Introduction: Satisfaction evaluation is an excellent opportunity to involve clients in the process of assessing programs from users' perspective and is recognized as a component of quality of care. This study aimed to identify determinants of client satisfaction with the family planning (FP) services provided in government health facilities in Sokoto metropolis. Materials and Methods: A descriptive cross-sectional study was conducted among FP clients that patronized the FP commodity delivery point in selected health facility in Sokoto, Northern Nigeria. A multi-stage sampling technique was used to select the study respondents. List of the clients that attended each clinic was compiled and used as a sampling frame. A set of pretested exit interviewer-administered questionnaire was used to collect data from the clients. Ethical approval was granted for the conduct of the study, and individual informed consent was obtained from each client. Thereafter, the exit questionnaire was administered. Results: All the respondents were females and those aged 25-29 years constituted a larger proportion of 26%. Overall mean age was 30.8 ± 7.0 years. Large proportion (85%) expressed satisfaction with FP services provided. About 49% of the respondents reported waiting for 30 min before being attended to by service providers while 13% waited for more than 2 h. Average waiting time was 60.3 ± 21.3 min with clients mean desired waiting time of 35.2 ± 11.1 min. Clinic waiting time, being examined during the visit, and attitude of both service providers and other clinic staffs were found to be the key determinants of client satisfaction. Conclusion: Although, most of the clients waited for more than 30 min, majority were satisfied with the services offered. There is a need to reduce waiting time of FP clients at the clinic and ensure clients are appropriately examined.

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Introduction: The pressure on couples and particularly women to have children is strong in developing countries where a childless woman is considered a social pariah. This study aimed to determine the predictors of fertility desire among people living with HIV. Materials and Methods : This is a descriptive cross-sectional study conducted among 400 HIV-positive clients receiving follow-up care at anti-retroviral (ART) clinic in a tertiary health facility in Sokoto. A list of clients that came to the clinic was compiled and served as sampling frame. A two stage sampling method was used to select study respondents from the sampling frame. Interviewer- administered closed-ended questionnaire was used to collect the required data from the respondents. Ethical approval was granted for the conduct of the study and informed consent was obtained from the respondents. Descriptive, bivariate and multivariate analyses were carried out. Results : Majority (56.2%) of the respondents were females. The overall mean age was 34.5 ± 0.4 years (male 38.4 ± 0.5 years), and (females, 31.4 ± 0.4 years). A large proportion of the respondents (67.7%) reported desire to have children in future. Using logistic regression analysis, younger age (adjusted odd ratio [aOR] = 2.0, P = 0.023), marital status (aOR = 1.9, P < 0.001) and number of living children (aOR = 0.7, P < 0.001) were the key factors influencing respondents desire for children. Conclusion : Many HIV-positive clients in the clinic reported desire to have children. It is recommended that full reproductive health services be provided in the clinic to help them achieve their reproductive goal without risk to their partners and new born.

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Background/Aim: The placenta plays a major role in fetal well-being, and fetal weight is very important to neonatal survival. There probably exists a relationship between placental dimension and fetal size. Data on ultrasound assessed placenta thickness and fetal weight are scanty in the Nigerian literature. This study aimed to establish a relationship between ultrasound estimated placental thickness and fetal weight. Materials and Methods: Four hundred and twenty apparently healthy pregnant women at gestational age 15-40 weeks were sonographically examined, with a 3.5 MHz curvilinear transducer of a Sonoace X6 machine (Medison Co., Korea). Placenta thickness, in millimeters, and fetal weight, in grams, was estimated for each subject. Correlation between the two parameters was assessed. P ≤ 0.05 were considered to be significant. Results: Mean placental thickness (PT) ranged from 22.6 ± 2.5 mm at 15 weeks to 40.9 ± 7.2 mm at 30 weeks, while estimated fetal weight (EFW) ranged from 147.0 ± 16.5 g at 15 weeks to 3.304.8 ± 284.6 g at 40 weeks. The mean values of placenta thickness and EFW throughout gestation were 35.5 ± 7.0 mm and 1555.0 ± 1004 g, respectively. There was significant correlation between placenta thickness and EFW r = 0.668; P = 0.000. Conclusion: The study established a fairly linear relationship between placental thickness and EFW. A normogram of ultrasound estimated placenta thickness and fetal weight is derived.

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Background: Under-five morbidity and mortality from childhood preventable diseases are still very high in most of the developing countries, especially Nigeria. We describe the morbidity and mortality of childhood illnesses at the Emergency Pediatric Unit (EPU) of the Federal Medical Centre, Azare. Materials and Methods: A retrospective study of Emergency Pediatric Unit admissions over a 1-year period. Epi-info statistical software was used for data analysis. Results: A total of 1,161 patients, aged 1 month to 13 years with a mean age (±1 SD) of 9.8 ± 2.6 years were admitted into EPU during the period. There were 576 (49.6%) males and 585 (50.4%) females and 1,034 (89.1%) patients were children under 5 years of age. The major causes of admission were malaria (44.8%). There were 103 (8.9%) discharges, 886 (76.3%) transfers to pediatric wards, 38 (3.3%) referrals to other hospitals, and 11 (0.9%) discharges against medical advice. There were 123 (10.6%) deaths during the period of the study with 107 (87.0%) of the deceased being children ≤5 years of age. Severe malaria 61 (49.6%) was the major cause of deaths in the unit, followed by Protein energy malnutrition (PEM) and pneumonia occurring in each of 10 (8.1%) patients. Conclusion: Malaria, PEM, and pneumonia remained the major causes of morbidity and mortality, especially among the under-five children.

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Introduction: The APGAR score rapidly assesses the condition of the newborn at birth and is a predictor of neonatal mortality. Despite the fact that this scoring system is limited by inter and intra-observer variation, its knowledge is essential to residents involved in newborn care at delivery. This study was therefore carried out to determine the knowledge and application of the APGAR score by these residents. Materials and Methods: The questionnaire-based survey was conducted at the Jos University Teaching Hospital and administered to all consecutive residents in pediatrics, obstetrics and gynecology (O and G), anesthesia, family medicine and public health. Domains assessed both knowledge and application of the APGAR scoring system. Data analyzed with the Epi Info 3.5.1 and P < 0.05 was considered as statistically significant. Results: Of the 74 completed questionnaires, 21 were filled by Pediatric residents, 27 by O and G residents and 26 by other residents. Residents with 10-15 years of work experience had a significantly higher mean score on their knowledge compared with those with <10 years work experience (P = 0.015). The mean application score was significantly higher among the Pediatric residents compared with the O and G and other residents (P = 0.015). Using linear regression, there was a significant association between the knowledge and application of the APGAR scoring system - coefficient = 0.179, P ≤ 0.001. Conclusion: Adequate knowledge and application of the APGAR scoring system by residents who use it frequently is necessary to avoid its misuse. Training and retraining of these residents on the correct use of the APGAR score during neonatal resuscitation is important to ensure adequate knowledge and its proper application.

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Secure laparoscopic cholecystectomy operation requires a sound anatomical knowledge of cystic artery (CA) and all possible variations involving it. Very rarely the CA arises from an extra territorial source of celiac axis. Since CA is to be ligated always during cholecystectomy, its variant origin, course and position in the Calot's triangle should be carefully noted. We report here a concurrent arterial variation showing rare origin of CA from superior mesenteric artery and trifurcation of common hepatic artery into right and left hepatic artery together with gastro duodenal artery just above the proximal part of the duodenum. Among the branches of celiac trunk, variant morphology of its common hepatic branch is reported to be rare. Ample knowledge of multiple arterial variations in the supracolic compartment of the abdominal cavity warrants the clinical attention. Overlooking such variations might result in iatrogenic injury to the vessels leading to fatal haemorrhage during surgical approaches.

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Renal osteodystrophy is a skeletal pathology characterized by bone mineralization deficiency, which is a direct result of endocrine and electrolyte derangements that accompany chronic kidney disease. We hereby present a case of a 60-year-old man with chronic renal failure showing classical osseous changes of osteomalacia and osteosclerosis.

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Background: Computed tomography (CT) is the imaging modality of choice in evaluating patients with acute head trauma. Objective: The objective of this study is to assess CT utilization in head trauma in University of Benin Teaching Hospital (UBTH) with reference to sociodemographic characteristics and cause of injury. Materials and Methods: A retrospective study of patients who had CT scanning done for head trauma in the UBTH, from 2011 to 2013 was undertaken. Medical Records of patients with special emphasis on the patient's demographic characteristics and detailed information about the cause of injury of the patients were obtained from the accident and emergency department of the hospital. Data were analyzed using SPSS version 17. Results: A total of 1387 patients with male: female ratio of 3.7:1 were studied. The mean age of the patients was 33.2 ± 18.8 years. Road traffic accidents (RTA) were the predominant cause of injury among the patients accounting for 62.6% of the cases. Gunshot injury (GSI) and patients struck by objects accounted for only 2.7% and 1.3% of the cases, respectively. The Glasgow coma score (GCS) of the patients revealed that 42.0%, 26.1%, and 31.9% of patients had severe head injury, moderate injury, and mild injury, respectively. Conclusion: Road traffic accidents involving young adult males constituted the predominant cause of injury in patients that had brain CT in UBTH. There is an urgent need for improvement in the condition of roads and enforcement of the use of protective devices by road users to curb the epidemic of head injury resulting from RTAs.

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Context: Biceps brachii muscle (BBm) is a very variable muscle, the variations being associated with a variety of clinical conditions. This study delves on anatomical variations in this muscle, possible phylogenic causes for their frequency and their clinical importance. Aims: The aim was to study anatomy of bicep brachii muscle, its variations and their clinical importance. Subjects and Methods: A total of 60 upper limbs preserved in 10% formalin were dissected meticulously to study anatomical details of the BBm. Results: The incidence of variation in anatomy of BBm was 15%, with incidence being 11.6% and 3.3% among male and female cadavers studied, respectively. Variation was unilateral in 10% and bilateral in 3.3%. The incidence of third head was 13.3% out of which 3.3% took origin from the capsule of the shoulder joint, 8.3% from humerus, and 1.6% from brachialis muscle. Incidence of extra bellies of insertion was found to be 1.6%. A 3.3% incidence was observed in the nerve supply. Conclusions: Variations in BBm are a reflection of its late development in human phylum. The extra bellies can cause neurovascular compression, change the kinematics at the elbow joint and be misinterpreted as tears of muscle on magnetic resonance imaging. They should be watched for in the shoulder as well as elbow joint surgeries. The authors suggest that the extra bellies of BBm instead of being labeled as third, fourth or fifth heads, can be classified as those of origin and insertion and bellies of origin be referred to clearly as capsular, humeral or brachial heads.

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Biliary and nonbiliary disorders are responsible for postcholecystectomy syndrome (PCS). The most common cause of late PCS of biliopancreatic origin is calculi in the common bile duct or the cystic duct remnant. Intra-hepatic calculi causing PCS is very uncommon. We present a case of late PCS caused by intrahepatic calculi in the left intra-hepatic biliary radicles and left hepatic duct causing obstruction of the left ductal system. Endoscopic retrograde cholangiopancreaticography did not show any stricture in the ductal system. Sphincterotomy followed by stenting of the left hepatic duct was performed to relieve the obstruction.

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