, especially agoraphobia in association with unemployment and high health-care costs correlated with poor well-being among stroke survivors. Proactive measures to ensure prompt identification and management may potentially improve outcome and QoL after stroke.

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Context: Congenital cataract is a priority of Vision 2020: the right to sight, the global initiative to reduce the world's burden of avoidable blindness because it is an important treatable cause of visual physically challenged in childhood worldwide. Prevention and treatment require information about etiology that is currently unavailable for many regions of the world. From an epidemiologic study, the causative factors of pediatric cataract can be identified. Aims: This study aims to determine causes of childhood cataracts and to identify the preventable factors in tribes of hilly areas of Western India. Settings and Design: The present study is a hospital-based retrospective study. Materials and Methods: A retrospective study was conducted after reviewing the details of 165 patients of pediatric cataract aged between 3 months and 15 years who underwent cataract surgery in our institute from April 2011 to March 2014. A team of ophthalmologists and pediatricians attached to the center examined all the patients preoperatively. The type of cataract was determined using slit lamp biomicroscopy or operating microscope. Results: Nontraumatic cataract was 72.1% and traumatic cataract was 27.9%. Nontraumatic cataract includes hereditary (10.1%), rubella (5.0%), secondary (16.8%), and idiopathic (68.1%). In nontraumatic cataract group, 66 patients had bilateral cataract and 53 had unilateral cataract. Traumatic cataract was the most common in the age group of 6–10 years and most common cause of trauma is thorn (23.9%) followed by stone (21.7%), crackers (17.4%), wood stick (13%), finger (4.3%), chemical injury (4.3%), needle (4.3%), wire (2.2%), and others (8.7%). Conclusions: About 5% of nontraumatic bilateral cataracts in hills of Western India are due to rubella. An awareness program for precaution during pregnancy and immunization against rubella is needed to prevent it. School children must be educated for factors causing traumatic cataract and need supervised play in outdoor.

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Background: Cancers in children are increasing all over the globe, however, the outcome in LMICs is still quite poor due to a myriad of factors. Aim: This review focused on pattern of admissions in a pediatric oncology unit in Lagos, Nigeria and the determinants of outcome. Settings and Design: This was a retrospective descriptive study at the Lagos University Teaching Hospital from January 2015 to July 2017. Common treatment protocols like UKALL, NWTSG etc are adapted for use in the unit. Data Analysis: This was done using SPSS version 22. Results: A total of 178 children were seen at the oncology unit with a slight male preponderance of 1.4:1. The most common malignancy seen was acute lymphoblastic leukemia (20.8%) while retinoblastoma was the commonest solid tumor (19.6%). Mortality rate observed in the period under review was 45% and a large number of patients (22%) abandoned treatment. Conclusion: The management of childhood cancers is still a big challenge in resource constrained settings and a robust health insurance policy will improve outcomes.

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Congenital maxillomandibular fusion is a very rare condition with few cases reported worldwide. This paper reports a rare case of bony maxillomandibular fusion of the jaws, with synechiae of buccal mucosa and the gingivae in an adult patient. Separation of the fusion was done under general anesthesia. Isolated cleft of the hard palate was discovered during surgery. This report adds more information to literature, by reporting an adult with syngnathia and isolated cleft of the hard palate.

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Introduction: Quality of life (QoL) assessment has become an integral component of the assessment of the holistic care of patients with chronic diseases, including sickle cell disease (SCD). Objective: To evaluate the quality of life in patients with SCD managed in our centre. Patients and Methods: Eighty consecutive patients with confirmed hemoglobin SS or SC were recruited. Age and sex-matched volunteers served as controls. Ethical approval was obtained from the Institutional Review Board and all participants gave informed consent. Information on socio-demographic, quality of life and clinical variables, including the presence of complications were recorded in a modified version of the WHO Quality of Life Brief version (WHOQOL-BREF) questionnaire. Data was analyzed using Microsoft Excel and SPSS 17 computer softwares. Descriptive statistics were used to represent socio-demographic variables while the Student t-test was used to explore relationship between the variables and the quality of life domains. Results: Significantly fewer participants with SCD are married compared to their age- and sex-matched controls (P = 0.01). Similarly, participants with SCD scored significantly lower in the physical and psychological domains as well as in overall QoL and general health domains compared to controls (P = 0.001). Avascular necrosis of the femur significantly affected the overall QoL and general health of participants with SCD, respectively while the means of the QoL assessment domains were not significantly different in participants with SCD with and without complications, except in the general health domain (P < 0.001). Conclusion: Avascular necrosis of the femoral head significantly affects overall QoL in participants with SCD.

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Background: The prevalence of diabetes mellitus (DM), a noncommunicable disease (NCD) in adolescents, is on the rise worldwide; therefore, knowledge which facilitates prevention and early detection is important. The objective of this study was to determine the knowledge of DM and self-reported risk factors among adolescents in a senior secondary school, in Surulere, Lagos State. Methodology: This was a cross-sectional descriptive study of 144 male and 106 female senior secondary students with a mean age of 15.2 ΁ 1.3 years. Respondents were selected through multistage sampling technique. A structured pretested questionnaire was used to collect data. Epi Info 7.1.5 was used for data analysis and the level of statistical significance was set at 5%. Results obtained were presented with the use of frequency tables. Results: Two out of three respondents had heard of DM. Among those who were aware of the condition, 64.9% knew it referred to abnormally high blood glucose. Only (10.9%) knew it was a lifelong condition and less than a third (26.7%) knew the measurement of blood glucose with a device for the screening test. Less than 30% considered obesity, family history, diet, and physical inactivity as risk factors. Their main source of information was the mass media. Overall, 46% of respondents had good knowledge of DM. As regards the presence of lifestyle behavior/risk factor for DM/NCDs in the respondents, 8.4% of the respondents had a family history of DM, had consumed alcohol (28.8%), smoked tobacco (4.8%), and were overweight/obese (5.2%). Conclusion: Two-thirds were aware of DM, of which over half had inadequate knowledge of DM despite the existence of some risk factors. There should, therefore, be an inclusion of NCD education in the curriculum of secondary school students.

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Background: A critical incident is any preventable mishap associated with the administration of anesthesia and which leads to or could have led to an undesirable patients' outcome. Patients' safety can be improved by learning from reported critical incidents and near misses. Materials and Methods: All perioperative critical incidents (excluding obstetrics) occurring over 5 months were voluntarily documented in a pro forma. Age of patient, urgency of surgery, grade of anesthetist, and patients' outcome was noted. Results: Seventy-three critical incidents were recorded in 42 patients (incidence 6.1% of 1188 procedures) with complete recovery in 88.1% (n = 37) and mortality in 11.9% (n = 5). The highest incidents occurred during elective procedures (71.4%), which were all supervised by consultants, and in patients aged 0–10 years (40.1%). Critical incident categories documented were cardiovascular (41.1%), respiratory (23.25%), vascular access (15.1%), airway/intubation (6.85%), equipment errors (6.85%), difficult/failed regional technique (4.11%), and others (2.74%). The monitors available were: pulse oximetry (100%), precordial stethoscope (90.5%), sphygmomanometer (90.5%), capnography (54.8%), electrocardiogram (31%), and temperature (14.3%). The most probable cause of critical incident was patient factor (38.7%) followed by human error (22.5%). Equipment error, pharmacological factor, and surgical factor accounted for 12.9%. Conclusion: Critical incidents can occur in the hands of the highly skilled and even in the presence of adequate monitoring. Protocols should be put in place to avoid errors. Critical incident reporting must be encouraged to improve patients' safety and reduce morbidity and mortality.

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Background: The adrenal gland is not spared from the involvement by tuberculosis. One of the recognized causes of adrenal insufficiency (AI) is tuberculosis. AI, mostly at the subclinical level, is common in persons with pulmonary tuberculosis (PTB) infection, occurring in about 23% of patients. Coinfection with PTB and human immunodeficiency virus (HIV) may compromise adrenocortical function and produce significant adrenocortical insufficiency. Objective: To determine if coinfection with tuberculosis and HIV have a compound effect on adrenocortical function in persons with HIV and PTB coinfection. Materials and Methods: Persons with sputum-positive PTB, treatment naive, who met our inclusion criteria, were selected. All the recruited patients were screened for HIV and those positive for HIV infection had confirmatory test. A baseline blood samples for cortisol, fasting plasma glucose, full blood count, and electrolytes were collected between 8.00 h and 9.00 h immediately before administration of adrenocorticotropic hormone (ACTH). The persons received an intravenous bolus injection of 1 μg ACTH (Alliance Pharmaceuticals Ltd., Chippenham, Wiltshire SN15 2BB) and blood sample was drawn for cortisol level at 30 min. Results: Forty-four people with PTB infection and forty people with PTB and HIV coinfection met the inclusion criteria of the study. The adrenal response to 1 μg ACTH stimulation in participants with PTB and PTB and HIV coinfection showed that the mean basal cortisol level in the 2 groups was not statistically significant; however, 30-min post-ACTH stimulation cortisol level was 630.84 ± 372.17 and 980.36 ± 344.82 nmol/L (P < 0.001) and increment was 367.79 ± 334.87 and 740.77 ± 317.97 nmol/L (P < 0.001), respectively. Fourteen persons (31.8%) with PTB has subnormal adrenal response to ACTH stimulation while only 2 (5%) persons with PTB and HIV coinfection has subnormal response. Conclusion: AI, at subclinical level, was less frequent in those with PTB and HIV co-infection.

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Background: Long-lasting insecticides nets (LLINs) are a key prevention tool that has been found to reduce uncomplicated malaria by 51% and decrease all-cause mortality by 18% in children. LLINs have been shown to be effective in reducing childhood morbidity and mortality by reducing mosquito bites while sleeping. This is a comparative cross-sectional study designed to determine and compare the ownership and utilization of LLINs among caregivers of children under 5 years in a rural and an urban area of Ogun State. Materials and Methods: A community-based comparative cross-sectional study on 575 caregivers of children under 5 years living in the urban and rural area of Ogun State was done using a multistage cluster sampling technique to recruit respondents. A pretested semi-structured interviewer-administered questionnaire was used to collect information on LLINs ownership and use. Analysis and statistical calculation were done using SPSS version 20.0. Relationships between categorical variables were tested using Chi-square test with P = 0.05. Logistic regression model was used to describe predictors of LLIN ownership and utilization among the respondents. Results: The study shows that 80% of caregivers of under-five living in the rural area compared with 63.5% living in the urban area owned LLINs (P < 0.001). Percentage of children under-five who slept under LLINs the night prior the study was 50.2% in the urban versus 52.4% in the rural households (P = 0.252). Stagnant water and dirty surroundings were identified as mode of transmission of malaria among 32.6% urban versus 44.8% rural respondents and 44.2% urban versus 29.7% rural respondents respectively (P = 0.005). Children were identified as one of the most vulnerable groups for malaria infection by 44.6% urban versus 33.8% rural respondents (P = 0.008). The LLINs was hanged on the bed by 81.2% urban versus 64.4% rural respondents (P = 0.018). The predictors of ownership of LLINs were as follows: urban residence (OR 0.34 [95% confidence interval [CI] 0.22–0.53]), caregiver with higher education (OR 4.85 [95% CI 1.42–16.55]), and the predictors of utilization of LLINs were as follows: level of education of the caregiver (OR 2.87 [95% CI 1.11–7.41]), possession of LLINs at immunization (OR 2.92 [95% CI 2.02–4.22]). Conclusion: Free distribution of LLINs may not necessarily lead to use. Behavior change interventions that address the community level perceptions that positively position LLINs as an effective prevention tool to prevent malaria should be strengthened among the caregivers of children under-five generally and most especially in the urban areas of Ogun State.

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Background: Health insurance (HI) can serve as a vital risk protection for families and small businesses and also increase access to priority health services. This study determined the knowledge, attitude of artisans toward HI as well as their health-seeking pattern and willingness to join the HI scheme. Methodology: This descriptive cross-sectional survey used a multistage sampling technique to recruit 260 participants, using self-designed, pretested, interviewer-administered questionnaire. Data were analyzed using Epi-info version 7.0. Chi-square test, Fisher's exact test, and logistic regression were used for associations; the level of significance was set at 5%. Results: The respondents were predominantly male, i.e., 195 (75.0%), with a mean age of 32.36 + 6.20 years and mean income of N 29,000 + 5798.5 ($1 ~ N 161). Majority of the respondents, i.e., 226 (86.9%) were not aware of HI. The overall knowledge was poor (6.5%) and the main source of information was through radio/television (41.2%). Nearly, half of the respondents (33 out of 67) identified the concept of HI as a pool of contributors' fund for only healthcare service. A high proportion of the respondents (27 out of 34) were aware of the benefits of HI, although majority, i.e., 27 (79.4%) identified access to medication as the benefit. The majority of the respondents, i.e., 228 (87.7%) expressed negative attitude toward the scheme; however, 76.5% were willing to join the HI scheme. Conclusion: The artisans had low awareness/poor knowledge of HI which translated to a negative attitude toward the scheme. There is need for an aggressive stakeholders' enlightenment campaign for increasing coverage.

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Multiple epidermal cysts over the scrotum is a rare condition and requires excision if infected or cosmetically unacceptable. Grossly enlarged or infected cysts require total excision of the scrotal wall followed by the coverage of bare testes. We are reporting a case of multiple epidermal cysts on the scrotum. Total excision of scrotal wall followed by the fascio cutaneous flap coverage was done in this case.

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Background: Our teaching hospitals have different grades of doctors with varied exposure to cardiac arrest settings and their resuscitation skills are often inadequate. Objectives: We investigated whether the grade of a doctor influenced acquisition of knowledge and skill during cardiopulmonary resuscitation (CPR) training in Nigeria. Materials and Methods: Doctors who attended a two-day resuscitation training program between December 2007 and April 2009 were scored on their knowledge of Basic Life Support, Advanced Life Support, and performance at five skill stations. A pass mark was awarded for a post-test score ≥ 75% and a pass in all skill stations. Results: A total of 130 doctors were studied with a mean of 10.99 ± 6.51 years since medical qualification (range, 2-28 years). The mean pre-test score was 54.43 ± 16.10% (range 30.5-91.8%) while the mean post-test score was 88.48 ± 6.8% (range, 54.6-94%), (P < 0.001). Mean post-test scores were not significantly different between grades. Mean scores for questions on Basic Life Support, defibrillator use, and drug therapy and in performance at skill stations were not significantly different between grades. A significant difference however existed in questions on cardiac arrest rhythms (P = 0.031). Sixty-five participants (50%) passed the post-test at first attempt. Consultants, senior registrars, and registrars had pass rates of 59.2%, 53.6%, and 43.5% respectively (P = 0.336). After re-training at performance stations, 124 doctors (95.4%) passed the test with no significant difference in overall pass in the various grades (P = 0.605). Conclusion : Grade of doctor did not affect the acquisition of knowledge and skill during resuscitation training.

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Background: The prevalence of diabetes mellitus (DM) among Nigerian adults is increasing. Besides the well-recognized microvascular complications of diabetes, there is also a growing epidemic of macrovascular complications. Patients with diabetes may not only have diabetes-related complications but may also have nondiabetes-related comorbidities. Aim: To determine the pattern of chronic diabetic complications and coexisting morbidities in patients attending the diabetic outpatient clinic of a tertiary health care center in Nigeria and the factors associated with the presence of complications. Materials and Methods: This was a cross-sectional descriptive survey carried out among patients attending the follow-up diabetic clinic of a tertiary health care center in Nigeria over a 3-month period. A systematic random sampling method was used and 422 eligible patients were selected and interviewed using pretested interviewer-administered questionnaires, after written informed consent was obtained. Data were analyzed using  Epi Info statistical package version 3.5.1. developed by Centers for Disease Control and Prevention (CDC) in Atlanta Georgia (USA). Results: Of the 422 patients interviewed, 400 (247 females and 153 males) had complete data for analysis. Eighty-eight patients had comorbidities, and the commonest was hypertension in 63 (71.6%). Out of the 61 patients who had complications, the majority, that is, 39 (63.9%) had eye complications. Factors significantly associated with the presence of diabetic complications were the duration of diabetes, marital status, and the presence of diabetic comorbidities. Conclusion: The frequency of diabetic complications and comorbidities is quite high in the patients studied. There is a need to improve the standard of care of patients and to ensure optimal blood glucose control. This will go a long way in reducing the frequency of complications and comorbidities.

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Background: In recent past, there has been a gradual increase in the volume of patients treated on a day case basis in our center. However, no study has been conducted to audit pediatric day case surgery practice at the Lagos University Teaching Hospital. Objectives: To determine the level of parental satisfaction with pediatric day case surgery at the Lagos University Teaching Hospital. Patients and Methods: A total of 101 parents or the patient's caretakers whose wards had day case surgery were administered a self-completed questionnaire on the first postoperative day visit at the surgical outpatient clinic. The questions assessed parental satisfaction with the following: (a) Communication with doctors (surgeons and anesthesiologists), (b) Physical conditions of the theatre environment, (c) Staff's care, (d) Need to care for the child at home, and (e) Postoperative complication. Result: There were 101 respondents with an age range of 22-56 years (mean 35.05 ± 6.85). Eighty-seven (86%) of the respondents were satisfied with the amount of information they obtained from their doctors before the operation; 43 (42.6%) were satisfied with the waiting time, whereas 47 (46.5%) were satisfied with the fasting time. However, 26 (25.7%) of the respondents were dissatisfied with the waiting room environment and 87 parents (87.1%) were dissatisfied with the nursing care. Conclusion: Most parents are satisfied with pediatric day case surgery care. Some adjustments, however, need to be made on reducing the waiting and fasting time of the patients and improving both the waiting room environment and the nursing care in order to increase its acceptance.

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