Curriculum Development: Postgraduate Diploma in Health Systems Management.

BACKGROUND: Postgraduate diploma in health systems management (PDHSM) curriculum was designed and developed to equip medical doctors with the knowledge, skills, and attitudes required to manage health systems and resources for quality patient care and safety. OBJECTIVES: Describe processes and steps to design and develop a new curriculum using the development of PDHSM as a guide by identifying learning needs; using the six-step approach to curriculum development; incorporating quality assurance and quality enhancement frameworks; and identifying evaluation methods. METHODOLOGY: Four (4) subject content experts in health policy, planning, and management and experienced public health physicians at the National Postgraduate Medical College of Nigeria deliberated, determined, and compiled learning needs that were incorporated into the design and development of the new curriculum for PDHSM. The learning needs, informal data on key learning issues in health system management and specific challenges in the context and operational environment were analyzed. Triangulation of information from these different perspectives and opinions was aligned with medical doctors' educational needs to acquire competency in managing health systems. The derived instructional needs, assessment methods, and resources were incorporated into the design, development, and evaluation of the PDHSM curriculum. The outline of the curriculum was developed using the curriculum matrix table. RESULTS: The contents of the developed curriculum in PDHSM include the purpose, organization of the programme, educational experience, and evaluation of the curriculum. The curriculum was structured into modules. Each module has intended learning outcomes (ILOs) of major subject areas of HSM and teaching and learning activities that outline methods of instruction and assessments. The Indicative contents of each module are topics of each subject area of the PDHSM. The assessment formats in the curriculum included both formative and summative assessment methods and types. The resources required for instructional and assessment activities were identified. The evaluation methods of the curriculum will be through reviews of assessment results and performance evaluation of students, tutors, and the PDHSM programme. CONCLUSION: The educational needs of medical doctors to function as managers in the health systems determine the development of intended learning outcomes, teaching and learning activities, indicative contents, resources required, and evaluation of the PDHSM curriculum. Quality assurance and quality enhancement should be part of curriculum design and development.

CONTEXTE: Le programme du diplôme de troisième cycle en gestion des systèmes de santé (PDHSM) est conçu et développé pour doter les médecins des connaissances, des compétences et des attitudes nécessaires pour gérer les systèmes et les ressources de santé en vue d'assurer la qualité des soins et la sécurité des patients. OBJECTIFS: Décrire les processus et les étapes de la conception et du développement d'un nouveau programme en s'inspirant du développement du PDHSM, en identifiant les besoins d'apprentissage, en utilisant l'approche en six étapes du développement du programme, en incorporant les cadres d'assurance et d'amélioration de la qualité, et en identifiant les méthodes d'évaluation. MÉTHODOLOGIE: Quatre (4) experts en politique, planification et gestion de la santé et des médecins expérimentés en santé publique du National Postgraduate Medical College of Nigeria ont délibéré, déterminé et compilé les besoins d'apprentissage qui ont été incorporés dans la conception et le développement du nouveau programme d'études pour le PDHSM. Les besoins d'apprentissage, les données informelles sur les questions clés de l'apprentissage dans la gestion des systèmes de santé et les défis spécifiques dans le contexte et l'environnement opérationnel ont été analysés. La triangulation des informations provenant de ces différentes perspectives et opinions a été alignée sur les besoins éducatifs des médecins pour acquérir des compétences en matière de gestion des systèmes de santé. Les besoins pédagogiques, les méthodes d'évaluation et les ressources qui en découlent ont été intégrés dans la conception, le développement et l'évaluation du programme d'études du PDHSM. Les grandes lignes du programme ont été élaborées à l'aide du tableau matriciel du programme. RÉSULTATS: Le contenu du programme d'études élaboré pour le PDHSM comprend l'objectif, l'organisation du programme, l'expérience éducative et l'évaluation du programme d'études. Le programme a été structuré en modules. Chaque module comporte des objectifs d'apprentissage (OIT) dans les principaux domaines de la gestion des systèmes de santé, ainsi que des activités d'enseignement et d'apprentissage qui décrivent les méthodes d'instruction et d'évaluation. Le contenu indicatif de chaque module correspond aux thèmes de chaque domaine du PDHSM. Les formats d'évaluation du programme comprennent des méthodes et des types d'évaluation formative et sommative. Les ressources nécessaires aux activités d'enseignement et d'évaluation ont été identifiées. Les méthodes d'évaluation du programme d'études seront basées sur l'examen des résultats des évaluations et sur l'évaluation des performances des étudiants, des tuteurs et du programme de PDHSM. CONCLUSION: Les besoins éducatifs des médecins en tant que gestionnaires des systèmes de santé déterminent le développement des résultats d'apprentissage prévus, des activités d'enseignement et d'apprentissage, des contenus indicatifs, des ressources nécessaires et de l'évaluation du programme d'études du PDHSM. L'assurance et l'amélioration de la qualité devraient faire partie de la conception et du développement du programme. Mots-clés: Curriculum, Conception, Développement, Évaluation, Assurance qualité.

ACUTE CHOREO-DYSTONIA IN A NEWLY DIAGNOSED PATIENT WITH DIABETES MELLITUS: A CASE REPORT AND REVIEW OF LITERATURE.

Introduction: Diabetes mellitus is a disease with diverse macrovascular and microvascular consequences. One of the unusual effects of hyperglycemia is involuntary movement, termed hyperglycemia-induced involuntary movement. This could range from hemibalismus, chorea, choreo-atethosis, tremors to dystonia. Chorea associated with dystonia is a less commonly reported manifestation. When it is focal, it can be misdiagnosed as stroke or seizure disorder. To the best our knowledge, there is hitherto no case report in sub-Saharan Africa describing the occurrence of focal choreo-dystonia in type 2 Diabetes Mellitus. Case presentation: Here, we present a case of a middle-aged Nigerian woman with focal choreo-dystonia of the right upper limb accompanying the diagnosis of type 2 diabetes. Achieving euglycemia with insulin resulted in complete resolution of the choreo-dystonia. Conclusion: Doctors in resource-constrained settings should be aware of this presentation to avoid misdiagnosis and to provide prompt and goal-oriented management with a view to reducing morbidity and attendant health-care costs.

Exposure to Agrochemicals and Markers of Kidney Damage among Farmers in Rural Communities in Southwestern Nigeria.

BACKGROUND: Chronic kidney disease of unknown origin (CKDu) is assuming an epidemic proportion, especially in farming communities worldwide. We explored the relationship between CKD markers and agrochemical exposure among rural farmers in South Western Nigeria. METHODS: We studied selected farming communities in Southwestern Nigeria where the use of agrochemicals was widespread. A pre-tested questionnaire was administered to participants. Anthropometric data, information on use of agro-chemicals; urine and blood samples were obtained. Informed consent was obtained from participants. The study was approved by the Institutional Ethics committee and complied with 1975 Helsinki declaration, as revised in 2000. RESULTS: A total of 438 farmers made up of 202 males (46.1%) and 236 females (53.9%) were studied. The mean microalbuminuria was 30.2 ±11.7 mg/dl. Majority of the farmers had CKD stage 2(42.0%) and CKD stage 3 (37.7%). The type of farming engaged in had a positive, but not significant, correlation with eGFR (r=0.012, p=0.832). There was positive correlation between type of farming and GFR category (r=0.24, p=0.000). Frequency of use of hexachlorocyclohexane had a positive and significant correlation with eGFR (r=0.111, p=0.045). Annual crop farming had a correlation with UACR (r=0.149, p=0.024). CONCLUSION: Annual crop farming had a positive correlation with UACR, eGFR and GFR category. The prolonged use of agrochemicals on an annual basis can cause kidney damage.

EFFICACY AND SAFETY OF LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE THERAPY FOR TREATMENT OF VASCULAR ERECTILE DYSFUNCTION IN NIGERIAN MEN: REPORT OF A STUDY IN IBADAN, SOUTH-WEST NIGERIA.

Background: Low Intensity Extracorporeal Shock Wave Therapy (LI-SWT) has been found to be effective in men with vascular erectile dysfunction (ED) but its efficacy and safety has not been investigated in a predominantly black population so we sought to study this. Materials and Methods: Men with vascular erectile dysfunction (ED) were assessed using the five-item International Index of Erectile Function (IIEF) score after which they were treated with 12 sessions of LI-SWT. Treatment efficacy was evaluated immediately after treatment, at 1 month and 6 months after using the IIEF questionnaire. 30 persons were recruited out of which 22 completed the study. Results: Mean IIEF score improved from 8.27±2.741 at baseline (pre-treatment) to 10.43±8.43 one month post treatment and was sustained six months post treatment at mean IIEF score of 10.70 ± 8.84. A larger no (86.4%) had an improvement of at least 5 in the IIEF score from baseline to 6 months -post treatment. None of the participants reported any adverse effects of treatment. Conclusion: Low intensity shock wave treatment is a useful addition to the medical armamentarium for the treatment of vascular ED.

Nutrient stability in mould-infested feed and mitigating effect of dietary supplemental vitamins in brown laying hens.

A 10-week study was conducted to assess the impact of mould infestation on nutrient stability of feed and the mitigating effect of supplemental tocopherol, retinol or a multivitamin on performance and hepatic histology of ISA Brown laying chickens. Two batches of corn were obtained: the aflasafe corn used in preparing control diet and corn with physical evidence of mould used in preparing diets 2 to 5 containing no supplemental vitamin, tocopherol, retinol or a branded multivitamin supplementations respectively. One hundred and fifty (150) laying chickens used were completely randomized into five dietary treatments with three replicates of 10 birds each. Results showed that there was gross instability in the nutrients of mouldy maize. The activities of the fungi depleted both protein and lipid contents by 11.54% and 12.72% respectively while crude fibre content rose by 31.7%. There was substantial drop in both retinol and tocopherol while aflatoxin content rose to 267 µg in mouldy corn and 118 µg in the mouldy diets. Feed intake was significantly (P < 0.05) reduced and consequently depressed (P < 0.05) egg production and feed efficiency. Egg quality differs (P < 0.05) in shell thickness and yolk colour. Proliferation of biliary duct epithelium, hepatic degeneration, cellular infiltration, hyper-cellularity or dilation of the sinusoidal spaces characterized livers of birds on mouldy corn diets while supplementation with vitamins subverted mycosis and aflatoxicosis as evidenced by normal-to-mild congestion of hepatocytes. It was concluded that mould contamination in feed compromised feed nutritive values, reduced bird performance and adversely impaired the liver of the experimental birds while tocopherol, retinol or a multivitamin supplementation relapses the damaging potential of mould and mycotoxin differently.

Mid-term impact of home-based follow-up care on health-related quality of life of hypertensive patients at a teaching hospital in Ilorin, Nigeria.

BACKGROUND: Health-related quality of life (HRQoL) is an important clinical outcome assessment in hypertension management, given the lifelong (chronicity) nature and the need for daily self-management for hypertensive patents. Of some of the studies that implemented home-based interventions on hypertension globally, the HRQoL is rarely used as a primary outcome measure. This study developed, implemented, and assessed the impact of home-based follow-up care (HBFC) on HRQoL of hypertensive patients attending outpatients' clinics in Ilorin, Nigeria. MATERIALS AND METHODS: A total of 149 and 150 patients were randomized to intervention and usual care (control) groups, respectively. A 12-month task-shifting (nurse-driven) HBFC intervention was administered to intervention group. The mid-term impact of intervention on HRQoL was assessed after 6 months intervention. Data were analyzed with intention-to-treat principle. Treatment effects were measured with the t-tests, analysis of covariance, and multivariate analysis of covariance analysis. Significant levels were set at P < 0.05 and 95% confidence interval. RESULTS: The between-group treatment effect was not statistically significant (P > 0.05), whereas the within-group treatment effects were statistically significant for both the intervention and control arms (P < 0.05) at 6 months. After controlling for age and baseline HRQoL, the intervention group had an improved physical component of HRQoL than the control group. The intervention group also had statistically significant improvement in blood pressure control, medication adherence, and symptom counts (P < 0.05). CONCLUSION: The HBFC intervention for hypertensive patients impacted positively on physical component of HRQoL after controlling for baseline HRQoL and age of the patients at 6 months post-intervention.

Knowledge of blood donation among adults in north-central Nigeria

Background: About half of the population in Nigeria is medically fit for blood donation but only four in one thousand are voluntary donors. The low level of blood donation has been attributed to poor knowledge, misconceptions, myths, bias, poverty, fear, malnutrition among the population. Therefore, this study assessed the knowledge of blood donation among adults in two selected North Central States of Nigeria. Methods: It was a descriptive cross-sectional study. A total of 3104 respondents comprising of adults between 18 and 60 years were involved in the study. A multistage sampling technique was used and the research tool was interviewer-administered questionnaire. The data generated were entered into the computer and subjected to appropriate statistical analysis using EPI INFO computer software package (version 3.5.3). Pearson Chi Square (χ2) was used to test statistical significance and p-value was set at < 0.05. Results: Majority of the respondents 2565 (82.5%) knew that blood donation save lives. More than three-quarters, 2468 (79.5%), knew where to go for voluntary blood donation. About one-third, (37.1%), demonstrated good knowledge of voluntary blood donation. Older respondents (>60 years) had poor knowledge of blood transfusion compared with younger age groups (p<0.001). Respondents' occupation and educational status were significantly associated with knowledge of blood transfusion (p<0.001). Conclusion: Periodic awareness programme on voluntary blood donation in rural and urban areas across Nigeria is needed. In addition, sensitization of the informal sector on the significance of non-remunerated voluntary blood donation should be given priority

Attention deficit hyperactivity disorder in Ilorin: screening with the conner's teachers' rating scale

Background: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) or its risk in North Central Nigeria has not been adequately reported. The consequences of missing the disorder and its co-morbidities are usually costly to the society. Method: Using a multi-stage sampling technique, nine primary schools from where a total of 1,480 pupils were selected across the three local government areas within Ilorin metropolis (two public and one private school from each LGA) we selected. An ADHD assessment tool - the short version of Conner's Teacher Rating Scale was administered on the pupils through their respective class teachers after training the teachers on how to administer the tool. They were classified into Inattention ADHD and Hyperactive/impulsive ADHD. Results: Of the 1480 (741 males and 739 female) pupils recruited, public schools contributed 1033 (69.8%) pupils while 447(30.2%) were from the private schools. A prevalence of 15.8% was found for ADHD risk. Statistically significant differences were present in the male to the female distribution of the Inattention ADHD, Hyperactivity ADHD (each with p< 0.05) but not in the overall ADHD index(p> 0.05). The ADHD Index was higher in the public schools. Conclusion: Prevalence of primary pupils aged 6-12 years in Ilorin at risk of ADHD is 15.8%, no significant gender variation was found. It is hereby recommended that Pre-primary school entry screening for ADHD should be instituted considered to enhance early recognition and prompt intervention so as to save the country from bad childhood that develops into bad adulthood with its myriads of anti-social and behavioural consequences

Medicine use among HIV/AIDS Patients in public hospitals, Kwara State

Background: The prognosis of HIV/AIDS and HIV-related comorbidities has been revolutionized by the use of medicines. However, World Health Organization reported that 50% of patients do not use their medicines as prescribed.Objective: To assess HIV/AIDS patients' knowledge of the use of medicines dispensed to them.Method: This study was conducted in seven public hospitals in six local government areas, Kwara State. Exit interviews of 780 eligible HIV/AIDS patients were conducted through use of structured questionnaire. Additionally, there were exit observational checks of medicines dispensed to these patients. Descriptive statistics and Fisher Exact test were used for data analyses.Results: Of the 780 study participants, 36.1% had no formal education, 99.9% knew the 'quantity' of medicines to be administered, while 99.2% knew the frequency of administration. All the patients knew the route of administration, 96.7% and 94.3% knew the general precautions to avoid concomitant use of dispensed medicines with alcohol or herbal products respectively, while 93.7% of those who received co-trimoxazole knew of the precaution to use "plenty of water" as the vehicle for its administration. There were no significant associations between the patients' knowledge of these precautions and duration of antiretroviral therapy (P>0.05). However, the patients lacked knowledge of specific precautions of some dispensed medicines.Conclusion: Most of the patients knew of the administration and the general precautions of dispensed medicines. However, lack of knowledge of specific precautions of some dispensed medicines calls for intervention

A review of nutritional and toxicological implications of castor bean (Ricinus communis L.) meal in animal feeding systems.

The nutrient-rich defatted castor meal has been tested as a potential source of protein in diets of many livestock species but has limitation due to challenges of toxins. This review was conducted to compile the relevant research information on advances in the use of raw and differently processed castor seed meal in animal feed. In this article, distribution and uses of castor and its products were identified. Research findings on the nutrients profile, principal toxins, various detoxification strategies, nutritional value and toxicity on common livestock species were compiled and reviewed. The defatted seed meal had crude protein range of 32-48%, gross energy of about 3200 kcal/kg. Ricin content was 9.3 mg/g seed, and the average RCA content was 9.9 mg/g. The meal had high activity of lectin, which produced agglutination at about 4.70 mg/ml minimum assays. Reports of detoxification strategies showed varying degrees of success but high pH, moist heating and microbial techniques appeared to exert greater effect on deactivating ricin. Detoxification strategy for the allergen component is inconclusive. Tannins and the phenolic contents were present at trace level and did not constitute notable threat. It was concluded that castor seed holds great potential as feedstuff when upgraded but such upgrading must be safe, cost-effective and labour efficient for commercial acceptability.

Type 1 diabetes mellitus and Graves' disease in Down's syndrome--a rare combination.

BACKGROUND: Autoimmune diseases including thyroid. disorders, type 1 diabetes and celiac disease are commoner in persons with Down's syndrome compared with the general population. Coexistent type 1 diabetes and hyperthyroidism in Down's syndrome is however not commonly reported in literature. OBJECTIVE: To report a case of a lady presenting with Graves' disease and type 1 diabetes at the same time. CLINICAL PRESENTATION: We report the case of a 22- year-old lady with Down's syndrome who presented with weight loss, polyuria and polydipsia. Physical examination revealed typical dysmorphicfacies of Down's syndrome and a goitre. Laboratory data revealed hyperglycaemia (random plasma glucose-331 mg/dl). She also had biochemical evidence in keeping with hyperthyroidism and markedly elevated thyroid peroxidase antibodies (>1087.0 IU/ml). She improved after rehydration, insulin therapy and antithyroid drugs. CONCLUSION: Coexisting autoimmune diseases may present in patients with Down's syndrome. We advocate for routine screening for diabetes and thyroid dysfunction in ersons with Down's syndrome.

Effect of health education on willingness to undergo HIV screening among antenatal attendees in a teaching hospital in north central Nigeria.

BACKGROUND: Testing for HIV during pregnancy provides a useful opportunity to institute treatment for HIV as required as well as protect the unborn baby. The aim of this study was to evaluate the effect of health education on the willingness of antenatal attendees to be screened for HIV. METHODS: This was a quasiexperimental study involving the sequential enrolment of 122 pregnant women attending antenatal care who were at a gestational age of between 13 and 28 weeks for the study group and subsequent enrolment of the same one month after for the control. Two-stage analysis was done with the use of descriptive statistics and bivariate analysis. Level of significance was set at 5%. RESULTS: Mean age of the study respondents was 27.6 ± 4.6 years while that of the control was 27.5 ± 4.8 years. Majority of the respondents were married in both study, 88 (72.7%), and control groups 84 (72.4%), 76.1% of the study group and 79.3% of the control group had at least secondary education, and 39.7% of the study group and 37.9% of the control group were primigravidae. Before intervention, 88.4% of the study group and 88.8% of the control group were willing to undergo voluntary HIV screening. There was an increase in this number after intervention (P < 0.05). Age, education, occupation, marital status, and parity were not significantly associated with a willingness to be screened for HIV before and after intervention among the study or control groups. CONCLUSION: Health education as a strategy to enhance voluntary counseling and testing uptake in antenatal settings is advocated.

COMPARISON OF IOP READINGS USING REBOUND I CARE TONOMETER AND PERKINS APPLANATION TONOMETER IN AN AFRICAN POPULATION.

BACKGROUND: Accurate intra ocular pressure (IOP) measurement and monitoring using tonometry is a common clinical measurement in diagnosis and management of glaucoma, this is often a challenge in children. The ICare and Perkins tonometers are both handheld tonometers, Perkins uses applanation while ICare measures IOP with a rebound method. OBJECTIVES: The objectives of research were to study the IOP values from each tonometer, compare the value of IOP readings from both tonometers, determined the ease of their use in young children and document the various positions in which the tonometers were used successfully in children. METHOD: Intra ocular pressure readings were taken by two experienced examiners in upright position without sedation or anaesthesia. ICare tonometer was first used. Data were entered and analysed with SPSS 17 statistical package. The means were compared using paired sample T-test. RESULTS: A total of 480 eyes of 240 persons, aged between 2months and 90years with a mean of 46.2±22 years had their intra-ocular pressure range between 3 and 44mmHg( Mean16.3±6) measured using ICare and Perkins tonometry. There was a high correlation, and no statistically significant differences in the mean IOP comparing ICare and Perkins tonometers. The mean difference in average IOP readings between ICare and Perkins was -0.08±2.8 (95% CI: 0.45-0.30; r=0.87, p= 0.68) for right eye and -0.15±2.8mmHg (95% CI -0.53 to 0.23; r=0.86, p=0.44) in the left eye The difference in the average IOP reading from both tonometers was within 2mmHg 288(66.2%) eyes. Among the 147 (33.8%) eyes with a difference in IOP greater than 2mmHg, Perkins was responsible for the higher IOP reading in 76(51.7%) and ICare in 71(48.3%) p=0.56. Among 42 eyes of 21 children aged ≤6years, IOP reading was successfully taken in 41(97.6%) and 21(50%) eyes with ICare and Perkins respectively without sedation or anaesthesia. CONCLUSION: The IOP readings using the ICare tonometer compares well with that of Perkins tonometer. The ICare was easier to use in young children (≤6year olds) without sedation or anaesthesia in this African population.

Perception and practice of contraception among male soldiers in Sobi barracks, Ilorin, Nigeria.

BACKGROUND: There is a popular belief among the general population that Nigerian soldiers tend to have large families but this has not been substantiated with evidence-based research. The Nigerian military health authority implements female-targetted contraception strategies, with less focus on their husbands; who are the dominant fertility determinants. OBJECTIVE: To determine the perception and practice of contraception among male soldiers of Sobi Cantonment, Ilorin, Nigeria, with a view to instituting male-targeted contraceptive/family planning strategies. METHODOLOGY: A cross-sectional survey of 334 male soldiers using multistage sampling technique and pre-tested interviewer administered questionnaires. RESULTS: The respondents' approval of contraception (73.6%) and willingness to discuss it with their spouses/partners (71.6%) were high. Fear of wives/partner's sexual promiscuity (55.7%), cultural and religious beliefs (43.2%), fear of the side effects of contraceptives (29.5%) and the desire for more children (21.6%) were reported reasons for the non-approval of contraception. The prevalence of contraceptive use among the respondents was low (12.3%). There was a significant relationship between the respondents' educational level and contraceptive use (p< 0.05). CONCLUSION: The study revealed a high approval and willingness to discuss contraception with their spouses/partners but low contraceptive use.

Insulin resistance in Nigerians with essential hypertension.

BACKGROUND: Reports on the association between hypertension and insulin resistance have been inconsistent even though most studies show a definite association. It is also not certain if the association between insulin resistance and hypertension applies to all populations. OBJECTIVE: To determine the prevalence of insulin resistance in hypertensive Nigerians and to examine the association of insulin resistance with hypertension and some anthropometric indices. METHODS: Thirty five adults with essential hypertension and thirty five normotensives were studied. Anthropometric parameters, blood pressure, fasting glucose and insulin were measured. Homeostasis model assessment (HOMA) was used to determine insulin resistance (IR). RESULTS: The hypertensive subjects had significantly higher fasting insulin and HOMA-IR compared with normotensives (p = 0.02 and 0.04) respectively. There were significant correlations between HOMA-IR, BMI, waist and hip circumference in subjects with hypertension. At multiple linear regression, hypertension and body mass index were found to be the only significant predictors of insulin resistance. CONCLUSION: The hypertensives we studied had a higher occurrence of insulin resistance compared to the normotensives. This makes it necessary for persons with hypertensive to have regular screening for diabetes and other categories of glucose intolerance as the increased insulin increases their risk of developing type 2 diabetes mellitus.

A report of three cases of jaundice with thyrotoxicosis.

BACKGROUND: Jaundice and hepatic dysfunction have been reported in patients with thyrotoxicosis and could be due to different mechanisms. OBJECTIVE: To describe three cases of jaundice occurring in patients with thyrotoxicosis and to illustrate the importance of early institution of thionamides when indicated. METHODS: We present the clinical and laboratory features of three patients presenting within a year with thyrotoxicosis and jaundice and whose clinical conditions improved remarkably following treatment with thionamides. In addition, current literature on the subject is reviewed and summarised. RESULTS: The three patients presented with goitre and jaundice. None of the patients had received blood products, undergone scarification markings or experienced any previous episode of jaundice. Thyroid function tests in the three patients were consistent with a diagnosis of thyrotoxicosis. Liver function tests showed elevated bilirubin and transaminases. All patients improved remarkably following treatment with thionamides. CONCLUSION: It is important to rule out thyrotoxicosis in patients with jaundice of unknown cause and consider early use of thionamides for treatment of the thyrotoxicosis, if confirmed.

Undiagnosed diabetes and prediabetes in hypertensive and normotensive adults at the university college hospital, Ibadan, Nigeria.

BACKGROUND: Essential hypertension is associated with an increased incidence of glucose intolerance (prediabetes and type 2 diabetes mellitus) but many persons with glucose intolerance remain undiagnosed for many years. AIMS: To determine the frequency of undiagnosed diabetes and prediabetes in a group of hypertensives and normotensives. METHODS: Anthropometry, blood pressure and standard oral glucose tolerance test (OGTT) were done in adult participants (hypertensive and normotensive controls) newly presenting to a General Outpatient Clinic of the University College Hospital, Ibadan. RESULTS: Using the OGTT, the frequency of undiagnosed diabetes was 10.4% and 4.3% in hypertensives and normotensives respectively (p = 0.031) but was 5.2% and 2.6% in hypertensives and normotensives respectively using fasting plasma glucose (FPG) alone (p=0.308).Using the OGTT, impaired glucose tolerance (IGT) was diagnosed in 32.2% of hypertensives compared to 14.8% of normotensives (p = 0.002) while impaired fasting glucose (IFG) was diagnosed in 5.2% of hypertensive and 2.6% of the normotensives (p = 0.288). After adjusting for hypertension, age, level of education, body mass index and waist circumference, hypertensives and persons with a higher waist circumference had statistically significantly increased odds of having glucose intolerance: hypertension (OR 2.915; 95% CI 1.526-5.556) and waist circumference (OR 1.050; 95% CI 1.010-1.090). CONCLUSION: Diabetes and prediabetes are commoner in hypertensive persons and such persons require close and frequent monitoring for the development of this disease. Screening with both fasting plasma glucose and post glucose load plasma glucose (OGTT) identifies more persons with glucose intolerance than fasting plasma glucose alone.

Health workers sensitization: effects on perceived quality of immunization services among mothers of under five children in Ilorin, North Central Nigeria.

Clients' satisfaction with services received is an important dimension of evaluation that is examined only rarely in developing countries. Health care professionals have always acknowledged that satisfying the consumers at some level is essential to providing services of high quality. This is a quasi-experimental study. The study group included 150 mothers bringing their children for immunization at Alanamu Health Centre, Ilorin. The control group included 150 mothers bringing their children for immunization at Okelele Health Centre. Total population of mothers bringing their children for vaccines against tuberculosis/poliomyelitis/hepatitis B (BCG/ OPV/HBV) and against diphterite-pertussis-tetanus (DPT)/OPV/ HBV were recruited sequentially until sample size was attained. Mean waiting time at pre-intervention was 82.7 +/- 32.5 and 90.4 +/- 41.7 minutes for the study and control groups respectively. Post intervention, there was a significant decrease (p < 0.05) in the estimated waiting time in the study group (mean = 48.0 +/- 24.4 minutes) while there was no observed difference in the control p > 0.05 (mean = 88.4 +/- 40.6 minutes). Perceived adequacy of information on services being provided by the health facility was low (58%) in the study group while it was relatively higher in the control group (80%) but there was a significant increase in proportion of those that felt information was adequate only in the study group (p < 0.05) at post intervention. Waiting time in health facilities by clients should be reduced as this may give clients a positive perception of the service they have come to access. Information dissemination to clients should be encouraged among health workers as this would affect clients' knowledge and also quality of health care delivery.

Prevalence and risk factors of cervical cancer among women in an urban community of Kwara State, north central Nigeria.

BACKGROUND: Cervical cancer is the second most common malignancy in women worldwide with a high incidence in under-developed countries and Nigeria is one of these countries. This study aimed at screening for cervical cancer using Papanicolaou smear and to identify risk factors for cervical cancer among women in Olufadi community, Kwara State, North-central Nigeria. METHODS: This was a cross-sectional study involving the screening of women aged 25-64 years for cervical cancer using Papanicolaou smear. Respondents were selected through systematic random sampling of households. Interviewer- administered questionnaire and clinical report form were also used to collect data. In addition, Pap smear samples were taken. Data was analyzed using SPSS version 15. RESULTS: Only 10 (5.0%) respondents had positive cytology result, while the rest were normal. Of the 10 positive cytology results, 1 (10.0%) was high grade squamous intraepithelial lesion (HGSIL) while the remaining 9 (90.0%) were low grade squamous intraepithelial lesion (LGSIL) which corresponds to 0.5% and 4.5% of the total respondents respectively. Risk factors for cervical cancer identified included coitarche, tobacco smoking, number of sexual partners and family history of cervical cancer. CONCLUSION: The findings from this study attest to the increasing burden of cervical cancer. The high number of positive results obtained from the study coupled with the presence of risk factors was an indication of how useful regular screening will be in the early detection of cervical cancer.

Psychological and Social Adjustment to Blindness: Understanding from two groups of Blind People in Ilorin; Nigeria

Background: Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often personalized and depends on nature and quality of prevailing psychosocial support and rehabilitation opportunities. This study was aimed at identifying the pattern of psychosocial adjustment in a group of relatively secluded and under-reached totally blind people in Ilorin; thus sensitizing eye doctors to psychosocial morbidity and care in the blind. Materials and Methods: A cross-sectional descriptive study using 20-item Self-Reporting Questionnaire (SRQ) and a pro forma designed by the authors to assess the psychosocial problems and risk factors in some blind people in Ilorin metropolis. Result: The study revealed that most of the blind people were reasonably adjusted in key areas of social interaction; marriage; and family. Majority were considered to be poorly adjusted in the areas of education; vocational training; employment; and mobility. Many were also considered to be psychologically maladjusted based on the high rate of probable sychological disorder of 51; as determined by SRQ. Factors identified as risk factors of probable psychological disorder were poor educational background and the presence of another medical disorder. Conclusion: Most of the blind had no access to formal education or rehabilitation system; which may have contributed to their maladjustment in the domains identified. Although their prevailing psychosocial situation would have been better prevented yet; real opportunity still exists to help this group of people in the area of social and physical rehabilitation; meeting medical needs; preventive psychiatry; preventive ophthalmology; and community health. This will require the joint efforts of medical community; government and nongovernment organizations to provide the framework for delivery of these services directly to the communities