Objectives: The lack of clear provision for health in the 1999 constitution as amended in 2011 has implications on health system. In 2004, Federal Ministry of Health (FMoH) in collaboration with the National Assembly of Nigeria proposed a National Health Bill (Public Health Law). The research was conducted to identify the constitutional gap on health systems and discussed the implication for the provision of tertiary health care systems in National Health Bill. Methods: Systematic and comprehensive assessment of the National health policy and constitution provision for health systems were reviewed. Key Informant Interview (Kll) was also carried out among the policy makers and desk review of documents and records. Results: The lack of clarity and specificity in the constitutional provision makes it possible for all tiers of government at all level to engage in all the three types of health care. The National Health Bill was developed as an instrument for correcting the gaps in the 1999 constitution of Federal Republic of Nigeria as it relates to the health sector. Its provisions have effects on all three levels of care and subsystems (primary, secondary and tertiary). Many provisions have implications on the tertiary health system in either directly or indirectly. However the sections that have most profound effects on the tertiary health system operation are sections 8 and 9, which provide for the establishment of National Tertiary Hospital Commission. The commission would bring all the tertiary facilities owned by Federal Government its control. Conclusion: The coming into being of National Tertiary Hospital Commission will lead to improved funding, management, regulation and coordination of tertiary health system.

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Background: Iron deficiency is a common public health problem in developing countries. Objective: To study the relation between hemoglobin level and Lower respiratory tract infections in children. Methods: A total of eighty patients who came to the outpatient department with lower respiratory tract infection were included in the study. Age and sex-matched eighty children, not having any respiratory illness, were taken as control. Complete blood count (CBC), C-reactive protein (CRP) and X-ray chest were performed for all patients. Peripheral blood smear, serum ferritin and serum iron binding capacity were done for all anemic children. Results: The age group of the children included in the study varied from seven months to fourteen years. CRP was positive in 36 children (45%) in the study group and 10 (12.5%) of the control group. Radiological evidence of pneumonia was present in 57(71.3%), and hyperinflation of lung fields in 19 (23.75%) among study group. Fifty nine (74%) of the study group and 24 (30%) of control were anemic Fifty two cases (65%) in the study group had a history of wheeze. Forty four (55%) gave a positive family history of asthma and atopy. Conclusion: Anemic children were more susceptible to lower respiratory tract infection compared to the control group with relative risk 2.46. Treatment of anemia will reduce the incidence of lower respiratory tract infection

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Background: Sickle cell disease is the most common single gene disorder in Nigeria and most of West Africa. Morbidity and mortality associated with the disease is high hence the need for screening. Most screening exercises conducted are hospital-based with its attendant limitations. A community survey was therefore carried out to establish the true prevalence of sickle cell disease. Methods: A descriptive and cross-sectional study involving 107 under-fives from Ekosodin community in Edo State, Nigeria was conducted between April and June 2007. The community leaders were sensitized, families were mobilized, educated on the subject and requested to present their under-five children during the house to house visits for physical examination, anthropometry, and screening. Haemoglobin phenotypes were determined using the cellulose acetate (CAC) electrophoresis for children aged six to 59 months and thin layer iso-electric focusing (TLIF) electrophoresis for those less than six months. Results: The overall prevalence of HbAA was 72.0% and 28.0% for HbAS. The prevalence of HbAS among infants and older children were 33.3% and 28.6% respectively with none identified among the newborns. No HbSS was identified among all the subjects. Majority (74.8%) of the children, also 96.4% of the 12-59 months were well nourished, 25.2% were underweight and three (3.6%) had borderline malnutrition. Conclusion: Beyond the neonatal age-group, one in every three of the subjects had HbAS, even among infants. The attendant risk associated with the carrier state remains real in this community, as is the case in similar Nigerian communities. Therefore, a multipronged programme on sickle cell counseling including a screening programme targeted at the neonatal period or early childhood is recommended for resource-poor communities like ours.

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Background: The practice of traditional uvulectomy in children is common in Africa. This is usually propagated by traditional health providers, the disease causal attributions by the uvula are the main influencing factors for subjecting children to the procedure. Objectives: To ascerlain the parent's reasons and perception of traditional uvulectomy in children, their educational and socioeconomic status. Methods: A one year prospective survey on all parents of children aged 15yrs and below presenting to our facilities and who were found to have an amputated uvula. A structured interviewer- questionnaire was administered to 385 parents; the interviewer-questionnaire contained the child's demographic data, age of the child at uvulectomy, the parent's educational level and occupation and also the parent's perception on the diseases caused by the uvula. The data collated was analyzed using. the statistical package for the social sciences (SPSS) software, version 16.0. Results: A total of 385 children with amputated uvula were studied, males constituted, 52.7%, and females, 47.3%. The commonest disease perception attributed to the uvula was frequent throat infections, 102(260.5%)0 . other perceptions include failure-to-thrive, 43(111 .2%), and some multiple disease occurrence which includes diarrhea and vomiting. The educational levels of the parents were mostly, non-formal, 194 (50.4%), with a significant disease attribution correlation, p=<0.005. Most of the parents were of the socio2-economic ciess3-v, 162(42.1 %), with a significant disease attribution correlation, p=<0.005. Conclusion: The main parental reason for traditional uvulectomy in children was found to be frequent throat infections and some multiple disease occurrences, parental poverly and lack of formal education were some of the major influencing factors, hence we recommend that, formal education, especially health education and creation of employments by the government will help in alleviating such practices4.

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Background: Necrotizing mastitis (NM) is a rare form of necrotizing soft tissue infection involving the breast. It is often a rapidly progressing infection of the skin and subcutaneous tissue with high morbidity and mortality if not promptly treated. Methods: We report two cases of necrotising mastitis in which both presented with acute features of breast pain and swelling with associated fever. Results: There was resulting gangrene with complete loss of affected breast in one case and partial loss of skin and subcutaneous tissue in the other. One of the patients left the hospital with a healed, grafted wound while the other left with a clean granulating wound because she had no money for skin grafting. Conclusion: Necrotising mastitis is a rare clinical condition that may present with auto amputation of the breast if treatment is delayed.

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Background: Febrile convulsions are a common paediatric problem, they can be extremely frightening, emotionally traumatic and anxiety provoking when witnessed by parents for fear of death. Appropriate home management of febrile convulsion is needed to lessen the parental anxiety and apprehension associated with it. Method: This study was a cross-sectional descriptive study designed to assess the home management practices of febrile convulsion amongst Hausa/Fulani mothers in a rural community in North Western Nigeria. A one in four samples of one hundred and twenty mothers who met the eligibility criteria were selected for the study. Results: The mothers were aged 18 years to 47 years; majority had Quoranic education only, were all of Islamic faith and were not gainfully employed. One hundred and six (88%) of the mothers were married, 9(8%) divorcees and 5(4%) widows. Their home management practices included removal of cloths, traditional medications, with only 16% of study subjects practicing appropriate home management of febrile convulsion. Conclusion: The home management practice of febrile convulsion was poor amongst the mothers studied. There is therefore, the need for interventions in the community to improve their practice of home management of febrile convulsion.

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Background: Congenital malformations are a major cause of perinatal and neonatal deaths, and disability both in developed and developing countries. Objective: The objective of this study was to determine the pattern of congenital anomalies seen in babies admitted into the special care baby unit of University of Benin Teaching Hospital, Benin City, Edo state, Nigeria. Method: A prospective register of all congenital anomalies seen in newborns were kept within the study period of 2years. The details of each child's anomaly were documented and characterized. All the babies with congenital anomalies admitted from f January 2008 to 31 ^st December 2009 were included in this study. Results: A total of 153 babies were admitted during the study period, 85 (5.6%) had congenital anomalies. More male babies had congenital anomalies, though the finding was not statistically significant. Booking status of the mother was significantly associated with having a child with congenital anomalies. More term babies had congenital anomalies than preterm babies. One quarter of the babies with congenital anomalies, died within the neonatal period. Gastrointestinal system malformations (36.5%) were the most common. CNS anomalies was second (29.4%) with myelomeningocele being the most common anomaly (18.8%), followed by musculoskeletal system anomalies (14.2%), genitourinary system (10.6%), chromosomal (5.9%), cardiovascular (3.5%). Conclusion: The pattern of congenital anomalies in our region is different from that of developed countries. The booking status of the mother is significantly associated with having a child with congenital anomaly. Proper antenatal care could help detect this problem for early intervention.

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Background: Tropical diabetic hand syndrome (TDHS) is a complication affecting patients with diabetes mellitus in the tropics, characterized by localized cellulitis and ulceration of the hands, to progressive, fulminant hand sepsis, and gangrene affecting the entire limb. The objective of this study was to determine the pattern of clinical presentation, causes and outcome of patients with tropical diabetic hand syndrome as seen in a tertiary health center in Nigeria over a three year period. Methods: All patients admitted at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, from January 2008 to December 2010 with tropical diabetes hand syndrome were included. The data retrieved from the case files of the patients included the age, gender, blood glucose, type of hand lesion, wound swab m/c/s, treatment offered and the outcome. Results: Of the thirty one patients diagnosed with TDHS, 18(58.1%) were females while 13(41.9%) were males. The mean (SD) blood glucose level at initial presentation was 18.1(5.9) mmol/l. The mean (SD) age of the study patients was 44.8 (6.1) years. Nine (29.1%) patients had hand ulcerations, 8 (25.8%) had cellulitis, 10 (32.2%) had palmar abscess, while 4 (12.9%) had localized gangrene. Wound swab cultures of hand lesions obtained yielded polymicrobial growth that included Staphylococcus aureus (36.4%), Pseudomonas aeruginosa^ 8.2%) and Escherichia coli (45.5%). Thirteen (41.9%) patients were completely healed after treatment, while18 (58.1%) had residual deformitie. Conclusion: Although all the patients survived, permanent disability was present in 58.1% of patients. There is the need for TDHS to be recognized early by clinicians in developing countries and treated aggressively to prevent occurrence of such complications with their resultant socioeconomic effects.

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Background: During treatment of HIV disease, a number of factors may influence the effect of the medications used: the presence and/or treatment of viral hepatitides, opportunistic infections, alcoholism, the use of various recreational drugs, immune reconstitution and/or the presence or emergence of diabetes and dyslipidemia which can adversely affect liver injury. The effect of CD4 cell count on liver injury after commencing HAART varies between cohorts. This study aims to determine the type of liver injury after commencing HAART in HIV infected patients and the effect of baseline CD4 cell count. Method: This study was carried out on patients with HIV on HAART attending infectious disease clinic, gastroenterology clinic or admitted into the medical wards of the University of Benin Teaching Hospital. Patients with HIV but not on HAART were used as controls. A clinical evaluation and relevant laboratory investigations were done. Hepatotoxicity was defined using a standardized toxicity grade scale. Results: A total of 84 cases and 42 controls were studied. The mean ages were 35.2΁ 9.9years and 35.5΁9.0years for the cases and the controls respectively. Over 70% of the study population and controls were females. The overall incidence of hepatotoxicity was 17.9% and severe hepatotoxicity occurred in 10.7% of the patients. Liver injury after commencing HAART in this study was 100% cytotoxic and was not affected by baseline CD4 Cell Count. Conclusion: This study shows that Liver injury associated with usa of HAART in HIV patients is cytotoxic and unaffected by baseline CD4 Cell Count.

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Background: Uterine fibroids are the commonest solid benign tumor in women of reproductive age. Pelvic ultrasonography is a very popular imaging modality used in its diagnosis. Objectives: This study was carried out to determine the various appearances of fibroids on ultrasonography, and to compare these findings with those obtained in the Western world. Methods: 120 consecutive patients in whom an ultrasound diagnosis of fibroids was made were analyzed. All patients were scanned via the transabdominal route. Their locations, sizes, and echotexture were noted. Results: Diffuse lesions were seen in 17. 5% patients, while 82. 5 % had focal masses. 33. 3 % and 30% patients had hypoechoic and echogenic masses respectively. There was also a high percentage of degenerative changes viz: fibrosis, necrosis (20. 8 %) and calcifications (9. 2%). Conclusion: The sonographic pattern of fibroids did not differ greatly from that previously reported although a higher percentage was echogenic, suggesting more fibrous tissue content

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Background: Urinary schistosomiasis or bilharziasis is an ancient disease found in many part the tropical world. It is the second most prevalent tropical disease after malaria, and a leading cause of morbidity in large areas of the world. Methods: A case report. Results: A case of ~Cow Horn deformity" of the distal ureters on intravenous urography in an 8- year old child with urinary schistosomiasis is reported.

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