Research Participation and Feedback: Perception of Adolescents and Young Adults Living with HIV in Lagos, Nigeria.

BACKGROUND: Evidence-based research remains the cornerstone in changing the narrative of wholesome health among Adolescents and Young Adults Living with HIV (AYALHIV). However, little is known about the perceptions of AYALHIV in research participation and outcomes, in low- and middle-income countries, especially in sub-Saharan Africa. This study describes the perception of AYALHIV in research participation and outcome in Lagos, Nigeria. METHODS: The study population was drawn from a cohort of participants in a cross-sectional study at the Nigerian Institute of Medical Research. The survey questions were on perceptions of the importance of research participation, the frequency, understanding of participation in research, the interest in the outcome, the knowledge of the interpretation of the outcome and the willingness to participate in future studies. Data obtained was analyzed using SPSS version 26.0. RESULTS: The mean age of the AYALHIV was 15.7(±3.1) years, with a male-to-female ratio of (0.8:1), and 85.7% on antiretroviral drugs for at least five years. Seventy-two percent (46/63) have been involved in previous studies at least once, with only 27% (17/63) informed on the outcome of the research they have ever participated. Only 30% (19) of participants understood they were involved in research, with 92% interested in the study outcome. 87.3% (55) will request more information before participating in future research activities. CONCLUSION: Educating AYALHIV on research participation is important in promoting concerted efforts by researchers towards improving engagement, patient-centred care, and research dissemination.

CONTEXTE: La recherche fondée sur des données probantes reste la pierre angulaire du changement du discours sur la santé saine chez les adolescents et les jeunes adultes vivant avec le VIH (AYALHIV). Cependant, on sait peu de choses sur les perceptions de l'AYALHIV dans la participation et les résultats de la recherche, dans les pays à revenu faible et intermédiaire, en particulier en Afrique subsaharienne. Cette étude décrit la perception d'AYALHIV dans la participation et les résultats de la recherche à Lagos, au Nigéria. METHODES: La population m'étudiée a été tirée d'une cohorte de participants à une étude transversale menée à l'Institut nigérian de recherche médicale. Les questions de l'enquête portaient sur les perceptions de l'importance de la participation à la recherche, la fréquence, la compréhension de la participation à la recherche, l'intérêt pour les résultats, la connaissance de l'interprétation des résultats et la volonté de participer à des études futures. Les données obtenues ont été analysées à l'aide de SPSS version 26.0. RESULTATS: L'âge moyen des AYALHIV était de 15,7 (± 3,1) ans, avec un ratio hommes/femmes de (0,8 : 1) et 85,7 % prenaient des médicaments antirétroviraux depuis au moins cinq ans. Soixantedouze pour cent (46/63) ont participé à des études antérieures au moins une fois, et seulement 27 % (17/63) sont informés des résultats de la recherche à laquelle ils ont déjà participé. Seulement 30 % (19) des participants comprenaient qu'ils étaient impliqués dans la recherche, et 92 % d'entre eux étaient intéressés par les résultats de l'étude. 87,3 % (55) demanderont plus d'informations avant de participer à de futures activités de recherche. CONCLUSION: Éduquer AYALHIV sur la participation à la recherche est important pour promouvoir les efforts concertés des chercheurs en vue d'améliorer l'engagement, les soins centrés sur le patient et la diffusion de la recherche. MOTS CLES: VIH, Adolescent, Jeunes adultes, Perception, Recherche.

Knowledge and sexual behaviors: A path towards HIV/AIDS prevention among university students.

Despite the world's commitment to end HIV/AIDS by 2030, the disease is still prevalent in sub-Saharan Africa. Although awareness is high among the youth, they are the most vulnerable because of their susceptibility to risky behaviors. This cross-sectional correlational study examined HIV/AIDS awareness and sexual behaviors among university students. Nine hundred and ten (910) students, attending an annual health screening exercise, were conveniently sampled to participate in the study by completing a structured questionnaire (Behavioral Surveillance Survey) in addition to socio-demographic information. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25 to obtain descriptive statistics. Results indicated that HIV/AIDS awareness is very high however, a sizable number of participants engaged in risky sexual behaviors inconsistent with their knowledge. There was a significant positive relationship between students' awareness of HIV/AIDS and their perception of the influence of the awareness on sexual behaviors. Yet, there was no relationship between awareness and actual sexual behaviors and HIV/AIDS attitudes. While students believed that their awareness positively influenced their sexual choices, the actual behaviors and attitudes were inconsistent with the awareness. Implications of findings for HIV/AIDS prevention are discussed.

Malgré l'engagement mondial à mettre fin au VIH/SIDA d'ici 2030, la maladie reste répandue en Afrique subsaharienne. Même si les jeunes sont très sensibilisés, ils sont les plus vulnérables en raison de leur susceptibilité aux comportements à risque. Cette étude corrélationnelle transversale a examiné la sensibilisation au VIH/SIDA et les comportements sexuels parmi les étudiants universitaires. Neuf cent dix (910) étudiants, participant à un exercice annuel de dépistage de santé, ont été échantillonnés pour participer à l'étude en remplissant un questionnaire structuré (Enquête de surveillance comportementale) en plus des informations sociodémographiques. Les données ont été analysées à l'aide du progiciel statistique pour les sciences sociales (SPSS) version 25 pour obtenir des statistiques descriptives. Les résultats ont indiqué que la sensibilisation au VIH/SIDA est très élevée, mais qu'un nombre important de participants se sont livrés à des comportements sexuels à risque incompatibles avec leurs connaissances. Il existe une relation positive significative entre la sensibilisation des élèves au VIH/SIDA et leur perception de l'influence de cette sensibilisation sur les comportements sexuels. Pourtant, il n'y avait aucune relation entre la sensibilisation et les comportements sexuels réels et les attitudes face au VIH/SIDA. Alors que les étudiants pensaient que leur conscience influençait positivement leurs choix sexuels, les comportements et attitudes réels étaient incompatibles avec cette conscience. Les implications des résultats pour la prévention du VIH/SIDA sont discutées.

Demographics and Clinical Characteristics of Burn Injuries in Nigeria: A Tertiary Hospital Cohort.

BACKGROUND: Burn injuries account for 4.8% of trauma deaths in Nigeria and annually for 20,000 deaths. AIM: This study was to catalogue the demographics of patient who presented at a referral center in Nigeria. PATIENTS AND METHODS: In a retrospective study, we reviewed the records of all burn patients who presented over a 36-month period (January 2018 to December 2020). The clinical and demographic data was extracted using a self-designed questionnaire. Information obtained included biodata, etiology, time of presentation, first aid used, TBSA, length of hospital stay (LOHS), and outcome which was analyzed with SPSS version 28. RESULTS: A total of 112 burn patients presented at our facility, 87 male and 25 female (m: f = 3.5:1). Forty-four percent were children 10 years old and below. Though scalding with hot liquids was the commonest cause of injury in children, flame burn was the commonest etiology (57.1%). Inhalational injuries occurred in 14.2%. Raw eggs and pap were used as first aid by 23%. Most patients were discharged home, and 19.6% died. CONCLUSION: The prevalence of burn injuries remains high in developing countries. Most causes of burns are preventable. Dangerous traditional practices add to patient morbidity. Education on effective prevention strategies is important in reducing morbidity and mortality.

The configurational effects of task-technology fit, technology-induced engagement and motivation on learning performance during Covid-19 pandemic: An fsQCA approach.

At the onset of 2020, Covid-19 pandemic began and disrupted teaching and learning activities with substantial implications for resources and operations. Against this backdrop, the configural causal effects of task-technology fit, technology-induced engagement and motivation, gender, and residential location on learning performance are examined. The proposed association was tested with a dyad sample of faculty members and students (n = 16) using fuzzy sets (fsQCA) analysis. Results show that (i) task-technology fit, and technology-induced motivation emerge as necessary conditions for high learning performance; (ii) task-technology fit, technology-induced engagement and motivation are sufficient conditions for high learning performance among female students, (iii) task-technology fit, technology-induced engagement and motivation are sufficient conditions for high learning performance among students living in urban areas and (iv) task-technology fit is a sufficient condition for high learning performance among female students living in rural areas irrespective of technology-induced engagement and motivation. Implications for theory and policy prescriptions are offered for practitioners.

Prevalence and pattern of skin diseases in patients with diabetes mellitus at a tertiary hospital in Northern Nigeria.

BACKGROUND: Diabetes mellitus is one of the most common metabolic disorders with a rising prevalence. It cuts across all ages and socioeconomic status. Various skin lesions are frequently observed in diabetic patients. AIMS: This study was carried out to determine the prevalence, pattern, and determinants of skin diseases in diabetic patients at the Barau Dikko Teaching Hospital, Kaduna, North West Nigeria. MATERIALS AND METHODS: One hundred consecutive diabetic patients attending the clinic were included in the study. RESULTS: Many of the patients had more than one skin condition at a time. The most prevalent skin diseases were idiopathic guttate hypomelanosis which was seen in 61% of patients, infections from fungal, bacterial, and viral causes occurred in 30% of patients, other skin disorders were diabetic dermopathy seen in 17% of patients, palmoplantar hyperpigmentation was seen in 13% of patients, while pruritus occurred in 12% of patients and xerosis was seen in 10% of patients. CONCLUSION: Skin disorders are common among diabetic patients at Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.

Pattern of renal diseases in children attending paediatric nephrology clinic of Aminu Kano Teaching Hospital, Kano.

BACKGROUND: The pattern of pediatric kidney diseases varies from one region to another because of genetic, racial, and environmental differences. This study was aimed at determining the pattern of renal diseases among children presenting at the pediatric nephrology clinic of the hospital. SUBJECTS AND METHODS: It was a retrospective study of all children aged less than 15 years seen at the pediatric nephrology clinic of the hospital over a period of 30 months. The records of 244 patients seen at nephrology clinic over the period of study were retrieved and studied. RESULTS: There were 155 males (63.5%) and 89 females (36.5%), with a male to female ratio of 1.7:1. The ages ranged between two months and 179 months, with a mean age of 104.8 ± 46.7 months. Nephrotic syndrome was the commonest renal disease and accounted for 33.6% (n = 82) of all cases, followed by acute glomerulonephritis with 25.8% (n = 63). Acute kidney injury and chronic kidney disease follow with frequencies of 34 (13.9%) each. The commonest congenital anomaly of the kidneys was ectopic kidney with 12 cases (4.9%). CONCLUSIONS: Our data reflects a high burden of renal diseases among children in our environment, and also reflects variations in regional patterns. The need for improvement of pediatric renal services and training of health workers in early detection and treatment of these conditions cannot be overemphasized.

Spectrum of Congenital Malformations in Federal Teaching Hospital Gombe: A Ten-Year Review.

BACKGROUND: Congenital malformations remain a leading cause of death in the neonatal period. The incidences of Congenital Malformations have been reported in other parts of Nigeria but there is paucity of data on Congenital Malformations in North-Eastern Nigeria. This review aims to determine the prevalence and pattern of Congenital Malformations in Federal Teaching Hospital Gombe, Northeastern Nigeria. METHODS: A retrospective review of records of all patients admitted into the Special Care Baby Unit of Federal Teaching Hospital Gombe who had a diagnosis of Congenital Malformations over a period of ten years (May 29, 2000-May 29, 2010) was carried out. RESULTS: Out of the 3,744 admissions during the period, 219 had congenital malformations, but 4 patients did not have complete information and were excluded from analysis. Two hundred and fifteen (215) were analyzed giving a prevalence of 5.7%. Among the subjects, 131(60.9%) were male and 84 (39.1%) female giving a male to female ratio of 1.6:1. Majority 110 (51.2%) of patients with congenital malformations were of Fulani ethnic group, followed by Hausa 39(18.1%). Neural tube defects were the commonest 95 (45.1%), while abnormalities of the musculoskeletal system were the lowest 4(1.9%). Outcome of the patients managed revealed that 131(61.2%) were discharged, 51(23.8%) died while 32(15.0%) signed and left against medical advice. CONCLUSION: The findings suggest that congenital malformations are common in Gombe, Neural tube defects were the commonest congenital malformations seen in this study and Fulanis were the most affected.

Knowledge, risk perception and practices related to antibiotic resistance among patent medicine vendors in Sokoto metropolis, Nigeria.

BACKGROUND: Resistance to antibiotics is now a serious threat to global health, and inappropriate use of drugs has been identified as a major contributing factor in the developing countries. OBJECTIVES: The aim of this study is to assess the knowledge, risk perception, and practices related to antibiotic resistance among patent medicine vendors (PMVs) in Sokoto metropolis, Nigeria. MATERIALS AND METHODS: A cross-sectional study was conducted among 200 PMVs selected by multi-stage sampling technique. Data were collected with a set of pretested, self administered, semi structured questionnaire. RESULTS: A larger proportion (83, 42.1%) of the 197 respondents who completed the questionnaire were aged 20 29 years. Most of them were males (80.2%) and had tertiary education (80.7%). Most of the respondents had adequate knowledge of the causes of antibiotic resistance (94.9%), and its prevention (98.0%). Most of the respondents also perceived antibiotic resistance as a serious threat to their own health (95.4%), and the health of their clients (89.4%). Practices favorable to the development of antibiotic resistance were very prevalent among the respondents. Majority of respondents (59.9%) consistently sell antibiotics to clients without doctor's prescription, and close to half of them (49.2%) consistently practice self-medication. CONCLUSION: Despite high levels of knowledge of the causes, prevention, and perception of the risks associated with antibiotics resistance, practices favorable to its development were very prevalent among PMVs in Sokoto, Nigeria. Government should regulate and closely monitor PMVs' practices in order to avert the looming crisis in medical practice that will become inevitable if there are no potent antibiotics.

A retroperitoneal extra-renal wilms' tumour: A case report.

Wilms' tumour originates predominantly in the renal tissue; in rare cases it can also arise from extra-renal sites accounting for 0.5-1% of cases of Wilms' tumours seen. A diagnosis of extra-renal Wilms' cannot be easily established with clinical and radiological features except when the histological facts are provided. Wilms' tumours arising from extra-renal sites may not be different in clinical features, protocol of treatment and outcome from a typical intra renal Wilms' tumour. A 2-year-old boy presented with an asymptomatic abdominal swelling for 3 months. Abdominal ultrasound and CT scans revealed an extra-renal mass. Intravenous urogram (IVU) showed prompt excretion bilaterally. Post excision histology of the tumour confirmed a Wilms' tumour.

Time interval to initiation of contraceptive methods following childbirth in a low-resource setting.

OBJECTIVES: The objectives of the study were to determine factors affecting the interval between a woman's last childbirth and the initiation of contraception. MATERIALS AND METHODS: This was a retrospective study. Family planning clinic records of the Barau Dikko Teaching Hospital Kaduna from January 2000 to March 2014 were retrieved. Information was collected on demographics, reproductive, and contraceptive history. Data were analyzed using the SPSS version 15 software, and missing responses were excluded. Chi-square was used as a test of association with significance level established at P = 0.05. RESULTS: A total of 5992 client's cards were retrieved. All were female and married. Majority were aged 25-34 years (53.1%), had completed secondary education (56%) and were Muslims (52.3%). Only 4979 cards (83.1%) had correct data on intervals and 22.1% of these clients initiated contraception within 6 months of their last childbirth. Education, religion, source of information, number of living children, desire to have more children, previous use of contraception, and type of contraception chosen were significantly associated with intervals for initiating contraception after last childbirth (P < 0.05) while the presence of complications in the last delivery was not (P > 0.05). CONCLUSIONS: Majority of women initiate contraception late after childbirth in this setting. Increased awareness on immediate/early postpartum contraception is required. Further qualitative studies will help to explore findings of this study.

Assessment of biochemical liver function tests in relation to age among steady state sickle cell anemia patients.

BACKGROUND AND OBJECTIVE: Multiorgan failure including liver dysfunction is a common finding in sickle cell anemia (SCA) patients, the cause of which is multifactorial with advancing age said to be a major determinant. There is a paucity of data on liver function among SCA patients in relation to age in northern Nigerian hospitals, including Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. This study was to assess the biochemical liver function tests (LFTs) as they relate to age among SCA patients in steady state, with a view to improving the overall monitoring of these patients. SUBJECTS AND METHODS: This study was carried out in ABUTH, Zaria, Northern Nigeria. LFTs were carried out in 100 SCA and 100 apparently healthy participants (controls). The SCA group was made up of fifty adults and fifty children diagnosed of SCA, whereas the control group was made up of fifty adults and fifty children who were apparently healthy and had hemoglobin AA. Paired two-tailed Student's t-test for matched samples and Pearson's linear correlation statistical methods were employed for the data analysis using Microsoft Office Excel 2007. A P ≤ 0.05 was considered as statistically significant. RESULTS: The serum concentrations of total bilirubin (TB), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and AST/ALT ratio were significantly higher in SCA patients compared to the controls (P = 0.001, P = 0.001, P = 0.05, P = 0.05 and P = 0.001, respectively). Serum total protein (TP) and ALB were significantly lower (P = 0.01 and P < 0.05, respectively) in SCA patients compared with the controls. The levels of TB, ALT, AST, ALP, and AST/ALT were significantly lower in SCA adults compared to SCA children, whereas TP and ALB were higher in SCA adults compared to the SCA children. There were significant negative correlations between age and each of TB, ALT, AST, ALP, and AST/ALT, and significant positive correlations between age and each of TP and ALB in SCA patients. CONCLUSION: There are mild LFTs derangements in SCA patients even in steady state with the extent of the abnormalities decreasing with advancing age of the patients.

Urinary incontinence: prevalence, pattern, and opportunistic screening in Ile-Ife, Nigeria.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence is a source of health-related poor quality of life. It is, however, rarely disclosed, except when specifically enquired about by the healthcare provider. This study determined the prevalence of urinary incontinence and opportunistic screening for it in women attending a general outpatient clinic. METHODS: A total of 1,250 consenting women attending a general outpatient clinic in Ile-Ife, a semi-urban town in Southwest Nigeria, were recruited into this cross-sectional study. Confidential post-consultation interviews were performed in each patient to determine whether they had been asked about urinary incontinence and whether they felt that they ought to have been asked. The Questionnaire for Urinary Incontinence Diagnosis (QUID) was administered to determine the prevalence and pattern of urinary incontinence. Results were expressed as proportions and compared using the Chi-squared test. RESULTS: The subjects' ages ranged from 20 to 100 years (mean = 46.8 ± 17.7 years). Sixty-five women had urinary incontinence (prevalence = 5.2 %). QUID classified 30 (2.4 %), 23 (1.8 %), and 12 (1.0 %) of them as having urge, stress, and mixed incontinence respectively. None of them self-reported incontinence to their physicians. Only 9 incontinent (13.8 %) and 44 continent women (3.7 %) had opportunistic screening (p < 0.001). Fifty of the incontinent women (76.9 %) felt that their physician ought to have asked them about it. Forty-eight of them (73.8 %) did not consider incontinence a sufficient reason for presentation in hospital, but the majority (90.7 %) desired treatment. CONCLUSION: Urinary incontinence was occasionally present, but usually undisclosed by women attending the general outpatient clinic, unless when specifically asked by their physicians. Opportunistic screening is therefore recommended in this setting.

Burden of acute respiratory disease of epidemic and pandemic potential in the WHO Eastern Mediterranean Region: A literature review.

There are gaps in the knowledge about the burden of severe respiratory disease in the Eastern Mediterranean Region (EMR). This literature review was therefore conducted to describe the burden of epidemicand pandemic-prone acute respiratory infections (ARI) in the Region which may help in the development of evidence-based disease prevention and control policies. Relevant published and unpublished reports were identified from searches of various databases; 83 documents fulfilled the search criteria. The infections identified included: ARI, avian influenza A(H5N1), influenza A(H1N1)pdm09 and Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Pneumonia and ARIs were leading causes of disease and death in the Region. Influenza A(H1N1) was an important cause of morbidity during the 2009 pandemic. This review provides a descriptive summary of the burden of acute respiratory diseases in the Region, but there still remains a lack of necessary data.

Middle East respiratory syndrome coronavirus: current knowledge and future considerations.

A literature review of publically available information was undertaken to summarize current understanding and gaps in knowledge about Middle East respiratory syndrome coronavirus (MERS-CoV), including its origin, transmission, effective control measures and management. Major databases were searched and relevant published papers and reports during 2012-2015 were reviewed. Of the 2520 publications initially retrieved, 164 were deemed relevant. The collected results suggest that much remains to be discovered about MERS-CoV. Improved surveillance, epidemiological research and development of new therapies and vaccines are important, and the momentum of recent gains in terms of better understanding of disease patterns should be maintained to enable the global community to answer the remaining questions about this disease.

Zika virus: no cases in the Eastern Mediterranean Region but concerns remain.

Following the WHO declaration on 1 February 2016 of a Public Health Emergency of International Concern (PHEIC) with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus, the WHO Regional Office for the Eastern Mediterranean conducted three rounds of emergency meetings to address enhancing preparedness actions in the Region. The meetings provided up-to-date information on the current situation and agreed on a set of actions for the countries to undertake to enhance their preparedness and response capacities to Zika virus infection and its complications. The most urgent action is to enhance both epidemiological and entomological surveillance between now and the coming rainy seasons in countries with known presence of Aedes mosquitoes. Zika virus like other vector-borne diseases poses a particular challenge to the countries because of their complex nature which requires multidisciplinary competencies and strong rapid interaction among committed sectors. WHO is working closely with partners and countries to ensure the optimum support is provided to the countries to reduce the risk of this newly emerged health threat.

Diabetes mellitus and comorbid depression in Zambia.

AIMS: To replicate, in Zambia, a recent global study by the WHO, which reported that the odds of depression were not increased in African people with diabetes, and to explore the sociodemographic and clinical factors associated with depression. METHODS: A total of 773 control subjects and 157 Zambian patients with diabetes completed the Major Depression Inventory and a list of demographic indicators. RESULTS: Compared with control subjects (mean ± sd Major Depression Inventory score 15.10 ± 9.19), depressive symptoms were significantly more common in patients with diabetes (mean ± sd Major Depression Inventory score 19.12 ± 8.95; P < 0.001). ancova showed that having diabetes [F(1,698) = 16.50, P < 0.001], being female [F(1,698) = 7.35, P < 0.01] and having low socio-economic status (F(1,698) = 13.35, P < 0.001) were positive predictors of depression. CONCLUSIONS: Contrary to the WHO study, we found that depression was a common comorbid health problem among Zambian people with diabetes. Clinicians should consider patients' health status, sex and socio-economic status as potential factors predicting depression.

Parent-child communication about sexual and reproductive health: evidence from the Brong Ahafo region, Ghana.

BACKGROUND: Young people aged 10-24 years represent one-third of the Ghanaian population. Many are sexually active and are at considerable risk of negative health outcomes due to inadequate sexual and reproductive health knowledge. Although growing international evidence suggests that parent-child sexual communication has positive influence on young people's sexual behaviours, this subject has been poorly studied among Ghanaian families. This study explored the extent and patterns of parent-child sexual communication, and the topics commonly discussed by parents. METHODS: A cross-sectional design was used to sample 790 parent-child dyads through a two-stage cluster sampling technique with probability proportional to size. Interviewer-administered questionnaire method was used to gather quantitative data on parent-child communication about sex. Twenty sexual topics were investigated to describe the patterns and frequency of communication. The Pearson's chi-square and z-test for two-sample proportions were used to assess sexual communication differences between parents and young people. Qualitative data were used to flesh-out relevant issues which standard questionnaire could not cover satisfactorily. RESULTS: About 82.3% of parents had at some point in time discussed sexual and reproductive health issues with their children; nonetheless, the discussions centered on a few topics. Whereas child-report indicated that 78.8% of mothers had discussed sexual communication with their children, 53.5% of fathers had done so. Parental discussions on the 20 sexual topics ranged from 5.2%-73.6%. Conversely, young people's report indicates that mother-discussed topics ranged between 1.9%-69.5%, while father-discussed topics ranged from 0.4% to 46.0%. Sexual abstinence was the most frequently discussed topic (73.6%), followed by menstruation 63.3% and HIV/AIDS 61.5%; while condom (5.2%) and other contraceptive use (9.3%) were hardly discussed. The most common trigger of communication cited by parent-child dyads was parent's own initiation (59.1% vs. 62.6% p=0.22). CONCLUSIONS: Parents in the Brong Ahafo region of Ghana do talk to children about sex, but their conversations cover limited topics. While abstinence is the most widely discussed sexual topic, condoms and contraception were rarely discussed. Sex educational programmes ought to encourage parents to expand sexual communication to cover more topics.

Developmental inventories using illiterate parents as informants: Communicative Development Inventory (CDI) adaptation for two Kenyan languages.

Communicative Development Inventories (CDIs, parent-completed language development checklists) are a helpful tool to assess language in children who are unused to interaction with unfamiliar adults. Generally, CDIs are completed in written form, but in developing country settings parents may have insufficient literacy to complete them alone. We designed CDIs to assess language development in children aged 0;8 to 2;4 in two languages used in Coastal communities in Kenya. Measures of vocabulary, gestures, and grammatical constructions were developed using both interviews with parents from varying backgrounds, and vocabulary as well as grammatical constructions from recordings of children's spontaneous speech. The CDIs were then administered in interview format to over 300 families. Reliability and validity ranged from acceptable to excellent, supporting the use of CDIs when direct language testing is impractical, even when children have multiple caregivers and where respondents have low literacy levels.

Anticonvulsant activity of aqueous fraction of Carissa edulis root bark.

CONTEXT: Carissa edulis Vahl (Apocynaceae) is used in Nigerian folk medicine to manage a plethora of diseases including epilepsy, cancer, and inflammation; its efficacy is widely acclaimed among communities of northern Nigeria. OBJECTIVE: This study establishes anticonvulsant activities of aqueous fraction of ethanol root bark extract of Carissa edulis (RAF) and sub-fractions (S1 and S2) in animal models. MATERIALS AND METHODS: We evaluated the acute toxicity of the RAF, S1 and S2, and the anticonvulsant activity using pentylenetetrazole (PTZ), picrotoxin, strychnine, N-methyl-d-aspartate (NMDA), isoniazid (INH), and aminophylline-induced seizures in mice. Their effects on maximal electroshock (MES) and kindling-induced seizures were studied in chicks and in rats, respectively, and in the electrophysiological study. The doses used for RAF were 150, 300, and 600 mg/kg while S1 and S2 were 250, 500, and 1000 mg/kg. Both RAF and sub-fractions were administered once during the experiment. RESULTS: The intraperitoneal LD50 of the RAF was estimated to be 2222.61 mg/kg and that of the S1 and S2 were above 5000 mg/kg. RAF protected the mice by 50% while sub-fractions by 16.67% against PTZ-induced seizures. RAF offered 33.33 and 16.67% protection against strychnine and NMDA models, respectively. However, RAF offered 66.67-33.33% protections against aminophylline-induced seizures at doses of 150 and 600 mg/kg, but RAF, S1, and S2 had no effect on MES-induced seizures. DISCUSSION AND CONCLUSION: Our results validate the use of the plant traditionally in the management of epilepsy, thus supporting the appraisal of biologically active components of this plant as antiepileptic agents.

Missed diagnosis of a delayed diaphragmatic hernia as intestinal obstruction: a case report.

Penetrating diaphragmatic injury rarely occurs in isolation. Diagnosis of traumatic diaphragmatic hernia resulting from penetrating diaphragmatic injury may be delayed or missed with attendant high morbidity and mortality. We reported a 28-year-old man who presented with features of subacute intestinal obstruction which became severe over the last four days. He had a stab injury to his left lower chest wall that was sutured 31/2 years prior to the development of symptoms. Emergency laparotomy with incidental findings of missed diaphragmatic hernia with gangrenous jejunal segment was found. The hernia was reduced, gangrenous segment resected with end to end anastomosis, and repair of diaphragmatic rent done. He had an uneventful recovery and follow up. There is the need to maintain high index of suspicion of Traumatic Diaphragmatic Hernia (TDH) in a patient with recent or previous thoraco-abdominal injury that will reduce the rate of missed or delayed diagnosis.