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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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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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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Purpose: The purpose of this study is to determine the properties of the dental procedures performed on children with dental problems under general anesthesia and compared between the patterns of dental treatment provided for intellectual disability and non-cooperate healthy child. Materials and Methods: In this retrospective study, the records of patients between the ages of 4 and 18 who were treated under general anesthesia were evaluated. Patients were divided into two groups: Those with intellectual disability and healthy patients who had difficulty cooperating. A statistical analysis of the mean standard deviation was conducted with a focus on two factors: Age and dental treatment methods. Results: In this study, it was observed that restorative treatment and tooth extraction was generally higher in intellectual disability children than in their healthy children. When evaluating the health status of teeth, the value of decayed missing and filled teeth (dmf-t) was observed to be close in healthy and intellectual disability individuals in the 4-6 age groups; it was higher in individuals with intellectual disability in the 7-12 age groups. There was no significant difference in terms of periodontal treatment and fissure sealants in the 12-18 age groups. Conclusions: By comparing the different patient groups who received dental treatment under general anesthesia, both the number of teeth extracted and DMF-T indices were higher in the disabled group. Therefore, especially more efforts should be made at encouraging these patients to visit the dentist earlier and receive primary preventive care.

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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: Disclosure may reduce the transmission of HIV by raising awareness and decreasing risky behavior, thus status disclosure is an issue to be addressed for HIV prevention and treatment. The objective of this study was to determine the prevalence and determinants of HIV status disclosure to sexual partners among People Living with HIV/ AIDS (PLWAs) in Ogun state, Nigeria. Materials and Methods: This study is an analytical cross-sectional study. A sample of people living with HIV/AIDS attending secondary health facilities in Ogun State were recruited into the study. Results: Of the total 637 interviewed, 324 (50.9%) indicated that they have disclosed to their main sexual partner. About 44.6% of the respondents reported that they do not know their partner's HIV status, while 30.3% had a negative partner and 25.1% with HIV-positive partners. Among the participants who disclosed their HIV status, 17.3% disclosed on the day of receiving test result, 15.5% within two weeks, 9.7% in 2 to 4 weeks, 8.3% in 1 or more months. Predictors of disclosure were individuals who were married [OR = 4.52, CI = 2.06-9.92] living within monogamous family [OR = 1.67, CI = 1.10-2.53], had anticipation of partner's support before disclosure [OR = 3.68, CI = 2.36-5.76] with knowledge of partner's sero-status either positive [OR = 4.08, CI = 2.62-6.35] or negative [OR = 2.49, C.I = 1.59-3.90] and had a low self-esteem [OR = 0.61, CI = 0.42-0.89]. Conclusion: Disclosure rate was low in this African population. The study implies that PLWAs especially those having a difficult family life should be supported to make effective decisions to disclose their status. HIV sero-status should be addressed in behavioral interventions like counseling on positive living and a multidisciplinary approach to develop positive self-esteem through follow-up counseling.

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Objective: Cesarean section (C/S) is still being perceived as an abnormal means of delivery by many antenatal women in Nigeria. This study aims to determine the perceptions of antenatal clients in the southeastern Nigeria on C/S. Materials and Methods: The study was conducted using a structured questionnaire administered to 300 consenting pregnant clients attending the antenatal clinic. The data were analyzed and presented in a simple frequency table. Results: The average C/S rate in the hospital was 16.6%. Only 4 (1.4%) viewed C/S as very good and elected to undergo C/S. Thirty-four (12.3%) considered C/S as bad and would reluctantly undergo the procedure. Two hundred and twenty-five (81.2%) would accept C/S if their life or that of their fetus is in great danger. Conclusion: This study affirms previous suspicion that a significant proportion of antenatal clients are averse to C/S and the negative cultural perception of the people to C/S reinforced this aversion.

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Background: Blood donation is the only way of acquiring blood to meet emergency requirements in cases of road traffic accidents, complications of pregnancy and childbirth, various anemic disorders and surgical emergencies among others. Globally, 80 million units of blood are donated each year, but only two million units are donated in sub-Saharan Africa where the need is enormous. The objective of this study was to determine the behavior of the students of a tertiary institution in Nigeria towards voluntary blood donation. Materials and Methods: This is a descriptive cross-sectional study, which involved students of a tertiary institution in Nigeria. A multistage sampling technique was employed in selecting the participants for this study. A semi-structured self-administered questionnaire was used to collect information on socio-demographic characteristics, knowledge, attitude and factors affecting voluntary blood donation. The data obtained were analyzed using EPI-INFO 2005 software Version 3.3.2. Results: Less than two-thirds (61%) of total respondents had good knowledge of blood donation. More than three quarters (85%) of the respondents had never donated blood. Of the 15% that had donated, only 3% donated voluntarily. Among those that had ever donated, males (57%) were more than females. Many of the donors donated for relatives (57%). The majority of the respondents were compelled to donate because of emergency situations (75%). The reasons why many did not donate were lack of opportunity (45%) due to tight lecture schedule and inadequate knowledge (24%). Gift items such as hematinics, T-shirts and wrist bands (29%) would motivate respondents to donate. Conclusion: The Students' Union body and other Organizations in the University should include a blood donation drive in their monthly/annual activities. The University authorities, the University health service centre and the Hematology Department of the Teaching hospital should collaborate in promoting voluntary blood donation among the students.

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Background: Anemia in pregnancy is highly prevalent among antenatal clinic attendees in Enugu, Nigeria despite the practice of routine iron supplementation in pregnancy. The major problem with iron supplementation in pregnancy is compliance, and this may be a potential driver to the persistent high prevalence of anemia in this population. Objectives: To find out the compliance rate and determinants of compliance to iron supplementation among pregnant women in Enugu, southeastern Nigeria. Materials and Methods: This was a questionnaire-based cross-sectional study of eligible pregnant women receiving antenatal care at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria between April 1, 2012 and January 31, 2013. Results: The knowledge of iron supplementation was 76.3% ( n = 302), however, the compliance rate was 65.9% ( n = 261). Tertiary level of education and high social class were factors significantly associated with compliance to iron supplementation after adjusting for other factors in the binary logistic regression analysis ( P < 0.05). The major barriers to compliance to iron supplementation included gastrointestinal side effects of iron supplements (41.7%), non-affordability of iron supplements (28.3%), and forgetfulness (15.0%) among the antenatal mothers. Conclusion: The compliance rate of 65.9% for iron supplementation by pregnant mothers in Enugu can further be improved by providing the drug free of charge in the short term and improvement in education and socioeconomic class of the populace in the long run.

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Background: It is well known that Hepatitis B virus infection is endemic in Nigeria. Even though studies have been carried out on Hepatitis B virus infection in different parts of Nigeria, and in different sub-groups of individuals, information regarding the prevalence of Hepatitis B virus infection in pregnant women is scanty especially from the North-eastern region of Nigeria. We therefore determined the seroprevalence of Hepatitis B surface antigen (HBsAg) amongst pregnant women in North Eastern Nigeria. Materials and Methods: A hospital-based cross-sectional study was carried out. The setting was the ante-natal clinic of the Federal Medical Centre, Yola, Nigeria. The duration of the study was from July 2008 to December 2008. Two hundred and thirty-one consecutively recruited pregnant women were screened for Hepatitis B surface antigen. Positive samples were re-tested using ELISA to eliminate false positives. Their biodata were obtained using a questionnaire to establish the presence of possible risk factors such as blood transfusion, surgery, etc. Written informed consent was obtained from each woman. Results: Out of the 231 pregnant women tested, nineteen of them were seropositive for Hepatitis B virus infection giving an infection rate of 8.2%. Women in the age group 25-29 years had the highest HBV infection rate. Conclusion: This study confirms a high seroprevalence of Hepatitis B virus infect ion amongst pregnant women. It is recommended that pregnant women should be routinely screened for Hepatitis B virus infection as part of antenatal care services.

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Objective: Despite the significant positive effect of Highly Active Antiretroviral Therapy on physical and psychosocial well-being of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (PLWHA); decreased physical activity and its associated cardiovascular risk still pose some consequences for health and general well-being. This study investigated the effect of an 8 week aerobic exercise training on cardiovascular parameters and CD4 cell (T-cells) count of PLWHA. Materials and Methods: This randomized controlled trial recruited 30 age matched PLWHA who were randomly assigned into exercise group (EG) ( n = 15) and control group (CG) ( n = 15) respectively. The PLWHA were patients receiving treatment in President's Emergency Plan for AIDS relief at the HIV clinic of the University of Nigeria Teaching Hospital, Nigeria. The EG in addition to conventional therapy received moderate intensity continuous exercise training (60-79% of the maximum heart rate [max]) of between 45 and 60 min, 3 times/week for 8 weeks, while the CG received conventional therapy involving antiretroviral therapy and counseling only. Systolic blood pressure (SBP), diastolic blood pressure (DBP), maximum oxygen uptake (VO ₂ max) and CD4 cell count were assessed at baseline (week 1) and week 8 respectively. Analysis of co-variance and Pearson correlation tests were used in data analysis. Results: Findings of the study revealed a significant effect (ANCOVA test) of moderate intensity continuous exercise training program on, SBP, DBP, VO ₂ max and CD4 cell count at P < 0.05. Changes in VO ₂ max significantly correlated (Pearson correlation test) with changes in CD4 cell count ( r = 0.528) at P < 0.05. Conclusion: Moderate intensity aerobic exercise is an effective complementary therapy in lowering blood pressure and increasing CD4 cell count in PLWHA.

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Background: Dermatophytic infections have been known to impact negatively on health and well-being of children. This study was undertaken to determine the prevalence, clinical types as well as the etiologic organisms of dermatophyte infection among primary school children aged 5-16 years in Oke-Oyi community in Kwara state. Materials and Methods: A 4-months descriptive cross-sectional survey was carried out among 602 children aged 5-16 years in Oke-Oyi community, in Kwara state. Results: The prevalence of clinically suspected dermatophytoses lesion was 29.9% (180/602). Dermatophyte accounted for 5.0% (30/602) on Sabouraud dextrose agar culture, while non-dermatophyte molds represent majority of isolate i.e., 15.4% (93/602). Tinea capitis is the commonest clinical type, followed by Tinea coporis and then Tinea pedis. Multiple infections are noted in nine respondents. Three species of dermatophytes belonging to only two of the three genera of dermatophytes were responsible for human infection in the area studied, of which Trichophyton mentagrophyte is the commonest, followed by Microsporum audouinii and Trichophyton verucossum. Among the non-dermatophytes, Aspergillus fumigatus and Candida albicans predominate. Conclusion: This study demonstrates that the prevalence of dermatophytoses in the school studied was significant. Control efforts should target this vulnerable group to reduce its prevalence.

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Background: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization's recommendation of maintenance of warm chain in newborn care, hypothermia continues to be a common neonatal condition which has remained under-recognized, under-documented, and poorly-managed. Objective: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa. Materials and Methods: All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed, Embase, Ajol, Cochrane Reference Libraries and Google Scholar. The search terms used included 'neonatal hypothermia,' 'Cold stress in newborn' 'thermal care of the newborn,' 'neonatal thermogenesis,' 'neonatal cold injury,' among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded. Result and Conclusion: Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty, home delivery, low birthweight, early bathing of babies, delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns.

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Objective: To determine the occurrence of percutaneous injuries (PI) and accidental exposure to patients' blood (AEPB) in surgical residents in Enugu, Nigeria, their awareness of universal precautions (UP), and use of post-exposure prophylaxis (PEP). Materials and Methods: Self-administered semi-structured pre-tested questionnaires were administered to 230 consenting trainee surgeons. Results: The rate of exposure to PI/ABE was 67.5%. The number of exposures ranged from 1 to 5 with a mean of 1.9±0.99. Senior registrars had the highest rate of exposure (76.9%). In 89 exposures (63.6%) needle-prick injuries were reported. Adequate knowledge of the UP and PEP to HIV virus was only 41%. In most cases (72.1%) respondents subsequently disregarded the exposure. Conclusion : The high rate of exposure to PI/ABE, inadequate knowledge and poor practice of UP/PEP seen in this study underscore the need for creating high level of awareness about UP/PEP, the development of clear institutional guideline and the provision of adequate materials and supervision to ensure adherence with the guideline. The practice of UP and PEP in PI and AEPB are life saving and should be emphasized in residency training.

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Background : Smoking control is urgently needed to prevent the epidemic of tobacco-related diseases and deaths in developing countries. This requires data on smoking, especially among vulnerable groups like students. We have surveyed cigarette smoking among undergraduates of the University of Ilorin, in the North Central region of Nigeria. Materials and Methods: This was a questionnaire-based survey among undergraduates of the University of Ilorin. A total of 1800 students were selected by multistage random sampling. Results: A total of 1754 students (234 medical and 1520 non-medical students) completed the questionnaires. They were 1148 (65.5%) males and 606 (34.5%) females with a mean age of 21.6 ΁ 3.1 years. The prevalence rate of current smoking was 5.7% (males 7.7%, females 2.0%) and of ever smoking was 17.1% (males 22.9%, females 6.2%). Smoking was more common in non-medical students. Eighty-three (83.8%) of the smokers had already started smoking by their eighteenth birthday. Fifty-one (51.5%) of them smoked ≤ 5 sticks of cigarettes daily. Most of them were influenced into smoking by peer pressure and commercial advertisements. Sixty-seven (67.6%) of them believed that smoking could never have a negative impact on their health status and quality of life and just 39 (39.4%) smokers were willing to quit. Conclusions: Despite the low prevalence rate of smoking in the studied population, a majority of them were not willing to quit because of a low perception of the negative effects of smoking on their health and quality of life. Comprehensive antismoking campaigns were urgently needed to control cigarette smoking among University undergraduates in Nigeria.

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Context: Maternal age, parity, and socioeconomic class are important determinants of obstetric outcome of pregnancy. Teenage pregnancy constitutes a high risk pregnancy with complications arising from a combination of physiological, anatomical, and socioeconomic factors Objective: The objective was to determine the current incidence of all teenage pregnancies and their obstetric outcomes at UNTH, Enugu. Materials and Methods: This was a retrospective review of all teenage pregnancies at University of Nigeria Teaching Hospital, Enugu over a 6-year period (2000--2005). A total of 74 teenage pregnancies were analyzed and compared with 105 controls (adult mothers). Results: Records of 74 teenage pregnancies were identified within the study period which constitutes 1.67% of 4422 deliveries within the period. Majority of the teenagers (78.3%) were nulliparous. There was statistically significant differences between the teenage mothers and older mothers in the rate of unemployment (75.7% vs. 24.8%, P = 0.000), booking status (41.9% vs. 100%, P = 0.000) anemia (32.4% vs. 24.8%, P = 0.001), unsure of last menstrual period (32.4% vs. 15.2%, P = 0.007), caesarean section (18.9% vs. 10.5%, P = 0.000), cephalopelvic disproportion as an indication for caesarean section (9.4% vs. 3.8%, P = 0.001), preterm delivery (18.9% vs. 11.4%, P = 0.001), low birth weight (23.0% vs. 10.5%, P = 0.005), episiotomy (61.7% vs. 28.7%, P = 0.001), instrumental delivery (6.8% vs. 2.9% P = 0.001), Apgar score at 1 minute (35.1% vs. 19.1% P = 0.005), and perinatal mortality (16.2% vs. 12.4%). There were no maternal deaths. Conclusion: Pregnant teenagers are at higher risk than their older counterparts. Female socioeducational development and proper use of contraceptive services will help reduce teenage pregnancy rate, while perinatal care will help to minimize it associated hazards

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Objective: To determine the prevalence of hypertension amongst persons with diabetes mellitus (DM) in Benin city. Materials and Methods: Four hundred and fifty diabetic subjects were evaluated for hypertension by measuring their blood pressure using a sphygmomanometer at the diabetes clinics of the University of Benin Teaching Hospital and Central Hospital, both in Benin City, Nigeria. Other data obtained included age, sex, type of DM, weight, height, body mass index and waist hip ratio. Results: Two hundred and forty-four out of 450 subjects had hypertension, thus giving a prevalence rate of 54.2%. 124 males (50.8%) were hypertensive compared with 120 (49.2%) females, but this difference was not significant (χ² = 0.1, df = 1, P > 0.05). Thirteen (22.4%) of the 58 Type 1 subjects had hypertension, while 231 (58.9%) of the Type 2 subjects had hypertension, and this difference was statistically significant (χ² = 27, df = 1, P < 0.05). Conclusions: Hypertension is prevalent in persons with DM. Studies have shown that adequate control of the blood pressure reduces the microvascular and macrovascular complications of DM. DM care providers must prescribe appropriate antihypertensive therapy to control hypertension in persons with DM.

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Background: Awareness and education on kidney disease impact on its effective management and will reduce the significant economic and public health burden. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behavior. We conducted a cross-sectional descriptive study to assess the level of awareness, knowledge and conventional risk factors of CKD in the community to strategize on preventive modalities using the information gathered from this population. Methods: We used a pretested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 563 residents aged >18 years. Results: A total of 454 residents completed this study, mainly farmers, with a mean age of 45.8 ± 19.0 years and male: female ratio of 0.8:1. Only 33.7% had heard of kidney disease with 59.3% from the media and 35.3% from health workers; the level of knowledge of CKD was good in 27.1%. The majority (67.0%) do not know the correct location of the kidneys. Only 10.6% could mention at least one function of the kidneys with only 24.5% agreeing that NSAIDs can cause kidney disease. A laboratory test for kidney function was known by 4.4%; 45.9% and 47.8% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Only 11.1% agreed that CKD can be hereditary. Abdominal obesity and cigarette smoking were seen in 14.6% and 16.6% respectively. Hypertension was seen in 26.5% while 17.8% actually knew they were hypertensive. Diabetes mellitus was found in 3.4%. None of the patients with CKD who had diabetes or hypertension was aware of kidney disease. Conclusion: There are a misconception and low level of awareness and knowledge of CKD, including those with risk factors, in the community. Efforts should be made to create awareness and educate people on CKD and prevention of its risk factors.

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Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patients' satisfaction with quality of care provided at the National Health Insurance Scheme (NHIS) clinic of a tertiary hospital in South-Eastern Nigeria. Materials and Methods: This was a descriptive study carried out on 400 NHIS patients from April 2011 to October 2011 at the general outpatient department of Federal Medical Centre, Umuahia. Patients were selected by simple random sampling using every second NHIS patient that registered to see the clinicians and who met the selection criteria. Data were collected using pretested, structured interviewer-administered questionnaire. Each satisfaction item was scored in a five-point Likert scale ordinal response, which was converted to percentage scale response. Satisfaction was measured from the following domains: accessibility, patient waiting time, patient-provider communication, patient-provider relationship, hospital bureaucracy, and hospital environment. Operationally, patients who scored 50% and above in the assessed domain were considered satisfied while those who scored less than 50% were dissatisfied. Results: The overall satisfaction score of the respondents was 66.8%. Specifically, the respondents expressed satisfaction with patient-provider relationship (81.5%), patient-provider communication (79.9%), accessibility (74.2%), and hospital environment (68.2%) and dissatisfaction with hospital bureaucracy (48.8%) and patient waiting time (48.3%). Conclusion: This study has shown that the overall patients satisfaction with the services provided was very good with patient-provider relationship rated highest and patient waiting time the lowest. There is need to improve on the current level of patients satisfaction while effort should be made to address the identified domains of dissatisfaction.

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Background: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and secondarily through screening and treatment of identified precancerous lesions. Aim: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu, southeastern Nigeria. Materials and Methods: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant. Results: The awareness of screening for cervical cancer (91%) was significantly higher than that of the HPV vaccine (62.7%) [odds ratio (OR): 0.17; 95% confidence interval (CI): 0.09-0.30]. However, the acceptability rate of the HPV vaccine (91.0%) was significantly higher than that of cervical screening (71.4%) (OR: 4.04;95% CI: 1.94-8.42)]. Only 25 (14.1%) of the health-care workers had done cervical screening, but 30 (49.2%) of the 61respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening, cost and availability of HPV vaccine was a major deterrent for the latter. Conclusion: With more public enlightenment, available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high.

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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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Objective: The purpose of the proposed study was to develop an identification unit for classifying periodontal diseases using support vector machine (SVM), decision tree (DT), and artificial neural networks (ANNs). Materials and Methods: A total of 150 patients was divided into two groups such as training (100) and testing (50). The codes created for risk factors, periodontal data, and radiographically bone loss were formed as a matrix structure and regarded as inputs for the classification unit. A total of six periodontal conditions was the outputs of the classification unit. The accuracy of the suggested methods was compared according to their resolution and working time. Results: DT and SVM were best to classify the periodontal diseases with a high accuracy according to the clinical research based on 150 patients. The performances of SVM and DT were found 98% with total computational time of 19.91 and 7.00 s, respectively. ANN had the worst correlation between input and output variable, and its performance was calculated as 46%. Conclusions: SVM and DT appeared to be sufficiently complex to reflect all the factors associated with the periodontal status, simple enough to be understandable and practical as a decision-making aid for prediction of periodontal disease.

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Objective: To compare the shear bond strength of resin cement to zirconia-based monolithic CAD-CAM materials subjected to different surface treatments. Methods: 2 brands of monolithic zirconia blocks (Vita YZ HT, Sirona inCoris TZI), yttrium-stabilized tetragonal zirconia (IPS e.max ZirCAD) and zirconia-reinforced lithium silicate ceramic (Vita Suprinity) were divided into six groups according to the surface treatment received: no treatment (control), HF acid etching, sandblasting, sandblasting + Er:YAG laser irradiation, Er:YAG laser irradiation and CoJet. Composite resin cylinders were bonded to blocks with self-adhesive resin cement (Theracem). Shear bond strength was evaluated after thermocyling. Failure modes were examined using SEM. Data was analyzed statistically by using 2-way ANOVA and post-hoc Tukey's test (P < 0,05). Results: The bond strength was significantly affected by the surface treatment and the type of CAD-CAM blocks (P < 0,001). Surface treatment with CoJet revealed significantly higher bond strength compared to sandblasting in Y-TZP and monolithic zirconia specimens. Conclusions: Monolithic zirconia blocks showed higher bond strength values compared to Y-TZP zirconia block in sandblasting and CoJet groups. HF acid etching is more effective than sandblasting and CoJet for Vita Suprinity.

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Background: The increasing use of commercial motorcycle as mode of transportation in urban cities in Nigeria has become important source of morbidity and mortality. This is coupled with poor helmet use, narrow roads, increasing traffic, and poor licensing of the motorcycle riders. The objectives of this study are to determine the pattern of injuries following accident involving motorcycles, the mortality rate, and the immediate causes of mortality. Materials and Methods: This is a combined retrospective and prospective study spanning over 2 years (1 year each). Patient's records were retrieved to collate data for the retrospective study while all the patients presenting to the casualty unit of Jos University Teaching Hospital following involvement in motorcycle accidents between April 2006 and March 2007 were selected for the study. Results: Out of 485 motorcycle injured patients, 295 and 190 were recruited from the retrospective and prospective study respectively. The male: female (M: F) ratio was 4.8:1. The ages ranged from 2.5 to 84 years with a peak at 21-30 years. The total number of injuries was 559 with 443 patients singly injured and 42 patients multiply traumatized. Head injury (40.1%) was the most frequently occurring injury followed closely by extremity injuries (38.1%). None of the patients wore protective helmet. Thirty-six (36) mortalities (7.4%) were recorded and all dead patients had head injuries. All deaths occurred within 24 h. Conclusions: Head injury represents a common cause of morbidity and mortality following motorcycle injuries in our environment. Therefore, strict enforcement of helmet laws from May 10, 2010 may reduce morbidity and mortality.

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Obesity is rapidly becoming an emerging disease in developing countries due to the increasing westernization of societies and change in the lifestyle. The etiology of obesity is said to be multifactorial, with a combination of genetic and environmental factors. Literature has been extensively reviewed to provide a broad overview of obesity. Data for this review were obtained from original articles, review articles and textbooks. Internet search engines were also employed. The years searched were from 1993 to 2008. Obesity, classified in terms of the body mass index and the waist-hip ratio, has several associated co-morbidities such as diabetes mellitus, hypertension, degenerative osteoarthritis and infertility. In Nigeria, there is limited information on obesity. A literature review on obesity is necessary to improve the knowledge about obesity in developing countries, its prevention and its management.

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