The way a country finances its health care system is a key determinant of the health of its citizenry. Selection of an adequate and efficient method(s) of financing in addition to organizational delivery structure for health services is essential if a country is set to achieve its national health objective of providing health for all. Health care in Nigeria is financed by tax revenue, out-of-pocket payments, donor funding, and health insurance (social and community). However, achieving successful health care financing system continues to be a challenge in Nigeria. This article examines the different financing mechanisms that have been used in Nigeria, including the National Primary Health Care Development Fund proposed for increasing the resource allocation to primary health care. It draws on available and relevant literature to provide an overview and the state of public health care financing in Nigeria. This article concludes by recommending the need for Nigeria to explore and strengthen other mechanisms of health system and shift focus from out-of-pocket payments, address the issues that have undermined public health care financing in Nigeria, improve on evidence-based planning, and prompt implementation of the National Health Bill when signed into law.

Lymphadenopathy (LAP) is a common clinical finding that may be localized, limited or generalized. The enlargement of a lymph node, due to primary disease or secondary cause, is of concern to both patients and clinicians, particularly, if the underlying pathology is a malignant disease. Lymph node aspiration or biopsy for histopathological evaluation may not reveal the diagnosis due to several factors. However, a methodological approach to LAP can disclose the accurate diagnosis with minimal discomfort to the patient and in a short time. In this review article, we provide evidence-based clinical evaluation of LAP, guided by the probability of the underlying disease to assist clinicians in establishing the proper cause and hence offer appropriate management.

Background : Our patients who required surgery for adhesive small bowel obstruction (ASBO) were noticed to have a peculiar association. This link was the type of surgery they had originally, operations in the pelvis or those in which the scars were below the umbilicus. These patients did not improve on conservative management. This study was then undertaken to investigate this trend and to recommend primary surgery for these group of patients, terming them as low ASBO for the purpose of the study. Aims : (1) To show that majority of patients with low adhesive bowel obstruction do not get better on conservative management. (2) To propose surgical operation as the primary management strategy of patients with low adhesive bowel obstruction. Settings and Design : The study is set in the gastrointestinal surgery unit of the University College Hospital (UCH) Ibadan. The hospital is located in Ibadan, the most populous city in West Africa with a population of roughly 2.5 million inhabitants. The UCH Ibadan handles more than 90% of all surgical cases in Ibadan. Materials and Methods : This is a retrospective descriptive study from April 2003 to February 2010 conducted on patients who were admitted on the service of the gastrointestinal surgery unit of the UCH Ibadan, Nigeria, with a diagnosis of ASBO and had surgery for relief of the condition. Admission records, operations registers, and patients' case files were used in sourcing the data. Demographic indices such as age, sex, and type of previous operation were taken into account. Statistical Analysis : Stata 11.0 statistical software was used. Results : There were 4 male and 17 female patients giving a male: female ratio of roughly 1:4. Their ages ranged from 23 to 60 years. The global mean age was 40 years. The mean age for males was 31.5 years while for the female patients it was 42 years. Previous surgical operations showed that gynecological operations were in the majority (62%), followed by appendicectomy (24%) and colorectal surgery made up the rest (14%). Statistically, female sex, gynecological operations, and Lanz incisions for appendicectomy increase the chances of having surgery to relieve ASBO. Conclusions : We propose primary surgical treatment for low ASBO, especially those from gynecological operations and appendicectomy. Conservative management should be reserved as the initial treatment of non-low-level ASBO until other features prove otherwise.

Background: Constipation is a common symptom in children and manometery can be a useful diagnostic method in choosing suitable therapeutic methods for these patients. Aim: The aim of this study was to assess the manometeric findings and determine its role in the management of children with constipation referred to our hospital. Setting and Design: This was a descriptive cross-sectional study. Materials and Methods : It was carried out on patients referred from September 2006 to December 2009 to the children hospital for performance of anorectal manometery because of constipation. They received their treatment according to findings at manometry (normal, absent, dilated, and retentive) with Botolinium toxin (BT) injection, surgery, enema, and medications, respectively. For each patient, variables such as age, sex, chief complaint, manometry result, food regimen, and treatment method were recorded. Symptom severity scale was assessed using a scored questionnaire. Statistical Analysis: Data were analyzed using SPSS 17 and descriptive statistics, t-test, and χ² . Results: Seventy-one patients were included in our study. The mean age of the participants was 4.98 ΁ 1.43. Sixteen (22.5%) had acute and 55 (77.5%) had chronic constipation. Seventeen (25.4%) had a diagnosis of Hirschsprung's disease and 22 patients (31%) had retentive type constipation. Nineteen patients (28.8%) received pull through treatment and 27 (38%) received BT, while 34 (47.9%) received medical treatment. Mean symptom severity score after treatment was 3.88 and 4.59 in males and females, respectively. This difference was statistically significant (P = 0.03). There was no statistically significant difference after treatment according to other variables. Conclusions : In summary, our study results were comparable with studies that reported an effective role for manometry in diagnosis and planning the type of treatment in constipated children. and is a useful physiologic tool for measuring anorectal complex function.

Background: Scabies is a common parasitic infestation of global proportion. It is a highly contagious skin disease which affects both males and females of all socioeconomic status and race. It is related primarily to poverty and overcrowding, which is also found in most rural communities. This study aimed at assessing the prevalence of scabies among school-aged children in Katanga community. Materials and Methods: In a descriptive cross-sectional study, pre-tested semi-structured questionnaire was administered to 206 school children aged 5-12 years through a total population study in Katanga rural community. Data collected were analyzed using SPSS version 17. Results: In this study, 45 (21.8%) children had skin infections, 33 (73.3%) of these skin infections were associated with itching and 6 cases of scabies were found giving a prevalence rate of 2.9% in the community. Conclusion: This study has shown that scabies is a disease associated with poverty, overcrowding, and sometimes water shortage, and is still endemic in rural communities in Northern Nigeria causing a substantial burden. These findings, coupled with the potential for clinical complications and a heavy socioeconomic impact, suggest that it is time for more concerted actions in terms of provision of adequate domestic water supply and improvement of personal and environmental hygiene against this disease in Nigeria.

Background: Anemia in pregnancy accounts for one fifth of maternal deaths worldwide and is a major factor responsible for low birth weight. In India, 16% of maternal deaths are attributed to anemia. The association between anemia and adverse pregnancy outcome, higher incidence of preterm and low-birth weight deliveries have been demonstrated. However, high prevalence of anemia among pregnant women persists in India despite the availability of effective, low-cost interventions for prevention and treatment. A knowledge of the sociodemographic factors associated with anemia will help to formulate multipronged strategies to attack this important public health problem in pregnancy. Aim: To study the prevalence of anemia and the various sociodemographic factors associated with anemia among pregnant women at an urban health center in Aurangabad city, India. Setting: Urban Health Center (UHC) of Government Medical College, Aurangabad, India. Study Design: Descriptive cross-sectional study. Materials and Methods: The study was carried out from August 2006 to July 2008. A total of 352 pregnant women were selected using a systematic random sampling technique. The participants were included only after confirmation of the pregnancy. Statistical Analysis: Chi-square test, Chi-square test for trend. Results: Overall prevalence of anemia among the pregnant women was found to be 87.21%. Factors such as religion, level of education of women and their husbands and socioeconomic status were found to be significantly associated with the prevalence of anemia in pregnancy ( P < 0.05). Conclusion: Low socioeconomic class, illiteracy, Hindu religion were significantly associated with high prevalence of anemia during pregnancy in Indian women.

Aim: To study the clinical spectrum of patients with Glanzmann's Thrombasthenia (GT) in a tertiary care hospital in South India and to correlate the clinical & laboratory parameters of GT. Materials and Methods: This study includes 15 patients who were diagnosed as GT by characteristic clinical features, basic lab parameters (prolonged bleeding time, abnormal clot retraction and absence of platelet clumps on direct smear) and platelet aggregometry. Results: 66.6% of our patients were below 10 years of age. The common forms of bleeding in our patients was epistaxis,gum bleeding and prolonged bleeding from trauma site which was seen in >50% of our patients.The significant findings on routine laboratory testing was a prolonged bleeding time (93.33%) and an abnormal clot retraction test (66.6%). Platelet aggregation studies showed decreased aggregation with ADP, Collagen and Epinephrine in 100% of our patients whereas 50% also showed decreased aggregation with Ristocetin.Hence most of the patients in this study presented with the classical symptoms and laboratory findings of GT however some had unusual findings. Conclusion: The prevelance of GT is higher in southern India due to increased incidence of consanguineous marriages in this area.Though basic hemostatic screening tests and platelet aggregometry are sufficient to establish the diagnosis in majority of the patients,however some may require more sophisticated tests like flowcytometry for glycoprotein (GP) IIb-IIIa.

Multicystic peritoneal mesothelioma is an unusual mesothelial lesion that deserves separate consideration because of its characteristic histologic picture and its benign behavior. In the past, this lesion was often confused with cystic lymphangioma, mesenteric lymphatic cyst, diffuse mesothelioma, and disseminated form of mucin-producing adenocarcinoma. Diagnostic accuracy and long-term follow-up are needed due to high incidence of recurrence. We report a rare case of huge multicystic peritoneal mesothelioma in a 36-year-old woman. At follow-up 18 months after surgery, the patient remained asymptomatic with no further growth.

Multicystic dysplastic kidney is a nongenetic, congenital, cystic renal disease in which the renal cortex is replaced by numerous cysts of multiple sizes. The most common clinical presentation of unilateral renal dysplasia is abdominal lump in a new born infant who is otherwise healthy. Unilateral renal dysplasia is compatible with life. In adults, it is either diagnosed incidentally, can be an autopsy finding, or very rarely is symptomatic. Presented here is an unusual clinical presentation of unilateral renal dysplasia in a 30-year-old woman who presented with acute severe right lumbar and iliac fossa pain. Ultrasound and computerized tomography scans of the abdomen revealed absent right kidney with compensatory hypertrophy of the left kidney. As symptoms did not settle with standard conservative line of treatment, cystoscopy with retrograde pyelography was performed for evaluation of microscopic hematuria. A diagnosis of dysplastic kidney was made; exploratory laparotomy with right nephroureterectomy was performed. Patient had a smooth postoperative course. Histopathology confirmed renal dysplasia with pyelonephritis.

Filariasis is one of the parasitic diseases endemic in India, manifesting as acute, chronic or asymptomatic disease. Wuchereria bancrofti accounts for 90% of cases. Microfilaria in fine-needle aspiration cytology is not a common finding. It has been occasionally detected in association with neoplasms. Coexistence with metastatic deposits is even rarer on cytology. We found it incidentally in metastasis to cervical lymph node from squamous cell carcinoma growing in the middle third of the esophagus on fine-needle aspiration (FNA). This patient presented with left-sided neck swelling for 2 months and complete hemogram and peripheral blood smear were normal. We report this case for the rarity of pathology.

Surgery (ECCE+ PCIOL) is an unusual possible aetiology of Mooren's corneal ulceration. A clinical and laboratory evaluation of a case of a 60-year-old male Nigerian who in the immediate postoperative period developed Mooren's corneal ulceration after an uneventful extracapsular cataract extraction and a posterior chamber intraocular lens (ECCE+PCIOL) implantation at an outreach center is presented. Healing occurred within 2 weeks of medical and surgical intervention, but no remarkable visual improvement. A review of literature from relevant sources with emphasis on management options is also incorporated. Many cases of Mooren's corneal ulceration remain refractory to treatment even in advanced countries. However, early case finding and prompt referral by trained primary eye care personnel may help to reduce severe visual morbidity in this environment.