Adenoma malignum of the cervix is a rare variant of Adenocarcinoma of the uterine cervix. Its overall incidence rate is low. We report a case of a 51-year-old married multipara who presented with a 4-year history of recurrent, heavy, prolonged menstrual flow, postcoital bleeding, and passage of mucoid vaginal discharge. Pelvic examination revealed a bulky, firm, endophytic cervical mass with ulcerative areas. Ultrasonography showed features of multiple uterine fibroids. Cervical smear cytology and histology of cervical punch biopsy did not show evidence of malignancy. The patient subsequently had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a purportedly benign pathology of the cervix. Diagnosis of cervical adenoma malignum was made from the surgical specimen postoperatively.

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Background: Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. It is extremely prevalent among university students and is a widespread problem globally. This study was conducted to determine the prevalence of depression and the academic factors that are associated with it among students of Ahmadu Bello University (ABU), Zaria, Nigeria. Methodology: This was a cross-sectional study conducted among 127 undergraduate students of ABU. Data were collected using a structured, self-administered Patient Health Questionnaire-9 (PHQ-9) and were analyzed using IBM-Statistical Software for Social Sciences, version 20.0. Results: Majority of the respondents (58.2%) had depression, with 37.0%, 15.7%, 3.9%, and 1.6% having mild, moderate, moderately-severe, and severe depression, respectively, according to the PHQ-9 scoring system, using a cutoff score of 5. There was no statistically significant association between depression and academic performance of respondents (P = 0.360) nor with interest (or lack thereof) in the course of study (P = 0.266). Conclusion: Depression, at different levels of severity, was noted among respondents. More screening and counseling services should be made easily accessible to students in the study area. Further research on nonacademic factors that could predispose to depression is recommended. This will aid in formulating policies for prevention and control of depression in the study area.

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Gravitational pull and subtle uterine contractions on huge polypoidal submucous uterine fibroid may dilate the cervix and prolapse into the vagina. Such prolapsed fibroid can either be removed through the vaginal route if it is connected with a long stalk or through an abdominal route if it has a broad base or if it is coexisting with multiple uterine fibroids. We present two cases of grand multiparous women with huge prolapsed submucous fibroids where neglect led to presentation with life-threatening infection and bleeding.

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Context: The World Health Organization 2013 estimates revealed 49,000 newborns died from neonatal tetanus (NT), a 94% reduction from the late 1980s. Over 24 countries, including Nigeria, have still not reached maternal and NT elimination status. Aims: The aims of the study were to assess knowledge and determine the extent of tetanus toxoid (TT) coverage among women of reproductive age in Kwarbai, Zaria, challenged by effects of tetanus and inadequate vaccination. Settings and Design: Kwarbai is essentially an agrarian, trading, and blacksmithing Hausa Muslim-dominated community with rich culture exhibited in its creations, festivals, and local events that bring together people from all over to socialize and share information. Subjects and Methods: The cross-sectional descriptive study was conducted between December 2014 and January 2015. Semi-structured, interviewer and self-administered questionnaires were used to obtain data on reported findings. Statistical Analysis Used: Statistical Package for the Social Sciences software SPSS^® version 20 was used. Descriptive statistic measures presented as tables and graphs. Chi-square was applied for the comparison of proportions and associations between categorical variables. Results: Respondents' median age was 27 years, Hausa/Fulani (99%), Muslims (100%), married (82%), have more than four children (25%), and half attained tertiary education (54%). Women, 20–34 years, received more than one dose with education as major determinant of immunization uptake. Although level of TT knowledge is high, very few received the recommended five doses. Misconceptions linked to perceived benefits of the vaccine, route of administration, being a contraceptive and religion were some of the factors that reported to hinder respondents' uptake of the TT vaccine. Unavailability/short supply (81.8%) identified as reason for not receiving vaccine at health facilities. Conclusions: Despite high knowledge, completion of recommended doses of TT vaccine was not guaranteed due to stock-outs coupled with detrimental cultural and religious beliefs.

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Context: The birth of a baby is a major reason for celebration worldwide. Yet, in most countries of the world, pregnancy and childbirth is a perilous journey. In Kaduna State, Northwestern Nigeria, the estimated maternal mortality ratio figure is 1025/100,000 live births. Despite the higher rates of maternal deaths, there is no empirical evidence on women's knowledge, perception, and attitudes toward pregnancy danger signs in Kaduna State. Aims: To determine the knowledge, attitude, and perception of pregnancy danger signs among women of childbearing age (15–49 years) in Samaru community Sabon-Gari Local Government Area in Kaduna State. Settings and Design: A community-based descriptive, cross-sectional study was conducted among 185 women of reproductive age group. Subjects and Methods: Participants were randomly selected using a multistage sampling technique. Pretested structured interviewer administered questionnaire was used for data collection. The completed questionnaires were cleaned, coded, the data entered into a computer and SPSS version 20.0 was used for analysis. Statistical Analysis Used: Frequency, percentage, and descriptive summaries were used to describe the study variable using univariate analysis, while bivariate analysis was carried out to test for a relationship between categorical variables. Results: Only 4.9% of the respondents had good knowledge about danger signs in pregnancy while 3.8% of them have good attitude and one in ten respondents only (10.3%) has good perception of pregnancy danger signs. Conclusions: Our findings show that majority of women in childbearing age have poor knowledge, attitude, and perception on danger signs of pregnancy. Hence, the need to train and involve them on pregnancy dangers signs to curb the unnecessary deaths occurring during such period.

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Background: Water is one of the basic needs for survival, and potable water is essential for good health. Contaminated drinking water is a major health hazard in developing countries, and water-related diseases are a significant contributor to the global burden of illness. Thus, for populations without reliable access to safe drinking water, household water treatment provides a means of improving water quality and preventing disease. This study aimed to assess the knowledge, attitudes, and practices of household water purification among caregivers of under-five children in Biye community. Methodology: This was a descriptive cross-sectional study. A multi-stage sampling technique was used to recruit 142 caregivers of under-five children who were randomly selected. Data were collected using a semi-structured questionnaire and analyzed using IBM SPSS. Chi-square was used to test associations. The level of significance was set at <0.05. Results: Majority (63.4%) of respondents used unprotected well, and only 26.1% used protected well as a source of water. Only 12% of respondents had good knowledge. However, the majority of respondents (63.4%) had a positive attitude toward household water purification. Boiling was the most common (79.6%) method of water purification respondents are aware of and only about a third (32.4%) currently practiced household water purification. Conclusion: Majority of the respondents had poor knowledge and practice of household water purification. However, significant proportion of the respondents had a positive attitude toward household water purification. The local government authority should embark on the mass campaign on the importance and methods of household water purification in rural communities.

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Background: Street-food vendors play an important role in the etiology of foodborne disease outbreaks. Foodborne disease pathogens may be transferred by street-food vendors to food either directly or by cross contamination. Deeply concerned by this, the 53^rd World Health Assembly in May, 2000 adopted a resolution calling on the World Health Organization (WHO) and its member states to recognize food safety as an essential public health function. The resolution also called on WHO to develop a global strategy for reducing the burden of foodborne diseases. This study, therefore, was aimed at assessing the personal and food hygiene among street-food vendors in Sabon Gari Local Government Area of Kaduna State. Materials and Methods: A cross-sectional descriptive study was conducted among 109 adults food vendors that sell cooked food or food items by the roadside or open spaces in the streets of Sabon Gari local government area (LGA) using multistage sampling technique. Observation checklist and a pretested interviewer-administered questionnaire with closed-ended questions were used for data collection. The obtained data were entered into a computer, cleaned and analyzed using IBM SPSS statistics version 20. Univariate and Bivariate analyses were conducted among the variables. Associations between categorical variables were tested for significance using Chi-square or Fischer's exact test. Statistical significance was said to be achieved where P ≤ 0.05. Results: Most of the street-food vendors were within the age group 35–44 years (40.4%), while 49.5% of the people who patronized them were passers-by. Half (50.5%) of the street-food vendors normally operate under a shade to sell food to customers. All of them did not receive any formal training on personal and food hygiene. Half (50.4%) of the respondents and 48.6% of them had poor practices of personal and food hygiene, respectively. However, 67.0% of the street-food vendors had a fair environmental sanitation status around their vending sites. Conclusion: The study found that none of the street-food vendors had ever received any form of formal training on personal and food hygiene. Many of them have poor personal and food hygiene practices; however, a significant proportion of them have a fairly good environmental sanitation status around their vending sites. Formal training on personal and food hygiene should be conducted among all street-food vendors in the LGA to improve on their personal and food hygienic practices for the vending of safe food to their consumers.

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Background: Workers in bakeries face many hazards in their work environment, and these hazards have the potential to cause injury or illness. The study assessed the knowledge of occupational hazards and the use of preventive measures among bakery workers in Kaduna North Local Government Area of Kaduna State. Materials and Method: The cross-sectional descriptive study was carried out in January 2017. The data collection tools were 258 pretested semi-structured interviewer-administered questionnaires and observational checklist. The collected data were manually cleaned, checked for completeness; entered into SPSS software version 20.0 and analyzed. The results were presented as tables and charts. Results: Majority (77%) were within the age bracket of 15–30 years with a mean age of 23 ± 2.1 years, 63% of males and 37% had secondary education with different job descriptions. The mean working experience was 5 years with only 14% and 2% of the workers having had training on prevention of workplace hazards and the use of fire extinguisher, respectively. The workers had poor awareness of occupational hazards such as tightness on the chest (30%), skin reactions/allergy (16%) and falls (17%) but with better awareness of burns (46%), cuts (37%) and hearing problems from excess noise (40.0%) among others. The most encountered symptoms/problems by workers were a muscular problem (72%), recurrent catarrh (65%), tightness on the chest (54%), recurrent cough (54%) and sneezing (52%) and symptoms of asthma among others. Apron, hand gloves and face masks were the commonly used protective devices by the workers and only 19% of the bakeries had functional first aid boxes. Burning was the most common method of solid waste disposal (52%). Conclusion: The workers had poor to average awareness of some occupational hazards with some encountering some problems as a result of their work. The use of personal protective devices such as apron, hand gloves and face masks were encouraging. However, the availability of functional first aid box and training on the use of fire extinguishers were major problems. There is a need for continuous training of the workers on prevention of workplace hazards, use of fire extinguisher and provision of basic functional first aid box among others in the workplace.

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Context: Numerous methods have been used for obtaining intermaxillary fixation (IMF) in the treatment of mandibular fractures. Conventional methods such as arch bars and eyelet wires have been the most common methods for achieving IMF, but they have their own disadvantages. During the last two decades, IMF using intraoral, self-tapping IMF screws have been introduced for the treatment of minimally displaced fractures of the mandible. The present case control study evaluated the efficacy and associated complications of self-tapping IMF screws in the treatment of minimally displaced mandibular fractures. Materials and Methods: A total of twenty patients of minimally displaced mandibular fractures were divided into two groups and were treated with open and closed reduction methods using self-tapping IMF screws to evaluate the efficacy of IMF screws and associated complications. Results: The most common complications encountered were pain and edema in almost all patients. In Group I treated with open reduction, damage to the roots of teeth occurred in two patients, which later became nonvital after 6 weeks, while in Group II treated with closed reduction, two patients were seen with tissue overgrowth and screw loosening. In one case, postoperative malocclusion was also observed in Group I. Conclusion: Use of self-tapping IMF screws for IMF is a valid alternative to conventional methods in the treatment of minimally displaced mandibular fractures. Iatrogenic injury to roots of the teeth is the most important complication of the IMF screws but that can be minimized and/or overcome by a careful evaluation and treatment planning of the cases.

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Background: Cold chain management is a system of transport and storage of vaccines in a potent state from the time of manufacture to the time of administration. Preserving vaccines from its manufacture through administration requires adequate cold chain infrastructure, compliance with standards, and effective management. At the end of the chain, are healthcare providers who should have adequate knowledge to manage the cold chain. Aim: The aim of this study is to assess knowledge, attitude, and practice of cold chain management among primary health care (PHC) workers. Materials and Methods: A cross-sectional study was carried out using a pretested, structured, interviewer-administered questionnaire. A multistage sampling method was used in selecting the 78 respondents. Data were collated and analyzed using Statistical Package for Social Sciences version 23. Data were presented using frequencies and proportions. Results: Majority (71.8%) of the respondents knew the correct temperature range for which vaccines should be stored. Only 3.8% of the respondents had good knowledge of cold chain management. About two-thirds (75.6%) of the respondents agreed that cold chain management is important. Most respondents (78.5%) showed a positive attitude toward cold chain management. Only over half (51.3%) of the respondents had appropriate practice. Conclusion: This study has shown that the PHC workers in the study area had poor knowledge, about two-thirds had a positive attitude and only about half of them had appropriate practice on cold chain management. The local government department should improve on training and retraining of PHC workers on cold chain management.

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Background: The use of natural family planning (NFP) methods is low worldwide with few existing data. Aim: The aim of the study is to determine the factors affecting the use and discontinuation of NFP methods in our setting. Methodology: In this descriptive cross-sectional study, 302 clients who presented at the Reproductive Health Clinic of Ahmadu Bello University, Zaria, were interviewed, with the aid of pretested questionnaires. Sociodemographic variables, reasons affecting the use, and discontinuation of NFP methods were recorded and analyzed using SPSS software version 15. Results: Among the 302 clients interviewed, 88.1% (266) had used a form of family planning method: 38.4% (116) used NFP, 49.7% (150) used artificial methods, whereas 37.1% (43) discontinued the NFP methods. Major factors hindering the use of an NFP method include lack of awareness (24%), been single (17%), unknown reason (17%), irregular menstrual cycle (10%), and fear of method failure (8%). Major factors for discontinuing the NFP methods include high failure rates (21%), irregular menstrual cycle (18%), introduction to other methods (14%), want of conception (12%), and fear of pregnancy (12%). Conclusion: The most common factor affecting the uptake of NFP was lack of awareness. Failure rates and irregular menstrual cycles were the common denominators, affecting both the use and discontinuation of NFP methods.

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Introduction: Prolonged pregnancy is a high-risk pregnancy that is associated with increased maternal morbidity and increased perinatal morbidity and mortality. Objectives: The objective was to evaluate the effectiveness of sweeping of the fetal membranes to reduce the incidence of elective induction of labor for postdate pregnancy and to compare pregnancy outcome among women who had sweeping of membranes at 40 weeks with those who did not have sweeping of membranes. Subjects and Methods: This was a randomized, controlled study conducted from September 2017 to June 2018. One hundred and ninety-four consenting participants with no contraindication to vaginal delivery were randomized into two groups, those who had membrane sweeping at 40–41 weeks' gestation and a control group who had vaginal examination to assess Bishop score only at recruitment. Participants were followed up to delivery. Results: Sweeping of membranes effectively reduced the incidence of elective induction of labor. The proportion of those that had spontaneous labor in the treatment group was 85 (87.6%) compared to the control group that had 67 (62.9%). This was statistically significant with P < 0.001. The incidence of induction of labor was significantly lower in the membrane sweeping group compared with the control group (12.4% vs. 37.1%; P < 0.001). There was a significant higher mean time interval from recruitment to admission (recruitment admission interval) among the control group (5.76 ± 2.75 days) compared with those that had membrane sweeping (3.35 ± 2.55; P < 0.001). Conclusion: Sweeping of the membranes appears an effective and safe procedure in reducing the incidence of elective induction of labor and duration of pregnancy at term in low-risk population.

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Objective: Hyperprolactinemia may be associated with galactorrhea, menstrual abnormalities, and infertility. When diagnosed and appropriate treatment instituted, there may be early relief of these symptoms and pregnancy rate may increase. This study determined the prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities and/or galactorrhea. Patients and Methods: A cross-sectional study of women attending the infertility clinic who had galactorrhea and/or menstrual abnormalities. Menstrual abnormalities for this study refer to those with oligomenorrhea and amenorrhea. Results: Out of the 207 women studied, 75 of them have hyperprolactinemia, giving a prevalence of 36.2%. Galactorrhea has higher sensitivity (68%), a higher positive predictive value (39.5%), and a higher negative predictive value (69.3%) when compared with menstrual abnormalities which had sensitivity of 44%, positive predictive value of 29.7%, and negative predictive value of 56.3%, respectively. They, however, have the same specificity of 40.9%. Conclusion: The prevalence of hyperprolactinemia is high in this study. Galactorrhea is a better clinical indicator of hyperprolactinemia when compared with menstrual abnormalities.

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Background: Antenatal care (ANC) is one of the pillars of safe motherhood initiative aimed at preventing adverse pregnancy outcome. Early initiation of ANC may provide avenue for early identification and management of many medical illnesses in pregnancy with the resultant better feto-maternal outcome. The objective of the study was to determine the average gestational age (GA) at booking and to determine the effect of GA at booking on the feto-maternal outcome. Materials and Methods: This was a prospective cohort study of 414 women consecutively recruited at the booking clinic of the Teaching Hospital from September 2016 to July 2017. This was divided into two arms, early and late booking. However, only 186 and 189 women in the early and late booking women, respectively, completed the study and their data were available for analysis, and they were followed up to delivery. Results: The mean GA at booking in the study was 19.4 ± 8.14 weeks. The incidence rate of low-birth-weight was 8.3%. The recorded incidence rate of low-birth-weight of 7.8% among early attendees was similar to 8.8% recorded among those that booked late in pregnancy (P = 0.373). The overall stillbirth rate in this study was 29.33/1000 birth. The cumulative incidence of hypertensive disorders in pregnancy in the study was 12.8%. The overall mean packed cell volume (PCV) at booking was 33.6 ± 3.2 and similar to the respective PCV at booking in both early and the late booking women. The PCV at delivery was, however, significantly higher among those women that booked early when compared with those that booked late. Conclusion: The mean GA at booking in our unit is 19.4 ± 8.14. Early booking and access to routine hematinics may guarantee sustenance of this recorded higher PCV at delivery. Furthermore, educated and less parous women tend to book early from this study.

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Background: Cardiovascular (CV) risk factors tend to aggregate in geriatric population with variable distribution. These risk factors may act as alert signals for proactive geriatric CV health programs. This study was aimed at determining the frequencies of CV risk factors among geriatric Nigerians in a primary care clinic of a tertiary hospital in Southeastern Nigeria. Patients and Methods: This was a cross-sectional study carried out on 280 geriatric Nigerians at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Geriatric Nigerians aged 60 years and above were screened for risk factors of CV disease. The data collected included sociodemographic variables and metabolic, dietary, and behavioral risk factors using a structured, pretested, and researcher-administered questionnaire. Results: The top five most common CV risk factors were physical inactivity (67.1%), inadequate fruit consumption (65.7%), hypertension (48.2%), abdominal obesity (47.9%), and dyslipidemia (36.8%). Others were general obesity (31.1%), inadequate vegetable consumption (22.5%), diabetes mellitus (15.7%), habitual use of alcoholic beverages (9.0%), habitual use of snuff (3.9%), and nonhabitual smoking of cigarettes (2.8%). Conclusion: This study has demonstrated that the risk factors of CV disease exist among geriatric Nigerians in primary care, with five most frequent being physical inactivity, inadequate fruit consumption, hypertension, abdominal obesity, and dyslipidemia. Screening geriatric Nigerians for modifiable CV risk factors should be integrated into geriatric primary care in the study area.

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Introduction: Periodic health examination (PHE) serves as a medium through which the workpeople receive recommended interventions to help them remain in a state of fitness throughout their period of employment. This study comparatively analyzed the awareness and practice of PHE among workers in public and private establishments in Zaria, Kaduna State, Northwestern Nigeria. Materials and Methods: A cross-sectional, descriptive study was carried out among 115 workers in private and 140 in public establishments in Zaria town, selected through a multi-stage sampling technique. Data were collected using a structured, self-administered questionnaire containing close-ended questions. Data were analyzed using SPSS version 17.0. Results: The mean age of the workers was 34.04 ± 9.65 years in private and 40.94 ± 8.99 years in public establishments. Majority of the workers in public 106 (93.0%) and private 125 (89.3%) were aware of PHE, but only 42.0% in private and 44.3% in public establishments had a good practice. Conclusion: The awareness of PHE among workers in both public and private establishments in Zaria was high; however, the practice was generally poor. There is the need for an intervention study among the establishments that will help translate such high awareness into practice for their benefit.

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Background: Temporomandibular joint (TMJ) ankylosis is a condition associated with restricted mouth opening. Following induction of general anesthesia, airway obstruction may occur leading to “can't ventilate and can't intubate scenario.” The anticipation of difficult airway and choice of appropriate intubation techniques usually prevent anesthetic morbidity and mortality. Patients and Methods: Both the surgeons' and the anesthetic review, as well as the anesthetic chart of the 36 patients managed at Ahmadu Bello University Teaching Hospital between January 2006 and December 2017, were studied. Data collected were bio-data of the patients, extent of mouth opening, and the techniques of intubation used. Results: The mean age of the patients was 26.9 ± 1.64, with a male to female ratio of 1:1.1. There were more male 19 (52.8%) than female 17 (47.2%). Tracheal intubation was achieved with the aid of nasal fiberoptic technique in 22 (61.1%) patients, 8 patients (22.2%) were intubated by tracheostomy, 4 patients (11.1%) were intubated by blind nasal intubation, while 2 patients (5.6%) required endotracheal intubation through conventional oral laryngoscopy. The interincisor gap was between 0 and <1 cm in all the patients which indicated significantly restricted mouth opening, with an average of zero interincisor gap. Conclusion: Fiberoptic intubation was the most used approach of achieving tracheal intubation in patients with TMJ disorder.

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Background: Visceral metastasis from breast cancer usually results in high tumor burden with poor prognosis. Aim: This study aimed to document the pattern, treatment, and outcome of breast cancer patients with visceral metastasis in our hospital. Patients and Methods: This is a 5-year prospective study of breast cancer patients with visceral metastasis from January 2011 to December 2015. All patients had tru-cut biopsy to establish diagnosis. Chest X-ray, abdominopelvic ultrasound, and computed tomography of the thoracoabdominal region were done to establish the extent of visceral organ involvement. Information documented included patients' biodata, histology, site of visceral metastasis, treatment, and outcome. Results: Two hundred and fourteen out of 1087 patients with breast cancer had visceral metastasis (19.7%). Their age ranged 15–83 years. Eighty-four (39.4%) patients had metastasis to the lungs. Thirty-nine (18.3%) patients had metastasis to the liver. Fifty-eight (27%) patients had metastasis to two or more visceral organs. One hundred and eighty-one (84.6%) patients had chemotherapy, 158 (73.8%) had hormonal therapy, whereas 103 (49.1%) had surgery. The mortality at 3-year follow-up was 58.4%. Conclusion: The lungs were the most common organ of visceral metastasis followed by the liver in this study. A significant percentage had metastasis to two or more visceral organs. Early presentation will reduce the incidence of visceral metastasis and the high mortality associated with it.

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Introduction: The World Health Organization recommends that infants should be exclusively breastfed to achieve optimal growth, development, and health. Nonexclusive breastfeeding (EBF) causes infant malnutrition which is widespread in most developing countries and accounts for 11% of global disease burden. The aim of the study was to determine the effect of integrated nutritional intervention on maternal knowledge, practice of exclusive breastfeeding, and nutritional status of under-five children in two rural communities of Kaduna State, Nigeria. Materials and Methods: The study employed a quasi-experimental design, carried out between November 2014 and June 2015 with baseline, intervention, and postintervention phases in two rural communities of Kaduna State, Nigeria (Dangaiya (Sabon Gari Local Government Area [LGA] and Kufena [Zaria LGA] communities). The intervention was conducted among 167 mother/child pairs independently selected from the study and control areas through a multistage sampling technique. Data were collected using interviewer-administered questionnaire at baseline and 6 months after intervention from both communities. Weights and heights/length of recruited children were measured. Data were analyzed using SPSS statistics software version 20.0. (IBM). Results: The result indicated that malnutrition exists among under-five children in the study area. Postintervention, mothers of the children in the study community had better knowledge of EBF (P = 0.001), duration of EBF (P = 0.001), and recommended total breastfeeding duration (P = 0.001). The change in the malnutrition status of the children was not statistically significant (P > 0.05). Conclusion: In this study, nutritional education of mothers only had positive impact on their level of knowledge of EBF but not on their practice; therefore, there is a need for the Kaduna State Ministry of Health and Local Government Authorities to put in place prolonged (>4 weeks) integrated nutritional interventions with emphasis on correct exclusive breastfeeding practices to improve the level of malnutrition in the state.

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Introduction: The revised Nigerian National Health Policy and the WHO Expert Committee on the Role of Hospitals as the First Referral Level both recognize primary health care (PHC) as the entry point in the referral system. This study was carried out to assess the effect of training of PHC workers on referral and instituting referral focal person among PHCs on key referral indicators in Zaria and Giwa local government areas, North-Western Nigeria. Methodology: The study was a quasi-experimental study with pre- and postinterventional components carried out among seventy participants in the intervention and 62 participants in the control groups who were selected through a multistaged sampling technique. Data were collected using a structured self-administered questionnaire containing close-ended questions. Data were analyzed with SPSS software version 20.0. Results: Preintervention, majority of the respondents (74.3%) in the intervention and (67.7%) control groups had not received training on referral process. Postintervention, increase was noted in mean referral rate from 0.18 ± 0.28 to 0.52 ± 0.34, which was statistically significant, and mean counter referral rate from 0 ± 0 to 40.34 ± 45.53 in the study group, but there was no statistically significant change in the control group. Conclusion: Postintervention, significant increases were noticed in two of the practice indicators; referral rate and counter-referral rate in the study group only. The other practice indicators did not record a significant increase.

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Background: Globally, sickle cell disease (SCD) is the most common inherited disorder, with Nigeria having the greatest burden of the disease. SCD was thought to be a disease of childhood because many died early in life from related complications. However, advances in SCD treatment have altered its course such that the majority of children are living into adulthood. Individuals with SCD suffer increased school absenteeism, poor school performance, increased hospital visits, and increased hospitalization, thus affecting their quality of life (QOL) compared to normal individuals. Subjects and Methods: We conducted a hospital-based, descriptive, cross-sectional study among 120 individuals with SCD attending hematology clinic in a tertiary hospital, selected using systematic sampling technique. Pretested, structured, interviewer-administered questionnaire adapted from RAND's Short Form-36 was used for the data collection. Completed questionnaires were coded, and data were entered into SPSS software version 23.0 for analysis. Univariate and bivariate analyses were conducted among variables. Associations between categorical variables were tested for significance using Chi-square test and Student's t-test. Statistical significance was said to be achieved where P < 0.05. Results: A total of 120 participants were studied with an age range of 10–45 years and a median age of 20 years. Majority (54.2%) of the participants were in the age group of 10–20 years. In addition, 13 (10.8%) perceived their general health status as poor, whereas 71 (59.2%) had the perception of falling sick easily, than the normal individuals. The Health-Related Quality of Life (HRQOL) scores for the eight domains are as follows: bodily pain (62.3 ± 24.3), physical functioning (56.7 ± 25.5), physical role limitation (32.1 ± 37.7), social activities (59.5 ± 27.4), general mental health (42.0 ± 39.7), emotional status (59.1 ± 14.1), vitality (52.9 ± 13.1), and general health perceptions (50.8 ± 21.1). Conclusion: We found that the QOL of individuals with SCD is generally poor in all the domains of HRQOL, especially in the areas of role limitations due to physical and emotional health. Therefore, in addition to measures taken to reduce SCD complications, other interventions should target improving their physical and emotional health. We also recommend improving HRQOL among all the other domains as a clinical end point.

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Background: Nigeria like the rest of the world is exposed to a wide range of natural and human-induced disasters such as flood, plane crash, communal clashes, and postelection violence and recently, insurgency from Boko Haram. Most of these disasters have led to population displacement and its consequences. This study assessed the social characteristics and risk factors for diseases among the internally displaced persons (IDPs) at Stefano's foundation camp in Jos, Nigeria. Methodology: The study was a cross-sectional descriptive in nature carried out on March 1–30, 2015. The data were collected using 312 interviewer-administered questionnaire, key informant interview, and participant's observation and analysis was performed using SPSS version 20.0. Results: Majority (85%) of the respondents were within the age bracket of 18–49 years, 61% of females, 39% had no formal education, 53% of farmers by profession among others, 96% and 4% of them were displaced as a result of the insurgency in Borno and Adamawa States, respectively and had stayed in the camp for 3 months (43.8%). There was report of several morbidities and one case of mortality from malaria, diarrhea, and cholera due to inadequate water supply, poor refuse, and fecal disposal and the presence of disease vectors in the camp and a case of death of a 6-year-old child from malaria. Majority (83%) of the IDPs obtained medical treatment at the ill-equipped camp clinic. Conclusion: This study showed that the IDPs were faced with so many challenges and the nongovernmental organization has been rendering assistance. There is a need for all relevant stakeholders to key in to make life meaningful to this vulnerable group.

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Background: Nigeria has high maternal mortality ratios, and women of high parity are at higher risk of obstetric complications. Understanding barriers to the uptake of contraception is thus important. Methodology: A cross-sectional quantitative survey was done at the antenatal and postnatal clinics of Barau Dikko Teaching Hospital between September and December 2015. Questionnaires were administered to 400 married consenting women of high parity (five or more deliveries). The questionnaire extracted general and demographic information, history of contraception, and possible barriers to contraceptive uptake. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 22. Descriptive analysis was done using frequencies, percentages, and cross-tabulation. Chi-square test was used as a test of association where relevant, and P< 0.05 was considered statistically significant. Results: About 353 questionnaires were retrieved; respondents were mainly aged between 30 and 39 years, educated up to secondary level, Hausa and Muslims, and homemakers or traders. Women had a mean parity of 7 deliveries and highest, 15. There was high level of awareness of contraception, adequate spousal communication, and approval but a perception of high risk and side effects with contraceptive use. Conclusion: Fear of side effects was a major barrier to contraceptive use. However, a window of opportunity exists because they would be willing to use contraception in future. Hence, specific and individualized contraceptive counseling and patient selection is needed, as well as further education of women.

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