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.

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

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.

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

Assessment of violence against women in Kano metropolis, Nigeria.

BACKGROUND: Violence against women, in its various forms, is endemic in communities and countries around the world, cutting across class, education, race, age, religious and national boundaries. AIMS AND OBJECTIVES: This descriptive cross-sectional study was conducted to identify various forms of gender based violence affecting women in Kano metropolis, determine factors responsible for gender based violence and use this to suggest ways of preventing gender based violence. SUBJECTS AND METHODS: Respondents for this study were selected from the eight metropolitan Local Government Areas of Kano State, Nigeria. Six hundred adult males and females were selected through a multi-stage sampling technique by the use of questionnaire as the data tool. RESULTS: More than three quarters 436 (75.7%) of the respondents knew that women are subjected to various forms of verbal abuse in their homes by their spouses. Deprivation of assess to health care and education was identified by 454 (78.8%) and 490 (85.15) respondents as challenges faced by women at homes. Majority of the respondents 498 (86.4%) identified financial reason, four hundred and forty (76.4%) respondents mentioned unfaithfulness and three-quarters 434 (75.3%) of the respondents said refusal of sexual advance is a reason for violence activities witnessed by women in their respective homes. There was a statistically significant relationship in opinion of male and female on coercion of wife for sexual activities when she is tired and when she is not in the mood (p-value=0.0000). CONCLUSION: Government and Non Governmental organisation should intensify activities to promote awareness and advocacy on violence against women. Involvement of males in all programmes relating to violence against women should be done especially since the perpetrators in most cases are men.

Awareness and perception toward referral in health care: a study of adult residents in Ilorin, Nigeria.

BACKGROUND AND OBJECTIVE: The Nigeria Health System operates three levels of health care, which correspond to the tiers of government and interacts through a referral system. The national health policy recommends the Primary Health Care (PHC) as the entry point to health care system. However, these facilities are poorly managed leading to underutilization. Therefore, people usually attend any facility that will meet their needs, not considering the appropriateness of the level of care. This study is to determine the awareness and perception of adult residents in Ilorin toward referral in health care. METHODS: A cross-sectional descriptive survey was conducted among 366 adult residents in Ilorin, selected by multi-stage sampling technique. Data were obtained using a semi-structured questionnaire, appropriately scored and analyzed with Epi-Info 2005 computer software. RESULTS: Only 22 (6.0%) respondents knew that PHC is supposed to be the fi rst point of call when ill and 25 (6.8%) were aware that referral hospitals have the right to reject patients without referral. More than two third, 256 (69.9%) of the respondents felt it will be unreasonable for any hospital to reject patients on the basis of not being referred. The level of education was significantly associated with the knowledge and perception of referral in the health care. CONCLUSION: There is low awareness and poor perception of referral protocol in the health care system among the people of Ilorin. The higher the level of education, the more knowledge the respondents have about referral in the health system and the more likely they have correct perception of referral in health care. The Nigeria health care system policy on referral and appropriate hospital utilization could be more effective if public awareness is created about it via the media while making effort to improve the credibility of the PHC.

Determinants of referral practices of clients by traditional birth attendants in Ilorin, Nigeria.

A sizeable number of deliveries still take place with the assistance of Traditional Birth Attendants in Nigeria. This study aims to determine the factors that determine the referral practices of the TBAs in Ilorin of high risk and complicated pregnancies. This descriptive study was conducted among all the 162 registered TBAs in Ilorin that were traceable using pre-tested semi-structured interviewer-administered questionnaire. About 90%, whose source of skill acquisition was by inheritance did not refer their clients appropriately compared with 48% of those whose source of skill acquisition was through formal training (p<0.05). The more the numbers of trainings, the more appropriate the referral (p<0.05). Having supervisory visit by qualified personnel is associated with appropriate referral practices (p<0.05). Regular training and re-training of TBAs with routine monitoring and supportive supervision will promote prompt referral of high risk and complicated pregnancies and deliveries.

Determinants of referral practices of clients by traditional birth attendants in Ilorin, Nigeria

A sizeable number of deliveries still take place with the assistance of Traditional Birth Attendants in Nigeria. This study aims to determine the factors that determine the referral practices of the TBAs in Ilorin of high risk and complicated pregnancies. This descriptive study was conducted among all the 162 registered TBAs in Ilorin that were traceable using pre-tested semi-structured interviewer-administered questionnaire. About 90%, whose source of skill acquisition was by inheritance did not refer their clients appropriately compared with 48% of those whose source of skill acquisition was through formal training (p<0.05). The more the numbers of trainings, the more appropriate the referral (p<0.05). Having supervisory visit by qualified personnel is associated with appropriate referral practices (p<0.05). Regular training and re-training of TBAs with routine monitoring and supportive supervision will promote prompt referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010; 14[2]:77-84)

Prevalence of cigarette smoking and the knowledge of its health implications among Nigerian soldiers.

OBJECTIVE: Several studies have reported a negative relationship between smoking and military performance. This study was conducted to determine the prevalence of cigarette smoking and knowledge of its health implications among Nigerian Army personnel. MATERIALS AND METHODS: A descriptive cross-sectional survey of 853 soldiers using a self-administered pre-tested semi-structured questionnaire. RESULTS: One hundred and seventy three respondents (20.3%) out of 853 respondents smoked. About three-quarter of them started smoking in the army. Derivation of pleasure and relaxation (24.9%), allaying anxiety (21.4%) and peer influence (34.1%) were the most frequent reasons for smoking. Skin disorder (75.9%), lung cancer (68.6%), addiction (65.2%) and dental problems (57.5%) were the most commonly reported effects of smoking. Only half (50.3%) of the total respondents believed that these effects of smoking could limit military fitness and performance. Forty five (26.1%) of the smokers had attempted to quit smoking. Majority (92.7%) of all the respondents have never had anti-smoking sensitization while in the army. CONCLUSION: The prevalence of smoking among the respondents was high. In spite of their knowledge its health hazards, the respondents could not relate this to military fitness and combat effectiveness. Also, their knowledge of the adverse effects did not translate to their smoking behaviour. There is need for continuous anti-smoking programmes to be established by the medical authority in the Nigerian Army to sensitize personnel on the dangers of cigarette smoking.

Glycated haemoglobin and glycaemic control of diabetics in Ilorin.

OBJECTIVES: With increasing adoption of Western Lifestyle in Nigeria, the incidence of Diabetes Mellitus is on the increase in the country with its attendant complications. The objective of this study was to determine the prevalence of patients at risk of developing diabetic complications in Ilorin, Nigeria, among our patients with diabetes mellitus. METHODS: A cross-sectional study of diabetic patients attending the University of Ilorin Teaching Hospital ted haemoglobin as an index of medium term glucose control was assayed in established diabetics. The result obtained was evaluated against the bench mark HbA1c value of 7.2% for the development of complication. RESULTS: Fifty-six percent of the subjects were females and all of them were forty years and above in age. Only four percent of the patients were below the age of forty years. Seventy-two percent of the subjects had diabetes for less than 10 years. Only female patients had BMI values greater than 30 kg/m2. About 64% of the patients had HbA1c value > 7.2%. More males (73.7%) had HbA1c 7.2% than females (64.5%) (P < 0.05). The patients had a mean HbA1c value of 8.0%, while the mean HbA1c in the control was 5.2%. These two mean HbA1c values gave a P-value of 0.0001 on Student t-test. The female diabetic patients had a mean HbA1c value of 7.8% (SD = 1.96) against the value of 5.1% (SD = 1.13) for the female control patients (P-value of 0.0001). Similarly, the male patients and male control subjects had mean HbA1c values of 8.1% (SD = 1.96) and 5.6% (SD = 1.00) respectively with P-value of 0.0001. The control subjects had a mean fasting blood glucose level of (+/- SD) 4.93 +/- 1.09 mmol/L and the corresponding value for the diabetics was 8.5 +/- 4.2 mmol/L. when these two values were compared we got a P-Value < 0.05. CONCLUSIONS: The mean HbA1c values between the patients and the control subjects were significantly different. Diabetics in our environment with mean HbA1c value of 8.0% are prone to developing complications because of poor glycaemic control. We therefore advise that, periodic estimation ofglycated haemoglobin be carried out along side fasting blood glucose, in our diabetics.

Pattern and outcome of medical admission of elderly patients seen at University of Ilorin Teaching Hospital, Ilorin.

The elderly are increasingly been hospitalised into medical wards in Nigeria and little information is currently available on this group of patients. The objective of this study was to describe the demographic, clinical characteristics and outcome of management of elderly patients admitted into medical wards at the University of Ilorin Teaching Hospital Ilorin, Nigeria. A retrospective study in which hospital records of patients admitted between years 2001 to 2004 were reviewed. Information obtained included gender, occupation, diagnosis, investigations, duration of stay and outcome management. A total of 4113 adults were admitted into the medical wards within the period under review. Of these, 456 were aged 60 years and above. The elderly patients accounted for 11.1% of total hospitalisation into the medical wards. The mean age of the patients was 69 +/- 9 years with male:female ratio of 243:105. The 3 most common diagnoses were: hypertensive heart failure (HHF), 19%; cerebrovascular accident (CVA), 12%; and tuberculosis (TB), 11%. The mean duration of hospitalisation was 15.6 +/- 13.8 days. Cases of mortality had significantly higher value of mean serum potassium, urea and creatinine, compared to those with favourable outcome and were eventually discharged home. A total of 192 patients (55.2%) were discharged home, while 109 (31%) died giving in-hospital mortality of 31.7%. Majority of the deaths (75%) occurred within 14 days of hospitalisation. Significantly higher number of patients died within the first seven days compared to those discharged (P<0.01). The mean duration of hospital stay was 15.6 +/- 13.8 days. Patients with favourable outcome spent a mean of 18.5 +/- 14.1 days while cases of mortality had a mean of 10.4 +/- 8.8 days in hospital before death. Geriatric patients constituted more than a tenth of total hospitalisation into UITH medical wards. They accounted for a significant proportion of in-hospital mortality. Since a third of the death occurred within the first few days of admission, improvement in the management of acute medical cases especially in the elderly is urgent needed. This will ensure survival of greater number of patients and thus reduces mortality.

Family communication on HIV/AIDS among secondary school students in a northern state of Nigeria

Most Adolescents in Nigeria; like many others in Africa; are potentially at risk for contracting HIV through unprotected sexual intercourse. Yet the issue of how to help youth avoid risky sexual behaviour through family communication / education on HIV/AIDS is still of serious arguments within the society. This study examines the practice of family communication on HIV / AIDS among secondary school students. A descriptive study using 420 secondary school students selected by multi-stage random sampling was done. Self administered semi-structured questionnaire was used to collect relevant data. Only 48 (12.1) reported family as the first source of information. However; most of the students 315 (79.7) had family communication on HIV/AIDS with their family members. There is a gender difference in practice of family communication. Significantly higher proportion of the female students had family communication more than their male counterparts. The educational status of the parents significantly determined whether or not a student had family communication on HIV/AIDS. There is considerable level of family communication in the study population which should be encouraged further to cut across all members of the family