Edwin Nwobodo

Abstract: BACKGROUND: Nigeria operates a three-tier political system consisting of a national government: 36 states, Federal Capital Territory and 768 local governments. There are three levels of health care: primary, secondary and tertiary levels corresponding to and funded by local, state and national governments, respectively. A budget prepared at the district level was not possible until 2006 when the 2007 annual budget was prepared. AIM: The goal of this study was to identify the key challenges of budgeting in a newly introduced District Health System and to share our experience with other scholars. METHODOLOGY: This study is a descriptive case study using interviews and focus group discussions of district and local health officers and the District Health Management Team as well as field notes made from participant observers and reviews of relevant documents. FINDINGS AND DISCUSSION: The study showed that a bottom-up approach was used at the district level, while the concept of business planning was introduced to underscore the seriousness of health planning and efficient resource allocation. The two systems of expenditure classifications, i.e., functional and economic classification, were used in a complementary manner. The capacity for planning and budgeting was found to be lacking among the district health officers. The crosscutting contextual issues constraining budgeting included the inadequate Health Management Information System (HMIS), a non-functional Financial Management System (FMS) and an unreliable Human Resources Management System (HRMS). RECOMMENDATIONS: There is a need for further study to be carried out to determine the factors that constrain the collection, analysis and dissemination of HMIS. In addition, there is a need to study the constraints to proper implementation of the FMS, HRMS and the linkage between the quality of the essential data-set with the efficiency of resource allocation in budgeting.

Abstract: BACKGROUND: Family planning in our environment had remained a delicate issue that is still reluctantly being accepted based on religious belief and the perception that it is synonymous with population control. OBJECTIVE: This study was carried out with the objectives of identifying the characteristics of contraceptive acceptors in our family planning unit, their source(s) of information and methods of preference among others. MATERIALS AND METHODS: The record cards of all clients who attended the family panning clinic between January 1st 1998 and December 31st 2002 as well as the theatre records of patients that had bilateral tubal ligation (BTL) during the study period were reviewed. Relevant information on biodata, reasons for family planning, methods of choice and reasons for discontinuation were extracted and analysed. Comparative percentage was used for the analysis. RESULT: A total of 839 clients requested and were served with contraceptives during the study period with an acceptor rate of 167.8/annum.Over 75% of the acceptors were Muslims. The main reason for selecting family planning services was for child spacing (84.9%) with only 12% requiring the service to end the reproductive carrier. Antenatal/postnatal clinics were their main source(s) of information about family planning services. CONCLUSION: The study revealed that the practice rate of family planning in this community is still low. Female education, use of religious/traditional leaders along with improved dissemination of information using the mass media may go along way to increase contraceptive up take.

Abstract: INTRODUCTION: Malaria in pregnancy is a formidable misery in Africa and contributes significantly to maternal death in Nigeria. The use of insecticide treated mosquito bed nets is one of the strategies of the Roll Back Malaria initiative. It is a form of vector control measure but there exists discordance between awareness and utilization of insecticide treated nets in Nigeria. This study set out to assess the level of awareness and utilization of insecticide treated nets among pregnant mothers attending antenatal clinic. METHODS: Using a structured questionnaire, a cross sectional study of 250 consecutive pregnant mothers attending antenatal booking clinic in Usmanu Danfodiyo University Teaching Hospital Sokoto between January and March 2008 was conducted. RESULTS: Seventy four percent of the clients were aware of Insecticide treated nets. Awareness of insecticide treated nets was significantly higher in clients with post primary education (66.8%) compared to those with at most primary education (33.2%); p < 0.05. Thirteen percent of the clients were using insecticide treated nets while 67.6% were not. The main reason for non-utilization of insecticide treated nets were non availability of the nets (58.8%) and inconvenience of the barrier to the clients (29.4%). CONCLUSION: There is high level of awareness of insecticide treated nets among the study population but very low utilization largely due to non availability. For Nigeria to achieve the millennium development goal target in combating the menace of malaria in pregnancy, more effort is required to increase the availability of insecticide treated nets. In addition, proper education on the benefits of insecticide treated nets may increase its utilization.

Abstract: This study aimed at ascertaining the status of students' performances and their perception of the learning of neurophysiology in a Nigerian medical school. The goal of the study was to determine ways of addressing identified negative perceptions for the purpose of improving upon the overall learning and use neurophysiology knowledge by structured curricular reform. We analyzed and compared the performances of students in three areas of physiology at the second professional examinations over a three-year period [n=300]. We also surveyed learning experience of a batch of graduating doctors in neurosciences [n=50] and surveyed the staff and students' perception of the teaching of neurophysiology. The students performances in neurophysiology was comparatively poorer than in cardiovascular and endocrinology aspects of the subject over a three year period at the second professional examinations. The reported students perception of their neurophysiology learning included uninteresting, abstract concepts, lack of real examples and conflicting facts with their prior basic knowledge. Over 50 % of the graduands rated their learning experiences as poor or very poor or below average for the neuroscience courses. The analyses of the curricular contents of neurophysiology in the preclinical departments indicted asynchrony and redundancy in topics that may reduce the learning and reduce teaching time efficiency of the neuroscience courses. It is suggested that learning experiences of medical students should be routinely monitored and structured to ensure that the graduate doctor is able to understand and transfer learned experiences into clinical studies and practice. A horizontally integrated curriculum may be one way of raising students knowledge, attitude and skills in neuroscience courses as taught in the preclinical departments and is suggested.

Abstract: This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.

Abstract: In this study, the effects of two antimalarials-amodiaquine hydrochloride and artemisinin were investigated in ulcerated albino rats of Wistar strain. Rats were treated with amodiaquine (30 mg kg(-1)) and Artemisinin (2.86 mg kg(-1)) for 24 h after formation of ulcers induced by indomethacin. Treatments with Amodiaquine Hydrochloride led to significantly increased gastric lesions while artemisinin led to significantly decreased gastric lesions. Also, amodiaquine hydrochloride seemed to elaborate the indomethacin induced effects on gastric juice volume, pH and acid output, while artemisinin attenuated these changes. The data indicates that the use of amodiaquine hydrochloride may be dangerous to the integrity of the stomach, especially in existing gastric ulcers, while artemisinin is mild and ameliorating, may result from their lipid peroxidation/apoptosis activity interference.

Abstract: CONTEXT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. OBJECTIVES: To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction. MATERIALS AND METHOD: Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor. RESULTS: Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80% (120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture. CONCLUSION: Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.

Abstract: Currently, understanding of Physiology and disease patterns is undergoing a fundamental paradigm shift with attendant shift in education of health professionals worldwide towards active learning to encourage exploration of connections and their relationships. We introduced problem-based learning to Physiology teaching of medial laboratory students to confirm worldwide reports that active learning environments offer better learning opportunities over the traditional methods which is the predominant teaching method in Nigerian universities. Our findings indicate that Problem-based learning increases students' attendance/participation in classes and performance in examination. We recommend the integration of active learning into physiology curriculum of Nigerian Universities.

Abstract: CONTEXT: The maldistribution of physicians in sub-Saharan Africa is having serious impacts on population health. Understanding the effect requires investigation from both donor and recipient countries. However, investigation from the perspective of donor countries has been lacking. METHODS: This brief communication describes a model process for the design of a research project that addresses medical migration issues from the perspective of eight African medical schools. During an international meeting, the participants designed an initial "ideal" study, and then rapidly tested its feasibility through a brief survey, and group discussion through a listserv, teleconferences and one face-to-face meeting. FINDINGS AND PRACTICAL IMPLICATIONS: Innovative research ideas can be followed-up with surveys to test the feasibility of an "ideal" research design, modifying the design accordingly. This is currently occurring with our medical migration survey study.

Abstract: BACKGROUND: Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening. Aims: To determine the knowledge and utilisation of cervical cancer screening services in a cohort of subjects where awareness is naturally expected to be high. METHODS: A cross sectional questionnaire survey of 159 female health care providers in Usmanu Danfodiyo University Teaching Hospital Sokoto. The sample included doctors, nurses, pharmacists, laboratory scientists and medical social workers. RESULTS: Knowledge of cervical cancer screening is high among the respondents. However, only 4.4 % had availed themselves of the opportunity for the test. CONCLUSION: Health care providers should improve on opportunistic screening. It is necessary for a national screening policy to be formulated and implemented in Nigeria.

Abstract: Daily exposure to fuel vapour may pose significant health risk to exposed individuals. Fifteen each of male and female albino rats weighing between 110-230g were divided into test (10) and control (5) groups each. The test animals; were exposed to inhalation gasoline for one hour daily for twenty-one consecutive days. All animals were then bled and the serum levels of the reproductive hormones determined. The results showed significant [P < 0.05] reduction in the serum levels of all the hormones of reproduction in both the male and female test animals. The results suggest that inhalation gasoline exposure significantly [P < 0.05] lowers the levels of reproductive hormones in albino rats and may thus interfere with reproduction.

Abstract: Uterine rupture is the most common cause of maternal mortality in our institution. Case fatality for the year 2001 was 47%. Health care including emergency obstetric care (EmOC) is not free, hence, delays in receiving care could occur in patients with limited resources. The objectives of the study were to promote access to emergency obstetric care through a loan scheme for indigent patients with ruptured uterus and determine the success or otherwise of the scheme. The scheme was initiated in January 2002, with the sum of thirty eight Thousand Naira (about 300 US dollars) by consultant obstetricians in the department. Funds were released to the patient only after assessment of her financial capability to enable her get emergency surgical packs. All that was required was a promise to pay back the loan before discharge. Following resuscitation, surgery was performed by one of the consultants. Eighteen cases of ruptured uterus have been managed. Treatment was initiated within 30 minutes of admission. Admission-laparotomy interval averaged 3.5 hours (+/-1.2). There were two maternal deaths, giving a case fatality of 11% (2/ 18). The case fatality from a previous study from the same centre was 38% (16/42). There was a significant difference in case fatality between the two studies (P<0.05; confidence limits are-0.328 and -0.211). Of the seventeen patients that benefited from the scheme, 16 repaid the loan before discharge (94% loan recovery). Only one patient defaulted with five thousand Naira (40 US dollars). A loan scheme for indigent patients with ruptured uterus that enabled them receive emergency obstetric care reduced case fatality. Loan recovery was good. In our quest to reduce maternal mortality in low-income countries without health insurance policies, there might be a need to extend similar initiative to other obstetric emergencies.

Abstract: In a five year retrospective study (between January 1990 and December 1994), there were 86 twin births out of 5,953 deliveries at University of Maiduguri Teaching Hospital giving a twin delivery incidence of 14.4/1000 birth. Only 82 case notes were available for this study. Dizygotic twins accounted for 80.5% of the cases while monozygotic twins represented 19.5% in the series. Increasing maternal age during the reproductive age and positive family history of multiple pregnancy were associated with increase twinning rate. The main complications encountered during pregnancy were hyperemesis gravidarum, pregnancy-induced hypertension and preterm labour. The frequency of preterm labour in this study was significantly higher than the observed among the singleton pregnancies within the period of study (P < 0.005). The perinatal mortality rate 85.4/1000 births was similarly significantly higher than that observed among the singleton deliveries (P < 0.005). Compared to singleton pregnancies there was a higher rate of caesarean section intervention (P < 0.005). The commonest mode of presentation and sex distribution were vertex-vertex and male-female respectively. The vertex-vertex presentation accounted for 48.8% of all the presentations while the male-female ratio was 1.2.

Abstract: OBJECTIVES: This investigation was set out to determine whether mercury at a very low dose (4ppm) induces testicular damage on murine testis, and if so whether the toxic effects of mercury could be prevented by zinc. STUDY DESIGN: One of the following solutions was administered in the drinking water of CD-1 male mice: (1) 4ppm HgCl(2); (2) 800ppm ZnCl(2); (3) 4ppm HgCl(2)+800ppm ZnCl(2); or (4) deionised water; for 12 weeks. At the expiration of the treatment period, animals were sacrificed, testes excised and weighed, and epididymal sperm number taken. The testes were processed for histological examination. RESULTS: Both zinc and mercury significantly (p<0.05) decreased the absolute and relative testicular weights, with mercury producing the highest reduction in weight. Mercury reduced significantly (p<0.05) the epididymal sperm number, while zinc and mercury/zinc produced statistically same effect with control on the sperm number. Histological study showed that mercury at the concentration employed produced remarkable degenerative lesions on the testes, as the zinc-treated group showed a normal morphology. Majority of the animals in the mercury/zinc-treated group exhibited complete or partial protection as evidenced by the morphology of the seminiferous tubules. CONCLUSION: Zinc prevents mercury-induced testicular damage in mouse. These findings highlight the risks exposure to inorganic mercury might pose to male reproduction of mice, and suggests possible therapy with zinc. Study in humans is therefore advocated.

Abstract: The leaves of Moringa oleifera Lam (Moringaceae) are used by the Indians in their herbal medicine as a hypocholesterolemic agent in obese patients. The scientific basis for their use in hypercholesterolemia was therefore examined. It was found that administration of the crude leaf extract of Moringa oleifera along with high-fat diet decreased the high-fat diet-induced increases in serum, liver, and kidney cholesterol levels by 14.35% (115-103.2 mg/100 ml of serum), 6.40% (9.4-8.8 mg/g wet weight) and 11.09% (1.09-0.97 mg/g wet weight) respectively. The effect on the serum cholesterol was statistically significant. No significant effect on serum total protein was observed. However, the crude extract increased serum albumin by 15.22% (46-53 g/l). This value was also found to be statistically significant. It was concluded that the leaves of Moringa oleifera have definite hypocholesterolemic activity and that there is valid pharmacological basis for employing them for this purpose in India.