Background: The quality of drinking water is an important environmental determinant of health. Widespread production and consumption of inadequately processed or contaminated packaged drinking water can lead to waterborne disease outbreaks. To safeguard public health, it is important that available packaged water is duly registered and regularly analysed. Aim: This study was carried out to determine the bacteriological quality of ten selected brands of sachet water produced and sold in Samaru Zaria metropolis. Materials and Methods: From the brands of sachet water being sold in samaru, ten most popular brands were identified and selected based on patronage by consumers and distributors. A total of 20 samples, two from each of the ten brands of sachet water were bought from water vendors every fortnight for 1 month (may - june 2013). Results: The total coliform count ranged from 2-18+/100 ml. Isolates were identified to be Klebsiella spp., 0[40%] Proteus spp., [30%] Pseudomonas spp. [20%] and Chromobacterium violaceum [10%]. All were negative for thermotolerant coliforms, Salmonella, Shigella and Vibrio cholera. Conclusion: The results of this study showed contamination with micro-organisms found naturally in water, soil or vegetation which indicates a problem with the overall quality of water production but showed no contamination with sewage or animal waste. Microbiological assessment of drinking water quality should be done periodically with the regulatory body National agency for food and drug administration and control (NAFDAC) ensuring good quality assurance and maintenance of internationally defined drinking water standards.

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Context: Cervical cancer is the leading cause of cancer related deaths among women in developing countries. Lack of awareness and comprehensive cervical cancer screening programmes offered in most developing countries are partly responsible for the high burden of disease. In developed countries, routine use of Papanicoloau smear, in part, has led to a decline in cervical cancer incidence and mortality. Objective: To determine the level of awareness, utilisation and factors associated with awareness of Pap smear test as a tool for cervical cancer screening among health care workers (HCW) in Maiduguri north-eastern part of Nigeria. Subjects and Methods: This was a cross-sectional questionnaire based study conducted among 150 health care workers in Maiduguri, between January and March 2010. Simple descriptive statistics was employed in the analysis of data. Results: A total of 150 participants were recruited for the study. The majority (141) of respondents were aware of Papanicolaou smear and 23.3% of the female respondents had done the test previously. Majority (90.8%) of the men were willing to pay for their spouses to do the screening; some of them (20.0%) were indifferent if their spouses perform the cervical screening without their consent. The major reason given for carrying out the test was for prevention of the disease. The major source of information was the hospital (84.7%). Majority of the women were willing to do the test if offered the opportunity either free (70.6%) or with payment (29.4%). A number of socio-demographic variables played crucial roles in awareness and utilisation of Pap smear. These included higher level of educational status ( P = 0.000) of the respondents, increased maternal age ( P = 0.001) and high parity ( P = 0.003). Conclusion: There is poor utilisation of Pap smear among HCW despite high level of awareness and availability of screening services. A number of socio-demographic variables play crucial roles in awareness of Pap smear. The reasons for the low utilisation among health care workers, who are the custodians of health care need to be investigated to improve their utilisation of Pap smear.

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Background/Aim: The practice of informed consent prior to any surgical procedure should form the fundamental element that serves to protect both patient and surgeon from prosecution. The aim of this study was to assess knowledge, attitude and perception of women towards informed consent prior to Surgery in Obstetrics and Gynaecology department of Aminu Kano Teaching Hospital. Materials and Methods: This was a cross-sectional study conducted among 398 women who had undergone surgery at the Obstetrics and Gynecology department of the Aminu Kano Teaching Hospital, Kano State, Nigeria. Data was obtained following surgery but prior to discharge and was analyzed using SPSS version 17. Results: Three hundred and ninety eight women were recruited. The mean age was 30.3 years ± 5.2. All respondents believed signing a consent prior to surgery was important and believed it was a legal document involved in decision making process. Ninety seven percent of the respondents were satisfied with the explanation given to them prior to the surgery however, 15.8% had some reservations to the explanations while 3% were not completely satisfied with the explanations. Conclusion: Awareness and knowledge of consent was high in this study and the respondents had positive attitude towards signing consent.

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Background and Objective: Thyroid gland lesions occur globally with geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. There is, however, no published histological study from northwestern Nigeria; hence, we undertook this study to describe the spectrum, frequency, age and sex distribution of thyroid gland lesions seen in Kano, as well as compare the findings with previous studies done in Nigeria and elsewhere. Materials and Methods: This is a retrospective descriptive study of all thyroidectomy specimens received from January 1 ^st , 2002 to December 31 ^st , 2011 at the histopathology department of Aminu Kano Teaching Hospital, Kano, Nigeria. Results: Five hundred and twenty-two thyroid gland lesions were diagnosed during the ten year period with a female to male ratio of 6.4:1. The ages range from 5 months to 86 years with a mean age at presentation of 36.3 years and relative peak age of incidence occurring in the 30-39 years group. The most common entity was goitre (57.2%) with a mean age at presentation of 37.5 years. It was followed by thyroid adenomas (15.7%) and thyroid carcinomas (12.6%). Specifically among cancers, papillary carcinoma predominated (53%), followed by follicular carcinoma (33.3%) and medullary carcinoma (9.1%). There were 36 cases (6.9%) of thyroglossal duct cysts and 28 cases (5.4%) of toxic hyperplasia while thyroiditis was uncommon with only 2 cases (0.4%). Conclusion: This study shows that thyroid gland diseases are common in Kano and are seen in both genders with a striking female preponderance. It revealed a higher incidence of papillary carcinoma over follicular carcinoma, a reverse of the finding of an earlier clinicopathological study on thyroid gland diseases in Kano. The age and sex incidences as well as the histological featuresof thyroid lesions in this study are, however, similar to reports from other local and international studies.

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Background: Transthoracic Echocardiography is an important non-invasive technique which provides information about cardiac structure and function, thus useful in the evaluation and management of cardiac diseases. Previous studies on echocardiography findings in our environment documented Hypertensive heart disease, Dilated Cardiomyopathy and Rheumatic Heart Disease as the commonest findings in patients with cardiac diseases. This study aimed to provide an update on the common echocardiography findings in this part of the country since previous studies were done over a decade ago. Materials and Methods: We reviewed echocardiographic reports of 1012 consecutive patients aged ≥15 years from September 2011 to August 2014 (3 years). The reports were reviewed for demographic parameters, indications for the procedure and main echocardiography diagnoses. Results: The mean age of the 1,012 individuals studied was 41.28 ± 16.25 years. There were 330 males and 682 females. The commonest clinical indication for echocardiography was Systemic hypertension/Hypertensive heart disease (41%) followed by Peripartum cardiomyopathy (20%) and Congestive cardiac failure (12%) of unknown cause. The most prevalent echocardiographic diagnoses was Hypertensive heart disease seen in 40.3%, followed by Peripartum cardiomyopathy (32%), Dilated cardiomyopathy (5.9%), and Rheumatic heart disease 4.6%. Normal echocardiographic findings were seen in 14.9% of the subjects. Conclusion: Hypertensive heart disease remains the most common echocardiographic indication and diagnosis. Peripartum cardiomyopathy was frequent in our centre and this may be related to the increased availability and accessibility to echocardiographic facility as well as the low socioeconomic status of the category of patients that attend the centre.

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Background: Neonatal tetanus (NNT) is one of the childhood's preventable diseases and a leading cause of neonatal death especially in developing countries. It is entirely preventable through effective immunisation of women of child-bearing age, and through simple and basic precautionary measures in child delivery. Objective: This study highlighted the burden of neonatal tetanus in Kano over a period of ten years. Materials and Methods: We retrospectively studied the case notes of neonatal tetanus admitted over a ten-year period (2000-2009). The records of neonates admitted as cases of neonatal tetanus into the special care baby unit of Aminu Kano Teaching Hospital, a tertiary health facility in Kano, northern Nigeria, over a ten-year period were reviewed. Data on age at presentation, local government area from which the neonates presented, antenatal history, maternal immunisation status, clinical feature, complications and the outcome were noted. Results : Majority of the cases (74%) were concentrated in the cosmopolitan areas of Kano. Only 33% of the mothers had antenatal care (ANC) while only 18 (24%) of the mothers received immunisation against tetanus. In all, 76% of the mothers delivered outside the medical facility. The umbilical cord was the route of infection in 52.7% of cases. The case-specific fatality rate was 51.4%. Conclusion: The incidence of NNT is still very high in Kano and this scourge can be tackled through improved quality and accessibility of ANC services and tetanus toxoid (TT) vaccination, provision of skilled attendants at delivery under hygienic conditions and avoidance of harmful traditional practices.

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Vitamin C deficiency is a prevalent problem among pregnant women in developing countries. This review is undertaken to evaluate current literature on effect of vitamin C supplementation on the course and outcomes of pregnancy so as to recommend its supplementation or otherwise. Electronic search of Medline, PubMed, Health Internetwork access to Research Initiative (HINARI), and Google Scholar databases was conducted for articles from 1 ^st January, 1993 to 30 ^th November, 2014 using keywords such as "micronutrients", "vitamin C", "ascorbic acid", "vitamin supplementation", and "nutrition in pregnancy". Current evidence from developing countries where vitamin C is deficient among pregnant women has shown that vitamin C may reduce the incidence of some complications of pregnancy and therefore encourage their supplementation in pregnancy. Additional studies, however, are needed in different geographic regions to identify whether vitamin C supplementation in pregnancy results in functional and measurable outcomes for maternal and foetal health. These studies would enable the appropriate intervention strategies to be developed, implemented, and evaluated. Such efforts will require the collaboration and commitment of government agencies, health care providers, nutritionists, research institutions, and the community.

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Objective: To determine the frequency, severity, and determinants of diabetic sensorimotor polyneuropathy (DSPN) in adults from a tertiary hospital in Northwestern Nigeria. Materials and Methods: A cross-sectional hospital-based study where 400 type 2 diabetes mellitus patients attending clinic in a tertiary hospital were screened for DSPN and graded for severity using the United Kingdom screening test (UKST). Logistic regression was used to identify independent predictors of DSPN after controlling for other covariates. All data were analysed using Predictive Analysis Software (PASW) version 18.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: Frequency of DSPN among the study (comprising 59 males and 66 females) subjects was 125 (31.2%), of which 105 (26.3%) patients were symptomatic. Sixty-eight (17%) patients were at high risk of developing diabetic feet ulceration. Multivariate logistic regression showed that marital status (OR = 0.55; 95% CI = 0.31-0.98) was protective, while the duration of diabetes (OR 5.80; 95% CI = 3.38-9.95) was a significant independent predictor of DSPN. Conclusions: The high frequency of DSPN in patients with high risk of feet ulceration from this study prompt the need to adopt efficacious and less-expensive strategies for screening and preventing diabetic foot complications in our resource-constraint settings.

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Background: Episiotomy can be defined as a surgical incision made at the perineum to widen the introitus and facilitate delivery. Objective: To assess the perception of women on episiotomy. Design: A prospective cross sectional study. Settings: This was the antenatal clinic of Aminu Kano Teaching Hospital, Kano. Methods: All consented pregnant women at booking were recruited and interviewed. Results: Over the six weeks period of the study, 109 women were interviewed. Majority of the women (94.5%) have heard of episiotomy and 81.7% were able to describe it as a surgical incision to facilitate delivery. Most of their sources of information were from friends/relatives (52.3%). Fifty seven (52.3%) out of the 109 women have had episiotomy and 'Big baby' as described was the commonest indication for the episiotomy (62.5%). Majority of the women (66.1%) Did not have prior counselling before episiotomy and 76.8% Did not have any complication following the repair. Most of the women (69.6%) had their episiotomies repaired within an hour of delivery. Twenty eight (49.1%) out of the 56 women who had episiotomy do not believe women should be routinely given episiotomy at delivery while 40.4% of the women were of the opinion that it should be routine to avoid injury to the baby. Majority of the women (82.1%) advocated for anaesthesia prior to episiotomy. Conclusion: There is a good knowledge of this procedure among pregnant women in AKTH Kano.

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Background: Prolapse of the umbilical cord is an obstetric emergency with life-threatening effect on the foetus. The outcome of umbilical cord prolapse (UCP) depends on immediate and proper interventions. Objectives: To determine the incidence of cord prolapse, predisposing factors, foetal outcome and decision-delivery interval in emergency caesarean section (c/s) due to cord prolapse in our Teaching Hospital. Materials and Methods: A retrospective review of 42 consecutive cases of UCP over a 5-year period was conducted at Aminu Kano Teaching Hospital, Kano, in North-Western Nigeria. Results: There were 42 cases of cord prolapse out of 13,292 deliveries during the study period giving an incidence of 0.32% or 1 in 316 deliveries. The highest incidence occurred in women aged 25-34 years. Multiparous women constituted 76.2% of the patients. Prematurity was the highest contributing factor (47.6%). Twenty-five (59.2%) of the 42 patients had emergency c/s (1.41% of the 1,771 emergency c/s and 0.99% of a total of 2,053 c/s). The mean decision to delivery interval in patients who had c/s was 92.8 minutes (range 10-180 minutes). The mean birth-weight was 2,864 g. The mean Apgar score at 5 minutes was 5.2. There were 19 fresh stillbirths with perinatal mortality of 45.2%. Conclusion: Cord prolapse is relatively uncommon in our environment. There is the need to identify and educate those women at increased risk of their babies having UCP. Delay in presentation may have contributed to the high perinatal mortality. Smooth organisation of an emergency c/s is essential for rapid and safe management of patients with UCP.

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Histoplasmosis is a worldwide fungal infectious disease caused by inhalation of spores of Histoplasma capsulatum. It may present as chronic pulmonary infection or in disseminated form. Disseminated histoplasmosis frequently affects the adrenal gland; however, unilateral involvement in immunosuppressed patients is the usual presentation. We report a case of an immunocompetent old male with history of weight loss, fever and bilateral adrenal masses. Computed tomography (CT)-guided biopsy of adrenal mass revealed histoplasmosis. This case report emphasizes the importance of considering fungal infection as differential diagnoses of mass lesions involving bilateral adrenals even if the patients are immunocompetent, along with the commoner lesions at these sites.

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Leiomyoma are known to occur in the uterus. It is unusual to find these benign smooth muscle tumours anywhere else. We report the occurrence of a swelling that appeared like a huge Bartholin's cyst in the vulva of a 30 year old married nulliparous woman. She had successful excision and histology confirmed it to be a leiomyoma.

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Background and Objective: Tumours of skin adnexae are an uncommon group of neoplasms that have not been formally studied in our locality. We undertook this review to document and evaluate the pattern in Kano, northern Nigeria. Materials and Methods: This is a 10-year (2004-13) retrospective study of all skin adnexal tumours diagnosed at the pathology department of Aminu Kano Teaching Hospital (AKTH), Kano. Results: Ninety-two skin adnexal tumours were diagnosed during the study period, and there was no significant gender predilection - males (49%), females (51%). The overwhelming majority were benign (86%), while malignancies comprised just 14%. Patients ranged from 4 to 90 years of age, peaking in the third and fifth decades. The most common histological types were nodular hidradenoma (17.4%), eccrine poroma (9.8%) and pilomatrixoma (9.8%), with sebaceous carcinoma (5.4%) as the most frequent adnexal malignancy. The tumours were most commonly located in the head and neck region (52%), followed by the trunk (25%) and extremities (23%). Conclusion: Skin adnexal tumours are relatively uncommon in Kano affecting predominantly people in the third and fifth decade without a definitive sex predilection. Most of the tumours showed sweat gland differentiation with nodular hidradenoma and sebaceous gland carcinoma being the most common benign and malignant tumours, respectively.

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