Monkeypox (MKPX) is a rare viral zoonosis which was first discovered in a laboratory in Denmark in 1958. This critical review involved literature search of data on the history of MKPX virus (MKPXV), its emergence and re-emergence, molecular virology, global epidemiology and geographical distribution, the recent outbreak of MKPX in Nigeria, diagnostic and treatment considerations using Google Scholar, PubMed and Scopus. Findings from this review revealed that the first human cases of MKPX were diagnosed and differentiated from smallpox in the early 1970s. Since this period, several cases have been reported in rural, rainforest areas of West Africa and the Congo Basin, especially in the Democratic Republic of Congo, Cote d'Ivoire, Cameroon, Midwest of the United States of America, South-Sudan, Central African Republic, and recently in Nigeria. The outbreaks in the non-endemic areas of the US and Sudan occurred due to zoonotic transmission of the virus into these nonrain forested areas. The geographical spread of MKPXV until date has renewed research efforts in unravelling environmental factors that favour ecological niche of this pathogen. This study aimed to review both biotic and abiotic factors that are responsible for the expansion of the ecological niche and geographic distribution of human MKPX in Nigeria. It appears that environmental factors, conflict and globalisation are responsible for the increasing risk of animal-human transmission through direct contact between the cutaneous or mucosal lesions of the infected animal and the compromised skin barrier of a human, and the consumption of poorly cooked-infected flesh. Lymphadenopathy is a distinguishing clinical feature of MKPX from other pox-like illnesses. Laboratory diagnosis of anti-poxvirus antibodies in an unvaccinated person with a clinical history of severe illness and total body rash is suggestive of MKPX infection. The lack of sufficient data to guide the identification of potential reservoir hosts, and public health intervention strategies/surveillance, inadequate training for health workers, unavailability and inaccessibility of suitable diagnostic assays, vaccines and anti-viral treatment could be some of the reasons cases of MKPX re-emerge when not successfully contained, especially in endemic regions.

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Background: Missed immunisation appointments are a common occurrence among Nigerian children, and it is due largely to forgetfulness on the part of the parents/caregivers. Although the use of mobile phones is widely available to Nigerian mothers, the readiness of Nigerian mothers to accept a mobile phone short message service (SMS) for interacting with immunisation providers, specifically, for tracking immunisations appointments, notifying absence of vaccines and accessing other vaccine information remains uncertain. Aim: The aim of this study was to assess the acceptance of mobile phone text messaging for childhood immunisation reminders by Nigerian mothers as well as its determinants. Methods: A descriptive cross-sectional, questionnaire-based study carried out over 3 months (June–August 2017) at the Federal Medical Centre, Owerri, Nigeria. Results: A total of 253 mothers were interviewed. About 27% of the mothers reported to have missed their babies' immunisation appointments in the past. Mothers who are currently married (χ² = 5.954, P = 0.015) and those with higher levels of education (χ² = 13.001, P = 0.005) were significantly less likely to forget their child's immunisation dates. Majority (75.9%) believe that reminders will reduce missed immunisation appointments. A greater proportion (61.7%) of the mothers would accept a phone reminder for their babies' immunisation appointments. Many (76.9%) of them were willing to pay for such services. Conclusion: Forgetfulness is one of the major reasons for missed immunisation appointments among mothers in Nigeria. Considering the acceptance of SMS by the majority of the mothers studied, there is no doubt that its adoption in Nigeria will create a positive impact in improving immunisation of children in Nigeria.

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Background: The risk of nosocomial infection is increasing due to the increasing number of patients with immune depression. Good ventilation is one of the methods used to reduce the ambient air levels of the causative agents, but this is rarely observed in Nigeria as hospital designs used to shut out the inclement weather in temperate countries are copied without many modifications, and without adequate provisions to constantly power the mechanical ventilation mechanisms. This study tested the microbiological air quality at different areas of the University of Port Harcourt Teaching Hospital to ascertain the levels of airborne bacteria and fungi in the ambient air. Methods: The study was carried out in July 2015 in randomly selected inpatient wards, outpatient clinics, and clinical laboratories of the hospital. The assessment was carried out by exposing Petri dishes containing the appropriate culture media for about 30 min at a convenient place in each of the nine study sites. Thereafter, the plates were covered and immediately transferred to the laboratory for incubation at 37°C, for 24-48 h, for bacteria; and at room temperature, for 5-7 days, for fungi. The number and types of bacteria and fungi in the cultures were determined at the end of the incubation period. Results: There were detectable bacteria and fungi in the ambient air of all the study sites. The mean bacterial count ranged from 9.5 colony forming unit per cubic meter (CFU/m ³ ) in the urology ward to 199.33 in the HIV clinic, with a mean of 80.0 CFU/m ³ , while the mean fungal count ranged from 10.5 CFU/m ³ in the surgery outpatient clinic (SOC) to 23.5 in the Anatomical Pathology Laboratory (APL), with a mean of 16.9 CFU/m ³ . Staphylococcus and Streptococcus were the most common bacteria in the SOC; Klebsiella was predominant in the immunization clinic; Escherichia coli were the most common in the APL, while bacillus was most frequently isolated in the gynecology ward. The fungi cultured from the study sites include Aspergillus, Penicillium, Fusarium, Trichophyton, Candida, and Rhizopus. Unlike the bacteria count, the fungal count increased in all the study sites at the end of the working day. Conclusion: The number and types of bacteria and fungi cultured from the study sites have the potential to cause ill health. Corrective actions are therefore needed.

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Introduction: The perceived high cost of eye care services has been implicated as one of the reasons for the use of traditional eye medications (TEMs) in the country. Other factors including distance, tradition, ignorance, and failure of medical treatment among others have also been documented as determinants of TEM use. TEMs constitute a wide range of unorthodox therapies utilized for treatment of ocular disorders. They have been reported to have no beneficial effect rather causing more harm than good. Aim: This study sought to determine the prevalence, types, and ocular indications for TEM use in the study population. Methods: This was a cross-sectional study in which a structured questionnaire was used to collect relevant data from consecutive patients attending the eye clinic during the study. Results: At a prevalence of 15.8%, the highest use of TEM was noted among artisans, those in the seventh decade of life, with low level of education, ocular complaints of poor vision, and illness of <1 year duration. Its use though high, was not significantly associated with age, sex, education, occupation and illness duration. Roots and herbs were the most common types of TEM used. Conclusion: There was a high prevalence of use of TEM in this study. The deleterious effect of its use is known and has been reported in literature. Education and enlightenment of the public are needed and highly recommended.

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Background: The use of herbicide in weed control has grown significantly in Nigeria in recent years. Most of the applications are indiscriminately carried out by illiterate farmers, and therefore pose a significant threat to the environment, crop yield and human health. This study assessed the effects of different application rates of the herbicides on the residual levels of the herbicides and their metabolites in harvested maize cobs. Methods: The study was carried out in a plot of land at the University of Port Harcourt in 2013 and 2014, using a randomised complete block design with three replicates, and plot size of 2 m × 2 m. N-(phosphonomethyl) glycine was used to prepare the experimental plots, while different application doses of Primextra dual gold (2-chloro-4-(ethylamino)-6-isopropylamino-1,3-5-triazine and 2-chloro-N-(ethy-6-methy(phenyl)-N-(2-methoxyl-1-methylethyl acetamide) were applied to the plots, after planting the maize. The control plot was not treated with the herbicides. The residual levels of the herbicides and their metabolites in the cobs harvested from the plots were tested using gas chromatography, with Pulsed Flame Photometric Detector. Results: The residue of the herbicides and their metabolites were barely detectable in the harvested maize cobs when the herbicides were applied at or below their recommended dose, but noted at up to 0.09 ppm, when applied at twice the recommended dose. The residues were also noted in some of the cobs harvested from the control plot, at a mean concentration of 0.0033 ppm, which is significantly <0.012 ppm recorded in the treated plot. Conclusion: The residual concentrations of herbicides and their metabolites in harvested crops increased with increasing application dose of the herbicides. Proper education of farmers is, therefore, needed to safeguard the environment and public health.

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Background: Improving efficiency in patient flow and the satisfaction of patients attending outpatient clinics may require paying close attention to the actual time spent by patients at the various service points during their visit to the hospital. This study assessed the time clients spent at various service stations, the level of their satisfaction with the time spent and the relationship between waiting time and satisfaction for patients seeking care at the General Outpatient Clinic of the University of Port Harcourt Teaching Hospital. Methods: A total of 422 adult patients seeking care at the clinic were selected by time-limited systematic random sampling and followed through all their engagements within the hospital. Details of the time spent at each service station and clients' satisfaction with the time spent were collected using record sheet and a patient satisfaction questionnaire. Data were analysed with the Statistical Package for the Social Sciences, version 20. The statistical effect sizes and confidence intervals of measured outcomes were reported. The P < 0.05 was considered statistically significant. Results: More of the patients were female (58.6%), married (65.3%) and regular visitors to the clinic (72.6%). The mean time of 83 min was spent on the movement to the hospital and further 274 min to conclude all relevant activities in the course of seeking general practice service in the hospital. The average time of consultation with the doctors was 19 min, whereas the longest mean waiting times of 77 and 50 min were spent while waiting to access radiological and laboratory services, respectively. More patients were satisfied with the time they spent consulting the doctors (93%) or waiting to have their vital signs checked by the nurses (83%) than they were with the time taken to access radiological (30%) and laboratory services (47%). There was a significant inverse relationship between the level of patient satisfaction and the duration of time spent at the service stations. Conclusion: The waiting time for patient accessing general outpatient care in the teaching hospital is long and could be a major contributor to negative patient experiences. There is a need for system redesign, establishment of patients' appointment scheduling and other interventions by service providers that will ensure efficient and effective management of patient flow, timely access to health services and an overall improvement of patient experience with the general outpatient encounter.

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Background: Palliative care, a multidisciplinary approach to specialised medical care, focuses on improving the quality of life for both the patient and the family. It increases their satisfaction and improves clinical outcome. Its concept, however, is relatively new in Nigeria, with services mainly limited to patients who attend the tertiary hospitals. Aim: The aim of this study is to evaluate the knowledge and perception towards palliative care among health-care providers in Rivers State. Methods: This cross-sectional study was conducted in November 2012 at the University of Port Harcourt Teaching Hospital, among participants of a workshop on Hospice and Palliative care. Participants were healthcare providers from within and outside the hospital, including doctors, nurses, pharmacists, social workers, medical and nursing students. A structured, anonymous and self-administered questionnaire was used to obtain data on knowledge of palliative care and awareness information. Data were analysed using SPSS version 20.0. Results: There were 114 respondents and this comprised of 29 (25.4%) males and 85 (74.6%) females, giving a male-to-female ratio of 1:3. They were mainly doctors (44.7%) and nurses (44.7%). Majority (88%) had previously heard of palliative care. Sixty-four (56.1%) of them heard of it in a hospital setting from doctors/nurses, 37 (32.5%) from friends/family and 10 (8.8%) in school. Forty-six (40%) respondents believed that nurses should be the ones to provide palliative care services, while 32 (28%) believed the doctors should. Less than half (47.4%) were aware of the interdisciplinary facet of palliative care. Ninety-five (83.3%) respondents believed that terminally ill patients should benefit from palliative care services, while 17.5% believed that patients with diabetes should. More doctors (80%) than nurses (47%) rightly identified the components of palliative care. Conclusion: Healthcare providers had insufficient knowledge concerning the interdisciplinary nature of the palliative care team, potentials beneficiaries and components of palliative care.

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Background: Scalp and hair disorders are common and of immense health and cosmetic significance. Alopecia, the most common presentation of scalp disorders, has been found to impact negatively on the quality of life of patients. Aim: This study aimed to document the spectrum of scalp and hair disorders, with the age and sex distribution, at the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) between 2004 and 2012. Methods: This is a retrospective study of patients who presented primarily with hair and scalp disorders. Data was obtained from clinic records and patients clinic notes; and included biodata, diagnoses, age and sex distribution. Results: During the study period, 860 patients (5.3%) of the 16,160 patients presented primarily with scalp and hair disorders. Both children and adult patients are seen at the clinic. Patients seen ranged from 3 months to 80 years of age. More males (67.2%) than females (32.8%) were seen; with ratio 2.05:1. Tinea capitis, dermatophyte infection of the scalp, was the most common disorder (30.5%), with male preponderance in the first decade of life. Chronic inflammatory scalp disorders such as acne keloidalis, dissecting folliculiis and folliculitis decalvans were found predominantly in adult males; while alopecia areata, scalp psoriasis and pityriasis amiantacea were noted to be more common in adult females. Conclusion: This study noted high frequency of chronic inflammatory scalp disorders found predominantly in males. However, disorders of hair care practices such as traction alopecia found commonly in community surveys were not frequent presentations in our practice. Further to determine the epidemiologic factors, aetiology and clinical characteristics of the common scalp and hair disorders will be necessary.

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Background: Human papillomavirus (HPV) is a sexually transmitted infection found most commonly among sexually active adolescents and young women. HPV vaccine is available in Nigeria. However, very few persons have been vaccinated. This study, therefore, aimed to assess the level of awareness of HPV infection and its vaccine uptake among female university students in Rivers State. Methods: This was a descriptive cross-sectional study carried out between July and October 2015 in three Universities in Rivers State, Nigeria. Multistage sampling was used to identify the study participants. Results: A total of 780 eligible females were recruited into the study. About 262 (33.6%) had heard of HPV infection and 203 (26%) had heard of HPV vaccines. Among those who had heard of HPV vaccines, 148 (72.9%) were aware that the vaccine could protect against HPV infection while 97 (47.8%) were aware that the vaccine could protect against cervical cancer. Only 40 (5.1%) of study participants had been vaccinated with HPV vaccine. HPV vaccine uptake was significantly predicted by respondent's marital status (adjusted OR [AdjOR] = 0.061; 0.015–0.246), parity (AdjOR = 5.855; 1.433–23.923) and knowledge about HPV (AdjOR = 7.918; 3.062–20.475). Conclusion: Awareness of HPV infection and HPV vaccine among female undergraduates in Rivers State is poor. There is, therefore, need for health promotion interventions that address this gap as part of cervical cancer control activities.

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Background: Mortuary workers face various hazards in course of carrying out their duties. These hazards may be ignored by employers and employees alike. Identifying these hazards in time before they become risks that cause accidents and even death is recognized mode of prevention and control. This study was to assess the workplace hazards in mortuaries located in Port Harcourt City Area. Methods: Following ethical approval, this descriptive cross-sectional study recruited 100 eligible respondents from private and public mortuaries, respectively, balloted for from six known and registered mortuaries in Port Harcourt city. Respondents answered pre-tested, close-ended, structured, self-administered questionnaires which probed sociodemographics, occupational history, knowledge and behaviour towards hazards encountered while at the workplace. There was also an adapted checklist used for the walk-through survey of the study sites' identification and quantification of hazards. Data obtained were analysed and presented using descriptive and analytical statistical tools. Results: The study had mostly male (95%) respondents with only 15% having acquired tertiary education. The majority (94%) of the hazards respondents were exposed to were mechanical slips, trips and falls. The majority (93%) of respondents had safety training on the hazards associated with the mortuary, while 11% used personal protective equipment (PPE) always. Conclusion: Hazards abound in mortuaries in Port Harcourt City even though most workers had received training on hazards and hazards prevention. There was also a poor use of PPE. It is recommended that health education, provision, enforcement and monitoring of the use of PPE be intensified among this group of workers.

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Background: Uterine fibroid, over the years, has remained a major gynaecological problem in Nigeria, and although various treatment modalities exist, abdominal myomectomy has remained the mainstay of treatment for those women who want to preserve their reproductive capacity. Most of them, however, present late when the fibroids are either huge or associated with complications. Aim: The aim of this study was to present experience with abdominal myomectomy vis-a-vis its outcome and also to show the symptoms at presentation. Methods: This is a study of the first hundred abdominal myomectomies carried out by the author in Imo State University Teaching Hospital and St. Damian's Catholic Mission Hospital both in Orlu, Imo state, Nigeria. The myomectomies were carried out between August 2007 and September 2013. Data were recorded in a pre-surgery-prepared pro forma administered by the author prospectively. The data were analysed using SPSS version 15 and the results presented in descriptive, tabular and graphical forms. Results: The age of the hundred women who had myomectomy ranged from 20 to 49 years. The most common symptoms these women presented with were menorrhagia (69%), abdominal mass (63%), dysmenorrhoea (33%) and infertility (33%). The sizes of the uterus on abdominal palpation ranged from not palpable (5%) to as much as 36 weeks gestation. The major myomectomy-associated complications in this study were blood transfusion rate of 86%, post-myomectomy pyrexia (44%), severe haemorrhage (25%) and post-myomectomy anaemia (24%). There was one mortality due to severe haemorrhage. Conclusion: Menorrhagia and abdominal mass are the chief symptoms of the fibroid. Severe haemorrhage still remains a major threat to successful abdominal myomectomy and efforts should be geared towards reducing this.

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Background: Diseases associated with diarrhoea rank second among the top five diseases which account for childhood morbidities and mortalities in developing countries. Home-based management of diarrhoea is a globally recommended approach to reversing this trend and averting preventable deaths among under-five children. Aim: To explore the knowledge of, attitudes to and the practice of home management of diarrhoea (HMD) among mothers of under-five children. Methods: A cross-sectional, descriptive study was conducted in Samaru, Kaduna State, Nigeria, among mothers of under-fives, selected by multistage sampling method. Data were collected using interviewer-administered, close-ended, structured questionnaires, and then cleaned for errors and electronically analysed. Results: The awareness of the concept of HMD was universal. Diverse methods were mentioned by respondents, ranging from recommended to inappropriate options. The knowledge of oral rehydration salts was high (93.7%), with the main source of information being health facilities. However, only 34.4% of the respondents would resort to using ORS for HMD, and the overall practice of any form of HMD was only 64%. Conclusion: The knowledge of both recommended and inappropriate methods of HMD was demonstrated among respondents. Their awareness of ORS was high. However, the actual practice of HMD was relatively low. The promotion of positive HMD methods of fluid and electrolyte replacement; continuous, nutritious feeding and zinc supplementation for children with diarrhoea among mothers and caregivers is recommended.

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Background: Drug resistance to anti-tuberculosis (anti-TB) medication and human immunodeficiency virus (HIV) infection undermines global control of TB. Aim: The aim of this study is to determine sputum mycobacteria/rifampicin resistance obtained from Xpert MTB/RIF molecular assay in five health facilities in Borno state. Methods: Records of 5518 presumptive TB cases that presented for care from September 2014 to December 2017 were retrieved from TB registers in this multicentre descriptive study. Results: A total of 5518 pulmonary TB presumptive cases, out of which 5484 were drug-sensitive TB (DSTB) and 34 drug-resistant TB (DRTB). The MTB detection rate was 19.1% and it was higher among DRTB with rate of 41.2% than DSTB of 19.0%. The prevalence of rifampicin resistance was 6.1%, with higher preponderance rate of 78.6% among DRTB cases than 5.1% among DSTB cases. Only 2566 (46.5%) had HIV counselling and testing. The MTB detection rate of 22.1% in HIV-negative patients was significantly higher than 16.5% in HIV patients, P = 0.001, 95% confidence interval (CI) = 2.27–8.93. Conversely, RIF resistance of 7.0% obtained in HIV patients was significantly higher than 4.8% in HIV-negative patients, P = 0.03, 95% CI = 0.06–4.34. Previous TB treatment was significantly associated with RIF resistance, P = 0.000, odd ratio = 1318.1, 95% CI = 302.1–6318.3. Conclusion: GeneXpert is a valuable tool for the detection of both MTB and RIF resistance. It is therefore useful for both management and TB infection prevention and control. Given the observed strong association between previous exposure to anti-TB medication and RIF resistance in this report, we advocate mandatory resistance test for TB patients with previous exposure to TB medication in addition to good adherence to TB medication.

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Background: Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular risk factors. Cardiovascular disease is the leading cause of death in patients with CKD. Aim: The aim of this study is to determine the prevalence of the various cardiovascular risk factors in CKD patients and compare with that of healthy controls. Methods: A case-controlled study. The study sample included 94 diagnosed CKD patients above the age of 18 years without symptoms of cardiac disease and 70 controls. Fasting plasma glucose, lipid profile, creatinine, albumin, glomerular filtration rate and urinary albumin-creatinine ratio were estimated in participants. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The cardiovascular risk factors found in CKD patients versus controls were hypertension (62.7% vs. 11.4%), diabetes (13.8% vs. 7.1%), dyslipidaemia (50.0% vs. 31.4%), obesity (14.9% vs. 20.0%), hypoalbuminaemia (19.1% vs. 0%), microalbuminuria (55.3% vs. 20.0%) and macroalbuminuria (21.3% vs. 0%). However, only the prevalences of hypertension (P < 0.001), hypertriglyceridaemia (P = 0.007), low high-density lipoprotein (HDL) (P = 0.050), hypoalbuminaemia (P = 0.007), microalbuminuria (P < 0.001) and macroalbuminuria (P < 0.001) were statistically significant. Patients on maintenance haemodialysis had higher prevalence of hypertension (P = 0.018) and hypoalbuminaemia (P = 0.001) than pre-dialysis patients. Conclusion: Prevalences of hypertension, hypertriglyceridaemia, low HDL, hypoalbuminaemia, microalbuminuria and macroalbuminuria were significantly higher in CKD patients than in controls.

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Background: Sexually transmitted infections (STIs) are diseases of public health concern among adolescents and young adults and occur in a quarter of teenagers who are sexually active. This study assessed the knowledge on STIs and the practice of risky sexual behaviours among senior secondary school students in Jos North Local Government Area, Plateau State, Nigeria. Methods: This was a cross-sectional study in which a structured, self-administered questionnaire was used to collect data on sociodemographical characteristics, knowledge on STIs and risky behaviours associated with STIs. Multistage sampling technique was used. Analysis was done using SPSS software version 20. Results: A total of 398 adolescents aged 13–20 years with a mean age of 15.5 (1.37) years participated in the study. About 50% were females and 90% of them were Christians. A majority (99.2%) of them had heard about STIs, and the major sources of information were from schools (21.7%), radio (13.7%) and television (13.2%). In all, 19.8%, 65.6% and 14.7% of the respondents had poor, fair and good knowledge of STIs, respectively. Of the 54 (14.7%) students that were sexually active, 48% practiced unprotected sex, 63% had more than one sexual partners and 25.9% had traded sex for money. Knowledge was not statistically significantly associated with the practice of risky sexual behaviour (χ^[2] = 5.381, P = 0.250). Conclusion: The study found out that the participants generally had a fair knowledge about the types of STIs and they were found to exhibit worrisome risky sexual behaviour (having multiple sexual partners and recurrent STIs). Reinforcement of the current secondary school curriculum to emphasise comprehensive health education on STIs and dangers of the practice of risky sexual behaviour is needed.

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Background: The prevalence of genitourinary malignancies has been found to be increasing in most centres in Nigeria and worldwide. Petroleum and gas explorations have been associated with some genitourinary cancers. Port Harcourt is a major city in the oil and gas exploration zone in Nigeria. Aim: This study aimed to determine the prevalence and pattern of genitourinary malignancies at the University of Port Harcourt Teaching Hospital, Port Harcourt. Methods: A 7-year retrospective study spanning between January 2005 and December 2011 was carried out to document the frequency and pattern of genitourinary malignancies in patients above 16 years of age in the University of Port Harcourt Teaching Hospital. Data were retrieved from patients' case notes, histopathology reports and theatre registers. Information retrieved included gender, age, organ involved and the histologic type. Analysis was done using Statistical Package for Social Sciences version 20.0. Results: A total of 477 cases were isolated. Adenocarcinoma of the prostate was the most common genitourinary malignancy in the region (86.8%), followed by bladder cancer (6.5%) and then malignant renal tumours. The median age for prostate cancer was 67.8 ± 10.3 years, bladder cancer was 58.0 ± 15.6 years and malignant renal tumour was 41.0 ± 19.9 years. Malignant renal tumour had an early peak in the 21–30 years' age range. Transitional cell carcinoma accounted for 83% of bladder cancer. Papillary cell type was the most common renal cell carcinoma seen. Conclusion: There are observed differences in the age of presentation of prostate and renal cancers in this region. The histologic pattern of renal cancer is also different from the pattern observed elsewhere.

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Background: It is generally believed in third world countries that labour pains are well tolerated and so analgesia in labour is unnecessary. Studies have shown high levels of awareness but poor utilisation among parturients. This study assessed the level of awareness, desirability and barriers to the use of labour analgesia among pregnant women in Zaria. Methods: This was a prospective, cross-sectional and descriptive study carried out on 368 antenatal clinic clients at Ahmadu Bello University Teaching Hospital, Zaria, from November, 2011 to January, 2012. A semi-structured, pre-tested questionnaire was administered, and the data collected were analysed using the Statistical Package for Social Sciences software version 16. Results: The mean age of the respondents was 29.1 ± 5.5 (standard deviation) years. Majority (41.3%) were Hausas, 61% were Muslims, 56% were aware of labour analgesia and most (34.8%) got their information from nurses. The most common method of pain relief known was music and hypnosis, constituting 97.3%. Only 13.3% of the clients (49) have ever experienced any form of analgesia administered during labour and half of which got their experience overseas. About 62.5% of the clients desired pain relief in labour, but the major obstacle to its uptake was unavailability of the methods. Conclusion: Although patients are aware of labour analgesia, most have not experienced it mainly due to nonavailability of the methods. Clients need further education, and pain relief in labour should be made available in maternity centres.

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Background: The use toothbrush and paste are the most common means of oral prophylaxis in Nigeria and how the frequency of this prophylaxis affects the prevalence of periodontal disease has not been fully ascertained. Aim: This study aims to assess if frequency of self-oral hygiene prophylaxis in a day, using the toothbrush and paste, had any relationship on the prevalence of inflammatory periodontal diseases, using the community periodontal index of treatment needs (CPITN). Methods: A cross-sectional study of 894 subjects (428 males and 466 females), who reported for the first time at the Dental Centre, of the University of Benin Teaching Hospital, Benin City, Nigeria, were examined. Only those that used toothbrush and paste once or twice daily, as the only oral hygiene method and were 18 years and above of age, were selected and investigated. Results: 58.3% of the entire subjects surveyed and 63.1% of male subjects indicated twice-daily oral prophylaxis when compared to 53.9% of female subjects. There was a statistical significant difference in the distribution of subjects with respect to occupation, between the two groups. This difference was most marked among the professional subgroup as compared to other subgroups. There was a statistical significant difference in the prevalence of periodontal diseases as indicated by CPITN scores. The group that performed oral prophylaxis twice daily had a higher proportion of those with CPITN codes 0 and 1 whereas codes 3 and 4 were more predominant with the group that perform oral prophylaxis once daily. Conclusion: The distribution of CPITN scores had a relationship with the frequency of daily oral hygiene practices. In view of the results of this study, it is suggested that some form of preventive oral hygiene programs be embarked on where emphasis is placed on regular and higher frequency of tooth brushing.

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Background: Neurofibromatosis (NF) is a neurocutaneous disorder which involves many organs in the body. There are two types: NF-1 and NF-2. Orbital manifestation is a rarity in NF-1, and it involves dysplasia of the sphenoid bone resulting in herniation of the temporal lobe and subarachnoid space into the orbit culminating in pulsating exophthalmos. Aim: To highlight the clinical presentation and radiological investigation of this rare ocular manifestation of NF-1. Methods: A case report. Results: The case of a 20-year-old male student presenting with a pulsating right eye swelling of about 17-year duration is presented. There was a family history of a first-degree relative with multiple skin swellings. Plain skull radiograph and cranial computed tomography (CT) scan were done and both revealed absence of the right sphenoid bone with herniation of the right temporal lobe and cerebrospinal fluid space into the right orbit. The patient was subsequently lost to follow-up. Conclusion: Pulsating exophthalmos is a complication of sphenoid dysplasia, a rare component of NF-1. Plain skull radiograph and cranial CT scan are two important radiological imaging modalities for investigating patients with such presentation.

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Background: Chronic periodontal disease is important in the aetiology of various life-threatening systemic diseases. Its surveillance using self-report questionnaire has become necessary due to the disadvantages associated with its surveillance using clinical examination methods. Aim: The aim is to determine the validity of periodontal disease surveillance self-report questionnaire in a Nigerian population. Methods: A representative sample of 250 consecutive adults, attending the dental clinic, University College Hospital, Ibadan, were interviewed and clinically examined using a periodontal disease self-report questionnaire, and community periodontal index of treatment need (CPITN), index as a gold standard. Tooth mobility and gingival recession were also assessed. The data were analysed using SPSS version 15 and OpenEpi module for performance evaluation of a diagnostic test. Validity was determined using receiver operating characteristic curve, the sum of sensitivity and specificity as well as the sum of positive and negative predictive values. Results: The mean age of the study participants was 40.9 ± 16.3 years where the males accounted for 48.9%. It demonstrated low sensitivity, high specificity and low diagnostic accuracy with receiver operating characteristic curve of 0.6. The sum of sensitivity and specificity as well as the sum of positive and negative predictive values were below 120. Only 21.7% reported they had the periodontal disease as compared to 87% diagnosed cases using the clinically based examination method (CPITN index). Conclusion: The periodontal disease self-report questionnaire demonstrated low validity in the study group as many people who had periodontal disease were missed. Development of a questionnaire tool adapted specifically for this environment is hereby recommended.

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Background: Highly active antiretroviral therapy (HAART) improves immunity and reduces the occurrence of enteroparasitic infections. Aim: This study aimed to determine the prevalence and risk factors of intestinal parasitic infection among human immunodeficiency virus (HIV) patients on HAART in Kogi State, Nigeria. Methods: Blood and stool specimens were collected from 511 subjects including 411 HIV patients on HAART and 100 apparently healthy non-HIV individuals. The blood specimens were used to determine CD4 count and haemoglobin concentration, whereas the stool specimens were processed to detect intestinal parasites using standard techniques. Socio-demographic data were obtained with the aid of a questionnaire. Results: Entamoeba histolytica was the predominant parasites recovered generally and in both genders as well as being the only parasite that was associated with immunodeficiency as measured by CD4 count <200 cell/μL (P = 0.0059) HIV status was a significant risk factor for acquiring intestinal parasitic infection (odds ratio = 8.213 95% confidence interval = 1.971, 34.225; P = 0.0012). Among the other risk factors, CD4 count <200 cell/μL (P < 0.0001) and farming (P = 0.0202) were associated with intestinal parasitic infections among HIV patients on HAART. Conclusion: An overall prevalence of 14.4% of intestinal parasitic infections was observed among HIV patients on HAART in this study. Routine diagnosis of intestinal parasites among HIV patients on HAART is advocated.

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Background: Good ventilation is one of the structural designs used to reduce the risk of transmission of airborne infections in hospitals. This is, however, rarely observed in Nigeria as hospital designs used to shut out the inclement weather in temperate countries are copied without much modification. This study assessed the physico-chemical air quality at different areas of the University of Port Harcourt Teaching Hospital, Port Harcourt, to ascertain the level of pollutants in the ambient air. Methods: The study was carried out in July, 2015, in randomly selected inpatient wards, outpatient clinics and clinical laboratories of the hospital, using the appropriate measuring equipment. The study tested for the presence of particulate matter 2.5 (PM_2.5), volatile organic compounds (VOCs) and nitrogen dioxide (NO₂) in the ambient air; as well as the prevailing micrometeorological indices of relative humidity, temperature, wind direction and speed of the study sites. Results: A total of 36 air quality measurements were carried out in nine study sites in the hospital. The assessed pollutants were present in the ambient air of most of the study sites but were within the regulatory limits. The concentration of NO₂in the study sites ranged from 133 μg/m^[3] in the immunisation clinic to 151 μg/m³ in the gynaecology ward, with a mean concentration of 141 μg/m³; while PM_2.5was not detected in the gynaecology and urology wards and present in very low levels in the other study sites. There was, however, greater variability in the levels of VOCs, ranging from 236.57 mg/m³ in the HIV clinic to 530.77 mg/m³ in the male surgical ward. Conclusion: The levels of the assessed pollutants were within regulatory levels, even as there were evidence of poor ventilation in several of the study sites.

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Background: Breast cancer is the most common cancer in women both in the developed and less developed world. Regular self, clinical and mammographic examination of the breast according to internationally acceptable guidelines can result in early detection of cancer in asymptomatic women thereby reducing morbidity and mortality related to the disease. Aim: The aim of this study is to assess the knowledge, practice and attitude of breast examinations and breast cancer amongst medical doctors in Bayelsa State to achieve the desired reduction in mortality. Methods: This is a descriptive cross-sectional study of Doctors in Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State carried out between September 1, and October 1, 2015. A structured self-administered questionnaire was designed and used to collect information from 216 medical doctors. The data were processed using SPSS Windows version 20. Summary statistics, sample frequencies and crossed tabulations were then computed. Results: Of the 176 respondents, none had a low level of knowledge; 58 (33.0%) showed moderate level of knowledge, whereas 118 (67.0%) showed a high level of knowledge. Only 55.7% of doctors had performed breast self-examination (BSE), 16.5% clinical breast examination (CBE) and 4% mammography. However, when it was coned-down to only female doctors, it was found that whereas 54 (85.7%) of our female respondents practiced BSE, only 15 (23.8%) had CBE, and only 2 (3.2%) had done screening mammography. Majority (92.6%) believed that breast cancer can be cured if detected early, with 100% opted to seeing a doctor. Conclusion: Convincing majority of medical doctors in our study had excellent knowledge about BSE, CBE and mammography as screening modalities, respectively, for breast cancer. Attitude towards breast cancer treatment was also positive. However, their practice levels were quite poor.

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Background: Comorbidities associated with HIV infection may have profound impact on the future clinical outcomes of infected patients. This study was carried out to assess the prevalence and types of comorbidities in newly diagnosed, highly active anti-retroviral therapy (HAART)-naïve adult HIV patients. Methods: A retrospective study of 501 consecutive newly diagnosed, HAART-naïve HIV-infected patients was carried out between April 2014 and September 2015 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Demographic characteristics, clinical data and comorbid disease condition at initial presentation were retrieved from the hospital records of study patients. Summary statistics was used to present discrete variables. Medians were calculated for continuous variables (age and CD₄counts). Kruskal–Wallis test was used to compare the medians across the different groups, and the Dunn's post's test was used to compare medians between two groups. Results: One hundred and sixty-one (32.1%) of 501 study patients were identified with comorbid conditions, of which 6 patients had more than one comorbid condition, indicating polypathology. The prevalence of comorbid conditions observed include renal disease (14.4%), hypertension (6.2%), tuberculosis (3.4%), oral thrush (2.4%), malaria (1.6%), urinary tract infection (2.2%), hepatitis-B (1%), diabetes mellitus (0.6%), while oesophageal candidiasis, herpes zoster, hepatitis-C and toxoplasmosis were 0.2% each. Comorbidities of infective origin were found predominantly in patients with WHO clinical class 3 and 4, corresponding with declining CD₄cell counts. Renal disease was present in all four clinical stages of HIV. Conclusion: Renal disease was the most prevalent comorbidity. Comorbidities of infective origin were found almost exclusively in patients with WHO clinical class 3 and 4. Findings highlight the need for detailed evaluation at initial presentation, prior to treatment initiation.

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Background: Lassa fever is known to be endemic in West African region, and Nigeria bears the most burden of the disease and case fatalities. It is worrisome and disheartening for an emerging infectious disease such as Lassa fever, to linger for 49 years but surge in incidence in a country such as Nigeria, endowed with both human and natural resources. Methods: The sources of the information presented was obtained through detailed review of literatures using Medline, Ovid and PubMed (search terms Lassa fever, Arenaviridae and viral haemorrhagic fever), case analysis, and surveys undertaking from the field, and relevant websites (such as Nigeria Center for Disease Control, Nigerian Federal Ministry of Health, Centers for Disease Control and Prevention). Results: The possibility of a large outbreak in Nigeria and other sub-Saharan Countries characterised by dearth of laboratory facilities for prompt diagnosis and personal protective equipment (PPE) and its potential use as a biological weapon has also raised the profile of this disease. Health education of the communities, improved funding through budgetary allocation for surveillance, prompt case management including laboratory facilities, training of health personnel, isolation of cases, barrier nursing, contact tracing, provision of antiviral drugs and vaccines that is effective against this disease and supply of PPE is not only necessary but also expedient in the light of the threat due to Lassa fever. Conclusion: The weak health-care delivery system in Nigeria, would continue to impede effective control of emerging and re-emerging infectious diseases including Lassa fever. There is an urgent need to provide resources to effectively control and prevent Lassa fever.

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