Background: Sex business is global, but the health issues associated with it are especially more critical and urgent in the West African sub region where more than a third of the sex workers are reported to be infected with HIV. This study was carried out to determine condom use and the socio-economic and behavioural predictors of unprotected sexual intercourse among commercial sex workers in Kano, Nigeria. Methods: We used a descriptive cross-sectional design to study a random sample of 248 brothel based female commercial sex workers in Sabon-Gari, Kano, Nigeria. Data was collected using semi-structured questionnaires and analysed with Epi Info® 3.5.1. Results: Majority (96.8%) of the sex workers were within 18- 38 years of age, indigent Hausas (33.9%) and Tiv (31.8%), single (50.8%) and had at least secondary school education (51.7%). Most (97.6%) were in the trade for 5 years or less and 44.3% had other sources of income. Majority used one or more of addictive substances (82.3%), entertained an average of three customers per day and also engaged in casual sex (85.5%). Up to 73.4%> and 45.3% were consistent with condoms at sex with clients and with intimate partners, respectively. However, 7.0% never used condoms during casual sex. After standardization, marital status, having other source of income and substance abuse were the only predictors of unprotected sexual intercourse. Conclusion: Sex workers engage in unhealthy sex for social and economic reasons. They should be empowered through vocational training to acquire sustainable sources of income. Regulatory authorities should also work with development partners/Non-governmental organisations (NGOs) to package and implement a formidable health strategy/intervention for the control of substance abuse and promotion of safer sex among both the sex workers and their clients.

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Background: The placenta plays important nutritional, metabolic and endocrine roles that ensure proper foetal growth and development. Since placental growth occurs throughout pregnancy, its measurement can be correlated with the growth of the foetus. This study determines the relationship between placenta thickness and foetal growth. Methods: Four hundred and twenty healthy singleton pregnancies were sonographically examined between 15 and 40 weeks gestation at the Radiology Department of the University of Benin Teaching Hospital Benin-City. Placental thickness was measured perpendicularly at the level of cord insertion. The measurements were correlated with foetal gestational ages obtained from the crown rump length, biparietal diameter and femur length. Results: The age range of study subjects was 18-43 years (mean 29.2+1.6 years). Their parity ranged from 0-7 (mean: 1.50+1.6). Placenta thickness ranged from 26.6 ±2.51 mm at 15 weeks to 39.2 + 5.69 mm at 40 weeks. There was linearity of measurements throughout gestation. Pearson's correlation analysis showed a coefficient of +0.632 between placental thickness and gestational age. There was a statically significant association between placental thickness and gestational age (P=0.000), and between estimated gestational age and foetal biomedical parameters, (p=0.000). Conclusion: Our data demonstrate a relationship between placental thickness and estimated foetal gestational age. However, more longitudinal studies are recommended to support these observations.

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Background: Chronic pain occurs in various medical conditions including among others, arthritis, herniated disc, cancer and trauma. It is a leading cause of lost workdays and economic loss worldwide. Doctors may view pain as a mere vexing side effect of a primary medical conditions rather than a serious and consequential health issues in its own right. This study seeks to assess doctor's attitude towards management of chronic pain. Methods: The study was conducted between January and March 2007 at the University of Maiduguri Teaching Hospital, using a 7-item self-administered questionnaire to determine the attitude of medical practitioners towards pain management. Data obtained included gender, type of chronic pain disorder, goal in pain management, use of analgesic and strong opiates; and multi-disciplinary approach to chronic pain management. Results: Of the 65 medical practitioners, 52 (80%) responded. Respondents represented the following medical disciplines: Internal Medicine (17.3%) Surgery (5.8%) Pediatrics (11.4%) Obstetrics/ Gynecology (15.9%o) and General Out-Patient Department (49.6%>). Low back pain was the commonest type of chronic pain. It was observed in 48.1%> of patients. The main goals of medical practitioners in chronic pain management included adequate pain relief (65.4%), absolute pain relief (30.8%) and moderate pain relief (3.8%). A high percentage (51.9%>) of clinicians showed negative psychologic traits regarding use of opiates. Conclusion: Adequate rather than absolute pain relief or moderate pain relief is the main goal of chronic pain management among medical practitioners. Many clinicians demonstrated negative attitude regarding use of opiates.

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Background: A preliminary unpublished review of two-year antenatal and labour ward records revealed that of the 4537 women seen at the antenatal clinic of Jos University Teaching Hospital (JUTH) per year, 2318 (51.1%) delivered in the labour ward per year. There is thus a gap between antenatal clinic attendance and hospital delivery in JUTH. Objectives: To determine the choice of place and its determinants for delivery among women attending antenatal clinic in JUTH. Study design: A cross-sectional design was used to study the proportion of pregnant women who booked for antenatal care in JUTH and delivered of the index pregnancy in the same institution. Results: A total of 347 women were recruited. The women's place of delivery included JUTH (33.1%), home (31.1%), private health institutions (13.5%), primary health care centers (10.1%), other public hospitals (5.8%) and nursing homes (6.3%). Lack of privacy (22.4%) and long waiting-time (20.2%) were the main reason for non-utilization of the delivery services in JUTH. The other reasons included far distance (17.7%) and family members' preference (11.6%). The utilisation of delivery services in JUTH was influenced by women's education (p < 0.05) and first trimester booking in the index pregnancy (p < 0.05). Conclusion: Many women who booked for ANC in JUTH delivered by choice outside the institution. We recommend that pregnant women be given health education on the benefits of hospital delivery, particularly, in institutions where their antenatal history is known. This will ultimately reduce maternal morbidity and mortality.

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Background: Knowledge of seizure precipitants has practical implications on the management and counseling of patients. This study was designed to determine the common endogenous and exogenous precipitants of epileptic seizures among epileptics in Kano. Methods: Adult epileptic patients of 2 tertiary-care centres whose seizures were classified in accordance with ILAE criteria, were consecutively surveyed with the use of a standardized questionnaire that lists precipitants which might trigger or aggravate seizures (emotional stress, hunger or fasting, missing of AEDs, fatigue, febrile illness, flashing lights, heat, cold, alcohol caffeine, menstrual cycle, sleep, sleep deprivation and others). Categorical variables were compared using Chi square and cross correlation was detrmined using Pearson's correlation. Results: Two hundred and ten patients comprising 124 (59 %) males and 86 (41%) females were studied. At least one specific seizure precipitant was noted by 184 (87.6) patients.. In descending order, stress (53.3%), febrile illness (35.7%), missing AEDs (22.4%), 13.9%) hunger or fasting, heat, fatigue were cited as seizure precipitants. Nineteen (22%) out of the eighty six women in the study cited menstruation as seizure precipitant. Caffeine (3.8%), alcohol (2.4%) and sleep (1%) were infrequently noted precipitants. Thirteen patients (6.1 %) noted other precipitants, including pain, bad odor, physical exertion and loud noise. Twenty six (12.4%) patients reported no precipitant. Hunger, stress fatigue, and sleep deprivation were oositively correlated. Conclusion: Common precipitating factors of seizure included stress, febrile illness and non adherence to antiepileptic drugs. Knowledge of these precipitating factors are vital prevention of seizure.

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Background: The aim of this study is to examine the auditory function in adult diabetics and to determine the association between, duration of diabetes, glycosylation, and hearing impairment. Methods: A one year hospital based prospective study of adult diabetic patients consecutively attending the endocrinology clinic of university of Maiduguri teaching hospital. Fasting blood sugar and glycosylated heamoglobin levels were estimated. The degree of hearing loss was assessed using pure tone average of air conduction thresholds at frequencies between 250-8000 Hz. Equal number of healthy controls matched for age and sex had PTA. Results: There were 150 patients recruited but 127 patients (50 males and 77 females; mean age: 47.8 ±11.6) years were analyzed. The 1-5 years duration of diabetes was the highest constituting 43.4% of patients (43.4%). The mean fasting blood sugar and glycosylated heamoglobin levels were 8.6 mmol/L ± 4.1 and 9.0% ± 2.0%, respectively. Mild sensorineural hearing loss was observed in 63 (49.6%) patients. There was no significant correlation between the diabetics PTA and the controls (p=0.542). The duration of illness significantly correlated with hearing impairment (p<=0.0001), but there was no significant correlation between glycosylated heamoglobin levels and hearing impairment, (p=0.154). Conclusion: Mild sensorineural hearing loss (SNHL) is the main type of hearing impairment in diabetics. Duration of illness correlated significantly with hearing impairment.

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Background: To determine the pattern, intervention and outcome of critically ill obstetric patients admitted into the intensive care Unit (ICU). Methods: This is a retrospective analysis of the records of all critically ill hypertensive obstetric patients admitted into the ICU of Usmanu Danfodiyo University Teaching Hospital, Sokoto over a five-year period (January, 2001 - December, 2005). Results: Of the 5750 deliveries during the study period, 112 critically ill obstetric patients were admitted into the intensive care unit. This gives ICU admission rate of 19.5 per 1000 deliveries representing 1.94% and 33.7% of total deliveries and of all ICU admissions respectively. Eighty-one (72.3%) patients had hypertensive disorders in pregnancy comprising of intrapartum eclampsia 49(60.5%), severe preeclampsia 22(27.2%) and postpartum eclampsia 10(12.3%). Majority (78.6%) of the hypertensive disorders patients were primigravidae and only 19.8% of these had antenatal care (ANC). The other indications for ICU admission included respiratory insufficiency 14(12.5%) and major obstetric haemorrhage with cardiovascular haemodynamic instability 10(9.0). The modes of delivery were caesarean section 102 (91.1%), spontaneous vaginal delivery 8(7.1) and forceps delivery 2(1.8%). Three (6.0%) patients required ventilatory support which lasted less than 36 hours. The length of stay in the ICU ranged between 2 and 7 days. Maternal mortality rate was 12%. Conclusion: This data demonstrates a high proportion of obstetric patients with pregnancy induced hypertension requiring critical care therapy. The high maternal mortality underscores the need for intense health education on the utilisation of antenatal care services.

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Background: Identification of predictors of outcome is vital to the development of therapeutic measures that could improve outcome. This study determined the relationship between clinical and biochemical variables on 30 days outcome after first- ever acute stroke. Methods: Consecutive first-ever acute brain CT scan confirmed stroke patients were prospectively enrolled between April 2009 and May 2010. Severity was determined using National Institute of Heath Stroke Score (NIHSS). Admission serum albumin, sodium, potassium, urea, creatinine, uric acid, blood sugar, erythrocyte sedimentation rate (ESR) and total white cell count (WBC) were determined at entry. Patients were followed up for 30 days. Outcome measures were 30-day mortality and functional outcome using the Modified Rankin Scale (MRS). Relationship of these parameters and stroke outcome was determined. Results: Seventy five acute stroke cases (39 men and 36 females) were studied. Mean age was 57.68 ± 12.4years. Outcome was favourable in 48% while 30-day case fatality was 17.3%. The mean age (61.13years) of those with poor outcome was significantly higher than those with favourable outcome. Mean serum albumin (2.9g/L) of those with good outcome was also significantly higher. Patients with poor outcome had significantly higher mean admission WBC and ESR. In a multivariate logistic regression, only admission stroke severity measured by NIHSS and erythrocyte sedimentation rate correlated with 30- day case fatality and adverse functional outcome. Conclusion: Admission stroke severity (measured by NIHSS) and ESR were independent determinants of 30- day mortality.

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