Oral contraceptive marketing in Ibadan, Nigeria.

The demographic transition in Nigeria is gradually moving towards the second stage. There is clear evidence of a declining mortality but the fertility rate remains exceptionally high. A realistic approach towards reducing fertility rate is the use of oral contraceptive. This study assesses the distribution system of oral contraceptive in Ibadan, the second largest city in Nigeria. The findings revealed that the people are aware of modern oral contraceptives as they purchase them freely at chemist shops. But effective distribution is hampered by existing channels and high costs. A local source recommended is the proprietary medicine stores, often at convenient locations to the potential users of contraceptives. The current cost which is between $1.3 and $19.5 per couple-years of protection is exorbitant, consuming 0.5-7.8% of the gross annual income of the average individual. Therefore, the government should subsidize the prices of oral contraceptives, to facilitate freedom from the tyranny of excessive fertility.     

Hemodialysis: management problems in developing countries,with Nigeria as a surrogate

The incidence of end-stage renal failure is increasing worldwide at an annual growth rate of 8%. Data for much of the developing world are often unavailable, but given the prevalence of poor socioeconomic factors, the incidence is likely to be greater. In Sub-Saharan Africa, economic and manpower factors dictate a conservative approach to therapy in most instances. The majority of those with end-stage renal disease (ESRD) perish because of the lack of funds, as very few can afford regular maintenance dialysis and renal transplantation is often not available. Hemodialysis (HD) remains the most common modality of management, with a very few units offering peritoneal dialysis (PD). Limitations to regular maintenance HD include the paucity of dialysis units, restriction of those units to urban centers, and the absence of government funding or subsidy and health insurance to cover the relatively high costs of dialysis. The few available units are bedeviled with multiple problems: old machines frequently break down, absence of adequate maintenance technical support and spare parts, and frequent power outages. Staff motivation and remuneration are equally poor with consequent disruption of services due to industrial action and emigration of trained staff to the Middle East and Western world. Present avenues for improvements include: focusing on prevention to stem the high prevalence of ESRD, greater government involvement to better fund units and thus enhance the quality of services rendered, and the wider availability of transplantation.     

Spinal tuberculosis: a 15 year review at OAUTHC Ile-Ife

A review of the hospital records over 15 years was made. The objective of the study was to describe the clinical presentation, management and outcome of spinal tuberculosis. Thirty-four patients were studied. There were 15(44.16%) males and 19 (55. 9%) females. Their age range was 2-80 years with mean (+/- SD) of 25.28 +/- 22.33 years. The occupations most commonly affected are Students (44.1%), Pre-school Children (17.6%) and Traders (14.7%). Back pain (100%), weight loss (47.1%), paraparesis (47.1%), kyphotic spinal deformity (32.4%) and night sweats (29.4%) were common features. Only 26.5% patients had active pulmonary tuberculosis. All the vertebral segments were involved. The Lumbar spine was the most involved vertebral segment in 50% patients. Using the Westergren method the mean (+/- SD) Erythrocyte Sedimentation Rate (ESR) mm/hour at the initial diagnosis was 83.58 +/- 31.11 mm/hour whereas three months after the commencement of antituberculosis chemotherapy it was 30.06 +/- 11.96 mm/hour. All the patients were given multiple antituberculosis drugs therapy and spinal traction. Spinal support was offered when the patients became ambulant. At the end of two years follow-up, 94.1% patients were alive, while 5.9% patients died during the course of treatment due to overwhelming sepsis. Among the patients that were alive, 14.7% still had persistence of their neurological deficit ie. paraparesis. Ten percent of the patients were mobilised on crutches while 5.96% were confined to wheelchair. This study shows that in tuberculosis endemic areas, symptom of back pain especially in the younger age group should be thoroughly investigated as this group constituted the largest affected population.     

Overweight and Obesity in Saudi Arabian Adult Population, Role of Sociodemographic Variables

The objectives of this Community-based National Epidemiological Household Survey, conducted between 1990–1993, were to estimate the prevalence of overweight and obesity in Saudi Arabia and to examine its association with the socio-demographic characteristics of the adult population. A sample of Saudis 20 years and over was selected using a multistage stratified cluster sampling technique with probability proportionate to size. The selected subjects were requested to visit primary health care centers in their localities. Physicians in these clinics took measurements of heights and weights and collected other relevant data. Obesity was measured by the Body Mass Index, using the Quetelet Index. The results showed the sample of 10,651 subjects of which 50.8% were males, had a mean age of 35.8 years (SD = 14.27 years). The prevalence of overweight was 31.2% (95% confidence interval: 30.3%, 32.1%); 33.1% for males and 29.4% for females. For obesity, the overall prevalence was 22.1%; males 17.8% and females 26.6%. The study design suggested that these estimates could be closer to the true values. The multiple logistic regression analysis showed that age, residential area, region, income, gender, and education are statistically significant predictors of obesity. The prevalence of obesity was higher in females than males, lower in subjects living in rural areas with traditional lifestyles than those in more urbanized environments, and increased with increasing age. The observed prevalence and pattern of overweight and obesity with age and gender is similar to those observed in the Arab community and some Western nations. There is a need for increased physical activity and better nutrition education programs to reduce the extent of obesity and to pre-vent the serious health consequences, especially, in the middle age group.     

Is HLA-DRW 13 (W6) Associated with Juvenile Myoclonic Epilepsy in Arab Patients?

Summary: In a study of 32 unrelated Arab patients with juvenile myoclonic epilepsy (JME), we compared the frequencies of human leukocyte antigen (HLA) class I and II alleles with those of unrelated healthy controls. A significant difference between the phenotypic frequencies in JME patients and controls was observed for DRW13, the split of DRW6 (37.5 vs 11% of controls). The strength of association as measured by the relative risk was 4.85 for this antigen (p = 0.002). The possible association of JME with HLA-DRW6 recently reported in Caucasians was confirmed in this study. This finding speaks for the homogeneity of the disease among Arabic and Caucasian JME patients. The existence of this association is evidence of a locus in the HLA region that influences expression of JME.     

Attitudes and opinions of medical staff towards computers.

The attitudes and opinions of 120 medical staff and 22 medical students towards the use of computers in medicine were assessed through a self-administered questionnaire. More than 60% of the respondents have never used computers. Age, sex, nationality and employment status correlate with computer usage. Students, interns, residents and consultants above 50 years of age have poor attitudes towards computers. This category of respondents believe that computers are important but not essential for medical practice. A higher proportion of those who showed positive attitudes to computers had no prior formal training in computer usage. However, they expressed their desire to attend computer training programs. There is a great need to emphasize automation in the undergraduate and postgraduate medical training to cope with improved technology in the practice of medicine. In fact about 90% of the respondents in this study demanded that computer training and applications be introduced in the medicine curriculum either at undergraduate, postgraduate or both levels.