Appropriateness of ophthalmic cases presenting to a Nigerian tertiary health facility: implications for service delivery in a developing country.

OBJECTIVE: To assess whether the ophthalmic cases presenting at a Nigerian tertiary eye unit are appropriate for such level of care and also draw necessary implications for service delivery. METHODS: Data on 1321 consecutive new patients that presented at the ophthalmic clinic of the University of Teaching Hospital, Ilorin, Nigeria between February and July 2005 were reviewed on demographics, referral routes, and reasons for patronage, diagnoses and disease categories. Information on the general situation of health infrastructures prevailing at the surrounding health facilities was collected from key-informants. RESULTS: One thousand and ninety-one (82.6%) presented without any referral and 1095 (82.9%) patronized in order to access perceived good quality of eye care service being rendered. However, only a small proportion of their ailments (191, 14.5%) actually required attention at the tertiary level of eye care. The key informants painted a picture of severely-challenged general and health infrastructures particularly at the primary health care facility level. CONCLUSION: An overwhelming majority of ophthalmic patients directly accessed eye care at the tertiary level, even though most of their ailments could have been satisfactorily treated at the lower facilities of health care were the latter to be functioning optimally. A better coordinated and strengthened health care system, particularly at the primary and secondary health care facilities would ease the burden of inappropriate presentations on tertiary health facilities in Nigeria.

Conjunctival Kaposi's sarcoma in HIV-positive heterosexual Nigerian woman--a case report.

BACKGROUND: Neoplastic conditions are increasingly been encountered in HIV/AIDS patients. Till date only two cases of conjunctiva Kaposi sarcoma (KS) have been reported in the background of HIV and both in males. OBJECTIVE: To present a 27-year-old African woman with histologically proven conjunctival KS and marked CD4+ cell depletion and to reinforce the fact that KS is an important differential of conjunctival tumour especially in the background of immunosupression in Africa. METHODS: A 27-year-old housewife, presented to the hospital with a three-month history of a rapidly growing tumour attached to the right upper eyelid, cough and weight loss. Patient was given full workup including x-rays, HIV status determination and histological assessment. RESULTS: She was markedly wasted, with widespread pruritic papular skin lesion, and florid oropharyngeal candidiasis. Clinical and chest x-ray findings were suggestive of bilateral lower lobar pneumonia. Screening and confirmatory tests were positive for human immunodeficiency virus (HIV) with CD4+ lymphocyte cell count of 120 cells/ml. Histologic report of the biopsy revealed the mass to be a conjunctival KS. Patient was subsequently commenced on antibiotics and antiretroviral combination therapy. The mass had regressed in size considerably along with improvement in her clinical condition at six months review. She is still being followed up at the medical clinic. CONCLUSION: This is the first reported case of conjunctival KS in an HIV positive African woman. KS should be considered as a possible differential of conjunctiva mass, especially if the patient is HIV positive irrespective of patient's gender.

Childhood malignancies of the eye and orbit in northern Nigeria.

One hundred four histologically proven malignant tumors of the eye and orbit in children seen in Guinness Eye Clinic, Kaduna, Nigeria between 1975 and 1982 are presented. Retinoblastoma and Burkitt's lymphoma account for the majority of the tumors. The data are compared with those from Ibadan, Nigeria. Burkitt's lymphoma occurs less frequently in Kaduna, whereas the incidence of retinoblastoma is almost the same. Chloroma, which was not seen in Ibadan, accounted for 2.9% of the current series. Factors that may be contributory to the observed differences are discussed.