The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

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Context: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is one of the world's most challenging pandemics. For treatment with Highly Active Anti-Retroviral Therapy (HAART) to be effective, high rate of adherence is essential. Aim: To demonstrate the effect of adherence counseling and text message reminders in improving patients' adherence to HAART. Settings and Design: A randomized control trial among non-adherents was carried out in a tertiary hospital in Nigeria between March and July, 2011. Materials and Methods: A total of 104 patients: 45 males (43.3%) and 59 females (56.7%) participated in the study. They were randomized into intervention and control groups. The intervention group received monthly adherence counseling and twice weekly short message reminders for four months, while the control group received only standard care. Self-reported adherence and CD4+ cell counts were measured pre- and post-intervention. Statistical Analysis Used: Data was analysed using Statistical Package for Social Sciences (SPSS) version 18. Risk rates, Chi-square, Mann-Whitney U test and Cohen's effect size were calculated. Level of significance was set at P = 0.05. Results: At post-intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ² = 5.211, P = 0.022, RR = 0.75 (0.55-0.96), Cohen's w = 0.224). Also, median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0 cells/ml to 361.5 cells/ml in the control group (P = 0.007). Conclusion: Adherence counseling and text message reminders improved adherence among HIV patients. Its adoption for HIV patient management is advocated.

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Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria, HBV is reported to be the most common cause of liver disease. However, the extent of HBV exposure among Nigerians at average risk is unknown. Our aim, therefore, was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34,376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%). The pooled prevalence (% [95% CI]) among subgroups was: 14.0% (11.7, 16.3) for blood donors; 14.1% (9.6, 18.6) for pregnant women attending antenatal clinics; 11.5% (6.0, 17.0) for children; 14.0% (11.6, 16.5) among adults; and 16.0% (11.1, 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [% (95% CI)]: 12.3% (10.1, 14.4) by using enzyme-linked immunosorbent assay; 17.5% (12.4, 22.7) by immunochromatography; and 13.6% (11.5, 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria.

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Background: Liver size can be influenced by various factors, including malignant diseases, infective processes, and anthropometric variations among individuals from different geographical locations and races. Therefore, the exact definition of hepatomegaly in the ultrasonographic measurement of liver size is controversial. Moreover, the majority of studies regarding the study of liver size are not community-based. Aims: The aim of this study is to establish a range of normal liver sizes by ultrasonography with respect to age and sex in healthy individuals and to identify factors affecting liver size. Study Design: This was a prospective, community-based study. Methods: Liver size was measured ultrasonographically from the midclavicular line in 822 individuals, of which 49.3% (n = 405) were male and 51.7% (n = 417) were female. Following physical examination, all participants provided blood samples. Height, weight, and waist circumference were recorded. The mean liver length was calculated for males, females, and for the whole study group. It was also determined whether there was an association between liver size and age, weight, height, body mass index (BMI), body surface area, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) enzyme levels. Results: The mean liver length was significantly different between males (150.04 ± 14.84) and females (147.57 ± 18.32, P = 0.034). Weight and BMI were the most strongly associated with liver size. There was a significant difference between liver size in individuals with normal and elevated levels of AST and ALT enzymes (P < 0.01). Conclusion: In a northern Anatolian Turkish population, liver size was greater among males than females. In light of these data, we believe our study may serve as a reference source for the evaluation of liver size.

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Background: Infertility is a prevalent condition in many developing countries with significant physical and psychosocial implications. The aim of this study is to discuss briefly the ethics of newer assisted reproductive technology (ART) with special emphasis on the peculiarities in Nigeria. Methods: MEDLINE and Google Scholar were searched for English-language articles from January 1990 to July 2014 using the search terms "ethics of ART AND Nigeria," "ethical issues in in vitro fertilization AND Nigeria." Using the above search phrases, a total of 43 articles were retrieved out of which only 5 dealt specifically with the subject matter. Results: The core ethical issues found in the reviewed literature are listed in [Table 1]. Inequitable access to ART due to its high cost, lack of regulatory body, safety of the procedure, and fate of the embryos were the main themes identified from the papers. Surrogacy, sex selection, and gamete donation were additional relevant ethical issues. Conclusion: There is an urgent need for stakeholders in developing countries to formulate cultural and context-specific guidelines to help address some of these ethical dilemmas.

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Background: Belated booking for antenatal care remains a common practice among pregnant women in developing countries. Many of the existing conventional ultrasonographic indices used for assessing gestational age (GA) become increasingly unreliable beyond the 2^nd trimester. Materials and Methods: A prospective cross-sectional study of booked healthy pregnant women with regular menstrual cycles and certain last menstrual period (LMP) were examined using ultrasound over a 6-month period. Fetal kidney length (FKL) was measured, beginning from 20 to 41 weeks of gestation. Results: A total of 400 pregnant women were examined. The mean left FKL was slightly but significantly higher than the mean right FKL across the various weeks of gestation (P < 0.05). The mean combined FKL (MKL) was 32.18 ± 5.96 mm, with a reference range of 20.87 ± 0.75 mm to 41.41 ± 0.07 mm from 20 to 41 weeks of gestation. There was strongly positive significant correlation between MKL in millimeters and GA by the LMP in weeks (r = 0.997, P = 0.000). The standard error of prediction (SE) of GA was least for MKL (±7.17 days), followed by femur length (FL) (±8.38 days), head circumference (HC) (±9.02 days), abdominal circumference (AC) (±9.14 days), and biparietal diameter (BPD) (±10.36 days). The best multiple regression model for predicting GA included the five variables such as MKL, FL, BPD, HC, and AC, with a SE of prediction of (±6.31 days). Conclusion: FKL can serve as an additional reliable parameter for accurate dating of GA during obstetric scan.

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Objectives: Impacted teeth, if left untreated, have a potential to induce various complications. The aim of the current study was to determine the prevalence and pattern of impacted mandibular third molar in the Iranian population. Study Design: This cross-sectional study was performed in patients who were referred to the Department of Oral Radiology between July 2009 and October 2010 to obtain an orthopantomogram (OPG). Data were collected regarding age and gender, prevalence of impacted mandibular third molars, angulation of impacted teeth (Winter's classification), level of impaction (Pell and Gregory classification), and relationship of the mandibular third molar with the ramus (Pell and Gregory classification). The collected data were analyzed using SPSS software version 11.0 with a confidence interval of 95%. Results: Among the 1433 patients included in the study, 489 (34.12%) patients were male and 944 (65.88%) were female. Of the total OPGs performed, 871 (60.78%) OPGs demonstrated at least one impacted mandibular third molar. In addition, of the 2866 mandibular third molars investigated, 1397 (48.74%) were found to be impacted. A significant association was observed between gender and the number of impacted teeth or the presence of impaction of any mandibular tooth (or teeth) (P < 0.05). The most common type of tooth angulation was mesioangular (48.67%). In addition, the most prevalent type of impaction level and ramus relationship was level B (63.85%) and Class II (48.46%), respectively. There were no significant differences between the two sides of the mandible for the prevalence of impacted third molar (P > 0.05). Conclusion: The pattern of mandibular third molars in the Northeast region of Iran revealed a high prevalence of impaction, which was mostly mesioangular, level B, and Class II with a gender predilection for females.

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Objective: The objective of this study was to determine the measurement of normal range of ultrasound (US) thyroid gland dimensions in school-aged children (6-16 years) in our environment and compared with what is obtained elsewhere. Setting and Design: A prospective ultrasound measurement study done in University of Benin Teaching Hospital Benin, Nigeria. Materials and Methods: A prospective ultrasound (US) study of thyroid dimensions of 500 school-aged children in our environment consisting of 227 boys and 273 girls was done from 1 December 2006 to July 2007. The subjects were examined by the authors and subjects with palpable abnormal thyroid gland were excluded from the study. The thyroid dimensions (length, height, and diameter) were taken for each lobe by means of ultrasound (US). In addition volume of each thyroid lobe was calculated and the summation of volume of the lobes was taken as thyroid gland volume of each subject. Also height and weight of patients were documented from which the subject's body surface was calculated. Incidental thyroid gland lesion in US was excluded from the study. Using the Statistical program of social science (SPSS) and INSTAT (Graph Pad Inc. USA) the data were analyzed. Informed consent was obtained from all the subjects and the study was done in line with the ethical guidelines of the centers. Results: The US thyroid gland volume in school-aged children in Benin City from this study ranges between 1.17 cm ³ and 7.19 cm ³ , mean volume range of 1.76-4.95 cm ³ , median volume range of 1.73-4.73 cm ³ , and range of standard deviation from 0.39 cm ³ to 1.49 cm ³ . The average mean thyroid volume is 2.32 cm ³ with the following average dimensions; anteroposterior right lobe =1.06 cm, mediolateral right lobe = 1.01 cm and craniocaudal right lobe = 2.34 cm, and anteroposterior left lobe = 1.01 cm, mediolateral left lobe = 1.04 cm and craniocaudal left lobe = 2.41 cm for both boys and girls respectively. These data are significantly lower than data obtained by European based World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) 1997. However there is significant similarity with data obtained in similar environment. Conclusion: Ultrasound thyroid gland dimensions in school-aged children in our environment are reproducible and the data obtained are comparable to those obtained in other environment. The values may be better used in our environment as reference data for screening purposes.

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Neonatal jaundice is a leading cause of hospitalization in the first week of life worldwide. If inappropriately managed, it may result in significant bilirubin-induced mortality and disability. We set out to describe the epidemiology of neonatal hyperbilirubinemia as well as the practices and challenges in the care of infants with significant neonatal hyperbilirubinemia (SNH) in Nigeria, as basis for policy intervention and research priorities. We systematically searched PubMed, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, WHO Library Database, African Index Medicus, African Journals Online, and local journals for studies published between January 1960 and December 2014. We included studies, without restriction on methodological design that provided evidence on the incidence/prevalence, etiological /risk factors and adverse outcomes of hyperbilirubinemia, care-seeking practices, diagnosis and treatment, as well as follow-up evaluation of infants with SNH in Nigeria. A total of 558 studies were identified from all sources out of which 198 (35.5%) were finally selected. SNH accounted for about one in five neonatal admissions and has been associated consistently with substantial case fatality and neuro-developmental sequelae such as cerebral palsy and auditory impairments, especially among out-born babies. Glucose-6-phosphate dehydrogenase (G6PD) deficiency, prematurity/low birth weight, infection, and ABO incompatibility were most frequently, and Rhesus disease rarely, associated with SNH. Late presentation at appropriate health facilities was common and resulted in high rates of acute bilirubin encephalopathy (ABE), kernicterus and avoidable exchange transfusions. Uniform practice guidelines, including developmental assessment and surveillance of infants with SNH, were rare at all levels of healthcare delivery. In summary, since 1960, SHN persists as a major contributor to neonatal mortality and developmental disabilities in Nigeria. The underpinning maternal, perinatal and neonatal factors as well as systems-based constraints are not insurmountable. Systematic and sustained interventions are warranted to curtail the disproportionate and perennial burden of this condition in this population.

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Introduction: Neonatal Jaundice (NNJ) is a common disorder worldwide and one of the important contributors to the high neonatal morbidity and mortality in Sub-Saharan Africa. Severe neonatal jaundice leads to brain damage or even death in otherwise healthy newborns. The objective of the study was to assess the knowledge, attitude and practice of expectant mothers about neonatal jaundice and its management. Materials and Methods: The study was descriptive cross-sectional, carried out among 389 expectant mothers who were attending the antenatal clinic at the University of Benin Teaching Hospital. A structured, Pre-tested, researcher administered questionnaire was used to interview the respondents. Data was analysed using SPSS version 15. Results: The mean age of the expectant mothers was 30.5 (SD 4.9) years. Fifty-five (14.1%) of respondents had previous experience with NNJ, 8 (2.1%) lost babies due to NNJ. 334 (85.9%) were aware of the condition, 381 (77.4%) knew how to recognize the symptoms of NNJ, 279 (71.7%) knew a correct method of treatment of NNJ. A large proportion of the expectant mothers 261 (67%) knew some complications of NNJ. Two hundred and five (52.7%) did not know any danger sign of complications of NNJ. Three hundred and fifty five (91.3%) had good attitude towards its management. Majority of expectant mothers whose previous babies had NNJ took the babies to the hospital for treatment. A large proportion also expressed their willingness to seek medical attention if their babies were to develop the condition. Their knowledge of neonatal jaundice was significantly influenced by their level of education and the number of their previous babies who had NNJ. Conclusion: This study revealed that expectant mothers attending antenatal clinic at UBTH had good knowledge of the treatment and complications of NNJ but inadequate knowledge of the causes and danger signs of the condition. Their attitude and practice towards the management of NNJ was good. It is therefore recommended that Health care providers should give more health education on NNJ to the expectant mothers during antenatal visits.

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Fatal scorpion stings are rare in Nigeria. Hitherto, there has been no report from Nigeria of death following scorpion stings. This report is that of a 2-year-old boy who was stung by a scorpion while playing outside his home environment in Osogbo, South West Nigeria. He subsequently presented to the Children Emergency Unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, in pain and with features of shock. He died within 2 h of admission despite all treatment given to relieve pain and manage shock. The case is reported in order to share the important lessons learned.

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Background: Nigeria is the most populous nation in Africa and the seventh most populous in the world. Despite a high fertility rate of 5.5 per woman and a high population growth rate of 3.2%, Nigeria's contraceptive prevalence is 15%, which is one of the lowest in the world. The objective of this study was to determine the knowledge of family planning and family planning preferences and practices of rural community women in Cross River State of Nigeria. Materials and Methods: This was a cross-sectional study involving 291 rural women. Convenience sampling method was used. The women were assembled in a hall and a semi-structured questionnaire was administered to every consenting woman until the sample size was attained. Data obtained from the study were analyzed using the Statistical Package for the Social Sciences version 20 and presented in tables as frequencies and percentages as well as figures. Association between categorical variables was explored using chi-square test. Binary logistic regression was also performed to determine predictors of use of at least one family planning method at some point in time. Results: Fifty (17.2%) respondents were using at least one family planning method. One hundred and ninety-eight (68.3%) respondents had used at least one family planning method at some point in time. Reasons given for not using any family planning method included “Family planning is against my religious beliefs” (56%); “it is against our culture” (43.8%); “I need more children” (64.9%); “my partner would not agree” (35.3%); “family planning does not work” (42.9%); “it reduces sexual enjoyment” (76%); and “it promotes unfaithfulness/infidelity” (59%). Binary logistic regression conducted to predict the use of at least one family planning method at some point in time using some independent variables showed that who makes the decision regarding family planning use was the strongest predictor of family planning use (OR = 0.567; 95% CI = 0.391–0.821). This suggests that family planning uptake is more likely when couples make a joint decision. Conclusion: The proportion of respondents who were currently using at least one family planning method was low. The findings of this study suggest that family planning uptake would increase if couples make joint decisions in this regard.

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Genital prolapse in the newborn is a rare clinical condition often times seen in association with congenital myelo-meningocele, or this could occur following shigellosis infection. We therefore report two neonates with rectal prolapse following diarrhea and utero-vaginal prolapse associated with congenital spinal bifida.

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Objective : Periodic patient satisfaction surveys provide feedback to hospital management and staff regarding the quality of services rendered. These surveys have become routine as part of total quality management in developed countries. We assessed patient satisfaction with services provided in a teaching hospital in northern Nigeria. Method : Structured questionnaires were administered on a cross-section of 201 patients and two focus group discussions were held with patient relatives at Aminu Kano Teaching Hospital. Results : Overall, 83% of the patients were satisfied with the services received from Aminu Kano Teaching Hospital, while the remaining 17% were dissatisfied. Specifically, 88%, 88%, 87% and 84% of the patients were satisfied with patient provider relationship, in-patient services, hospital facilities and access to care. However, 30% and 27% of the patients were dissatisfied with waiting time and cost of treatment respectively. Patients and their relatives complained about delayed appointments, missing folders, missing laboratory results and long appointments for ultrasound and other radiological investigations. Conclusion : The high patient satisfaction notwithstanding, health workers need to consider patients as customers by being friendly and reducing waiting time for consultation and investigations. Widespread implementation of the National Health Insurance Scheme will also reduce the cost of services and drugs to patients.

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Background and Objectives: This study aimed to assess the knowledge of secondary school pupils in Osun State about HIV/AIDS and the sources of their information. Materials and Methods: A multistage random sampling technique was used to select 592 secondary school pupils from 5 local government areas of Osun State, Nigeria. A self-administered questionnaire was used which composed of questions on their knowledge and sources of information about HIV/AIDS. Results: About half believed that HIV can be contracted via mosquito bites and 53.7% believed via kissing. Half of the respondents agreed that a person who looks healthy can be infected and possess the ability to describe the look of an infected person. Majority (92.6%) claimed to have heard about HIV/AIDS prior to the study. More than half (67.8%) agreed that HIV/AIDS is a life-threatening disease, 29.4% said there is a cure for AIDS, and 77.6% thought that the government is doing enough to deal with the disease. The most important sources of HIV/AIDS information among the respondents were the media and the least important sources of information were the traditional healers (35.3%). Conclusion: This study revealed a high-level misconception among secondary school pupils in Osun State, Nigeria. Mass media was the major source of information with doubtful effectiveness evidenced by obvious erroneous beliefs. An improved multisectorial approach in HIV/AIDS education with greater participation of school and public libraries is advised.

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It is presently being debated whether the partograph is a useful tool for labor supervision and, if useful, where should the action line be located between 2, 3 or 4 h to improve the fetomaternal outcome. This review adduces facts to show that this debate is because there is a poor understanding of the essence and purpose of the partograph. The partograph is a form on which labor observations are recorded to provide an overview of labor, aiming to alert midwives and obstetricians to deviations in labor progress as well as maternal and fetal wellbeing. When deviations in labor progress are recognized early and corrected, complications are prevented and normal labor and delivery can occur. The earliest deviation in labor progress is slow labor progress, for which the partograph alert line is a prompt for early recognition by the midwives and other non-obstetric staff. The intervention to correct the deviation is at the action line by the staff with the requisite skill. In the circumstance in which the partogram was produced, the action to correct the deviation in labor progress was after 4 h, represented by the 4-h action line, but other workers have attempted with 2- and 3-h action lines and have had equally good results. However, in all these, the action at the action line was instituted by the staff with the appropriate skill, irrespective of whether the action line was 2, 3 or 4 h. As long as the action at the action line is by the staff with the requisite training, the deviation in labor progress will be corrected by either medical or surgical means irrespective of the action line location at 2, 3 or 4 h. In conclusion, the essence and purpose of the partograph is to ensure that labor progress is monitored to identify slow labor by the alert line but appropriate treatment must begin at the action line by the staff with the cognate skill, whether at 2, 3 or 4 h. The appropriateness of the intervention at the action line is the determinant of the outcome and not the delay.

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Marfan syndrome is a variable, autosomal dominant disorder of connective tissue whose cardinal features affect the cardiovascular system, eyes and skeleton. The minimal birth incidence is around 1 in 9800. About three quarters of patients have an affected parent; new mutations account for the remainder. The patient's prognosis depends on the severity of cardiovascular complications and is mainly determined by progressive dilation of the aorta. If signs of Marfan syndrome are recognized, it is important to refer to the correct health care professional for further testing to prevent associated complications. If not properly treated, premature death may be caused by the severe cardiovascular and pulmonary complications associated with Marfan syndrome. Therefore, it is important to identify this potentially life-threatening condition in general practice. This article reports two cases with a very typical features of Marfan syndrome.

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Aim: The human coccyx varies considerably in shape and size. The objective of this study was to investigate the morphology and morphometry of the coccyx on pelvic magnetic resonance imaging in asymptomatic individuals among Turkish adults. Materials and Methods: This study was conducted retrospectively on the pelvic magnetic resonance images of 456 adult patients without a history of trauma in the coccyx region. The coccygeal vertebrae count, number of bone segments, and intercoccygeal and sacrococcygeal joint fusions were determined from the sagittal plane images. In addition, the length and angles (the sacrococcygeal angle, intercoccygeal joint angle, and sacrococcygeal joint angle) were measured. Statistical Analysis Used: Data were analyzed using the T-test or Mann-Whitney U-test, the ANOVA, or Kruskal-Wallis tests, and the chi-square test was used for the categorical variables. Results: The coccyx is formed by four, five, or three vertebrae in a decreasing ratio. The coccyx is composed of one to five bone segments; one bone segment was found in 2.8% of the cases. Intercoccygeal joint fusions been observed predominantly in the last intercoccygeal joint, with or without sacrococcygeal joint fusion. The coccyx was found to be longer in adult males than in adult females. The sacrococcygeal angle might be anteverted or retroverted. Conclusion: The findings are contrary to the conventional knowledge in that the vertebrae shaping the coccyx were completely fused and consisting of a single bone in very few cases. Better understanding of the anatomical variation of the coccyx may be useful for clinicians evaluating patients presenting with conditions in the coccygeal region.

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Termination of pregnancy (TOP) or feticide for severe fetal anomalies is ethically and morally challenging and maybe considered illegal in countries with restrictive abortion laws. While diagnostic modalities such as fetal ultrasound, magnetic resonance imaging, and genetic screening have improved prenatal diagnosis, these technologies remain scarce in many African countries making diagnosis and counseling regarding TOP difficult. Ethical dilemmas such as women's autonomy rights may conflict with fetus' right to personhood, and doctor's moral obligations to society. In liberal jurisdictions, previable fetuses may not have legal rights of personhood; therefore, appropriate action would be to respect pregnant women's decisions regarding TOP. However, in countries with restrictive abortion laws the fetus maybe imbued with the right of personhood at conception, making TOP illegal and exposing doctors and patients to potential criminal prosecution. Birth of a severely disabled baby with independent legal rights creates further conflicts between parents and clinicians complicating healthcare decision-making. Irrespective of the maternal decision to accept or refuse TOP, the psychological and emotional impact of an impaired fetus or neonate, often lead to moral distress and posttraumatic stress reactions in parents. Doctors have legal and ethical obligations to provide an accurate antenatal diagnosis with full disclosure to enable informed decision making. Failure to provide timely or accurate diagnosis may lead to allegations of negligence with potential liability for "wrongful birth" or "wrongful life" following birth of severely disabled babies. Mismanagement of such cases also causes misuse of scarce healthcare resources in resource-poor countries. This paper describes ethical challenges in clinical management of two neonates born following declined and failed feticide for severe central nervous system anomalies with a critical appraisal of the relevant literature.

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Objectives: This study was generally aimed at determining the prevalence and pattern of obesity using body mass index (BMI) criterion and specifically screening for its common primary co-morbidities among adult Nigerians attending a rural Mission General Hospital in Imo state, South-Eastern Nigeria. Materials and Methods: A descriptive study was carried out from June 2008 to May 2009. A total of 2156 consecutive new adult patients aged 18-90 years were screened for obesity using the BMI criterion, and 129 patients had BMI ≥30 kg/m ² and met the inclusion criteria. The data collected included age, sex, marital status, education, occupation, social class, weight, height and blood pressure, fasting blood sugar and lipid profile. Results: The prevalence of obesity was 6.0%, with class I obesity (86.1%) being the most common pattern. Hypertension (16.3%) was the most common primary co-morbidity; others included low high-density lipoprotein-cholesterol (21.7%), high low-density lipoprotein-cholesterol (9.3%), high total cholesterol (7.8%), high triglyceridemia (4.7%) and diabetes mellitus (3.9%). Conclusions: This study has shown that obesity and its primary co-morbidities are emerging as a serious health problem among the study population, with class I obesity being the most common pattern and hypertension being the most common primary co-morbidity. Anthropometric determination of obesity and screening for its common primary co-morbidities should be integrated as part of the clinic baseline assessment of adult Nigerians attending rural hospitals to facilitate their early detection and institutionalization of appropriate preventive and therapeutic measures.

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The management of deeply carious lesion could be accomplished conservatively by two techniques: an indirect single-step and stepwise techniques. The former involves incomplete removal of carious dentin and then application of a well-sealed permanent restoration. While the latter involves incomplete removal of caries and then reentry after a period to remove the residual caries, after changing its environment. The aim of this article was to review the dental literature concerning the conservative methods available to treat deeply carious teeth. A literature search was done using electronic databases “PubMed,” “Google Scholar,” and “Cochrane Database” for articles in English. Several keywords were used: conservative treatment, deep caries, deeply carious lesion, indirect pulp capping (IPC), and stepwise excavation. This review mentions two operative methods for conservative treatment of deeply carious lesions, namely, IPC, including criteria for case selection and success and failure of the deeply carious lesion, and an account on various used materials. Both single-step and stepwise IPC techniques could be used for managing deeply carious lesions with maintaining pulp vitality; more longitudinal studies are needed to determine which technique is preferable to be used.

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Objective: To assess the impact of the adoption of evidence based guidelines on maternal mortality reduction at Enugu State University Teaching Hospital, Nigeria. Materials and Methods: A retrospective review of all maternal deaths between 1 ^st January, 2005 and 31 ^st December, 2010 was carried out. Evidence based management guidelines for eclampsia and post-partum hemorrhage were adopted. These interventions strategy were carried out from 1 ^st January, 2008-31 ^st December, 2010 and the result compared with that before the interventions (2005-2007). Main outcome measure: Maternal mortality ratio (MMR) and case fatality rates. Results: There were 9150 live births and 59 maternal deaths during the study period, giving an MMR of 645/100 000 live births. Pregnant women who had no antenatal care had almost 10 times higher MMR. There was 43.5% reduction in the MMR with the interventions (488 vs. 864/100 000 live births P = 0.039, odds ratio = 1.77). There was also significant reduction in case fatality rate for both eclampsia (15.8% vs. 2.7%; P = 0.024, odds ratio = 5.84 and Post partum hemorrhage (PPH) (13.6% vs. 2.5% P value = 0.023, odds ratio = 5.5. Obstetric hemorrhage was the most common cause of death (23.73%), followed by the eclampsia. Conclusion: Administration of evidence based intervention is possible in low resource settings and could contribute to a significant reduction in the maternal deaths.

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Pheochromocytoma presents a challenge to the surgery team because of its clinical features and implications. The patient must be treated before the surgery until a stable hemodynamically state is achieved. The preoperative treatment includes α2-short acting adrenergic blocking and β-blocker agents. The most crucial intraoperative moments are induction of anesthesia and hemodynamic oscillations. An adequate preoperative preparation, modern anesthetic drugs, good collaboration between the surgeons and the anesthesiologists, and postoperative care decrease the rate of complications and improve the outcome. This review aims to discuss all the possible pharmacological strategies of perioperative management of phoechromocytoma, focusing on new drugs and treatments.

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A review of home management of childhood diarrhea in under-five children among 203 Nigerian mothers was carried out over a period of 3 months in order to ascertain how effectively they manage their children with diarrhea outside a hospital setup (infrastructural health facility). Mothers whose children had diarrhea, with or without other symptoms, and presented at the Children's Out Patient unit (CHOP), of the UNTH over the study period were consecutively interviewed through a questionnaire designed for the study. The questionnaires were designed and administered by the authors. There were 30 mothers in social class 1; 59 in social class 2; 52 in social class 3; 13 in social class 4, and 7 mothers in social class 5. Information was obtained on the method of detection, causes of diarrhea, and treatment including their knowledge and use of oral rehydration salts with or without anti diarrheal and antibacterial agents. Out of the 203 mothers interviewed, 140 (71%) correctly defined diarrhea. 112 (55.2%) could identify correct causes of childhood diarrhea. Only 80 (39.4%) could correctly manage diarrhea at home. About 76% (154 mothers) knew that they should use an oral rehydration salt; of this number, 56 (27.6%) could correctly prepare SSS, while 29 (14.3%) could do the same for the UNICEF ORS. In addition, anti bacterial, anti-diarrheal, and/or herbal preparations were used by 38 (18.7%) of the mothers. The level of knowledge of oral rehydration therapy has dropped in our locality since its inception in the early 1990s. There is need to intensify maternal education in this area since we now have a new generation of mothers who were not there during the inception of the program.

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