Background: Interest is growing in the value of the cardiothoracic ratio in clinical evaluation of patients, and the factors that influence its relevance. This study attempts to explore the normal values of the cardiothoracic ratio and asses its relation to the body mass index (BMI), height weight and age, of normal young Nigerians in a highland plateau area of Nigeria. Methodology: In this prospective study, a total of 100, standard posterior-anterior chest radiographs taken from normal adult Nigerians (41 females and 59 males) in Jos environment were reviewed. From the Chest radiographs, the cardiac diameters (CDs) were measured at the widest point of the cardiac silhouette. The thoracic diameter (TD) was taken at the costophrenic insertion of the diaphragm. Using these data the cardiothoracic ratio (CTR) was computed. Body index was calculated based on the formula Weight (Kg)/Height ² (m ² (Kgm ^-²) while CTR was determined by dividing the CD by the TD. Degree of correlation was assessed for all the parameters and analysis was made for regression and correlation coefficients using SPSS statistical package. Results: The age range of all subjects was from 17 years to 44 years with a mean age of 24.93 ± 7.42 years. The mean age for the males was 25.59 ± 7.04 years and for the females 23.98 ± 7.92 years. The average cardiothoracic ratio in males was 0.46 ± 0.04 while in females it was 0.457 ± 0.042 showing a slightly higher but not significant CTR in males at the P = 0.05 significance level. The mean BMI for males and females were 26.94 ± 3.97 (Kgm ^-²) and 28.94 ± 5.26 (Kgm ^-²) respectively. The averageCD, TD, for males and females were 1.7 ± 0.039 m, 12.86 ± 1.22 cm, 27.88 ± 1.82 cm, and 1.5 ± 0.057 cm, 11.7 ± 1.19 cm, 25.65 ± 1.85, respectively. Conclusion: The CTR did not correlate strongly with the BMI.

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Background: Sickle cell disease (SCD) is an inherited lifelong hemolytic disorder affecting many children in sub-Saharan Africa, especially in West and Central Africa. There is a limited public health education on SCD in Ghana with only two information centers in Accra and Kumasi, respectively. Methodology: This cross-sectional study evaluated the knowledge of SCD among people living in Sekondi-Takoradi metropolis. Churches, saloons, internet cafes and bus stations were randomly selected in the center of the city with proximity to the central market. Results: A total of 621 individuals were recruited, 52.5% (326) had knowledge of their hemoglobin (Hb) electrophoretic pattern while 47.5% (295) had none. In addition, 93.4% individuals had knowledge of SCD while 6.6% had no knowledge of SCD. Older individuals exhibited better knowledge of their Hb electrophoretic pattern than the younger ones (P = 0.019). Individuals with tertiary education and married couples exhibited higher knowledge of SCD when compared to their counterparts (P < 0.001). Conclusion: Despite the relatively high knowledge of SCD and Hb electrophoretic pattern observed in this study, it is very important to increase neonatal screenings and health care services to the region. In addition, more emphasis is needed to increase public awareness of SCD especially in schools, churches, hospitals and the media.

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Background : Cervical cancer is a preventable and the most common female genital tract cancer despite the availability of screening services for precancerous lesions of the cervix. This study aims to determine the prevalence of cervical dysplasia in women of reproductive age in Zaria. Methodology: A prospective study of 131 women of child bearing age attending the family planning and Gynaecology clinics in Ahmadu Bello University Teaching Hospital, Zaria - Nigeria were recruited for the study after obtaining their consent. Cervical samples were collected and subjected to pap staining and cytological examination by a pathologist and classified using the Bethesda System. The data were processed using Statistical Package for the Social Sciences (SPSS) version 17. Bivariate analysis was done and the level of significance was set at a P < 0.05. Results: Cervical dysplasia prevalence of 7.0% was found out of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.3% (n = 3), Low Grade Squamous Intraepithelial Lesion (LSIL) was 3.1% (n = 4) and Atypical Squamous Cells of Undetermined Significance (ASC-US) was 1.6% (n = 2). There were 13% (n = 17) inflammatory features. Normal cytological features for Pap smear testing was present in 77.1% (n = 101). Conclusion: These findings underscore the importance of routine screening and early treatment of cervical dysplasia in order to reduce morbidity and mortality associated with cervical cancer.

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Background: Food is an important basic necessity, its procurement, preparation and consumption are vital for the sustenance of life. Food handlers have been found to play prominent roles in the transmission of food borne diseases, therefore training of food handlers on food safety and hygiene is crucial to the prevention of food borne diseases. Methodology: A quasi-experimental study carried out among food handlers in boarding secondary schools in Jos North Local Government Area to determine the effect of training on the knowledge and practice of food safety and hygiene. EPI info statistical software version 3.5.4 was used for data analysis and 95% confidence interval was used in this study with a P ≤ 0.05 considered statistically significant. Result: The mean age of the food handlers in the study was 42.07 ± 8.71 years with the mean years of work experience as 11.59 ± 8.05 years. The level of knowledge of food safety and hygiene improved significantly after the training ( P < 0.001). Majority (98.5%) of the food handlers had good practice of food safety and hygiene after the training as against 51.5% who had same before the training (χ² = 76.6; P < 0.001). Conclusion: This study has demonstrated the effectiveness of training in improving the knowledge and practice of food safety and hygiene among food handlers.

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Background: Clinical audit of maternity services to ascertain the obstetric indices is vital for improvement in the quality of obstetric care. This study sought to determine the obstetric indices in an emerging private teaching hospital in Nigeria. Methodology: This was a retrospective review of obstetric records at Bingham University Teaching Hospital, Jos over a 3-year period. Data were extracted from the wards and intensive care unit records, delivery and operation registers and analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Results: There were 3817 deliveries conducted during the period under review. The mean age of the women was 29.3 ± 5.2 years and 78.3% of them booked for antenatal care. The cesarean section rate was 31.5%, instrumental vaginal delivery rate was 1.2%, and episiotomy rate was 19.5%. The most common indications for caesarean section were failure to progress in labor (19.7%), obstructed labor (11.6%) and previous successful obstetric fistula repair (11.2%). The average birth weight was 3.4 ± 0.6 kg, while 17.5% of the babies were macrocosmic. Male:Female babies' ratio was 1.1:1 and the twinning rate was 2.3% of all deliveries. Maternal mortality ratio was 530/100,000 live births, while the stillbirth rate was 3.5%. Severe preeclampsia/eclampsia was the commonest cause of maternal death. Conclusion: Most of the obstetric indices are comparable to those from other teaching hospitals in Nigeria. It is however essential to review intra-partum management of parturients in order to decrease cesarean deliveries arising from failure to progress in labor in this maternity unit.

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Introduction: The human immunodeficiency virus (HIV) and drugs taken for this infection are known to cause QTc interval prolongation which in turn can lead to severe arrhythmias. The prevalence and associated factors of prolonged QTc in HIV-positive children in sub- Saharan Africa have not been described. Objectives: To compare the mean QTc interval and prevalence of QTc prolongation in HIV-positive children and HIV-negative controls, and to determine the factors associated with prolonged QTc in HIV-positive children. Methodology: In a cross-sectional comparative study, the corrected QT intervals (QTc) of 100 HIV-positive children were compared with those of age- and sex-matched HIV-negative healthy controls. QTc > 0.46 seconds was regarded as prolonged. Results: Subjects were aged 9 months to 14 years. Mean QTc was significantly longer-43.31 (95% CI 43.30, 43.32) seconds in HIV-positive children (62% of whom were on anti-retroviral therapy) compared with controls-41.43 (41.42, 41.44) seconds (P < 0.0001). Mean QTc was also significantly longer in subjects receiving zidovudine (ZDV) - [0.46 (0.45, 0.47) versus 0.43 (0.42, 0.44) seconds] - P = 0.007 and efavirnez (EFV) - [0.45 (0.43, 0.47) versus 0.43 (0.42, 0.44) seconds] - P = 0.047 in subjects not on these drugs. Prolonged QTc was significantly more frequent in HIV-positive children (18.0%) compared with controls (0%) - P = 0.0001. There was no significant relationship between either the mean QTc or the frequency of prolonged QTc, and the subjects' mean age, sex, clinical or immunological stage of disease. Conclusion: Mean QTc is significantly longer in HIV-positive children (especially those receiving ZDV or EFV), compared with controls. Prolonged QTc is also significantly more frequent in subjects. Baseline and periodic ECG screening of HIV-positive children may facilitate early detection of QTc prolongation and help prevent fatal arrhythmias.

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Context: Cigarette smoking has became prevalent particularly in developing countries where youths get initiated at an earlier age than in the past two decades and there is only rudimentary support for smoking cessation. Although the relationship between cigarette smoking and health hazards is well documented, the incidence of cigarette smoking continues to increase despite global and local tobacco control efforts. Aims: The study objective was to determine the level of exposure of respondents to cigarette smoking and the factors associated with it. Materials and Methods: A pre-tested, self-administered questionnaire was used to collect data on socio-demographic features, knowledge about smoking and exposure to media for health information including exposure to tobacco adverts. Subjects were selected by multistage sampling technique. Results: One-third of the students were current smokers and most of them had poor knowledge of the consequences of smoking. All of the students were exposed to some level smoking adverts through electronic/print media. Over 90% of the students had no exposure to smoking prevention and none of the smokers were exposed to cessation interventions. One-fifth believed they were not at health risk as a result of smoking. The school had no smoking control policy. Conclusions: There was a strong, constant exposure of the youths to cigarette adverts in the media, on the streets, the school and homes. There is need to protect the youths from such excessive exposures to factors that encourage smoking and establish intervention strategies to prevent continued exposure to cigarette adverts.

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Background: The impact of HIV/AIDS has been felt in virtually all aspects of life. Long distance drivers are of particular concern to HIV prevention and care programs because they constitute a high risk group. HIV Counseling and Testing (HCT) is an intervention, which gives the client an opportunity to confidentially discuss his or her HIV risks and be assisted to learn his/her HIV status for purposes of prevention, treatment, care and support. The objective of this study was to determine the effect of health education on the uptake of HCT among Long Distance Drivers (LDDs) in Plateau State. Methodology: This was a quasi-experimental study with a pre and post intervention phase carried out among 161 LDDs in Jos North Local Government Areas. Health education intervention was provided using a structured health education guide in the form of lecture and discussion. Epi-info ^TM statistical software version 3.5.4 developed by Centre for Disease and Control and Prevention (CDC) 1600 Clifton Rd. Atlanta, GA 30333 usa was used for data analysis and 95% confidence interval was used for the study and P ≤ 0.05 was considered as statistically significant. Results: The mean age of the respondent in this study was 41.0 ± 7.9 years with majority (92.5%) of the LDDs married and 91.3% resident within the state. Knowledge and uptake of HCT among LDDs improved significantly from 4.17 ± 1.43 to 6.70 ± 1.55 and 18.6-57.2% following the intervention ( P < 0.001) respectively. Conclusion: This study has shown that health education is an effective tool in improving the uptake of HCT among long distance drivers. Therefore, it should be used to improve HCT uptake among high risk groups.

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Background: As per recent research patients with severe Plasmodium falciparum and Plasmodium vivax develop similar disease manifestations. Objectives: To compare the sociodemographic characters, clinical profile, and laboratory parameters of cases of malaria due to P. falciparum and P. vivax species. Methodology: Study design: Record-based retrospective study; study settings: Hospital based; study subjects: Records of malaria patients admitted to a tertiary care teaching hospital during 2009-2010. The malaria patients were categorized as P. falciparum and P. vivax malaria cases. The sociodemographic factors, clinical profile, and laboratory parameters of P. falciparum and P. vivax malaria cases was evaluated. Statistical analysis: Percentages, proportion, and χ² test. Results: A total of 111 malaria patients' records were studied. Twenty-five (22.52%) cases were due to P. falciparum and 86 (74.48%) cases were due to P. vivax. There was no difference observed in sociodemographic characters of P. falciparum and P. vivax malaria cases. Most of the common symptoms were similar in P. falciparum and P. vivax malaria cases. Splenomegaly was common in P. vivax cases, while hepatomegaly was common in P. falciparum cases. 18 (72%) P. falciparum cases and 50 (58.14%) P. vivax cases had thrombocytopenia. Severe anemia was present only in P. falciparum cases. Among other laboratory parameters, there was not much difference observed. Conclusion: There was not much difference in sociodemographic characters, clinical profile, and laboratory parameters of P. falciparum malaria or P. vivax malaria.

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Background: The global impact of the converging dual epidemics of tuberculosis (TB) and human immunodeficiency virus (HIV)/AIDS is one of the major public health challenges of our time. Ignorance, fear, stigma and poverty have promoted the course of TB and HIV infections, particularly among people residing in the rural areas despite the availability of free diagnostic and treatment services. Community volunteers (CV) have been used successfully to promote and sustain knowledge and utilization of health services in various parts of the world. This study sought to determine the impact of the use of CV on knowledge and uptake of TB/HIV screening services in the study population. Methodology: The study design was a community-based quasi-experimental study. A multistage sampling technique was used to select the study participants. The Primary Health Care (PHC centres offering TB and HIV screening services were the primary sampling units while the communities close to the PHCs were the secondary sampling units. The intervention involved a CV in each community providing education and services on TB and HIV/AIDS infections to the community members. Knowledge and uptake of TB and HIV screening services among the community members were assessed before and after the intervention. Results: A total of 1305 people were recruited into the study and five communities each were selected per PHC. Postintervention, there was an increase in the knowledge of the cause, mode of transmission, symptoms and treatment of TB among community members from a mean score of 2.23 ± 2.31 to 5.37 ± 2.64 (P < 0.0001). There was also an increase in the knowledge of the modes of transmission, symptoms and prevention of HIV/AIDS among community members from a mean score of 6.66 ± 2.92 to 8.36 ± 3.35 (P < 0.0001). Uptake of TB screening rose from 59.4% to 75.0% (P = 0.0161) among community members with a history of chronic cough and uptake of HIV counselling and testing (HCT) also rose from 53.8% to 64.1% (P = 0.0215) among the community members. Conclusion: Community Volunteers were found to improve the people's knowledge of TB and HIV/AIDS infections as well as uptake of HCT and TB screening services. Their use will help improve TB and HIV collaborative activities and also contribute to the reduction of morbidity and mortality associated with TB and HIV infections.

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Background: Nonadherence to antiretroviral therapy (ART) may encourage the development of resistance to antiretroviral drugs (ARVs). Poor adherence is known to be associated with ART failure which could compromise the benefits of ART in children. Therefore, it is important to identify the reasons why children on ART may fail to take their ARVs. In this study, we described the characteristics of human immunodeficiency virus-1 (HIV-1) infected children with ART nonadherence as well as the reasons for their nonadherence. Methodology: A retrospective cohort study in which data on 580 HIV-1 infected children enrolled on ART between February 2006 and December 2010 at the pediatric HIV clinic of the Jos University Teaching Hospital, Jos, was analyzed. Subjects were aged 2 months to 15 years. Information on adherence was obtained by child or caregiver self-report. They also had repeated adherence counseling during each clinic follow-up visit and were taught the use of alarm clocks daily for reminding them of when the next ARV dose will be due. Results: There were 30 (5.2%) children with non-adherence to ART. Among children with nonadherence, majority were: Children aged 1-10 years (76.7%), males (53.3%) and did not know their diagnosis of HIV (90.9%). The odds of nonadherence was two times higher among children who failed first-line ART compared with those who did not (odds ratio [95% confidence interval], 2.28 [1.03-5.02], P = 0.04). The most common reason for nonadherence was: Forgot to take medications (46.7%). Conclusion: The low rate of nonadherence to ART in this study could be attributed to repeated adherence counseling during each clinic follow-up visit and the use of alarm clocks daily for reminders on when the next ARV dose will be due.

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Suicide is a major public health concern in Afghanistan. However, in spite of substantial anecdotal reports of suicide incidences in the country, suicidal behavior (ideation, attempts, and completed suicide) has not been studied systematically in Afghanistan. Most of the data come from media reports. Such reports are inherently biased; most recent reports indicate that overwhelming majority of completed suicide are females (95%). Such observations are in stark contrast with what is seen globally and what was reported in 1960s in Afghanistan. We present a case of an Afghan man surviving a suicide attempt to highlight the underreporting of suicide and suicidal behavior in Afghanistan. We conclude that the Afghan people need international support to develop research strategies and devise suicide prevention methods to address the problem of suicide in Afghanistan.

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Orbital metastases are rare and are a relatively uncommon cause of adult proptosis. They can be difficult to diagnose, even with new diagnostic imaging techniques. Orbital biopsies with histology can demonstrate about 90% of cases and this diagnosis is often unexpected. In most cases of orbital metastatic disease with an unknown primary site, the site of origin may never be found, even at autopsy. This report is that of an adult male with orbital metastasis that was difficult to diagnose by medical imaging and the primary site could not be found. The rarity of this tumor and the fact that the histological type (adenocarcinoma) is even less common prompted the report of this case.

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Plasmodium vivax usually causes a benign illness in children, but a recent change in virulence has led to a drastic change in clinical spectrum. Falciparum malaria has been reported to present in family members simultaneously, but no such reports are documented for vivax malaria in the literature. The authors report two cases of P. vivax malaria presenting simultaneously in children belonging to the same family following visit to an endemic area.

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