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.

The Burden of Unsafe Abortion Six Years before the COVID-19 Era in a Nigerian Tertiary Hospital: An Analytical Retrospective Study.

BACKGROUND: Unsafe abortion remains a leading cause of maternal mortality and morbidity, especially in developing countries with restrictive abortion laws. Disease containment measures during the COVID-19 pandemic have reduced access to contraception and safe abortion care, potentially increasing rates of unintended pregnancies and unsafe abortion. OBJECTIVE: To evaluate the morbidity and mortality burden of unsafe abortion before the COVID-19 pandemic. METHODS: A six-year analytical retrospective study of unsafe abortion at the Federal Medical Centre, Lokoja, Nigeria. All case records of unsafe abortion managed within the study period were retrieved, and relevant data extracted using a purpose-designed proforma. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Associations between categorical independent and outcome variables were assessed using the Chi square test at 95% confidence level. A p-value of <0.05 was considered statistically significant. RESULTS: The prevalence of unsafe abortion was 8.6 per 1,000 deliveries. More than one-half (37, 52.9%) were medical abortions using misoprostol tablets. The mean age of the women was 23.15+ 3.96 years, and most of them were single (49, 70%), with primary/ secondary education (42, 60%), and of low socioeconomic status (67, 95.7%). Nearly one-half (33, 47.1%) had either never used any modern contraceptive (9, 12.9%) or only used emergency contraception (24, 34.3%). The predominant complications of unsafe abortion included retained product of conception (69, 98.6%), haemorrhagic shock (22,31.4%), and sepsis (19, 27.1%). There were two maternal deaths, giving a case fatality rate of 2.9%. CONCLUSION: Unsafe abortion remains a significant cause of maternal mortality and morbidity in our setting. Improving access to effective modern contraceptives and liberalizing our abortion laws may reduce maternal morbidity and mortality from unsafe abortion.

CONTEXTE: L'avortement à risque reste l'une des principales causes de mortalité et de morbidité maternelles, en particulier dans les pays en développement où les lois sur l'avortement sont restrictives. Les mesures de confinement de la maladie pendant la pandémie de COVID-19 ont réduit l'accès à la contraception et aux soins d'avortement sûrs, augmentant potentiellement les taux de grossesses non désirées et d'avortements à risque. OBJECTIF: Évaluer le fardeau de morbidité et de mortalité de l'avortement à risque avant la pandémie de COVID-19. METHODES: Une étude rétrospective analytique de six ans sur l'avortement à risque au Fédéral Médical Center, Lokoja, Nigeria. Tous les dossiers de tous les cas d'avortement à risque pris en charge au cours de la période d'étude ont été récupérés et les données pertinentes extraites à l'aide d'un formulaire conçu à cet effet. Les données obtenues ont été analysées à l'aide d'IBM SPSS Statistiques pour Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Les associations entre les variables indépendantes catégorielles et les variables de résultat ont été évaluées à l'aide du test du chi carré à un niveau de confiance de 95 %. Une valeur de p <0,05 était considérée comme statistiquement significative. RESULTATS: L'prévalence des avortements à risque était de 8,6 pour 1000 accouchements. Plus de la moitié (37, 52,9%) étaient des avortements médicamenteux utilisant comprimés de misoprostol. L'âge moyen des femmes était de 23,15+ 3,96 ans, et la plupart d'entre elles étaient célibataires (49, 70%), avec une éducation primaire/secondaire (42, 60%) et de statut socio-économique bas (67, 95,7%). Près de la moitié (33, 47,1%) n'avaient jamais utilisé de contraceptif moderne (9,12,9%) ou n'avaient utilisé qu'une contraception d'urgence (24, 34,3%). Les complications prédominantes comprenaient la rétention du produit de conception (69, 98,6 %), le choc hémorragique (22, 31,4 %) et la septicémie (19, 27,1 %). Il y a eu deux décès maternels, soit un taux de létalité de 2,9 %. CONCLUSION: L'avortement à risque reste une cause importante de mortalité et de morbidité maternelles dans notre contexte. L'amélioration de l'accès à des contraceptifs modernes efficaces et la libéralisation de nos lois sur l'avortement réduiront la morbidité et la mortalité maternelles dues à l'avortement à risque. Mots-clés: Planification familiale, Avortement illégal/criminel, morbidité et mortalité maternelles, Produit de la conception retenu, Besoin non satisfait.

COVID-19 vaccine hesitancy concerns: Findings from a Ghana clinical radiography workforce survey.

INTRODUCTION: Vaccination is a key global strategy to mitigate the clinical impact of the COVID-19 virus. As part of local efforts to manage the outbreak, the government of Ghana announced its intention to vaccinate its population starting with essential and high-risk workers including radiographers. However, there were reports of hesitance to receiving the vaccine among the radiography workforce. This study was undertaken prior to the intended vaccination exercise to assess the willingness and concerns of radiographers to undergo the COVID-19 vaccination and to suggest recommendations to improve the vaccine uptake. METHODS: An ethically-approved online survey strategy was employed for this cross-sectional study conducted between 24th-28th February 2021. The survey employed quantitative questions and open text response options. Quantitative and open text responses were analysed using statistical and thematic analyses, respectively. RESULTS: There were 108 responses (response rate of 46.3%). The majority (n = 64, 59.3%) were willing to have the vaccine, however, some (n = 44, 40.7%) were not. The main reason behind their willingness to have the vaccine was its ability to reduce the spread of infections and lower mortality (n = 35, 54.7%). However, doubts about the vaccine's efficacy and side effects (n = 26, 56.8%), conspiracy theory concerns about its effects on the Ghanaian race (n = 4, 9.1%), and fertility concerns (n = 2, 4.5%) were some reasons for their hesitance to receive the vaccine. The open text commentary further revealed that the vaccine was thought of as a lifesaving medication, however, clinical safety concerns, lack of education/information and religious beliefs were affecting peoples' willingness to be vaccinated. CONCLUSION: Our findings demonstrate the need for an urgent public health educational intervention to address the COVID-19 vaccine hesitancy concerns raised by radiographers to help increase the vaccine uptake. IMPLICATION FOR PRACTICE: The study provides pertinent information to improve COVID-19 vaccine uptake among radiographers to limit the spread of infections.

Predictors of arthritis in pediatric patients with lupus.

BACKGROUND: Arthritis is one of the most common manifestations of systemic lupus erythematosus (SLE). Although typically non-erosive and non-deforming, children with SLE arthritis can have significant morbidity with decreased quality of life. Our goal was to identify potential clinical and laboratory predictors of arthritis in a cohort of pediatric patients with SLE. METHODS: We performed a cohort study of incident and prevalent patients with SLE aged ≤ 19 years. In cross sectional analysis, we compared demographic and clinical characteristics at initial clinic presentation between patients with arthritis noted at any time during follow-up and those without arthritis. We performed time to event analysis using Cox proportional hazard ratios to identify predictors of arthritis, clustering for repeated measures. RESULTS: Forty seven children and adolescents with SLE were followed in the cohort, 91 % female and 68 % Black. In cross-sectional analyses, presence of malar rash was associated with arthritis. In longitudinal analyses, controlling for gender and race, increased age (HR: 1.4, 95 % CI: 1.1-1.7), malar rash (HR: 2.1, 95 % CI: 1.1-3.6), and presence of RNP antibodies (HR: 1.9, 95 % CI: 1.1-3.4) were predictive of arthritis. When controlling for gender, race, and medication use, anemia (HR: 8.5, 95 % CI: 2.9-24.2) and thrombocytopenia (HR: 6.1, 95 % CI: 2.4-15.6) were associated with increased risk of arthritis. CONCLUSIONS: We identified markers predictive of arthritis in a longitudinal cohort of children with SLE. The recognition of these markers may help clinicians identify patients at risk for arthritis before its onset thus improving quality of life in children with SLE.

Predictors of kidney disease in a cohort of pediatric patients with lupus.

INTRODUCTION: Children with systemic lupus erythematosus (SLE) have an increased prevalence of kidney disease compared to their adult counterparts. Our goal was to identify potential clinical and laboratory predictors of renal disease. METHODS: We performed a cohort study of incident and prevalent patients with SLE aged ≤19 years. Retrospective data from initial presentation until study enrollment was also collected. Laboratory and clinic data were recorded from each clinic visit including disease activity indices, autoantibodies, urinalyses, blood counts, and metabolic profile. Kidney disease was defined as the presence of abnormal renal biopsy or by American College of Rheumatology case definition for lupus nephritis. Logistic regression analyses were used to determine the association between clinical and laboratory data with kidney disease in those who had renal involvement within 30 days of SLE diagnosis. We also performed a time to event analysis to identify antecedents of renal disease. RESULTS: Forty-seven children and adolescents with SLE were followed in the cohort, 91% female and 68% black. All of the males in the cohort developed renal disease, and all within one month of the diagnosis of SLE. In logistic regression, low serum albumin (odds ratio (OR): 4.8, 95% CI: 1.9-12.5) and positive dsDNA antibodies (OR: 3.2, 95% CI: 1.7-5.9) were associated with kidney disease. In longitudinal analyses, isolated sterile pyuria (hazard ratio (HR): 3, 95% CI: 1.1-6.4) and low serum albumin (HR: 3.4, 95% CI: 1.7-6.9) were predictors of future kidney disease. The presence of antibodies against Ro were protective against renal disease (HR: 0.2, 95% CI: 0.05-0.5). CONCLUSION: We identified variables associated with kidney disease, both at initial diagnosis of SLE and in longitudinal follow-up in a cohort of children with SLE. The recognition of these abnormal laboratory values may help clinicians identify patients at risk for kidney disease before its onset thus preventing long-term complications.

Awareness, perception and coverage of tetanus immunisation in women of child bearing age in an urban district of Lagos, Nigeria.

AIMS AND OBJECTIVES: This study assessed the level of awareness and perception of women of child bearing age to tetanus immunisation and determines the cover- age rate in Ojodu Local Council Development Area (LCDA) of Lagos State, Nigeria. SUBJECTS AND METHODS: This is a descriptive cross-sectional study of 288 women of child bearing age selected using multistage sampling technique. Information was obtained using structured close-ended questionnaire. Data analysis was done using Epi-InfoTM software, version 3.5.1. RESULTS: There was high level of awareness of tetanus immunisation among respondents (89%) and as a method of prevention of tetanus (76%). There was a positive association between the level of awareness and respondents' educational level and occupation (p < 0.05). However, there is a low level of awareness regarding the number of doses of the vaccine required in pregnancy(14.4%) and for life protection (19.5%). Those who ever received the vaccine,got it post-injury (48.9%) and in pregnancy (45.2%). Age, occupation and parity were positively associated with receiving the vaccine (p < 0.05), while parity and marital status were positively associated with number of dose of vaccine received (p < 0.05). Only about 20% of the respondents had received two or more doses of the vaccine. CONCLUSION: This study concludes that despite the high level of awareness about tetanus and tetanus immunisation, there is a low coverage rate of tetanus immunisation among women of child bearing age in Ojodu LCDA of Lagos State. Women of child bearing age should also be targeted at the community level in tetanus immunisation campaign programme.

Audit of medication errors by anesthetists in North Western Nigeria.

BACKGROUND: Safety issues are an important aspect of anesthesia practice. The relevance of medication and drug administration errors in our everyday practice is an important aspect of medical audit. Although there have been few case reports of drug administration errors by anesthetists, there is paucity of information regarding medication errors in anesthetic practice in Nigeria. We set out to study the incidence of medication errors among anesthesia practitioners in Kaduna State, North Western Nigeria and to suggest ways to minimize such errors. MATERIALS AND METHODS: A questionnaire-based study was conducted among physician anesthetists and nurse anesthetists working in the major secondary and tertiary hospitals in Kaduna State, North Western Nigeria. The data obtained was analyzed using SPSS Version 17.0 and the data presented in relevant charts and tables. RESULTS: A total of 43 persons responded to the questionnaire with a high response rate of 86% and a male/female ratio of 2.3:1. Most of the anesthetists (38 or 88%) work in tertiary government hospitals. Twenty-four (56%) of them admitted to ever having a medication error, and 34 (79%) of them attributed the medication error to problems with drug labeling from manufactures using similar labels for different drugs. Untoward sequelae resulted in 44% of the patients that were affected by these medication errors and these ranged from cardiac arrest to delayed recovery from anesthesia. Majority of the respondents recommended vigilance, double checking of drug labels, and color coding of syringes as ways to minimize medication errors. CONCLUSION: Medication errors do occur in the everyday practice of anesthetists in Nigeria as in other countries and can lead to morbidity and mortality in our patients. Routine audit and reporting of critical incidents including errors in drug administration should be encouraged. Reduction of medication errors is an important aspect of patient safety, and vigilance remains the watchword.

Caregivers knowledge and utilization of child health services in an Urban District of Lagos, Nigeria.

BACKGROUND AND OBJECTIVES: Child health, growth and development can be affected by the level of knowledge of caregivers and utilization of available child health care services. The study objectives was to assess the knowledge and pattern of utilization of child health care services among caregivers of children under 5 years attending Primary Health Care (PHC) centres and factors influencing their utilization in Ejigbo Local Council Development Area (LCDA) of Lagos State, Nigeria. METHODS: A descriptive cross sectional design was used. An interviewer-administered questionnaire was used to obtain information from 148 caregivers of children under 5 years attending the three PHC facilities in the LCDA. Caregivers were selected by systematic random sampling method. Data entry and analysis was done using Epi InfoTM statistical software. RESULTS: The mean age of caregivers was 30 years (± 7.10 SD), about 53 percent are married, 74 percent had at least secondary school education, 43 percent are traders and 75 percent had access to media facilities. About 70 percent of mothers demonstrated good knowledge of preventive health services, less than half (46.3%) reported correctly the use of curative services and 88 percent were satisfied with the quality of care received. There is an association between caregivers education, occupation and their knowledge of use of curative services (p-value <0.05 in both). CONCLUSION: This study concludes that the knowledge and use of preventive services among respondents is above average, while fewer respondents used curative services which were influenced by education and occupation of respondent in Ejigbo, LCDA.

Increased hospitalizations and death in patients with ESRD secondary to lupus.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect almost any organ system, including the kidneys. Using a large national dataset, our goal was to compare the morbidity as measured by hospitalization and mortality rates between hemodialysis patients with end-stage renal disease (ESRD) secondary to SLE to those with ESRD due to other causes. METHODS: The risk of hospitalization was calculated by Poisson regression with clustering for repeated measures using the United States Renal Data System (USRDS) Hospitalization Analytic File in strata of pediatric and adult patients. Cox proportional hazard ratio was used to assess the mortality risk in hospitalized patients. Subjects were censored at transplantation or end of follow-up. RESULTS: Adult patients with ESRD secondary to SLE were hospitalized more frequently than other adults (incidence rate ratio (IRR): 1.43, 95% confidence interval (CI): 1.15-1.77) and had a higher risk of death (hazard ratio (HR): 1.89, 95% CI: 1.66-2.5). Mortality was higher in hospitalized pediatric patients with SLE compared to pediatric patients with other causes of ESRD (HR: 2.01, 95% CI: 1.75-2.31) and adults with SLE (HR: 2.05, 95% CI: 1.79-2.34). CONCLUSION: Our study demonstrates that there is a trend toward increased hospitalization rates in pediatric and adult patients with SLE. Among these hospitalized patients with SLE, there is an increased risk of death due to cardiovascular disease.

Modifying of Cotton Fabric Surface with Nano-ZnO Multilayer Films by Layer-by-Layer Deposition Method.

ZnO nanoparticle-based multilayer nanocomposite films were fabricated on cationized woven cotton fabrics via layer-by-layer molecular self-assembly technique. For cationic surface charge, cotton fabrics were pretreated with 2,3-epoxypropyltrimethylammonium chloride (EP3MAC) by pad-batch method. XPS and SEM were used to examine the deposited nano-ZnO multilayer films on the cotton fabrics. The nano-ZnO films deposited on cotton fabrics exhibited excellent antimicrobial activity against Staphylococcus aureus bacteria. The results also showed that the coated fabrics with nano-ZnO multilayer films enhanced the protection of cotton fabrics from UV radiation. Physical tests (tensile strength of weft and warp yarns, air permeability and whiteness values) were performed on the fabrics before and after the treatment with ZnO nanoparticles to evaluate the effect of layer-by-layer (LbL) process on cotton fabrics properties.

The fabrication of nanocomposite thin films with TiO2 nanoparticles by the layer-by-layer deposition method for multifunctional cotton fabrics.

A multilayer nanocomposite film composed of anatase TiO(2) nanoparticles was fabricated on cationically modified woven cotton fabrics by the layer-by-layer molecular self-assembly technique. For cationic surface charge, cotton fabrics were pre-treated with 2,3-epoxypropyltrimethylammonium chloride (EP3MAC) by a pad-batch method. Attenuated total reflectance Fourier transform infrared spectroscopy (FTIR), x-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) were used to verify the presence of deposited nanolayers. Photocatalytic activities of the nanocomposite films were evaluated through the degradation of red wine pollutant. Nano-TiO(2) deposition enhanced the protection of cotton fabrics against UV radiation in comparison with the untreated cotton fabrics. Air permeability and whiteness value analysis was performed on the fabrics before and after the treatment with TiO(2) nanoparticles by the layer-by-layer deposition method. Tensile strength tests of the warp and weft yarns were performed to evaluate the effect of solution pH value changes during the alternate dipping procedures. For the first time the durability of the effect of the self-assembled multilayer films on the cotton fabric functional properties was analyzed after 10 and 20 washing cycles at 40 degrees C for 30 min.

Birth preparedness and emergency readiness plans of antenatal clinic attendees in Ile-ife, Nigeria.

BACKGROUND AND OBJECTIVES: Adequate birth preparedness and emergency/complication readiness (BP/CR) planning could determine the survival of a pregnant woman and her unborn child in maternal emergency. The study assessed adequacy of BP/CR plans of antenatal clinic attendees in Ile-Ife, Osun State, Nigeria. METHODS: Pregnant women (less than 36 weeks gestation) attending antenatal clinics in selected health facilities were serially recruited into the study after they had given verbal informed consent. Data were collected with a purpose-designed questionnaire. SPSS version 11 statistical software was used for data entry and analysis. RESULTS: Four hundred pregnant women were recruited; 284 (71%) registered for antenatal care by 20 weeks of gestation. Concerning delivery planning, 350 (87.5%) had decided their place of delivery although 32 (9.1%) of these planned to deliver in mission houses or at home; 351 (87.8%) had started to purchase items needed for delivery or newborn care, 289 (71.0%) had identified someone to accompany them to health facility for delivery while 259 (64.8%) were saving money for delivery. Regarding emergency or complication readiness, knowledge of signs of severe maternal illness for which immediate care should be sought in an appropriate health facility was low, 113 (28.3%) respondents were able to mention 4 or more of such signs without prompting; 249 (62.3%) had made arrangements for transportation and 45 (11.3%) had identified potential blood donor. CONCLUSION: By the study criteria, 61% of the pregnant women studied made adequate preparations for delivery while 4.8% were ready for emergency/complication. It is recommended that greater emphasis be given to emergency/complication readiness during antenatal care sessions.

Operative vaginal deliveries in Zaria, Nigeria.

BACKGROUND: Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings. STUDY DESIGN: Labor records on operative vaginal delivery cases and matched controls who had spontaneous vaginal deliveries between January 1997 and December 2001 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were analyzed with respect to mode of delivery, indication for operative vaginal delivery, anesthesia use, fetal 5-min Apgar score, birth weight, fetal, and maternal complications. RESULTS: Of 7,327 deliveries at the center in the study period, 262 (3.6%) were by operative vaginal deliveries. Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy procedures were performed selectively (6.1%). Operative vaginal deliveries were more commonly employed on primigravida (78.6%) compared to multiparas and the most common indication was delayed second stage of labor. Forcep- and vacuum-assisted deliveries were both associated with maternal and newborn complications. There was no significant difference in the use of anesthesia between forceps and vacuum deliveries. CONCLUSION: Operative vaginal delivery rates in this center are comparable to other centers as are the possible complications. Making these procedures safer will improve safe motherhood in settings where there are performed.

Surface motility and associated surfactant production in Agrobacterium vitis.

AIMS: Agrobacterium vitis is the causal agent of crown gall of grapevine. Surface motility (swarming), an important mechanism for bacterial colonization of new environments and a previously unknown behaviour of Ag. vitis, was demonstrated. METHODS: Surface motility assays were performed on half-strength potato dextrose agar (Difco) containing 0.75% agar. To test for surfactant production, a drop-collapse test was used. Quorum-sensing (QS) negative and complemented mutants were tested for swarming activity. RESULTS: Ninety-one Agrobacterium strains representing -Agrobacterium tumefaciens (17 strains), Agrobacterium rhizogenes (14 strains) and Ag. vitis (60 strains) were tested for swarming and production of surfactant. All Ag. vitis strains expressed a surface-related motility. In contrast, none of 17 strains of Ag. tumefaciens or 14 strains of Ag. rhizogenes exhibited this behaviour. Surface motility in Ag. vitis was associated with surfactant secretion; both of which are regulated by a QS system previously associated with induction of a hypersensitive response on tobacco and necrosis on grape. An aviR (belongs to luxR family) mutant was surface motility negative and did not produce surfactant. An avsI mutant (autoinducer synthase) was also surface motility negative and was complemented with an Ag. tumefaciens clone expressing avsI. CONCLUSIONS: Agrobacterium vitis is able to produce a characteristic swarming phenotype that is regulated by a complex QS system. SIGNIFICANCE AND IMPACT OF THE STUDY: Swarming activity is unique to Ag. vitis among Agrobacterium sp. and may be associated with the ability of the pathogen to colonize grapevines.

Impact of nutritional education on nutritional status of under-five children in two rural communities of south-west Nigeria.

OBJECTIVES: This study evaluated the impact of nutritional education on knowledge, attitude and practices (KAP) of mothers concerning infants and young children feeding and their children's nutritional status in two semi-urban communities of south-west Nigeria. MATERIALS AND METHODS: This is a community intervention study. We recruited 150 mothers of children aged 0-18 months independently from the intervention and control communities through a multi-stage sampling technique. We collected data with the aid of an interviewer-administered questionnaire at baseline and at six months after intervention from both communities to obtain information on feeding of infants and young children. In addition, we measured weights and heights of recruited children. Intervention involved group counselling of mothers and food demonstrations at designated health facilities. Data analysis for quantitative data was done using Epi-Info software, and for qualitative data, content analysis of major themes was used. RESULTS: Before intervention, recruited mothers and their children from the two communities were comparable in terms of all the parameters assessed (P>0.05 in all cases). After six months of intervention, mothers who had nutritional education demonstrated better knowledge and attitudes to key infant and young children feeding recommendations. There was also limited improvement in feeding practices. Mothers from the intervention community exclusively breastfed their infants longer with mean age at introduction of complementary foods at 5.3 months compared to 4.5 months in the control community (P<0.05), breastfed their children longer (P<0.05). However, there was no statistically significant improvement in the weight of their children. CONCLUSION: In this study, nutritional education of mothers only had positive impact on their level of KAP on infant and young children feeding.

Utilization of primary health care facilities: lessons from a rural community in southwest Nigeria.

BACKGROUND: This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria. METHOD: A cross-sectional household survey in the community as well as key-informant interviews of opinion leaders and health care providers and participant observations of health facilities and utilisation pattern was used to collect data. RESULTS: Forty-four percent of respondents to the survey who were ill in the preceding six months visited a PHC facility for treatment, while others relied on self-medication/self-treatment. Education was positively associated with utilisation of PHC services (P<0.05). Maternal and child health (45.4%), prompt attention (23.0%), and appropriate outpatient (20.5%) services attracted respondents to use PHC services. Poor education about when to seek care, poverty, perceived high cost of PHC services, lack of drugs and basic laboratory services, and a regular physician on site at the facility were identified as barriers to utilisation. CONCLUSION: We conclude that community perceptions of poor quality and inadequacy of available services was responsible for low use of PHC services.

Contraceptive choices among women in Zaria, Nigeria.

AIMS/OBJECTIVE: To study the choice of contraceptive usage and the factors responsible for such choices in northern Nigeria. DESIGN: A cross-sectional study. SETTING: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. SUBJECTS: New clients attending the reproductive health centre. MAIN OUTCOME MEASURES: Choice of contraceptive, reason for choice, knowledge and source of knowledge about contraceptives. RESULTS: Four hundred and eighteen clients were interviewed. Three hundred and seventy two (89%) knew at least one method of contraception; 50.7% used injectable contraceptives, 22.5% intrauterine contraceptive devices, 13.9% Norplant and 10.3% oral contraceptive pills. One hundred and forty four (34.5%) were referred by midwives and 25.6% by other nurses. CONCLUSIONS: The most commonly used contraceptive in our environment is the injectable method.

Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria.

BACKGROUND/OBJECTIVE: To document the premenstrual and menstrual symptoms of Muslim women, with a view to providing adequate and sensitive care. METHODS: Two hundred Muslim women were interviewed at Ahmadu Bello University Teaching Hospital and Muslim Specialist Hospital, both in Zaria between August and October 2003. RESULTS: Premenstrual symptoms were present in 23.8% of the women and breast pain was the commonest symptom (50%). Self-medication was practiced by those who needed medication for the premenstrual symptoms (29.8%). Premenstrual symptoms were significantly associated with lower parity (p = 0.02), previous (p = 0.03) and current (p = 0.01) contraceptive use and dysmenorrhoea (p = < 0.001). Dysmenorrhoea was present in 36.4% and was significantly associated with lower age (p = 0.03), and lower parity (p = 0.01). CONCLUSIONS: Health care workers and the general public need to be aware of premenstrual symptoms and dysmenorrhoea in order to provide adequate care and support that is sensitive to Muslim women's needs. Health care providers should also be aware that premenstrual symptoms are more likely to coexist with dysmenorrhoea and provide therapies that can cater for both problems whenever possible.

Phytopatological problems and solutions in the walnut orchards along Lake Balaton.

European or Persian Walnut (Juglans regia) is an important and healthy food as well as base material of timber industry. Several pests (pathogens and insect pests) may cause serious damages on walnut. These are less known on the crop land of the tree. Results of some years of our experiments including bacteriological and mycological studies, are presented in this paper. The optimum time of chemical protection against the walnut blight (Xanthomonas arboricola pv. juglandis) was determined. Occurrences of pathogenic fungi were surveyed in an orchard and on home garden trees in Hungary (18 fungus species were identified). The following experimental results are reported on the pathogenic fungi: cultivar resistance to walnut anthracnose (Gnomonia leptostyla), dying of wood parts in the cultivar collection, application of the spore trap, in vitro fungicide testing against Phomopsis juglandina.