This is a review of the major publications from the Nigeria national blindness survey in order to highlight major findings and challenges of eye care in Nigeria. The review summarizes methodology and key findings. Survey publications on methodology, prevalence and causes of visual impairment and outcome of cataract surgery were retrieved, reviewed and relevant data extracted, reported and discussed. The study was the largest and more detailed eye survey in Nigeria (15,375 people 40 years and older recruited). Participants had detailed eye examination including visual acuity, autorefractokeratometry, A- scan biometry, visual field and basic eye examination. Cause(s) of visual impairment in each eye using WHO algorithm was determined among participants with vision < 6/12. Some of the participants also had qualitative questions on barriers to uptake of services, quality of life and visual function. Major highlights of the results as contained in the publications include a high prevalence of blindness with 4.2% (95% CI: 3.8-4.6%;),of the study population having blindness (using presenting vision (PVA)) even with best correction the prevalence was 3.4% (95% CI: 3.0-3.8%. The prevalence of SVI using PVA was 1.5% (95% CI: 1.3-1.7%).and with best correction 0.8% (95% CI: 0.7-1.0%). Blindness varied by age groups, sex, literacy level and geopolitical zone. Furthermore, 84% of blindness was due to avoidable causes with cataract responsible for 43% of blindness, glaucoma 16.7%, uncorrected aphakia 8.4% and corneal opacity 7.9%. Of the total 538 eyes that had cataract surgery procedures, 42.7% had couching and the remaining had cataract surgery, but only 41.4% of cataract operated eyes had IOL surgery. Outcome of cataract surgery was good at presentation for only 30.8% of eyes (84 eyes) which improved to 56.8% with correction. The possible remedy for the high burden of needless blindness and harmful eye health practices in Nigeria are discussed.

Background: Globally, the most common cause of cranio-facial fractures is road traffic accident (RTA) with computerized tomography (CT) scan as the gold standard in the diagnosis of patients with cranial and facial fractures. The purpose of this study is to assess the pattern of cranial and facial fractures on CT in head injured patients following RTA. Materials and Methods: Using CT, detailed analyses of 236 patients with head injury following RTA were performed between 2006 and 2008, Data recorded included cause of injury, age and gender distribution, cranial and mid-facial fractures sustained, associated intracranial and soft tissue injury and the types of vehicular accident. Results: The peak age of the patients was between 30 and 39 years. RTA was more common in males than females. Motor-vehicle was the most common cause of RTA in the present study (66.9%). More passengers were involved in the motor vehicle (87.3%) and motorcycle (52.0%) accidents than their corresponding drivers, and they were predominantly males. Majority of the patients involved in pedestrian road traffic accident (PRTA) were motor vehicle victims (93.3%). There were more patients with cranial (59.8%) than mid-facial fractures (40.2%). Majority of the patients had temporal bone cranial fracture (31.1%) and combined or mixed type of mid-facial fractures (41.3%). Intracranial bleeding (31.7%) was the most common associated intracranial finding. Conclusion: RTAs continue to be a menace and are the main cause of craniofacial injury in Nigeria. This pattern of etiologic factors is in accordance with data from most developing countries. Special attention should be paid to reinforcement of legislation and enactment of laws aimed at the reduction of head injury and provision for easy access to CT for the head injured patient.

Background: Food security is access at all times to adequate, safe and nutritious food for healthy and active life. In recent times food insecurity has been a global concern particularly in developing countries. Materials and Methods: A descriptive, cross-sectional study carried out among households selected by multi-stage sampling method in Egor Local Government Area. The Household Food Insecurity Access Scale (HFIAS) for measurement of food access was used to assess the household food security situation. Results: A total of 416 households were studied. The prevalence of food insecurity was 61.8%. Food insecurity was higher among households with younger heads (P = 0.159), female headed households (P = 0.114) and those with larger households (P = 0.228). Lower education status (P = 0.001) and lower household income (P = 0.001) were the significant factors affecting food insecurity. Conclusion: This study has revealed a very high level of food insecurity among these urban households. An urgent call to all stakeholders for strategies to improve this trend is needed.

Background: Surgical training involves acquisition of knowledge and skills. The district hospitals are known to play complementary role in surgical training in many parts of the world; it is time to evaluate for the possible role Federal Medical Centers (FMC) in Nigeria can play to complement the training of urologists. Against this background, we retrospectively reviewed the relative frequency of urologic procedures performed in one of the FMC as a case study. Materials and Methods: Hospital data were retrospectively reviewed from January 2007 to June 2010 and records of urologic procedures were extracted for analysis. The total numbers of operations done within same period were also recorded. Result: Urological procedures formed 24.6% of the surgical operation in the hospital during the study period. Uncomplicated prepuce, bladder outflow obstruction, uro-oncology and congenital urological lesion topped the list and accounted for 31.3%, 22.7%, 11.9%, and 11.0% of the cases, respectively. The most frequently performed urological operation in the center was circumcision. Nephrectomy, ureteroneocystostomy, pyeloplasty, cystectomy, and urinary diversion were other procedures performed. Conclusion: The varieties and volume of urologic cases recorded in this centre is comparable with those documented in other established training institutions and thus, it is recommended that the trainees should find time to visit some of these centers and acquaint themselves with hands-on surgical exposure.

Background/Objective: Deaf persons are equally susceptible to other otologic diseases as the rest of the population; however, there may be increased morbidity among the deaf population. The aim of the study is to determine common otologic problems and their prevalence among the deaf and to offer treatment where appropriate. Materials and Methods: Six hundred and twenty students aged between 5 and 38 years with profound hearing loss were recruited from a special school for the deaf. Hearing level was assessed and full ENT examination including otoscopy was done. Results: 22.4% [139] of the deaf students had otologic diseases, with 69.1% of them having wax impaction and chronic suppurative otitis media and otitis media with effusion accounting for 21.6 and 7.2% respectively. Conclusion: The study showed that wax impaction is a common problem and this can be quite uncomfortable for some of the students. A routine general and otologic screening program targeted at the deaf and deaf-blind is recommended.

Background/Purpose: This study compared the degree of patients' satisfaction with cataract surgical services at a private, semi urban secondary eye care hospital - St Mary's Catholic Eye Hospital, Ago Iwoye, (SMEH) and a public tertiary hospital-University College Hospital Ibadan (UCH) in South Western Nigeria. Materials and Methods: A prospective, observational study of consecutive patients undergoing cataract surgery at SMEH and UCH was conducted between May and October 2007. Questionnaires were administered to a total of 366 patients preoperatively, 1 ^st day and 8 ^th week postoperatively. Results were analyzed using the SPSS statistical software. Results: Evaluation of patients' satisfaction with preoperative care showed that patients were more satisfied with the pre-consultation time (P=0.006) and cost of surgery (P<0.001) at SMEH than in UCH. There was no statistically significant difference with respect to satisfaction of patients with vision in both hospitals (P=0.09). More patients were satisfied with overall care at SMEH than UCH and were therefore more likely to recommend the hospital. Conclusion: This study compared patients' satisfaction with cataract surgical services in two hospitals. Patients from the private secondary eye care hospital were more satisfied than patients from the public tertiary hospital. Satisfied patients have a great role to play in increasing cataract surgical uptake.

Background: Insecticide-treated bed net (ITN) is currently distributed free of charge to vulnerable groups in Nigeria, for malaria control. Consistent use of the nets is required for maximum effectiveness; but studies indicate that the nets are often jettisoned in periods of low mosquito activity and high night time temperature. The objective of this study has been to assess the use of mass distributed nets in a semi-urban community in Rivers State, south-south Nigeria, during the late dry season, when mosquito activity is at the lowest in the community. Materials and Methods: The study was carried out in Ishiodu - Emohua, using a cross-sectional study design. The data was collected using a structured, interviewer-administered questionnaire, administered to female head of households in the community, with under-five children. Results: A total of 170 respondents were studied; they had an average age of 34.3 ± 7.6 years, most were married (86.5%), and had secondary school education (68.2%). All the households owned at least one ITN, and an average of 1.7 nets, with 75.3% of the households owning two or more ITNs. Almost all the nets (99.4%) were obtained free of charge. Of the 170 households that received the nets, 71.8% had hanged the nets as at the time of the survey; 83.6% of these hanged the nets over a bed, while 10.7% used the nets as window curtain. Of the 102 ITNs that were properly deployed, only 27.5% were occupied the night before the survey, by an average of 2.5 persons, mainly under-five children (37.7%). Conclusion: The distribution of free ITNs has resulted in universal household ownership, but the use of the nets is still very poor. Proper health education is required to encourage the consistent use of the nets, even in hot night, with low mosquito activity.

Background: Compared to the developed world, there are relatively few studies that describe the tumor biology of breast cancer in African women. While little is known about the tumor biology, clinical and epidemiologic studies suggest that breast cancer in African women are characterized by presentation at late stage and poor clinical outcomes. Analysis of the biological features of breast cancers in Nigerian women was designed to bring additional insight to better understand the spectrum of disease, the phenotypes that present, and the types of interventions that might improve outcomes. Materials and Methods: We performed histological analyses for hormone receptors (estrogen and progesterone receptors), HER2, and tumor infiltrating macrophages (TAM) on 17 breast cancers, obtained from Abia State University Teaching Hospital (Aba, Nigeria), between November 2008 and October 2009. On a subset of these cases, we investigated the potential role of a virus in the etiology of these aggressive cancers. Results: The majority of cases in this cohort were characterized as high grade (100% were grade III), triple-negative (65%), and occur in young women (mean age 47 years). We observed high infiltration of TAMs in these tumors, but no evidence of a viral etiology. Conclusion : Our findings indicate that breast cancers in Nigerian women have a highly aggressive phenotype (high grade, hormone receptor negative), which is similar to other studies from Africa and other developing nations, as well as from African American women, but is significantly different from Caucasian women in the developed world. The presence of high numbers of TAMs in these tumors raises the possibility of targeting the immune microenvironment for therapeutic interventions.

There is an increase in the incidence of abdominal aortic aneurysm (AAA) over the last six decades, probably as a result of higher longevity and lifestyle changes witnessed in the years following World War II. Though earlier studies mainly from Southern Africa suggest abdominal aortic aneurysms as uncommon amongst black Africans, recent reports from Africa emphasized an increasing incidence of vascular diseases and its sequelae including AAA. There are, however, few documented case reports of AAA in our environment over the years suggesting the rarity of this disease. We report the management and outcome of three different types of infrarenal AAA with synthetic graft in a General Surgery Unit over a four-year period between 2001 and 2005. Follow-up evaluation confirmed a successful outcome in two patients. Abdominal aortic aneurysms may be occurring more frequently than reported in our environment and its management, using basic evaluation techniques, can be successfully achieved with reasonable outcome when performed in a non-specialized unit by General Surgeons in institutions with limited resources. Contrary to the popularly held view of rarity of AAA, the disease may be increasing in incidence amongst black African. Its evaluation and treatment is also feasible with the availability of reconstructive graft in a non-specialized surgical unit.

Spontaneous bone regeneration is an uncommon condition following traumatic or iatrogenic bone loss. The factors responsible for its occurrence are yet to be fully elucidated. This report presents spontaneous bone regeneration following mandibular resection for a giant odontogenic myxoma in a 16-years-old Nigerian male. New bone formation was observed at the postoperative fourth week and has continued for one year after. Likely factors that favor this occurrence are critically examined. The advantages of spontaneous bone regeneration in resource-poor settings include low biologic and economic costs as compared to bone grafting.

Urethral duplication is a rare congenital genitourinary abnormality. The purpose of this report is to add to the scanty literature on the subject. We emphasize the significance of high index of suspicion, thorough evaluation, and to discourage circumcision performed by unqualified individuals. A six year old with a finding of urethral duplication is presented along with the review of the literature.The patient presented with of passage of urine from 2 orifices on the penis following circumcision, six months prior presentation. He voids with double streams - clear urine and the other haematuria. Examination revealed a normal primary urethral meatus and an accessory opening on the corona of the dorsal surface of the phallus. No other abnormality detected. Patient had single stage urethroplasty with good outcome. Urethral duplication is rare. Diagnosis requires a high index of suspicion. Optimal knowledge of the duplication is significant for the managing surgeon in order to avoid complications. The overall outcome is good.