Changing Patterns of Unmet Needs for Family Planning Among Women of Reproductive Age in Nigeria.

Unplanned pregnancy poses a major public health challenge to women of reproductive age in Nigeria and this has been hastened by poor use of modern family planning methods. This study employed secondary data analysis of the National HIV/AIDS and Reproductive Health Survey conducted in 2007 and 2012 to explore the the pattern of unmet needs for family planning and associated factors over the five year period. The total unmet needs were 9.1% in 2007 and increased to 11.4% in 2012. Identified predictors were locality, fear of side effects and geopolitical zones in both the 2007 and 2012 surveys though with some variations. The level of family planning use among married couples is still very low in Nigeria and there was a rise in the unmet need for family planning among women of reproductive age group over the 5 year period. Regional specific interventions as well as provider-client discussions about family planning can be key to sustained use of modern contraceptives in Nigerian women.

An appraisal of convergence failures in the application of logistic regression model in published manuscripts.

BACKGROUND: Logistic regression model is widely used in health research for description and predictive purposes. Unfortunately, most researchers are sometimes not aware that the underlying principles of the techniques have failed when the algorithm for maximum likelihood does not converge. Young researchers particularly postgraduate students may not know why separation problem whether quasi or complete occurs, how to identify it and how to fix it. OBJECTIVE: This study was designed to critically evaluate convergence issues in articles that employed logistic regression analysis published in an African Journal of Medicine and medical sciences between 2004 and 2013. METHODS: Problems of quasi or complete separation were described and were illustrated with the National Demographic and Health Survey dataset. A critical evaluation of articles that employed logistic regression was conducted. RESULTS: A total of 581 articles was reviewed, of which 40 (6.9%) used binary logistic regression. Twenty-four (60.0%) stated the use of logistic regression model in the methodology while none of the articles assessed model fit. Only 3 (12.5%) properly described the procedures. Of the 40 that used the logistic regression model, the problem of convergence occurred in 6 (15.0%) of the articles. CONCLUSION: Logistic regression tends to be poorly reported in studies published between 2004 and 2013. Our findings showed that the procedure may not be well understood by researchers since very few described the process in their reports and may be totally unaware of the problem of convergence or how to deal with it.

Are patients with primary hepatocellular carcinoma infectious of hepatitis B, C and D viruses?

Primary HepatoCellular Carcinoma (PHCC) has been strongly associated with HBV and HCV infections among other aetiological factors. However; do the patients still spread the viruses? This study involved forty one Nigerian adult patients with PHCC and 45 controls who were tested for HBsAg, HBeAg, Anti-HBe, Anti-HBs, anti-HCV IgM and IgG, anti-HDV and HDV antigen using ELISA. Statistical analysis was carried out with the student - t - test and Mc Nemar test at p < 0.05. The subjects consisted of male:female ratio of 3:1 for both the PHCC patients and controls. Evidence of exposure to hepatitis B, C and D viruses was detected in 95.1%, 44% and 0% of the patients respectively while the respective values of 24%, 11.1% and 0% were obtained for the controls. Indication for high (HBeAg) and low (anti HBe) HBV viral replication, and acute HBV infection were detected in 12.5%, 92.7% and 2.2% respectively among the patients while only 35.6% of the controls had low HBV viral replication. Acute and chronic infections of HCV were also found in 26.8% and 24.4% of the patients respectively compared to the respective values of 2.2% and 11.1% of the controls. Occult HBV infection occurred in equal proportions (11%) of both the patients (31.7%) and controls (35.6%). In conclusion, infectious HBV and HCV particles are present among Nigerian patients with PHCC while HDV infection is uncommon. Hence, safe medical care should be practised for all patients with PHCC while relatives should be screened for these viruses.

Childhood leprosy in Essimbiland of Cameroon: results of chart review and school survey.

BACKGROUND: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT, endemic pools still exist in some countries that have attained the national elimination threshold. OBJECTIVE: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. METHODS: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. RESULTS: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991.From chart review, 42 (23.3%) new leprosy cases from 1961-1967 and 35 (12.2%) from 1982-1998 were from the Mbingo leprosarium. 31 (39.7%) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998, 24 (68.6%) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools, 6 (1.3%) new leprosy cases were identified giving a prevalence of 131 per 10,000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16 (3.5%) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. CONCLUSION: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-to-house search for new cases.

Childhood leprosy in Essimbiland of Cameroon: results of chart review and school survey.

BACKGROUND: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT, endemic pools still exist in some countries that have attained the national elimination threshold. OBJECTIVE: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. METHODS: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. RESULTS: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991. From chart review, 42 (23.3%) new leprosy cases from 1961-1967 and 35 (12.2%) from 1982-1998 were from the Mbingo leprosarium. 31 (39.7%) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998, 24 (68.6%) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools, 6 (1.3%) new leprosy cases were identified giving a prevalence of 131 per 10,000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16 (3.5%) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. CONCLUSION: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-to-house search for new cases.

Occult HBV Infection among a Cohort of Nigerian Adults

Objective: To determine markers of HBV infection and detect the presence of its occult infection in serum of a cohort of adult Nigerians. Methodology: The study involved 28 adult Nigerians with viral hepatitis (Group 1) and 28 apparently healthy adult Nigerians as controls (Group 2). Their sera were assayed for HBsAg; HBeAg; anti-HBe; anti-HBc; anti-HBs; and anti-HCV; while HBV DNA was determined in 15 patients with chronic hepatitis. Significance of differences between the patients and control subjects was assessed using Chi-square test at a 95confidence level. Results: Sero-detection of HBsAg; HBeAg; anti-HBe and anti-HBc was higher among the patients compared to the controls. HBV infection was diagnosed by HBsAg (89) and a duo of HBsAg and anti-HBc (100) among the patients. Similarly; eleven and four types of different patterns of HBV markers were observed among the respective groups. Anti-HBe (9.5); anti-HBc (14.3); and anti-HBs (9.5) were detected among all the subjects who were sero-negative for HBsAg. HBV DNA was also detected in 86.7of the 15 patients with chronic hepatitis; while occult HBV infection was observed in 7.2of the patients and none (0) of the controls; p 0.05. Furthermore; HCV infection occurred among subjects with all the different patterns of HBV markers; except those with occult HBV infection and natural immunity to HBV. Conclusion: This study shows that occult HBV infection is present among Nigerian adults and determination of HBsAg; anti-HBc; anti-HBe; and HBV DNA will assist in its detection

Childhood Leprosy in Essimbiland of Cameroon: Results of Chart Review and School Survey

Background: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT; endemic pools still exist in some countries that have attained the national elimination threshold. Objective: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. Methods: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. Results: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991.From chart review; 42 (23.3) new leprosy cases from 1961-1967 and 35 (12.2) from 1982-1998 were from the Mbingo leprosarium. 31(39.7) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998; 24(68.6) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools; 6(1.3) new leprosy cases were identified giving a prevalence of 131 per 10;000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16(3.5) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. Conclusion: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-tohouse search for new cases

Causes of death in childhood cancer at the Department of Paediatrics, University College Hospital, Ibadan.

There is a dearth of information on the mortality of children with cancer in Nigeria but the few available reports suggest a poor outcome. The objectives of this study were to determine the underlying and immediate causes of death from childhood cancer. The mortality summary cards of all cases of childhood cancer seen at the Department of Paediatrics, University College Hospital, Ibadan between January 1998 and December 2004 were reviewed. Eighty-eight cases of childhood cancer were seen, out of whom 52 (59.1%) died, but only the 48 deaths with complete data were analyzed. These deaths comprised of 37 males and 11 females giving a male:female ratio of 3.4:1. Their ages ranged from 1 to 13 years with a mean of 7.3 +/- 3.4 years. The majority (71.4%) of all patients presented with diffuse or metastatic disease at diagnosis and this was associated with increased risk of dying. Of the 48 cases reviewed, 39 (81.3%) died without any remission of the primary tumour including 5 (10.4%) with disease progression despite treatment and 15 (31.3%) who died before treatment; only 4 cases (8.3%) died from tumour relapse. The immediate causes of death were infections (39.6%), bone marrow suppression (29.2%), treatment-related mortality (27.1%), organ failure (22.9%), bleeding (16.7%) and other metabolic causes (8.3%). Potentially reversible factors such as infections, bone marrow suppression and treatment-related events are the commonest causes of death from childhood cancer in Ibadan. Therefore, early presentation, prompt identification and effective management of these problems may reduce childhood cancer mortality in Nigeria.

Early deaths and other challenges to childhood cancer survival in Ibadan, Nigeria.

OBJECTIVES: To determine the frequency of early deaths and the associated risk factors in children suffering from cancer at the University College Hospital, Ibadan. DESIGN: A retrospective study involving review of case notes of children suffering from cancer. SETTING: Department of Paediatrics, University College Hospital, Ibadan, Nigeria. SUBJECTS: All cases of childhood cancer managed in the Department between January 1998 and December 2004. Inclusion criteria were histological or cytological confirmation of diagnosis, suggestive clinical features and availability of details about the course of the illness. MAIN OUTCOME MEASURES: Interval between diagnosis and death, rate of early death (death within 30 days of diagnosis) and risk factors for early death. RESULTS: Eighty eight cases of childhood cancer were seen out of whom 52 died during the period. Four cases with incomplete data were excluded from subsequent statistical analysis. There were 29 (34.5%) early deaths defined as death within 30 days of diagnosis. The odds of early death were increased in the presence of bilateral kidney involvement, masses in the liver, splenic masses, pulmonary metastasis and stage D of Burkitt lymphoma. Logistic regression analysis revealed that pulmonary metastasis was a significant independent predictor ofearly death. CONCLUSIONS: Early childhood cancer mortality rate is high. Early diagnosis and referral for appropriate care may reduce childhood cancer mortality in Nigeria.

Risk factors for cancer of the cervix.

BACKGROUND: Cancer of the cervix is the second most common cancer among women worldwide and the leading cancer in Nigeria. OBJECTIVE: This study examined the risk factors associated with cancer of the cervix as seen in patients presenting to a tertiary hospital with gynaecologic conditions. STUDY DESIGN: The case control study design was used with a retrospective review of records of randomly selected cases of cancers of the cervix from the cancer registry and appropriate controls among hospital patients. RESULTS: Binary logistic regression carried out on the data revealed that contraceptive method (OR = 3.38, 95% CI = 1.75, 6.51) number of children (OR = 1.27, 95% CI = 1.09, 1.47), and age (OR = 1.07, 95% CI = 1.05, 1.10) were the significant risk factors out of all the potential risk factors that were assessed. CONCLUSION: These findings provide a useful insight into the general pattern of risk associated with cancer of the cervix in our environment.

Haematological profile of healthy pregnant women in Ibadan, south-western Nigeria.

There is a dearth of information on the reference values for haematological indices particularly according to the relevant trimesters of pregnant women in Nigeria. The objective of this study was to provide reference values for Nigerian pregnant women. The study took place at the Adeoyo Maternity Hospital and the University College Hospital, both in Ibadan. This descriptive study was carried out over a period of 8 months. Subjects were apparently healthy pregnant women that satisfied the inclusion and exclusion criteria. The mean values (and 95% confidence intervals, CI) of haematological indices were as follows -- First trimester: Haemoglobin (Hb) 112.44 (101.64 - 123.25) g/l, haematocrit (hct) 35 (32 - 38)%, WBC 5.488 (4.025 - 6.950) x 10(9)/l and platelet counts 227.56 (165.21 - 289.90) x 10(9)/l;Second trimester: Hb 100.39 (97.85 - 102.92) g/l, hct 29.3 (28.5 - 30.1)%, WBC 6.57 (6.19 - 6.95) x 10(9)/l, platelet count 229.56 (211.86 - 247.26); and the Third trimester: Hb 98.06 (96.12 - 100.00) g/l, hct 29.4 (28.7 - 29.9)%, WBC 6.92 (6.53 - 7.30), platelet count 186.52 (177.67 - 195.38) x 10(9)/l. These results were compared with those of 52 non-pregnant age matched women volunteers as controls whose mean haematological indices and 95% CI were: Hb 120.51 (116.61 - 124.41) g/l, hct 36 (25 - 48)%, WBC 5.28 (2.9 - 8.7) x 10(9), platelet count 330.87 (176 - 538) x 10(9)/l. The following haematological indices: WBC, platelet counts, RBC, PCT, and PDW, of women between the trimesters showed statistical significance (p value < 0.001 in each case). The WBC is inversely proportional to the PCT and the MCV in the pregnant women was slightly raised. In this study, pregnancy is characterised by lowest values of haemoglobin parameters in trimester three and there are statistically significant differences between the WBC, platelet counts, RBC, PCT, and PDW of women between the three trimesters.

Validity and internal consistency of a Yoruba version of the Ibadan knee/hip osteoathritis outcome measure (Yoruba IKHOAM).

The Ibadan Knee Hip osteoarthritis Outcome measure (IKHOAM) was developed for patients with Knee/Hip Osteoarthritis in the Nigerian and similar environments. The Yoruba Version was developed to encourage its use in the Southwestern region of Nigeria. The IKHOAM was translated into Yoruba in four separate processes of translation, back translation, committee review and pre-testing. It was administered to a cohort of 164 outpatients with symptomatic OA of the knee and or Hip who attended physiotherapy units in selected hospitals from Southwestern region of Nigeria. The IKHOAM (English Version) was correlated with the Yoruba version and Visual analogue scale (VAS). The Validity of the Yoruba IKHOAM was found to be satisfactory and comparable to the original version (r = 0.67, p = 0.005) for the criterion-related validity and r = -0.31 (p = 0.005) for construct validity. The items in the Yoruba IKHOAM correlated well with each other with Cronbach's alpha coefficient ranging between 0.69 and 0.99. The correlation on the different parts of the Yoruba IKHOAM was satisfactory (alpha = 0.52-0.87). The Yoruba IKHOAM like the original version is a reliable consistent and valid instrument that can be considered for use in the Nigeria environment for evidence based quality healthcare promotion in Knee/Hip OA patients.

Self medication practices among workers in a tertiary hospital in Nigeria.

Studies in most developing countries revealed (70-95%) of illnesses are treated through self medication. Poor accessibility to medical services have been associated with this practice. This study determines the pattern of self medication among workers at the University College Hospital, Ibadan, Nigeria. In a cross sectional study, workers were selected using a stratified random sampling technique. A high proportion of workers (73%) reported the practice of self medication and 95.6% of them correctly use appropriate drugs. About 80% of these workers stock their drugs at home. Also, 80.4% procure their drugs in chemist shops. A higher proportion of workers directly involved with medical care services (90.9%) practice self medication compared to those involved with non-medical care services (62.9%), P < 0.01. Also, the higher the education of workers the more is the proportion that practice self medication. (P < 0.05). Self-medication is commonly practiced among the hospital population who have relatively easy access to medical care services. Thus self medication may be a real health option.

Demographic factors in HIV infected patients seen at UCH, Ibadan, Nigeria.

There is a rising rate of Human Immunodeficiency Virus (HIV) infection in Nigeria. Good knowledge of the demographic characteristics of the patients with HIV/AIDS may be of great importance in understanding its epidemiology in Nigeria and could facilitate efforts at curtailing the spread of the infection. The study was planned to determine the demographic factors in Nigerian patients with HIV infection. The study was conducted at the University College Hospital (U.C.H), Ibadan, located in the South West of Nigeria. It was a retrospective study of patients with HIV infection attending the U.C.H. from 1988 to 2002. The data collected from the clinical records of the patients with HIV infection included age, sex, marital status, number of spouses, tribe, occupation, education and their religious affiliation. A total of 460 patients aged 1-76 years with peak at 30-34 years were studied. The male/female ratio was 1.06 and the males were the older group. Traders accounted for 40% with female preponderance while the artisans (19.9%) and the military (2.9%) were mostly males. The patients were of Yoruba (70.6%), Igbo (20.0%) and Hausa (9.1%) races. Among the patients with marital status, majority (71.4%) were married while those separated and widowed accounted for 3.5% and 2.6% respectively. Also, a higher proportion of the female HIV patients were Christians whereas the majority of the males were of Islamic religion. Although, there was a low frequency of records on education, the males had better formal education. In conclusion, the study shows that HIV infection is presently an adult disease affecting the most productive segment of the Nigerian population regardless of the individual occupation, educational status, tribe and religious affiliation. Also, it shows that the infection could be associated with heterosexual intercourse.

The bacteriology of open fractures in Ile-Ife, Nigeria.

BACKGROUND: The objective of this study is to determine the pattern of bacterial isolates and antibiotic sensitivity profile in open fractures. Fifty-nine patients with open fractures of the lower limb long bones were studied. The majority of the cases were Gustilo and Anderson types II 21(35.6%), and IIIA 16(27.1%). METHOD: The patients were assessed by history taking, physical examination, and plain radiographs. Wound swabs were taken for bacteriological studies. Other necessary investigations were also done. During wound debridement open fractures were classified into Grades I, II and III using the Gustilo-Anderson method of classification. RESULTS: The infection rate was 45.8%. Gram-positive cocci and Gram-negative rods were isolated. On the whole Staphylococcus aureus 13(25%), and Coagulase-negative staphylococci (CONS) 14(26.9%), were the commonest organisms isolated. The commonest Gram-negative rods that were isolated from the wounds were Proteus mirabilis 9(17.3%), and Pseudomonas aeruginosa 8(15.4%). Multiple organisms were commonly isolated from the wounds. While all the organisms isolated showed very good sensitivity to gentamicin, cloxacillin and ofloxacin, most of the organisms were resistant to penicillin, ampicillin and tetracycline. The sensitivity ranged from 62.5% to 100%. Coagulase-negative Staphylococci (CONS) showed sensitivity to the widest range of antibiotics which included penicillin, ampicillin, chloramphenicol, gentamicin, cloxacillin and ofloxacin. The sensitivity ranged from 35.7% to 100%. There was statistically significant difference between the open tibial and femoral fracture cases with respect to the interval between injury and debridement time (p = 0.008); the rate of wound infection (p = 0.021); and the occurrence of osteomyelitis (p = 0.023). The commonest complications observed were wound infection 27(45.8%), and delayed fracture union 26(44.1%), which were commoner in the open tibial fractures. CONCLUSION: This study shows that Staphylococcus aureus and coagulase-negative staphylococci (CONS) were the commonest organisms associated with open fracture of the lower limbs in our centre and that delay in the initial wound debridement was a major predisposing factor to wound infection.

Outcome of patients with systemic lupus erythematosus in intensive care unit.

The objective of the study was to identify the causes, outcome and prognosis of severe illness in patients with systemic lupus erythematosus (SLE) requiring intensive care unit (ICU) care in a University Hospital over a five-year period. The design was a cohort study. Forty-eight SLE patients requiring ICU management over a five-year period (January 1997-December 2001) were studied prospectively. Of 48 patients, 14 (29.2%) died, predominantly with multiorgan dysfunction syndrome (MODS). Patients whose APACHE II score was equal to or greater than 20 had higher mortality than those with APACHE score below 20 (60 versus 7.1%; and P < 0.01). All the 18 patients whose health status rated as 'good' survived, while 46.7% of 30 patients whose health rated as 'poor' died (P < 0.01). Patients who had thrombocytopenia associated with sepsis and/or disseminated intravascular coagulopathy (DIC) had the highest mortality (75%, five-year survival). In conclusion, SLE patients admitted to the ICU had a lower mortality rate than some of the previous reports. Patients with SLE with high APACHE score, > or =20, poor health status, thrombocytopenia and multiorgan dysfunction syndrome had poor prognosis in the ICU.

Influence of mothers' characteristics on their perceptions and use of the growth chart.

Although growth charts are recommended for monitoring children, recent reports indicate poor use by mothers. We investigated maternal knowledge and perceptions of growth charts and identified characteristics affecting use. At outpatient paediatric clinics of a Riyadh hospital, 305 mothers with children under age 5 were interviewed by questionnaire during May-June 2001. Overall awareness of growth charts was 35.8% and ever-use was 8.6%. Education, parity and number of living children were significantly associated with knowledge. Among mothers who ever used growth charts (8.7%), only 10% reported doctors recommended changes in health care because of them. Overall, 71% wanted to monitor their child's growth, but 20% did not know how. Increased health education in all health care delivery systems is needed.

Factors associated with growth faltering in children from rural Saudi Arabia.

Recent studies on the growth of children in Saudi Arabia have revealed that children under two years of age suffer from faltering growth when compared with the American reference population. The present study aims to identify parental and child characteristics associated with faltering growth among the children in a rural area of Saudi Arabia. A cross-sectional study of all women with a child less than three years of age in a rural community in NorthWestern part of Saudi Arabia was undertaken. Anthropometric measurements, socio-demographic and fertility variables were collected using a structured questionnaire. The indicators of growth were derived from the data and univariate and logistic models fitted to determine potential risk factors. There were 332 children, sex ratio 1.35 and 94.3% were less than 2 years of age. A low frequency (1.5%) had low weight for height, 11.4% low weight for age and 36.1% low height for age when compared with the American NCHS reference population. Multiple logistic regression suggested birth space > 2 years (OR = 0.44, 95% CI = 0.25 - 0.77), father's with primary or intermediate education (OR = 0.45, 95% CI = 0.25-0.90), birth weight > 2500 gms. (OR = 0.8, 95% CI = 0.03-0.75), male birth (OR = 2.60, 95%. CI = 1.54-4.59) were variables statistically and independently associated with faltering growth. The pattern of growth of children under 2 years deviated negatively from their NCHS-WHO reference. This is similar to the previous findings from urban communities in Saudi Arabia. This growth faltering could be attributed partly to the inadequacy of the reference to compare growth pattern of children in all geographical areas, of the world. While the effects of different dietary habits may not be ruled out, it may be important to develop a different anthropometrics and nutrients growth chart that could be more appropriate to compare variation of infant growth in all nations of the world.

The Ibadan glaucoma study.

To obtain epidemiological data on the prevalence and risk factors for open angle glaucoma in hospital workers of African origin, and investigate appropriate methods of a rapid, cost-effective screening procedure for glaucoma. A cross-sectional study of workers in the University College Hospital (UCH) Ibadan, using a structured questionnaire for data collection. The variables available for data analysis include workers demographic characteristics, visual acuity, pupil status, intraocular pressure, cup-disc ratio, central visual fields, family history of glaucoma, chronic diseases such as hypertension and diabetes. The data was analysed with EPI-INFO version 6.02 for simple analysis, while the SPSS package was used for multivariate analysis. A total of two thousand, one hundred and nine (2,109) UCH workers participated in the screening exercise for glaucoma. A high majority of the workers 1794 (85.1%) were negative to the diagnosis of glaucoma, while the remaining 315 (14.9%) were suspected to have glaucoma out of which 57 (2.7%) were confirmed as definite glaucoma cases. The prevalence of glaucoma among UCH workers was 27 per 1000, 95%, confidence interval = 20 per 1000, 35 per 1000. Factors associated with glaucoma were relative afferent pupillary defect, cup-disc ratio greater than 0.7, intraocular pressure, family history of glaucoma and the presence of chronic diseases such as diabetes. The left eye appears to have a higher probability of ocular problems compared with the right eye. The prevalence of glaucoma among hospital workers was 2.7% The cup-disc ratio appears to be a better diagnostic tool for glaucoma since it gives the best positive predictive value (with a cut-off point of 0.7) than all other variables.

Influence of mothers' characteristics on their perceptions and use of the growth chart

Although growth charts are recommended for monitoring children, recent reports indicate poor use by mothers. We investigated maternal knowledge and perceptions of growth charts and identified characteristics affecting use. At outpatient paediatric clinics of a Riyadh hospital, 305 mothers with children under age 5 were interviewed by questionnaire during May-June 2001. Overall awareness of growth charts was 35.8% and ever-use was 8.6%. Education, parity and number of living children were significantly associated with knowledge. Among mothers who ever used growth charts [8.7%], only 10% reported doctors recommended changes in health care because of them. Overall, 71% wanted to monitor their child's growth, but 20% did not know how. Increased health education in all health care delivery systems is needed