Snakebite is an important cause of amputation and disability in rural communities throughout the tropics. However, the details of the causes, types and estimates of disability are lacking. This report describes 16 snakebite victims who had amputations, including two who had above-knee amputations. The patients presented with limb swelling (16), gangrene (15), ischaemia (4) and three had possible compartment syndrome. All the patients used ineffective time wasting remedies that were potentially harmful as first-aid. The median delay to hospital following bite was 2.5 days. In order to prevent disability, efforts should be made to: reduce delay before hospital presentation; improve the knowledge of first-aid; provide effective antivenoms; improve wound and clinical care in communities; and improve facilities.

MDR-TB is present in Nigeria and larger studies are urgently required. TB clinical management and control efforts should be improved.

No abstract

In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.