Bedside teaching remains the most effective way of imparting competency in clinical skills in undergraduate medical education but there has been a noticeable decline in the practice of bedside teaching worldwide. This paper aims to emphasise the importance of bedside teaching, highlights the possible barriers to effective bedside teaching and equip medical teachers with the effective ways of achieving the intended goals of bedside teaching by emphasising the techniques recommended by experts in the field of medical education. Developed countries have employed the use of clinical skill centres to cushion the effect of the decline in bedside teaching, but in resource-limited countries it remains the only viable option. The advantages of bedside teaching include; learning in context, impartation of clinical skills, nurturing and development of clinical reasoning. In addition, bedside teaching provides opportunity for role modelling, professional thinking, observation of communication skills, team work and integration of communication skills, clinical skills and ethical issues in the process of patient care. Several hindrances to effective bedside teaching have been identified. These include a large student: teacher ratio, crowded lectures, improper use of logbooks, lack of preparedness and interest, increasing administrative and research works among medical teachers. The strategies recommended by experts can be categorised into three; based on the timing as; before, during and after bedside teaching. These emphasise the need for adequate preparation, setting of clear objectives before teaching, active participation, gentle correction during teaching, feedback and discussion of sensitive issues away from the patient.

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Background: The incidence of breast cancer is increasing and the presentation is often late in our environment with poor prognosis. Breast self-examination (BSE) remains an important diagnostic tool for the early detection of breast cancer in a resource-limited community. Nurses being in closer contact with patients should be in the forefront in educating the general public on BSE. Objectives: This study investigates the knowledge, attitude and practice of BSE among female nurses in Aminu Kano Teaching Hospital (AKTH) with regard to the number that practice, method and the frequency of BSE. Materials and Methods: The study is a descriptive cross-sectional study of female nurses employed in AKTH using self-administered questionnaire. Respondents were selected by simple random sampling methods from the register of nursing staff at AKTH. The data collected were on socio-demographic profile, knowledge, attitude and practice of BSE. The relationships between these factors were studied. Results: All the nurses studied are aware about BSE, with 91.2% practicing it. There is appallingly poor knowledge of its timing, frequency and method. Only 45 (41.2%) of the respondents practice BSE monthly, and none of the respondents can accurately describe the exact method of BSE. Conclusion: There is universal awareness of the BSE among nurses, with dismal awareness of its purpose, method, timing, and frequency among the female nursing staff studied. However, there is a lot of enthusiasm to encourage others to do it. Therefore, nurses need to be also further trained and educated about the procedure.

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Background/Aim: Low birth weight (LBW) is associated with a higher risk of mortality and long term consequences for the survivors. This study determines the incidence and risk factors for LBW babies in Maiduguri. Context/Setting: This study was done in the Departments of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital and the State Specialist Hospital, Maiduguri. Materials and Methods: This was a prospective study involving 854 pregnant women and their babies between 2 ^nd February 2009 and 29 ^th July 2009. Socio-demographic, obstetric, medical factors, obstetrics interventions and foetal birth weights were obtained and recorded. Association between variables were examined using student's t-test and Chi-squared test and multivariate logistic regression analysis a P < 0.05 was considered significant. Results: The incidence of LBW was 16.9%. The risk factors for LBW were non-use of haematinics index pregnancy (OR = 13.04; 95% CI = 12-36; P value 0.000); previous history of stillbirth (OR = 8.11; 95% CI = 6-19; P value 0.000); hypertensive disorders of pregnancy (OR = 6.12; 95% CI = 5-14; P value 0.000); ante-partum haemorrhage (OR = 5.85; 95% CI = 4-9; P value 0.000); less than 4 ANC visitsn (OR = 4.94; 95% CI = 3-12; P value 0.000); previous history of premature delivery (OR = 4.39; 95% CI = 4-11; P value 0.000); previous history of LBW (OR = 3.65; 95% CI = 2-21; P value 0.000) and non-use of intermittent preventive therapy in the index pregnancy (OR = 3.24; 95% CI = 1-16; P value 0.001); and teenage mother (OR = 2.75; 95% CI = 2-27; P value 0.006). Conclusion: This study showed high incidence of LBW. Obstetric factors (problems and intervention of the current pregnancy) and previous obstetric performances played crucial role in the occurrence of LBW in our study. Qualitative antenatal care should be made available and provided to pregnant women at all levels of care.

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Background: Hypertension is the greatest preventable cause of death one of the most important modifiable risk factors for cardiovascular diseases. There is paucity of studies on the relationship between obesity and hypertension in northern Nigeria. Objective: To determine the prevalence of hypertension and its relationship with indices of obesity in Maiduguri, northeastern Nigeria. Materials and Methods: We recruited 1700 consenting adults aged 15-70 years using a multistage random sampling technique. Data on socio-demographic characteristics were obtained using a pretested questionnaire. Physical measurements for anthropometric indices and blood pressure (BP) were carried out using standard procedures. Hypertension was defined as systolic BP ≥ 140mmHg and/or diastolic BP ≥ 90mmHg. Multiple logistic regressions were fitted and odds ratios with 95% confidence intervals were calculated to identify associated factors. Results: Of the 1700 subjects recruited, 1650 responde, d yielding a response rate of 97%. The overall prevalence of hypertension was 32.3%, with a higher prevalence among women than men (46.1% vs. 34.5%, P < 0.05). Obesity was found in 15.9% of the study subjects. The prevalence of obesity was higher among women (20.7%) than men (13.6%). All the obesity indices correlated significantly with both SBP and DBP. Age ≥ 40 years, BMI and waist circumference in men were significantly associated with hypertension. Conclusion: The prevalence of hypertension in our study is high, particularly among women. Increasing age (>40 years), BMI and WC were found to be independently associated with hypertension. There is need for further studies to determine the role of lifestyle modification in reducing the burden of hypertension in our environment.

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Background: Of all the direct influences on fertility, contraceptive use is the single most important factor for reproductive health policy makers and program managers. Increase in its use accounted for the largest proportion of fertility decline worldwide including the sub-Saharan region. Objective: To determine the trends of contraceptive use and the preferred method of contraception among the clients visiting the family planning clinic of Aminu Kano Teaching Hospital, Kano. Study Design: This is a retrospective descriptive study, involving all acceptors of contraceptive methods from January 1999 and December 2008 in the family planning unit of Aminu Kano Teaching Hospital Kano, Nigeria. Results: A total of 35,792 clients booked for antenatal care at Aminu Kano Teaching Hospital over the study period. Acceptors of contraceptive methods were 11,346 clients, giving contraceptive prevalence of 31.6%. The acceptors of modern contraceptive methods increased steadily from a total of 1009 in the year 1999/2000 to 3014 the year 2007/2008. Approximately 65% of the clients used the Injectables; implant was the least used, by 2% of the clients. Female sterilization contributed about 3.4%, intrauterine contraceptive device (CUT 380A) 16.6%, male condom 2.8%, and oral contraceptive pills 10.4%. There was a significant increase in the trend of use of modern hormonal contraceptive methods as compared to the non hormonal methods. χ^2trend = 87.21, P = 0.00000. No man had vasectomy over the 10-year period. Conclusion: There is an increase in the trend of contraceptive use over the study period. Injectable contraceptives are the most commonly used method in this study.

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Background/Objectives: Job satisfaction is the positive emotional state that results from the appraisal of one's job or job experience. Lack of good leadership in healthcare is responsible for employee dissatisfaction and turnover. This study was undertaken to assess the levels of job satisfaction and its association with leadership styles among the nurses in Aminu Kano Teaching Hospital (AKTH); and to compare the levels of job satisfaction between senior and junior nurses. Context/Setting: This study was done at AKTH, Kano, Nigeria. Materials and Methods: This was a cross-sectional study. Ethical clearance and informed consent were obtained. A total of 350 participants responded on a 5-point Likert scale to questions related to their work experiences. The data was analysed using Statistical Package for the Social Sciences (SPSS version 16.0) software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using the summarizing indices as appropriate. Statistical significance of differences between means was determined using analysis of variance. Significant associations between the measured variables were tested using Chi-square test for qualitative variable and Pearson's coefficient of correlation for quantitative variables. Statistical significance was considered at P < 0.05. Result: The mean ages were 30.26 ± 4.76 and 40.19 ± 5.61 years for junior and senior nurses, respectively. Most of the junior and senior nurses were satisfied with their jobs (87.5% and 92.3% respectively); but the senior nurses were more satisfied compared with their juniors ( P = 0.031). Democratic leadership styles showed significant association with job satisfaction. Conclusion: There are high levels of job satisfaction among nurses in AKTH and this is associated with leadership styles.

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Background: Tuberculosis (TB) has been a major cause of morbidity and mortality in Nigeria and Sub-Saharan Africa. The burden of the disease has increased with the high prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in Nigeria and Africa in general. The resultant effect has worsened the prognosis of tuberculosis treatment. This study aimed to determine the prevalence of TB-HIV co-infection relative to other cities/countries and compare the outcome of TB treatment among HIV-infected and non-infected patients in Abuja, Nigeria. Materials and Methods: Hospital records of TB patients registered for treatment in 39 health facilities in Federal Capital Territory (FCT)-Abuja were reviewed. Treatment records were selected through multi-stage sampling. Treatment outcome of patients-completion of treatment, death, treatment failure, default in treatment or transferred out-with and without HIV co-infection were compared. Results: Two hundred and forty-five (49%) of 501 adult TB patients were co-infected with HIV. Among HIV co-infected patients, 156 (64%) completed treatment, 12 (4.9%) died, 1 (0.4%) failed treatment, 41 (17%) defaulted, 30 (12%) were transferred out and 5 (0.02%) had an unknown outcome. Among the 256 HIV-negative patients, 172 (71%) completed treatment, 3 (1.2%) died, none failed treatment, 36 (15%) defaulted, 24 (10%) were transferred out and 6 (0.02%) had an unknown outcome. Conclusion Abuja has one of the highest proportions of TB-HIV co-infection rates in Sub-Saharan Africa. The outcome of patients with TB co-infected with HIV was less successful than among HIV-negative patients, with statistically significant higher mortality.

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Context: Cigarette smoke had been implicated in the aetiopathogenesis of certain features seen in children. Aims: The study is aimed at assessing the effects of high doses and long-term exposure to cigarette smoke (CSE) on the memory. Settings and Design: The study involved exposed and non-exposed rats. Materials and Methods: The rats were assigned into groups A, B, C and D respectively. Each group had 5 rats. Groups A was exposed to smoke in utero only and group C from 2 to 5 months of age. Groups B and D served as the controls, respectively. Exposures to cigarette smoke was monitored at 200 PPM of carbon monoxide. Assessment of memory was done by comparing two reference time records separated by 10 minutes, obtained from the water maze task for each rat just after the entire period of exposure to cigarette smoke. Statistical Analysis Used: A paired t-test was used to assess the differences using statistical package for the social sciences software (SPSS version 15). Results: The actual reference time records revealed a statistically significant difference between the initial and final water maze task time records. All the exposed 5-month-old rats showed the lowest repeat time records and also more predictability in their repeat time records. Conclusions: Regardless of the age at the onset and duration of exposure to cigarette smoke, all the rats were able to attain memory for the first session of water task. The 5 months of exposed rat attained more memory. Hence, long-term CSE was beneficial to memory attainment.

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Introduction: Tuberculosis (TB) is a serious public health problem associated with high morbidity and mortality. BCG vaccination as part of TB prevention strategy is faced with many challenges. The study sought to determine post BCG vaccination scarring and tuberculin reactivity, which may serve as useful indicators of routine BCG vaccination in infants. Materials and Methods: The study was descriptive cross-sectional. Infants were selected and physically examined for presence and size of BCG scar. Mantoux test was performed. Data were analyzed using statistical package for the social sciences software (SPSS version 16.0). Chi-square and Fisher's exact tests were used for association between categorical variables while Pearson's correlation co-efficient was used for the correlation between BCG scar size and Mantoux reaction. P ≤ 0.05 was considered significant. Results: The male:female ratio of the subjects was 1.6:1.0 with a mean birth weight of 3.2 ± 0.4kg.Mean age at Mantoux test was 19.0 ± 3.0 weeks and the prevalence of BCG scar was 81.5% with a mean scar size of 5.3 ± 3.2mm. Mantoux test was positive in 202 (56.7%), negative in 133 (37.4%), and indeterminate in 21 (5.9%) infants. The Mantoux reaction was significantly associated with the age interval between BCG administration and time of Mantoux test (χ² = 54.17, P < 0.05), the infants' gender (χ² = 31.23, P < 0.05) and their nutritional status (χ² = 22.60, P < 0.05). The reaction was not significantly associated with the social class of the infants' parents. Conclusion: The study demonstrated high prevalence of BCG scar and high Tuberculin skin test reaction. Regular evaluation of BCG vaccination is recommended using TST and scar observation as adjuncts to strengthen BCG vaccination processes for effective tuberculosis prevention.

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Background: Head injuries are a leading cause of death and morbidity among motorcycle users. Objectives: To determine the pattern, severity and outcome of motorcyclists' head injury presenting to our facility over 12 months. Materials and Methods: We prospectively studied 104 consecutive head injured motorcyclists using a predesigned questionnaire. Results: Seventy per cent of our patients were young adult males. Motorcycle versus other vehicle collision (49%) was the commonest mechanism of injury followed by lone cycle crash (26.0%). Only six motorcyclists, who were all riders (5.8%), wore crash helmet at the time of the crash. Brain contusions (33.3%) and intra-cerebral haematomas (26.7%) were the leading intracranial lesions. Seventy-eight percent of the patients suffered associated injuries, including face (63%) and extremities (24%). Mortality rate from lone crash was 37%, followed closely by motorcycle-vehicular collision. Conclusion: Outcome of head injury was significantly predictable by the nature of intracranial pathology and injury severity score (P = 0.000), being more favourable in younger age group, patients with normal brain computed tomography (CT) scan and those with extra-dural haematoma. Outcome was less favourable in patients with severe head injury, acute subdural haematoma and multiple intracranial haematomas.

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Background: The quality of care assessment is important to improve performance. The aim of this study is to assess the quality of trauma care in Aminu Kano Teaching Hospital, through the mortality methodology and analyze the failures of care. Materials and Methods: All patients above 18 years that died from trauma from 1 ^st January 2012 to 31 ^st December 2012 in the accident and emergency unit of AKTH were studied. Bio-demographic data, cause of injury, mode of presentation, time interval between injury and death and probable causes of death were recorded. A panel of surgeons reviewed these and failures of care were analyzed and categorised. Results: Out of 63 mortalities in the unit, only 58 (92%) had complete data for inclusion in the study. Forty-seven (81%) were from road traffic accident, six (10%) were gunshot wounds, four (7%) were fall and one from assault. Their age ranged from 18 to 76 with a mean of 31.9 years. There were 49 males and 9 females. Thirty (52%) were head injured, three mortalities (5%) had extremity injury, one each had abdominal and spinal injuries while 23 (40%) were multiply injured. Forty-nine (85%) patients had clearly identified failures of care. Seventeen of the head injuries were awaiting transfer to Intensive Care Unit (ICU) before death and 13 had airway problems at presentation. Of the non-Central Nervous System mortalities, six were fluid resuscitation and haemorrhagic shock, two had missed injuries, eight were from sepsis two of which were poorly controlled diabetics and two patients died from tetanus. Conclusion: There is high rate of failures of care directly contributing to the trauma mortality, mostly in head injuries. We recommend increased capacity of the ICU and involvement of anaesthetist in major trauma resuscitation for airway management to reduce the mortalities.

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Introduction: The preference of medical specialties by medical graduates may play a role in determining the pattern of the future workforce in the healthcare system. This was a longitudinal study over a 10-year period (2004-14) to determine what progress the graduates have made regarding their specialty choices at the graduation level. Materials and Methods: Structured self-administered questionnaires were administered to 40 final year medical students to determine their preferences for medical specialisation at graduation in 2004. Follow-up interviews were conducted after a10-year period (in 2014) to determine to what extent they were able to realise their objectives. Results: Out of the 40 medical students involved in this study, 24 were males (60%) and 16 were females (40%). Their mean age at graduation level was 27.3 ± 1.97 years. There was a high preference for Obstetrics and Gynaecology (O and G) and Paediatrics at graduation. At 10 yearspost graduation, 5 students had reached the level of Consultants, 20 were at the level of Senior Registrars while 15 were at the level of Registrars and Medical officers. At 10 years post-graduation, there was a preference for Family Medicine, Internal Medicine, Radiology, and Community Medicine; despite the predominance of Paediatrics and O and G at graduation. Whenthe age at graduation of these students was compared with their current status, those at the rank of consultants showed a younger age at graduation level of 26.4 ± 0.55 years, compared with Senior Registrars (27.45 ± 1.54 years), and medical officers/others (27.60 ± 2.50 years). However, these differences were not of statistical significance [one-way analysis of variance (ANOVA) F = 0.778, P = 0.467]. Pursuing the preferred area of specialisation at the graduation (P = 0.04) was associated with more progress in post-graduate training. Conclusion: Specialty choices are determined by availability of training posts, with choice of specialty at the level of graduation, giving way to what is pragmatically available and feasible. However, pursuing preferred area of specialisation at graduation is associated with more progress in career. Furtherstudies are required to determine the contribution of other factors in determining career progress and sticking to preferred area of specialisation at graduation.

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