The Nigerian National Health Bill 2011: Delay of Presidential Assent to an Act: Issues Arising

The Nigerian National Health Bill (NHB) was finally passed by the National Assembly on May 19 2011 after many years of delay. If the NHB is signed into law by the President of Nigeria, Dr. Goodluck Jonathan, it becomes an act that provides a framework for the regulation, development and management of the national health system and set standards for rendering health services in the federation, and other matters connected therewith. The NHB is arranged in parts and clauses, and there are seven main parts. Contained in the NHB are some good innovations, such as the establishment of the National Primary Health Care Development Fund and National Tertiary Hospitals Commission. Currently, the NHB is stuck in the presidency where it has been sent for Mr President's assent, as health sector professionals disagree over some parts and clauses in the Bill. The areas of conflict include: the headship of the National Tertiary Hospitals Commission, the establishment of the Nigerian National Health Council and membership of the National Health System. Several appeals had been made to the President by organisations, groups and individuals to sign the NHB into Law. The President had set up a Presidential Team to look into concerns raised about the passed NHB and resolve the issues. Hopefully, the NHB will be signed by the President into law when these issues are resolved.Journal of Community Medicine and Primary Health Care VOL. 23, NOS 1&2, MAR/SEPT. 201

Haemorrhagic Vaginal Discharge Following Ovariectomy in a Three Year Old Domestic Short-haired Cat

Nigerian Veterinary Journal, VOL:33 (1) 403-40

Performance of Sokoto red goats (bucks) fed urea treated and untreated rice milling waste in north western Nigeria

The study was carried out at the Livestock Teaching and Research Farm of Federal University Dutsin-Ma to monitor the performance of Sokoto red bucks fed urea treated and untreated rice milling waste. Twenty entire male Sokoto red bucks were used. The experimental animals were allotted (n=5) in a completely randomized design (CRD) to diets A and B with 15% and 30% inclusion levels of untreated rice milling waste, respectively, while C and D contained 15% and 30% inclusion levels of urea treated rice milling waste, respectively, in a completely randomized design (CRD). The feeding trial lasted for 84 days while the digestibility trial lasted for 14 days. Three randomly selected experimental bucks from each experimental treatment were housed in the metabolic cages and their faeces collected for seven days using faecal bag after the seven days adaptation period. The faeces were weighed and bulked 10% collected and oven-dried before they were stored in polythene bags until required for analysis. Urine was also collected for seven days inside the metabolic cages using urinary funnel piped into the bottle containing 2 ml 10% sulphuric acid to trap the nitrogen content. 10% of the urine was sampled and stored in freezer at -2C for chemical analysis. The dry matter intake was significantly higher (P<0.05) in treatments A and B than other treatments. However, this did not result in significantly better (P<0.05) performance (feed efficiency and Cost of feed/ live weight gain) as shown with treatment C and D that had significantly better (P<0.05) weight gain, feed efficiency, nutrients digestibility and nitrogen retention. The cost of feed per kg live weight was shown to be significantly lower (P<0.05) in treatments C and D compared to treatment B which was significantly lower (P<0.05) than treatment A. The study concluded that diet D which contained 30% inclusion level of urea treated rice milling waste was the best among all the diets because of the lowest cost per feed live weight of 1.40 USD/kg and feed efficiency of 0.10

Prediction of functional capacity during six – minute walk among patients with chronic heart failure

Formulae for predicting functional capacity during 6-minue walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations. The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 ) in Chronic Heart Failure Patients (CHF) during exercise.Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated.The result showed that the distance covered was highly correlated with the VO2 (0.65, p< 0.01). The regression analysis revealed that a linear equation model developed was a good predictor ofV0 for the group.The study concluded that in situation where sophisticated equipments are lacking, this equation might be useful during exercise supervision for patients withCHF. [VO2 (ml kg-1 min-1) = 0.0105 x distance (m) + 0.0238 age (yr) - 0.03085 weight (kg) + 5.598]

Burden of obesity in essential hypertension: Pattern and prevalence

Obesity continues to be an epidemic worldwide. There also continues to be a relationship between obesity and hypertension both causal and consequentially. The study aims at determining the prevalence and pattern of overweight and obesity among our patients being managed for essential hypertension. The study was a cross sectional study. Consecutive patients diagnosed with essential hypertension were recruited from two university teaching hospitals in the SouthWest of Nigeria. Demographicdata such as age, gender, weight and height were obtained from patients at recruitment. Patients with congestive heart failure, secondary hypertension, chronic kidney disease, and other chronic diseases wereexcluded. Pregnant women were also excluded. Obesity was defined according toWHOclassification. Statistical analysis was done by the Statistical Package for Social Sciences version 11.0. One thousand one hundred and two (1102) consecutive hypertensive patients were recruited. Two hundred and eighty six (286) were dropped due to evidence of overt heart failure (98) and chronic kidney disease and others (188).There were (420) males (51.5%) and 396 females (48.5%), mean age 54.97 (±13.14) years. (Range 10-91). 7.6% (62) were underweight (36 males, 26 Females): 260 (31.9%) were overweight, consisting of 148 males and 112 females: 135 (16.5%) had mild obesity consisting of 48 males and 87 females: 43(5.3%) had moderate obesity with 15 males and 28 females while 30 (3.7%) had severe obesity (consisting of 22 females).About two thirds of the hypertensive patients seen in two teaching hospitals in the SouthWest of Nigeria in this study were either overweight or obese. Therefore lifestyle modification geared toward weightreduction should be emphasized in these patients

Factors influencing compliance in patients with tuberculosis on directly observed therapy at Ile-Ife, Nigeria

Background: Increased morbidity and mortality of tuberculosis have been blamed on neglect of the human dimension of tuberculosis control. One of such factors included in human dimension is non-compliance, a behavioural parameter, which has led to the emergence of multi-drug resistant tuberculosis, and poor treatment outcome.Objective: To explore the impact of directly observed therapy (DOT) on compliance and the factors influencing it.Design: A retrospective study.Setting: Chest clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.Methods: Directly observed therapy (DOT) was employed. Records of the socio-demographic characteristics, treatment categories, complications developed, results of investigations, level of compliance and treatment outcome for the patients were kept. The data for thepatients seen between May 1996 and April 1997 were retrieved and analysed. Those that complied were compared with those that did not comply.Results: One hundred and ninety nine patients comprising ninety one males and 108 females, were seen during the period .They were mostly between the ages of 16 years and 45 years(mean ± SD = 31.7±14.98). One hundred and fifty eight (73%) complied and all of themwere cured. The only factor that significantly influenced rate of compliance was proximity to the chest clinic.Conclusion: DOT improves the rate of compliance. No socio-demographic factors considered significantly influenced the rate of compliance under DOT, and as such they are not reliablepredictive factors. Locating chest units in the existing primary health care facilities will improve the rate of compliance with antituberculosis therapy. More attention should be paid to behavioural aspect of tuberculosis control

The contribution of alcohol to chronic liver disease in patients from South-West Nigeria

Objective: This study aimed at determining the level and type of alcohol consumed by patients diagnosed with chronic liver disease (CLD) and, hence, the extent to which alcohol may have contributed to the development of the condition.Study Design: Patients with diagnosis ofCLDwere consecutively recruited and a structured questionnaire was administered on each of them. Diagnosis of CLD was made based on liver histology and/or typical clinical and laboratory features.Alcohol consumption was considered significant if a patient took 50g/day for 10 years.Results: A total of 145 patients were studied consisting of 102 males and 43 females. Their ages ranged from 20- 80 years with a mean of 46.8 ± 15.7 years. Fifty-one (35.2%) patients, all males, drank significant alcoholwhile consumption was not significant in 43 (29.6%) patients. Alcohol was not consumed at all by 51 (35.2%) patients made up of 18 males (35.3%) and 33 females (64.7%). Beer was the commonest form of alcohol consumed (70.2%) followed by palm wine (50%) and locally-brewed gin (20.2%).The diagnoses made were liver cirrhosis [LC] (60, 41.38%), chronic hepatitis [CH] (54, 37.20%), hepatocellular carcinoma [HCC] (23, 15.86%), alcoholic liver disease [ALD] (6, 4.14%) and non-alcoholicfatty liver disease [NAFLD] (2, 1.38%). The liver disease spectrum did not differ between the patients who drank significant alcohol and those who did not. However, the proportion of LC/HCC cases increased relativetoCHwith increasing age and consumption of alcohol.Conclusions: The proportion of CLD directly attributable to alcohol (i.e. ALD) is low among the patients studied. However, the burden of LC andHCCis directly related to age and the amount of alcohol consumed andthe determinants of alcohol abuse are gender and affluence

Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients.Objective: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH.Materials and Methods: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test.Results: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 &#177; 1.26 (normotensive control) to 7.62 &#177; 1.33 (hypertensive without LVH), 6.27 &#177; 0.99 (hypertensive with LVH) (P&lt;0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 &#177; 79.1 to 411.6 &#177;8 2.3, 315.8 &#177; 75.6 respectively (P&lt;0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P&lt;0.003).Conclusion: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor

Pattern of Urine Toxicology Screening in a Lagos Psychiatric Hospital

Toxicology screening has clinical and forensic applications in evaluating severe or life-threatening symptoms in patients presenting with signs and symptoms suggestive of intoxication or overdose. In both acute psychiatric and medical settings, urine toxicology has been found helpful in detection of substances of abuse. The aim of this study was to determine the pattern of substance use as detected by urine toxicology screening amongst patients at a psychiatric facility in Lagos Nigeria. A Total of 1555 subjects made up of males (1480) and females (75) were screened using the one step multi-6 drug test panel immunoassay for qualitative detection of Methadone, Methamphetamine, Benzodiazepine, Cocaine, Morphine and Tetrahydrocannabinol. 927 (59.6%) subjects were positive with one or more drugs passing the concentration cut off. Tetrahydrocannabinol (42.3%) and Benzodiazepine (49%) were found to be predominant in the population studied. This study shows the most common psychoactive substance used in this environment is cannabis and also, the significant agreement between clinical diagnosis and urine toxicology screening.Keywords: Urine screening, Toxicology, Substance use, clinical diagnosi

Pneumococcal Antibody Concentrations and Carriage of Pneumococci more than 3 Years after Infant Immunization with a Pneumococcal Conjugate Vaccine

BACKGROUND: A 9-valent pneumococcal conjugate vaccine (PCV-9), given in a 3-dose schedule, protected Gambian children against pneumococcal disease and reduced nasopharyngeal carriage of pneumococci of vaccine serotypes. We have studied the effect of a booster or delayed primary dose of 7-valent conjugate vaccine (PCV-7) on antibody and nasopharyngeal carriage of pneumococci 3-4 years after primary vaccination. METHODOLOGY/PRINCIPAL FINDINGS: We recruited a subsample of children who had received 3 doses of either PCV-9 or placebo (controls) into this follow-up study. Pre- and post- PCV-7 pneumococcal antibody concentrations to the 9 serotypes in PCV-9 and nasopharyngeal carriage of pneumococci were determined before and at intervals up to 18 months post-PCV-7. We enrolled 282 children at a median age of 45 months (range, 38-52 months); 138 had received 3 doses of PCV-9 in infancy and 144 were controls. Before receiving PCV-7, a high proportion of children had antibody concentrations >0.35 µg/mL to most of the serotypes in PCV-9 (average of 75% in the PCV-9 and 66% in the control group respectively). The geometric mean antibody concentrations in the vaccinated group were significantly higher compared to controls for serotypes 6B, 14, and 23F. Antibody concentrations were significantly increased to serotypes in the PCV-7 vaccine both 6-8 weeks and 16-18 months after PCV-7. Antibodies to serotypes 6B, 9V and 23F were higher in the PCV-9 group than in the control group 6-8 weeks after PCV-7, but only the 6B difference was sustained at 16-18 months. There was no significant difference in nasopharyngeal carriage between the two groups. CONCLUSIONS/SIGNIFICANCE: Pneumococcal antibody concentrations in Gambian children were high 34-48 months after a 3-dose primary infant vaccination series of PCV-9 for serotypes other than serotypes 1 and 18C, and were significantly higher than in control children for 3 of the 9 serotypes. Antibody concentrations increased after PCV-7 and remained raised for at least 18 months