Robotic Heller's cardiomyotomy for achalasia: early outcomes for a high-volume UK centre.

INTRODUCTION: Heller's cardiomyotomy (HCM) is the gold standard treatment for achalasia. Laparoscopic HCM has been shown to be effective with low rates of symptom recurrence, though oesophageal mucosal perforation rates remain high. The aim of this prospective case series is to assess the short-term complication rates and perioperative outcomes for the first cohort of patients undergoing robotic-assisted HCM for achalasia in a single high-volume UK centre. METHODS: Data were collected from a prospective cohort of patients who underwent robotic HCM at a single high-volume UK centre. Outcomes were assessed using the Eckhard score, which was calculated after their routine postoperative clinic appointments. RESULTS: Thirteen patients underwent robotic HCM during the study period; this is the second largest reported case series in the European literature. There were no intraoperative oesophageal perforations. Six patients were discharged as day cases, six patients were discharged on the first postoperative day and one patient's hospital stay was two nights. There was a single perioperative complication of urinary retention. All patients reported improvement of symptoms following their operation, and all had a postoperative Eckhard score of less than 3, indicating their achalasia was in remission. CONCLUSIONS: This cohort has demonstrated that robotic HCM has an exceptional safety profile and results in high levels of symptom resolution, even early in the learning curve. The robotic approach may be superior to laparoscopy as it allows more precise identification and dissection of the oesophageal muscle fibres, which likely reduces the risk of inadvertent mucosal damage or incomplete myotomy.

Evaluation of 4-methyl-2-[(2-methylbenzyl) amino]-1,3-thiazole-5-carboxylic acid against hyperglycemia, insulin sensitivity, and oxidative stress-induced inflammatory responses and ß-cell damage in the pancreas of streptozotocin-induced diabetic rats.

4-Methyl-2-[(2-methylbenzyl) amino]-1,3-thiazole-5-carboxylic acid (bioactive compound (BAC)), a novel thiazole derivative, is a xanthine oxidase inhibitor and free radical scavenging agent. Effects of BAC on hyperglycemia, insulin sensitivity, oxidative stress, and inflammatory mediators were evaluated in streptozotocin (STZ)-induced neonatal models of non-insulin-dependent diabetes mellitus (NIDDM) rats where NIDDM was induced in neonatal pups with single intraperitoneal injection of STZ (100 mg/kg). The effect of BAC (10 and 20 mg/kg, p.o.) for 3 weeks was evaluated by the determination of blood glucose, oral glucose tolerance test (OGTT), HbA1c level, insulin level, insulin sensitivity, and insulin resistance (IR). Furthermore, inflammatory mediators (tumor necrosis factor-alpha and interleukin-6) and oxidative stress were estimated in serum and pancreatic tissue, respectively. Significant alteration in the level of blood glucose, OGTT, HbA1c, insulin level, insulin sensitivity, in addition variation in the antioxidant status and inflammatory mediators, and alteration in histoarchitecture of pancreatic tissue confirmed the potential of BAC in STZ-induced neonatal models of NIDDM rats. Pretreatment with BAC restored the level of glucose by decreasing the IR and increasing the insulin sensitivity. Furthermore, BAC balanced the antioxidant status and preserved the inflammatory mediators. Histological studies of pancreatic tissues showed normal architecture after BAC administration to diabetic rats. Altogether, our results suggest that BAC successfully reduces the blood glucose level and possesses antioxidant as well as anti-inflammatory activities. This leads to decreased histological damage in diabetic pancreatic tissues, suggesting the possibility of future diabetes treatments.

Outcomes of an innovative training course in laparoscopic hernia repair.

Introduction The Ethicon™ laparoscopic inguinal groin hernia training (LIGHT) course is an educational course based on three days of teaching on laparoscopic hernia surgery. The first day involves didactic lectures with tutorials. The second day involves practical cadaveric procedures in laparoscopic hernia surgery. The third day involves direct supervision by a consultant surgeon during laparoscopic hernia surgery on a real patient. We reviewed our outcomes for procedures performed on real patients on the final day of the course for early complications and outcomes. Methods A retrospective study was undertaken of patients who had laparoscopic hernia surgery as part of the LIGHT course from 2013 to 2015. A matched control cohort of patients who had elective laparoscopic hernia surgery over the study period was identified. These patients had their surgery performed by the same consultant general surgeons involved in delivering the course. All patients were followed up at 6 weeks postoperatively. Results A total of 60 patients had a laparoscopic inguinal hernia repair and 23 patients had a laparoscopic ventral hernia repair during the course. The mean operative time for laparoscopic inguinal hernia repair was 48 minutes for trainees (range 22-90 minutes) and 35 minutes for consultant surgeons (range 18-80 minutes). There were no intraoperative injuries or returns to theatre in either group. All the patients operated on during the course were successfully performed as daycase procedures. The mean operative time for laparoscopic ventral hernia repair was 64 minutes for trainees (range 40-120 minutes) and 51 minutes for consultant surgeons (range 30-130 minutes). Conclusions The outcomes of patients operated on during the LIGHT course are comparable to procedures performed by a consultant. Supervised operating by trainees is a safe and effective educational model in hernia surgery.

Breastfeeding support at work: A comparison between career women in the public and private sectors in Trinidad and Tobago

OBJECTIVE: To evaluate knowledge and perceptions toward breastfeeding support at work among women in public and private sectors in Trinidad and Tobago. SUBJECTS AND METHODS: A purposive sampling design was used to select women employees from the public and private sectors. Employees were surveyed using a self administered 16-item structured questionnaire. Data were analysed using SPSS version 21. Independent t-test wasused to compare perceptions held by the public and private sectors. Pearson’s correlation was used to determine the relationship between the variables. The level of significance was set at the 0.05 level. RESULTS: The mean breastfeeding knowledge score for the participants was 2.31 ± 0.83, with the public sector employees having a mean score of 2.42 ± 0.759, which was statistically significant (p = 0.004) when compared to the private score of 2.14 ± 0.914. The mean readiness score 26to utilize breastfeeding support for the public and private sectors employees were 1.08 ± 0.482 and 1.14 ± 0.525, respectively; however, no significant difference was observed between the two groups (p = 0.294). The mean perception scores were 1.75 ± 0.985 for the public sector and 1.90 ± 0.950 for the private sector, with no significant difference between groups (p = 0.184). CONCLUSIONS: Participants had adequate breastfeeding knowledge and a positive attitude and perception toward breastfeeding at work. We recommend that an intervention programme be developed to increase the awareness of breastfeeding support at work so that employees and employers can become more aware of its purpose and benefits.

Impact of Makowal type water system on crop productivity in Shivalik foothills of India.

The availability of water through community based water harvesting structure has intensified agriculture and improved livelihood of the surveyed beneficiary households in the Shivalik foothills of India. Before the introduction of Makowal Type Water Harvesting System (before MTWHS), only 83.8% farmers in kharif and 79.7% during rabi season were growing crops but after its introduction (after MTWHS) the corresponding values improved to 100% and 97.3%, respectively, thus increasing cropping intensity from 145% to 189%. Introduction of MTWHS enabled farmers to take paddy and agro-forestry during Kharif, and vegetables and fodder during Rabi season. The increase in cultivated area due to MTWHS was to the tune of 46.1% in Kharif and 36.3% during Rabi, while increase in crop productivity ranged from 55.1% to 111.3% in kharif and 8.6 to 132.0% in Rabiseason. Better availability of irrigation changed varietal spectrum in favour of hybrids and high yielding varieties and farmers started adopting improved agronomic practices targeting better input-use efficiency. The MTWHS produced positive impact on the on-farm (crops, dairy and agro-forestry) sources of income and reduced the relative dependence on off-farm activities (labour, community forest area, etc.) for earnings. This system has brought drinking water very close to hutments of rural women thus reducing their drudgery and saving time. In general, rainwater harvesting from forest watersheds has resulted in quantum jumps in crop and milk production and acted as a catalyst to tie up the economic interest of communities, along with forest protection.

Nutritional status and eating habits among public primary school children aged 9-13 years in education districts 2, 3, 4 in St. Lucia as well as food preferences of their parents/guardians

OBJECTIVE: To determine nutritional status and eating habits among public primary school children aged 9-13 years as well as food choices and preferences of their parents/guardians. DESIGN AND METHODS: A total of 555 participants (380 children, 175 parents) took part in the study. Participants, who returned written consent forms were allowed to complete a questionnaire consisting of 17 questions on eating habits; Questionnaires were structured to obtain food preferences and nutrition knowledge where photographs of foods were included. Participants were categorized into percentiles using WHO Body Mass Index (BMI) for age growth charts, where BMI for age was plotted and body fat was categorized with the use of body fat reference curves chart for children 7-18 years. Linear regression was used to analyze the relationship between age, gender, consumption patterns of the participants with BMI. RESULTS: Food consumption patterns and preferences of children were similar to those of their parents except for juice drinks, sugary foods, fatty foods, water, salty foods and whole wheat bread. High preference for energy dense foods both by children and their parents was found. 61.7% of overweight participants were female i.e.; their weight exceeded the WHO suggested ≥85th percentile overweight value. 60.4% of obese participants were female (≥95th percentile as per WHO age and gender specific reference). CONCLUSION: Participants with higher salty food consumption had a higher BMI as compared to those who abstained from the intakes of such foods.

Intakes of high-iron and high-vitamin C foods by students at high risk for the development of iron deficiency anaemia

OBJECTIVE: To assess intakes of high-iron and high-vitamin C foods among year one students at the University of the West Indies (UWI), St Augustine Campus, who are at high risk for the development of iron deficiency anaemia stratified by gender, ethnicity and vegetarian status. DESIGN AND METHODS: The sample included 170 year one UWI students. Participants were divided equally based on gender using quota sampling. Frequency of consumption of high- and low-iron foods, as well as vitamin C consumption was assessed based on a food frequency questionnaire (FFQ). RESULTS: About one-half (48%) of the participants consumed vitamin C supplements every day. Through dietary assessment, 57% of the students were found to be at risk for the development of iron deficiency anaemia. Only 10% of the participants never consumed any of the foods decreasing iron bioavailability listed in the FFQ. Overall, 30% of the participants never consumed high-iron containing foods. Only 36% of the participants consumed foods that increase iron absorption every day, whereas 4% never consumed them. No significance difference was found between the risk for the development of iron deficiency anaemia and the intakes of vitamin C, by ethnicity, vegetarian status and gender. CONCLUSION: Males were found to consume more high-iron containing foods. Females were more at risk for the development of iron deficiency anaemia. Participants of African descents consumed more high-iron containing foods. Participants of African and mixed raced consumed less foods that decrease iron absorption.

Injection safety practices in a main referral hospital in Northeastern Nigeria.

BACKGROUND: No adherence of safe injection policies remains a major challenge, and, worldwide, annually, it leads to 21 million new hepatitis B cases and 260,000 HIV infection cases. This descriptive observational survey was conducted to determine the level of adherence to universal precaution for safe injection practices in the hospital. MATERIALS AND METHODS: The study units were selected using a simple random sampling of injection services provider/phlebotomist in 27 units/wards of the hospital. The study instruments were observation checklist and interviewer administered questionnaires. EPI info (version 3.5.2) software was used for data entry and generation of descriptive statistics was done with units of analysis (units/wards) on injection safety practices of health workers, availability of logistics and supplies, and disposal methods. RESULTS: Only 33.3% of the units (95% CI, 16-54) had non-sharps infectious healthcare waste of any type inside containers specific for non-sharps infectious waste and 17 (77.3%) of the observed therapeutic injections were prepared on a clean, dedicated table or tray, where contamination of the equipment with blood, body fluids, or dirty swabs was unlikely. Absence of recapping of needles was observed in 11 (50.0%) units giving therapeutic injections. Only 7.4% of units surveyed had separate waste containers for infectious non-sharps. CONCLUSIONS: This study depicts poor knowledge and a practice of injection safety, inadequate injection safety supplies, and non-compliance to injection safety policy and guidelines.

Radiological and clinical examination in the diagnosis of Spigelian hernias.

INTRODUCTION: Spigelian hernia are rarely reported lateral abdominal wall hernias. Clinical diagnosis of a suspected hernia can be challenging owing to vague presenting symptoms and signs. This study aimed to investigate the accuracy of preoperative imaging and clinical examination in the diagnosis of Spigelian hernias. METHODS: A retrospective analysis was performed of patients who presented to North Tyneside and Wansbeck General Hospitals between 1998 and 2010. All patients were assessed by a consultant general surgeon in the outpatient clinic or on the surgical admissions ward. Patients were included who presented with a history suggestive of a Spigelian hernia and a palpable lump or equivocal clinical examination. All patients proceeded to surgery, which was used as the reference standard. RESULTS: Overall, correlation with operative findings showed computed tomography (CT) to have a sensitivity of 100% and a positive predictive value (PPV) of 100%. Ultrasonography had a sensitivity of 90% and a PPV of 100%. Clinical assessment alone had a sensitivity of 100% and a PPV of 36%. CONCLUSIONS: This study shows that ultrasonography and CT have a high sensitivity and PPV in relation to occult Spigelian hernias. When no obvious Spigelian hernia is present, patients should be evaluated with radiological investigation to establish a diagnosis. Owing to diagnostic uncertainty, a laparoscopic approach should be favoured.

Management of perforated peptic ulcer in a district general hospital.

INTRODUCTION: Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons. METHODS: Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality. RESULTS: The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) ( p <0.01). There were six deaths in the laparoscopic group (11%) compared with 13 in the open group (15%) and one in the converted group (5%). Trainees performed 53% (47/89) of open repairs and 13% (7/54) of laparoscopic repairs. CONCLUSIONS: Both laparoscopic and open repair are equally safe in the management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.

Outcome of patients in laparoscopic training courses compared to standard patients.

BACKGROUND & AIM: Current Laparoscopic simulators have limited usefulness and patients have been used for training since the dawn of surgery. NUGITS (Northumbrian Upper Gastro Intestinal Team of Surgeons) Laparoscopic Skills courses utilise hands-on experience with simulators moving to live operating on volunteer patients. It is vital to know that the volunteer patient is not disadvantaged by greater surgical risk. METHODS: This was a case-controlled prospective comparison of patients undergoing both Laparoscopic Cholecystectomy (LC) [n=51] and Laparoscopic Inguinal Hernia (LIH) [n=62] during NUGITS training courses. They are compared with a matched (age, sex and ASA grade) control group LC (n=51) and LIH (n=62) operated on by consultants. The outcome measures were surgical peri-and post-operative complications, post-operative hospital stay, readmission and early recurrence of inguinal hernia (<6 months). RESULTS: In the LC cohort, there was no significant difference in the length of hospital stay (p=0.07) or readmission (p=0.16) in both the groups. The mean operating time was higher in the trainee compared to the control group (p=0.001). There was no difference in the post-operative morbidity or mortality in either group. In LIH cohort, the mean operating time was higher in the trainee compared with the control group. There was no significant difference in post-operative complications (p>0.05) and early post-operative recurrence of hernia (p>0.05). CONCLUSION: The post-operative outcomes of patients undergoing laparoscopic surgery during laparoscopic training courses are similar to consultant-operated patients. Thus, it is acceptable and safe to encourage patients to volunteer for laparoscopic training courses.

The functional status of disease surveillance and notification system at the local government level in Yobe State, Nigeria.

BACKGROUND: An effective Disease surveillance system provides information that is required for appropriate action. Although evaluated by attributes like sensitivity, predictive value and representativeness, the assessment of its operational status is critical, especially in developing countries. METHODS: We conducted this cross sectional survey among 144 health personnel from facilities and Local Government disease surveillance officers, using pre-tested, semi-structured, self-administered questionnaire and observational checklist. RESULTS: This showed that only 55 (38.2%) of the respondents were aware of the Disease surveillance and notification (DSN) system. Fifty-eight (65.9%) and 7 (8.0%) of the facilities had up-to-date registers and DSN forms respectively. Diagnostic support was lacking in most of the health facilities. Data was not analysed at LGA level, and forms and logistics for supervising disease surveillance activities and feedback were inadequate. CONCLUSION: We recommend training/retraining of health personnel on infectious disease surveillance, provision of logistics, improved supervision and feedback of information.

Day-case laparoscopic Nissen fundoplication.

INTRODUCTION: Nissen fundoplication has been performed laparoscopically for over 15 years, being associated with shorter hospital stay and fewer complications than conventional open surgery with good long-term outcomes. Day-case laparoscopic Nissen fundoplication (LNF) is rarely performed in the UK and most series in the literature report length of stay >2 days. METHODS: The objective of this study was to examine the safety and efficacy of day-case LNF. The clinical records of all patients undergoing LNF under the care of three surgeons in a district general hospital (DGH) during a 5-year period (January 2003 to December 2007) were reviewed to examine length of stay, complications, length of procedure, grade of operating surgeon and symptoms on follow-up. RESULTS: One hundred thirteen day-case LNFs were recorded in this series. Day-case LNF patients had median age of 45 years (range 20-68 years, 65% (64.6%) male) and 98% were American Society of Anesthesiologists (ASA) grade I or II. Twenty-one cases (19%) were performed by higher surgical trainees. Median operative time was 54 minutes (range 25-120 min). Only one perioperative complication (port-site bleed) occurred, treated without prolonging length of stay. The proportion of all LNF performed as day cases increased from 8% to 52% during the study period. Median operative time has significantly reduced from the first 20 consecutive LNF cases to the latest 20 cases [65 min (range 40-120 min) versus 48 min (range 25-72 min); p = 0.037]. At follow-up (median 7 weeks, range 2-31 weeks) 82% of patients had improvement in all presenting symptoms. Eight patients had postoperative complications [wound infection (n = 2), persistent regurgitation requiring laparoscopic division of a gastric band adhesion (n = 1), dysphagia (n = 5 with two patients requiring redo partial fundoplication and one patient requiring dilatation) and there were no conversions to open surgery. CONCLUSION: Day-case LNF is safe and effective for treating selected patients with gastroesophageal reflux disease (GERD) in a DGH. The proportion of day-case LNFs is increasing in our unit. Half of the LNFs in a DGH can be done as day cases. Experience is associated with a significant reduction in operative time.

Submental tracheal intubation in a case of panfacial trauma.

Airway management of panfacial fractures is complicated. Treatment of fractures of such bones presents a certain difficulty as in not only do the fracture fragments have to be aligned but the teeth have to be kept in proper occlusion as well. To achieve a proper pre-traumatic occlusion, the occlusion has to be maintained and checked at all times during the surgery. There are many options for the airway management of such cases. We present a case of panfacial fracture which was managed successfully with submental intubation.

The effect of training on the reporting of notifiable diseases among health workers in Yobe State, Nigeria.

The generation of data through disease surveillance and notification system is critical to appropriate planning and implementation of disease control programmes, outbreak investigation, emergency preparedness and response. Health workers therefore need to be trained, retrained and updated on the principles and practice of disease surveillance and notification. This quasi-experimental study compared a study and control group "before and after" an intervention (training programme) in the study group. The Experimental and control LGA's were selected using a multistage, stratified random sampling technique. Overall, three LGA's were selected and enrolled in each of the groups. In each of the selected LGA's, all functional health facilities and personnel that fulfilled the inclusion criteria were then included in the study. The total number of participants in the experimental and control groups were 73 and 71 respectively at baseline. The proportion of personnel who were aware of the surveillance system increased from 35.6% to 91.9% (p=0.00) and the mean knowledge score increased from 0.85+/-1.38SD to 6.152.64SD (p=0.00) post intervention in the experimental group. The percentage completeness was 2.3% before and 52.0% after (p-0.00), while the percentage timeliness was 0.0% before and 42.9% after (p=0.00) in the experimental group. These statistically significant differences were however not demonstrated in the control group. Training therefore had a positive effect on health personnel knowledge, reporting requirement and the timeliness and completeness of the disease surveillance and notification system.

Magnetic, electronic and electrochemical studies of mono and binuclear Cu(II) complexes using novel macrocyclic ligands.

A series of new mono and binuclear copper (II) complexes [Cul]X(2)and [Cu(2)lX(2)] where 1 = L(1), L(2) and L(3) are the macrocyclic ligands. In mononuclear complexes the geometry of Cu(II) ion is distorted squareplanar and in binuclear complexes the geometry of Cu(II) is tetragonal. The synthesized complexes were characterized by spectroscopic (IR,UV-vis and ESR) techniques. Electrochemical studies of the complexes reveals that all the mononuclear Cu(II) complexes show a single quasireversible one-electron transfer reduction wave (E(pc) = -0.76 to -0.84V) and the binuclear complexes show two quasireversible one electron transfer reduction waves (E(pc)(1) = -0.86 to -1.01V, E(pc)(2) = -1.11 to -1.43V) in cathodic region. The ESR spectra of mononuclear complexes show four lines with nuclear hyperfine splittings with the observed g(11) values in the ranges 2.20-2.28, g( perpendicular) = 2.01-2.06 and A(11) = 125-273. The binuclear complexes show a broad ESR spectra with g = 2.10-2.11. The room temperature magnetic moment values for the mononuclear complexes are in the range [mu(eff) = 1.70-1.72BM] and for the binuclear complexes the range is [mu(eff) = 1.46-1.59BM].

Protecting new ideas and inventions in nanomedicine with patents.

New paradigms are shrinking our world. Tiny is in and patents are essential for success in nanomedicine. In fact, patents are already shaping this nascent and rapidly evolving field. For the past decade a swarm of patent applications pertaining to nanomedicine has been arriving at the US Patent and Trademark Office (PTO). As companies develop products and processes and begin to seek commercial applications for their inventions, securing valid and defensible patent protection will be vital to their long-term survival. As we enter the "golden era" of medicine, or nanomedicine, in the next decade with the field maturing and the promised breakthroughs accruing, patents will generate licensing revenue, provide leverage in deals and mergers, and reduce the likelihood of infringement. Because development of nanobiotechnology- and nanomedicine-related products is extremely research intensive, without the market exclusivity offered by a US patent, development of these products and their commercial viability in the marketplace will be significantly hampered. In this article, we highlight critical issues relating to patenting nanomedicine products. Effects of the "nanopatent land grab" that is underway in nanomedicine by "patent prospectors" are examined as startups and corporations compete to lock up broad patents in these critical early days. Because nanomedicine is multidisciplinary, patenting presents unique opportunities and poses numerous challenges. Although patents are being sought more actively and enforced more vigorously, the entire patent system is under greater scrutiny and strain, with the PTO continuing to struggle with evaluating nanomedicine-related patent applications.

Utilization of obstetric care services in a rural community in southwestern Nigeria.

Utilization of Obstetric Services in Nigeria is very low with only a third of the deliveries being conducted under supervision of trained health personnel. Consequently maternal and infant mortality rates are unacceptably high at 1000/100,000 and 100/1000 live births per year respectively. We conducted a cross-sectional survey of 100 randomly sampled women in a rural community in Oyo State in Nigeria to study the pattern of utilization of antenatal, delivery and postnatal care services in the community. Results showed that utilization of antenatal care services to be relatively high but most of the respondents delivered at home without the supervision of trained health personnel. This poor utilization of delivery services was attributed to advanced labour and perceived poor quality of the health facilities in the community. Although postnatal care was given to the respondents, it did not include advice on family planning/child spacing. The variables found to have statistically significant association with seeking antenatal care were age and educational attainment (P < 0.0005). Educational attainment also significantly affects the respondents' choice of the place of delivery (P < 0.005). We recommend operations research to assess and improve the quality of existing health facilities and training/retraining of antenatal care providers on interpersonal communication skills, early recognition of labour and seeking delivery care. This training should also include providing advice on child spacing and use of obstetrics services provided.

Village health workers' and traditional birth attendants' record keeping practices in two rural LGAs in Oyo State, Nigeria.

Village health workers (VHWs) and Traditional Birth attendants (TBAs) provide health care services to the communities in which they live, improving access to health care as well as serving as an important link between the periphery (the communities) and the health sector. The data this category of workers generates about their communities will strengthen primary health care management information system in Nigeria. The objective of this study was to assess the knowledge, attitude and practices of VHWs and TBAs regarding record keeping in Ibarapa Central and Akinyele local government areas (LGAs) of Oyo State, Nigeria. Using a pre-tested, semi structured questionnaire and an observation checklist, trained research assistants visited and interviewed all the active, registered VHWs and TBAs in the two LGAs. Results showed that there were a total of 62 and 102 active VHWs/TBAs in Ibarapa Central and Akinyele LGAs respectively with most of them being farmers aged between 30-59 years. Over two-thirds in both LGAs knew the uses of record keeping for monitoring and evaluation purposes and most of them felt that keeping records was easy. Sixty-one percent of the respondents in Ibarapa Central and 96% of those in Akinyele LGA reported keeping records of their health activities. Of those who kept records, two thirds in Ibarapa Central and almost all (96%) in Akinyele LGA reported forwarding the records they keep. The type of records they keep was mostly on patients' treatment and (in Akinyele) delivery records using an exercise book. Most did not have the VHW/TBA record of work or the community profiles (wall chats) developed and recommended by the Federal Ministry of Health (FMOH) because they were not supplied. The factors associated with record keeping included duration as a VHW/TBA, previous training on record keeping, receiving feedback. Recommendations made included ensuring availability of materials and periodic training and re-training of the VHWs/TBAs by the LGAs, and regular provision of feedback by the National Primary Health Care Development Agency (NPHCDA).