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Introduction: Ethical norms in research promote the aims of research such as knowledge, truth and avoidance of error. Observing ethics in clinical research is very important and this should be well known by all health care practitioners. The aim of this study was to determine the knowledge of doctors working in a tertiary hospital about research ethics and the barriers they encounter in the ethical conduct of research. Materials and Methods: A questionnaire-based survey was conducted among 215 doctors in a tertiary hospital in Nigeria to determine their knowledge of the concepts of ethics in research, their research practices and perceived barriers to ethical conduct of research. Data obtained was analysed with SPSS v 20 and reported as Tables and charts. Chi square was used to test for differences between categorical variables and a P value < .05 was regarded as significant. Results: There were 108 consultants, while the rest were medical officers and resident doctors. The consultants were more active in research and 42% had between ten to fourteen published articles. There was fairly adequate knowledge of the 5 concepts of research ethics tested, with 90% who had knowledge of GCP. Common perceived barriers to ethical research conduct were poor funding and cultural beliefs. Conclusion: There remains a gap between knowledge of ethical research conduct and actual practice. This should be addressed by improved sensitization and oversight by the regulatory agencies and the IEC.

Introduction: Coronary artery disease (CAD), stroke and peripheral artery disease (PAD) are commonly referred to as cardiovascular disorders (CVD) due to a common underlying pathophysiology of atherosclerosis and are more common in diabetic patients. This study was carried out to determine the pattern and associated factors of CAD and PAD in asymptomatic patients with type 2 diabetes mellitus in South east Nigeria. Materials and Methods: One hundred and twenty stable adults with type 2 diabetes mellitus were recruited consecutively from two out-patient clinics in two tertiary hospitals in South east Nigeria at Nnewi and Enugu. They were assessed for risk factors for CVD including hypertension, obesity and dyslipidaemia. Their ankle-brachial index (ABI) was measured using a hand-held doppler and they also had a 12 lead ECG. Results were analyzed using SPSS V23; p value of < 0.05 considered significant. Results: There were 60 males and 60 females, with a mean age of 61.7(11.2) years and mean diabetes duration of 127.7(99.9) months. Dyslipidaemia was present in 73.3%, 70% had hypertension, PAD was present in 55.8%, while 16.5% had CAD. PAD was more common in those with higher BMI (p = 0.04), higher diastolic BP (p = 0.03) and higher mean arterial pressure (p = 0.03). On further multivariate stepwise regression analysis, there was no significant predictor of PAD. None of the clinical factors were associated with CAD. Conclusion: PAD and CAD are common in patients with type2 DM even in the absence of symptoms. Obesity, high diastolic and high mean arterial pressure are more common in patients with PAD.

Background: Health-related quality of life reflects a patient’s general subjective perception of the effect of an illness or in- tervention on physical, psychological and social aspects of daily life. HIV infection is a major public health problem especially in developing countries where poor health infrastructure and poverty are prevalent. This paper addresses the quality of life in patients with chronic HIV infection in South East Nigeria and addresses issues that may help improve the current situation. Methods: A cross-sectional survey was carried out at the University of Nigeria Teaching Hospital, Enugu, to assess patients with HIV receiving antiretroviral therapy (ART) using a validated structured questionnaire (WHOQoL-BREF). Ethical clearance for the study was obtained. Study period was from October - December, 2017. Data obtained was analysed. Results: A total of 389 HIV patients consented to the study. Over 70% were aged 18- 45 years and majority were females. Females had a higher quality of life score with respect to the domain of psychological health while males had a higher score with respect to the environmental domain. Older age and presence of co-morbidities were significantly associated with affectation of physical health while younger age was associated with affectation of psychological health domain. Conclusion: HIV impairs the quality of life for affected individuals in South East Nigeria especially across the domains of physical and psychological health. No age group is spared. The presence of co-morbidities significantly reduces quality of life in these patients. Younger patients may require mental health services in the management of their disease. Keywords: HIV; quality of life; South East Nigeria.

Background The prevalence of gastroesophageal reflux disease (GERD) in Africa is not known but is believed to be increasing because of demographic and epidemiologic transition. The main objectives of this study were to determine the prevalence and risk factors of GERD, and its degree of overlap with dyspepsia and irritable bowel syndrome (IBS) in Nigeria, a typical African population. Methods This was an observational, cross-sectional and descriptive study of adult Nigerians. Diagnosis of GERD was by means of the gastroesophageal reflux disease questionnaire (GERDQ) while the diagnosis of dyspepsia and IBS was based on the Rome III criteria for the diagnosis of functional gastrointestinal disorders. The GERDQ and Rome III questionnaires for dyspepsia and IBS were merged into a composite questionnaire and administered to the study participants who were recruited with a multi-stage sampling technique. Results Out of 3520 subjects who participated in the study across the country, 269 (7.6%) satisfied the diagnostic criteria for GERD, while 107 (3.0%) had GERD associated with significant impairment of quality of life. Risk factors of GERD (represented by odds ratios) were age 1.014(95% CI: 1.006–1.022), use of analgesics 1.461 (95% CI: 1.060–2.025), and use of herbs 1.318 (95% CI: 1.020–1.704). Overlap of GERD with dyspepsia and/or IBS was observed in over 50% of cases. Conclusions The prevalence of GERD in this study is 7.6%. Age, use of analgesics and use of herbs increase the risk, albeit minimally. A high degree of overlap with dyspepsia and IBS exists in Nigerian patients with GERD.

Background: There is a global trend of increasing obesity, affecting mostly the high-and-middle income countries. Obesity was more prevalent in the urban areas but recent studies have suggested a disproportionate increase in obesity in the rural areas outstripping that of urban areas thus fueling the global obesity epidemic. This cross-sectional community study was undertaken to determine the prevalence of obesity in a rural community in South east Nigeria using Body Mass Index (BMI), waist circumference and waist-hip ratio. Materials and Methods: Adults (≥18 years) in a rural community in Enugu State were studied in July 2019. The weight, height, waist circumference and hip circumference of the participants were taken. The BMI was calculated from the weight and height and the waist-hip ratio was determined for each participant. Results: A total of 210 participants were studied and analyzed. The prevalence of obesity and overweight by BMI was 10.9% and 28.0% respectively. There was no difference in the prevalence of obesity in males and females (10.9% vs 10.9%) and overweight (27% for males and 28% for females). Significantly more females (40%) than males (7.3%) were obese by sex specific waist circumference (p p = 0.629) and females (p = 0.439). However, middle aged females (40 - 59 years) had higher waist circumference than the younger and older females (p = 0.025), while the older males (60 - 79 years) had higher waist-hip ratio than younger age groups p = 0.002. Conclusions: The result of this study shows an increasing trend of obesity and overweight in a farming rural community in South east Nigeria compared with the prevalence recorded in the region in the past.

Background: Alcohol is one of the most commonly abused psychoactive substances in the country. Studies have shown sharp increases in alcohol consumption among Nigerians. This increase is likely to continue because of increased local production and availability of alcohol in the country. Knowledge of the prevalence and pattern of current alcohol use is important considering the public health and socio-economic effects of alcohol use. Methods: Using a semi-structured questionnaire, we estimated the prevalence of current alcohol use among adults 18 years and older living in urban slums in Enugu South East Nigeria. Current use of alcohol was defined as use of any or all alcohol beverages in the past 4 weeks. The safe limit of alcohol was defined using WHO guidelines. Study duration was 5 months. Results: A total of 1411 individuals were recruited into the study. Males were 658 (46.6%) and females were 753 (53.4%). The overall prevalence of current use of alcohol was 66.7%; males 75.7% and females 58.8% (p < 0.01). The commonest alcoholic beverage consumed was beer 37.1%. The peak age of consumption was 40 - 49 years followed by 50 - 59 years. About 8.1% drank alcohol above the generally recommended units per week while 5.2% drank above the safe limit for chronic liver disease. Significant correlates of alcohol intake were increasing age, male gender, having a job, cigarette smoking and the use of snuff. Significant correlates for excessive consumption of alcohol were increasing age and cigarette smoking while those for exceeding the safe limit chronic liver were increasing age, male gender and cigarette smoking. Conclusion: There is a high prevalence of current alcohol use among urban slums in Enugu. Public health educational measures for reducing alcohol consumption should be encouraged. Efforts should be made to educate the populace on the need for abstinence.

Background: Overweight and obesity present a growing health problem among Africans from all socioeconomic status. In Sub Saharan African, obesity is not only a consequence of overnutrition but possibly from excessive consumption of unbalanced diet dominated by carbohydrates and saturated fats. Characteristics of the distribution of obesity/overweight in Nigeria include its high prevalence along with socioeconomic class and in mid-life. Methods: Using the WHO STEP-wise approach to surveillance of noncommunicable diseases, we conducted a cross-sectional descriptive study of the adult population living in two urban slums in Enugu. The study was carried out in 2013. Statistical analysis was done using SPSS version. Results: A total of 605 (414 women (68.4%) and 191 (31.6%) men were recruited and analysed. The mean body mass index was 25.8 kg/m2 higher in females (26.7 kg/m2) than males (24 kg/m2) p < 0.01. The prevalence of overweight and obesity is 29.4% (178/605) and 19.5% (118/605) respectively. There also a modest prevalence of underweight 4% (24/605) among the population. All classes of obesity were significantly more prevalent in females. Significant positive correlates of BMI were: female sex (r = 0.21, p < 0.001), systolic blood pressure (0.25, p < 0.001), DBP (0.27, p < 0.001), fasting blood glucose (0.19, p < 0,001) and positive history of hypertension (0.23, P < 0.001). Negative correlates were physical activity and use of tobacco (0.2 (

Introduction: Early detection of proteinuria is early detection is a cost-effective method of assessing individuals with and without risk factors for chronic renal disease. Proteinuria is common in adults and may present a clinical challenge in the absence of obvious renal disease or risk factors especially in the tropics. Few studies in Nigeria have assessed the prevalence of proteinuria in adults using the dipstick method. The aim of this study was to document the prevalence of proteinuria among residents of a community in Enugu, south east Nigeria. Methods: This was a cross-sectional descriptive study carried out in an isolated urban slum settlement in Enugu, south east Nigeria. Dipstick testing of freshly voided early morning mid-stream urine samples was done to detect proteinuria. For database management and statistical analyses, SPSS version 23 was used. Results: A total of 262 individuals were recruited for the study, 165 (63%) females and 97 (37%) males. The participants’ age ranged from 18 to 90 years, averaging 43.7 ± 15.5. Trace amounts of protein were detected in urine samples of 225 (85.9%) individuals. Significant proteinuria was detected in 3.8% of the participants and was significantly higher 40 - 49-year-olds (6%). p = 0.02 and 0.02 respectively. Significant correlates of proteinuria were lower diastolic blood pressure and current tobacco use. Lower body mass index weakly correlated with proteinuria. Conclusion: The prevalence of significant early morning proteinuria in a community-based study in Enugu was 3.8%. Significant correlates of proteinuria included low diastolic blood pressure and tobacco use. Community based awareness programs targeted at prevention of chronic renal diseases should be incorporated in public health programs.

Sub-Saharan Africa (SSA), occupying about 80% of the African continent is a heterogeneous region with estimated population of 1.1 billion people in 47 countries. Most belong to the low resource countries (LRCs). The high prevalence of end-organ diseases of kidney, liver, lung and heart makes provision of organ donation and transplantation necessary. Although kidney and heart transplantations were performed in South Africa in the 1960s, transplant activity in SSA lags behind the developed world. Peculiar challenges militating against successful development of transplant programmes include high cost of treatment, low GDP of most countries, inadequate infrastructural and institutional support, absence of subsidy, poor knowledge of the disease condition, poor accessibility to health-care facilities, religious and trado-cultural practices. Many people in the region patronize alternative healthcare as first choice. Opportunities that if harnessed may alter the unfavorable landscape are: implementation of the 2007 WHO Regional Consultation recommendations for establishment of national legal framework and self-sufficient organ donation/transplantation in each country and adoption of their 2020 proposed actions for organ/transplantation for member states, national registries with sharing of data with GODT, prevention of transplant commercialization and tourism. Additionally, adapting some aspects of proven successful models in LRCs will improve transplantation programmes in SSA.

Summary Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial. Funding UK National Institute for Health Research Health Technology Assessment Programme.

Background Hepatitis B vaccination is the most effective method of prevention for hepatitis B virus infection. It is a major public health problem in Nigeria, and health workers are at increased risk. This study determined the uptake of hepatitis B vaccination and assessed its determinants among health care workers (HCWs). Methods A hospital-based cross-sectional study was conducted between July and August, 2016 using self-administered structured questionnaires among 3132 HCWs in University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria. Data was analysed using SPSS version 22. Binary logistic regression analysis was used to identify factors that influenced uptake of vaccination. Ethical clearance was obtained from the Research Ethics Committee of the health facility. Results The uptake of hepatitis B vaccination was 14.2% (n = 445). The number of doses received were: 3 doses (218/3132, 48.9%), 2 doses (71/3132, 16.0%), and one dose (156/3132, 35.1%). The reasons for non-uptake of vaccination included: cost of vaccine 48 (10.8%), ‘did not believe they could be infected’ 28 (6.6%), long vaccination schedule, and lack of time 150 (35.1%). The Odds for uptake of hepatitis B vaccination were 22% lower among nurses compared to doctors (AOR = 0.78, 95% CI = 0.54–0.98, P = 0.037). It increased with increasing age (AOR = 1.30, 95% CI = 1.08–1.59, P

Purpose Epilepsy related stigma is a barrier to recovery and has been linked to a broad range of psychosocial consequences and has the potential to influence the provision of care to people with epilepsy. Understanding the determinants of enacted stigma in epilepsy is relevant in the understanding of the burden of epilepsy in Nigeria. Method Using a semi-structured questionnaire, a cross-sectional descriptive study was conducted among rural dwellers receiving treatment for epilepsy in a tertiary referral specialist hospital in Enugu, south east Nigeria. Results The participants consisted of 108 patients, 63% of whom were males. Most patients 99(91.7%) reported experiencing stigma in the past. The commonest forms of enacted stigma were being regarded as having ‘spiritual attack' 88(81.5%) and restraining from interacting with others 49(45.4%). Most individuals who received nonorthodox treatment 55(55.6%) experienced stigma. Severely stigmatized individuals were more likely to be females. Age of onset of epilepsy, use of non-orthodox treatment, seizures occurrence in public places and the presence of physical injuries positively correlated with enacted stigma. Conclusions The burden of epilepsy related enacted stigma is high among rural dwellers attending a tertiary medical outpatient clinic in Enugu, southeast Nigeria.

Aim: To assess the lifetime prevalence of tension-type headache, migraine and chronic daily headache, including the primary headaches in a student population. Methods: This is a cross-sectional descriptive study. Data were collected from consecutive consenting students by means of a semi-structured questionnaire. The questionnaire was designed to assess demographic data, headache profiles and medical consultation. Results: Four hundred and forty-nine (89.8%) out of 500 students who were interviewed were analyzed. The lifetime prevalence of primary headache was 89.8%; it 90.5% and 88.6% in females and males respectively. The overall prevalence of migraine was 8.9%, with a prevalence of 10.6% in females and 6.5% in males. Migraine without aura was most commonly seen at 73%. The prevalence of migraine without aura was 7.6% in females and 4.9% in males. Tension type headache (TTH) had an overall prevalence of 22.9%, with a prevalence of 28.4% in females and 15.1% in males. Migraine and tension type headache co-existed in 5.8% of the students. About 8.5% suffered from chronic daily headache: chronic migraine 2.9%, chronic tension headache 3.1%. The rate of medical consultation was 54.8% (males 49.7%, females 58.3%). Conclusions: Headache is a common health problem among medical and nursing students in Enugu South East Nigeria where 89.8% of respondents have had primary headaches. The prevalence of migraine, TTH and chronic daily headache was 8.9%, 22.9% and 8.5% respectively. Headaches therefore, represent one of the most challenging neurological disorders in Sub-Saharan Africa where most sufferers do not have access to specialist care.

Background: Despite the rising prevalence of diabetes in Nigeria and sub-Saharan Africa, few studies have assessed the prevalence of prediabetes and diabetes in people with low socioeconomic status or urban slums. Methods: Using the WHO STEP-wise approach to surveillance of noncommunicable diseases, we estimated the prevalence of diabetes and prediabetes among adults 20 years and older living in two urban slums in Enugu south east Nigeria. Diabetes was defined as previous history of diabetes, use of hypoglycemic agents and fasting blood glucose within the diabetes range on two occasions during the survey period. Study duration was 5 months. Results: Out of the 811 individuals invited to the clinic, 605 (74.6%) participants had their fasting blood glucose measured based on the study protocol. The prevalence of diabetes and prediabetes in the population was 11.7% (95% CI; 9.2 - 14.3) and 7.6% (95% CI; 5.0 - 9.7) respectively. About 54.9% were newly detected and 28.1% of them had normal control. The prevalence of diabetes peaked at 55 - 64 years. The odds ratio for diabetes was significantly higher in participants ≥ 45 years (1.033, 95% CI; 1.208 - 3.420), participants with hypertension (0.442, 95% CI; 0.257 - 0.762) and stroke (1.638, 95% CI; 0.459 - 5.848). Conclusion: There is a relatively high prevalence of diabetes among adults in two urban slums in Enugu. Public health educational measures promoting prevention and early detection of diabetes should be encouraged. Efforts should be made to educate the populace on the need for early detection and treatment.

Background and purpose: Migraine is a common debilitating condition with variable prevalence in young Nigerians with significant deterioration in normal daily functioning and in the quality of life. Few data exist on the disability of migraine in Nigeria. The aim of this study was to measure the headache related disability of patients with migraine using the MIDAS among young Nigerians. Methods: This was a cross sectional study conducted in Enugu South East Nigeria. The questionnaire was designed to assess headache profiles according to ICHD-III beta and disability using the Migraine Disability Assessment Questionnaire. Results: About 40.6% of migraineurs were concerned about headache attacks and 39.1% consulted a doctor because of migraine. Most students were affected due to reduced effectiveness at school and number of days missed from housework—18.8% and 20.3% respectively. Overall, 47.8% had at least one day affected by headache in the last three months. The mean number of days disabled by headache was 14.3 days. The mean headache frequency was 5.7 days and the mean pain intensity was 4.2. About 27.5% of the migraineurs had moderate to severe disability due to migraine. There were no significant differences between males and females. Conclusion: Most with migraine experienced reduction in effectiveness at school and number of days missed from housework. Overall, 47.8% had at least one day affected by headache with an average of 14.3 days disabled by headache and 27.5% of the migraineurs had moderate to severe disability due to migraine.

Objectives Kidney transplantation is not readily available in low-resource settings because of poor health structure, dearth of experts, and pervading poverty. Although many centers now offer kidney transplant, patients still travel outside Nigeria for this service for many reasons and many return home without a detailed medical report. Materials and methods Medical records of individuals who underwent kidney transplant in Nigeria and elsewhere and who were presently receiving posttransplant care or had received such care from 2002 to 2018 at 4 Nigerian hospitals were retrospectively reviewed and analyzed. Results Of 35 patients (30 males; 85.7%) analyzed (mean ages of 42 ± 16 and 47 ± 8 years for men and women, respectively; P = .54), common primary kidney diseases included hypertension (27.2%), glomerulonephritis (24.2%), and diabetes mellitus/hypertension (18.3%). Most patients received transplants in India (48.6%), with others in Nigeria (23.0%) and Pakistan (8.6%). Relationships to recipient were unrelated (28.5%), living related (22.9%), and unknown (48.6%). Less than 30% of recipients had care details in their hospital records. Almost all transplant patients were treated with prednisolone (81.8%); cyclosporine (40.0%), mycophenolate mofetil (31.4%), tacrolimus (20.0%), and azathioprine (9.1%) were also used. Complications were documented in 88.9%, with 57.0% due to bacterial infections/sepsis. Many (88.9%) had more than 2 complications. In follow-up, median first transplant duration was 24 months (interquartile range, 6-44). Of total patients, 25.7% were still alive, 17.1% had died, and 54.2% were lost to follow-up. Follow-up data for only 2 donors were available. Conclusions Lapses in follow-up care of kidney transplant recipients and donors continue in lowresource settings where transplant tourism is still rife, resulting in poor graft/patient survival. Adherence to transplant guidelines is advocated. We propose a transplant stratification model according to level of development and resources of countries or regions. This model will encourage customizing strategies for improving patient outcomes.

Dysphagia and obstruction are among the most common indications for upper gastrointestinal endoscopy in African countries 1 . In a survey conducted by the European Society of Gastrointestinal Endoscopy (ESGE) International Affairs Working Group (IAWG), benign esophageal strictures as well as malignant upper gastrointestinal obstruction were reported as some of the most prevalent diseases leading to gastrointestinal endoscopy 1 . Management of esophageal obstruction may vary, depending on the cause of obstruction as well as the availability of resources. According to the ESGE original guideline, it could involve, for example, stent placement, radiotherapy/brachytherapy, or bypass surgery 2 . For resource-limited settings, however, a number of additional factors need to be considered before recommendations can be made. These involve economic considerations and resource availability. Furthermore, patients in low-resource settings presenting with malignant esophageal obstruction are often unfit for surgery due to presentation with advanced malignant disease as well as comorbidities such as HIV/AIDS and tuberculosis 3 . For such situations, self-expanding metal stents (SEMS) of the esophagus may provide a suitable palliative option 3 4 . After the initial ESGE cascade guidelines on non-variceal upper gastrointestinal bleeding (NVUGIH), we aimed this ESGE cascade guideline to standardize management of esophageal stenting for benign and malignant disease in low-resource settings 2 5 .

BACKGROUND: Hepatitis C virus (HCV) infection is a global public health issue. Health care workers (HCWs) are particularly at risk. Nigeria hepatitis prevention policy aims to achieve country wide elimination of hepatitis through early detection using mass screening with life-style modifications of “at risk population” which are key preventive strategies. AIM: To determine the seroprevalence of HCV infection among HCWs in a large regional referral hospital in Nigeria METHODS: A hospital-based descriptive cross-sectional study (hepatitis mass screening) was done at the University of Nigeria Teaching Hospital, Enugu, Nigeria between July and August 2016. Non-randomised sampling was used. Blood samples were assayed for antibodies to HCV. Data on knowledge, risk factors and mode of transmission were collected using a structured, pre-validated, pretested, questionnaire and analysed using SPSS version 20. RESULTS: A total of 3132 out of 5144 (60.9%) HCWs participated in the study. The seroprevalence of hepatitis C among UNTH staff was 0.90% (28/3132). The mean knowledge score of 68.95% ± 24.23 and 56.70±17.25 translates to fair knowledge level about mode of transmission and risk of transmission of hepatitis C among HCWs, respectively. There was no reported case of hepatitis B and C co-infection. Females HCWs had highest sero-prevalence for HCV 17/5144 (0.33%) (P = 0.164, AOR= 1.76, 95%CI =0.431-2.413) CONCLUSION: This study found a low seropositivity of HCV among HCWs. A pointer to the possible success of the hospital-based education awareness programme, an implementation of Nigeria’s national hepatitis prevention policy.

Background: Most recent studies in Nigeria have documented high prevalence of hypertension, diabetes, and obesity. Several mechanisms may link hypertension and obesity hence the high prevalences of both disorders in Nigeria. There are however no studies on the prevalence of hypertension among the obese in urban settings. Aims: The aim of this study was to describe the prevalence and pattern of hypertension in overweight/obese individuals in a community. Methods: We conducted a post-hoc analysis on obese subjects 20 years and above from two urban settlements within Enugu metropolis. For database management and statistical analyses, we used the SPSS version 22. Results: Data from a total of 301 individuals with obesity who met the selection criteria were re-analyzed. A total of 198 (65.8%) individuals were found to have hypertension most of whom were newly diagnosed 110 (55.6%). The prevalence of hypertension was 65.8% and increased with age and BMI. Conclusion: Individuals with overweight/obesity have very high rates of hypertension. The prevalence of hypertension also increased with and BMI. Thus, there is need for targeted health education in adults to address the burden of obesity and hypertension to reduce the burden of cardiovascular disease in the community.

In order to address the status of gastrointestinal (GI) endoscopy in Africa, a European Society of Gastrointestinal Endoscopy (ESGE) International Affairs Working Group (IAWG) was established with participation from the World Endoscopy Organization (WEO) 1 . A previous survey conducted by the IAWG on the main indications of GI endoscopy in African countries showed nonvariceal upper GI hemorrhage (NVUGIH) to be among the top three indications 1 . This indication may reflect the very high prevalence of Helicobacter pylori infection, which is well known to be associated with gastroduodenal peptic ulcers and their complications, such as bleeding. In addition, the increased use of aspirin as prevention and treatment of cardiovascular disease, and the increase in life expectancy, may also, at least in part, account for the NVUGIH indication 2 3 4 . The management of NVUGIH requires a multi-step approach, involving endoscopic factors such as emergency endoscopy with different hemostatic devices, and clinical factors such as hospitalization, blood transfusion, and drugs. Such an approach is clearly sensitive to organizational, medical, pharmaceutical, and technological resources. However, the lack of structural endoscopic and clinical health resources in some underserved African areas is likely to affect the clinical outcome of patients with NVUGIH. In this regard, the previous IAWG survey revealed several critical needs in training, education, and technology that may represent a barrier to adequate NVUGIH management 1 . Most of the respondents from the African countries participating in the IAWG survey reported a lack of national guidelines for GI endoscopy; however, there was interest in the international guidelines, pending adaptation to reflect the endoscopic resources available in their regions. For this reason, the IAWG decided to apply the cascade methodology to adapt ESGE guidelines to resource-sensitive settings in partnership with African experts 1 . Cascade guidelines are resource oriented and provide hierarchical recommendations based on the resources available to the medical care provider 5 6 . In detail, four levels of resource availability – basic, limited, enhanced, and maximal levels – are identified, with most of the interest being in the basic and limited levels. We aimed to standardize the management of NVUGIH in low-resources setting. Here, we report the cascade adaptation of the ESGE guideline on the diagnosis and management of NVUGIH 7 .

Background: Assessment of health-related quality of life (HRQOL) in resource-limited settings is critical to evaluate and improve the burden of morbidity and mortality associated with chronic medical disorders. There is a dearth of data on HRQOL among patients suffering from chronic medical disorders in Nigeria. This study assessed the HRQOL of participants with diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, and cancer in a hospital setting with limited resources and highlighted associated factors. Methods: The WHOQOL-BREF instrument was used to study a cross section of the participants at the University of Nigeria Teaching Hospital, Enugu. Data were analyzed using Statistical Package for Social Sciences (SPSS). Results: The distribution of the 613 study population was diabetes mellitus 120, HIV 389, and various cancers 104. Majority (67.9%) earned less than $1 per day and only 7.5% had any form of health insurance. The HIV group had higher QoL scores. Younger age, higher educational status, being employed, and having a care giver were positively associated with higher QoL. Patients with no comorbidities (76.6%) had an overall higher QoL score. Conclusion: Majority of the patients living with chronic medical diseases in Enugu, Nigeria were poor, vulnerable, and without access to health insurance. People living HIV generally had better quality life than those with other health conditions. There is a huge unmet need for people living with chronic medical conditions in Nigeria, which require strategies to counteract.

Background: Continental Africa is facing an epidemic of chronic kidney disease (CKD). APOL1 risk variants have been shown to be strongly associated with an increased risk for non-diabetic kidney disease including HIV nephropathy, primary non-monogenic focal and segmental glomerulosclerosis, and hypertension-attributed nephropathy among African ancestry populations in the USA. The world's highest frequencies of APOL1 risk alleles have been reported in West African nations, overlapping regions with a high incidence of CKD and hypertension. One such region is south-eastern Nigeria, and therefore we sought to quantify the association of APOL1 risk alleles with CKD in this region. Methods: APOL1 risk variants were genotyped in a case-control sample set consisting of non-diabetic, CKD patients (n = 44) and control individuals (n = 43) from Enugu and Abakaliki, Nigeria. Results: We found a high frequency of two APOL1 risk alleles in the general population of Igbo people of south-eastern Nigeria (23.3%). The two APOL1 risk allele frequency in the CKD patient group was 66%. Logistic regression analysis under a recessive inheritance model showed a strong and significant association of APOL1 two-risk alleles with CKD, yielding an odds ratio of 6.4 (unadjusted p = 1.2E-4); following correction for age, gender, HIV and BMI, the odds ratio was 4.8 (adjusted p = 5.1E-03). Conclusion: APOL1 risk variants are common in the Igbo population of south-eastern Nigeria, and are also highly associated with non-diabetic CKD in this area. APOL1 may explain the increased prevalence of CKD in this region.

Purpose To determine the prevalence of active convulsive epilepsy and treatment gap in two Urban slums in Enugu South East Nigeria. Methods A 3 phase cross-sectional descriptive study was done to survey individuals ≥15 years in 2 slums in Enugu, South East Nigeria. Results The prevalence of epilepsy was 6.0 (95% CI: 5.9–6.0) per 1000 (men 4.4/1000, 95% CI: 2.3–6.4, women 7.8/1000, 95% CI: 4.9–10.4), p =0.06. The peak age of active convulsive epilepsy was 40–44 years (11.2 per 1000) with two smaller peaks at 25–29 and ≥50 years. The age and sex adjusted prevalence using WHO standard population and 2006 Nigerian census population were 5.9 per 1000 (95% CI: 4.0–7.9) and 5.4 per 1000 (95% CI: 3.4–7.4). Conclusion The prevalence of epilepsy is high in urban slums in Enugu. Nationwide studies should be done to find out the true prevalence in the country.

Background/Objective: Hepatitis B virus (HBV) infection has remained a global public health challenge. Nigeria is in the high endemicitygroup with a prevalence of 8% or higher. The authors seized the opportunity of the 2010. World Hepatitis Day to mount a public enlightenmentcampaign and also screen civil servant in Enugu State of Nigeria for the infection.Materials and methods: In this cross-sectional study, civil servants attached to Government House, Enugu, Nigeria, were administered astructured questionnaire containing the putative risk factors for HBV transmission. They also underwent screening for hepatitis B surfaceantigen (HBsAg) in blood.Results: Out of 395 civil servants (206 males and 189 females) who participated in the screening, 36 were position for HBsAg giving aseroprevalence of 7.6%. Majority of the seropostive subjects (86.7%) were females (p < 0. 001).Among the risk factors examined, past history of native uvulectomy, sharing of toothbrush, sharing of razor blades and hair clippers weresignificantly more prevalent in the HBsAg positive group compared to the HBsAg negative subjects.In the females who had circumcision, the HBsAg seroprevalence was significantly higher than in the uncircumcized group (p = 0.014, oddsratio = 3.13).Conclusion: The seroprevalence of HBsAg in civil servants of Enugu State of Nigeria was 7.6%. More females than males were HBsAgseropositive and this may be related to previous circumcision in the females.Abbreviations: HBV�Hepatitis B virus; Apo�Apolipoprotein; Tg�Transgenic; HBsAg�Hepatitis B surface antigen; HCV�Hepatitis Cvirus; WHO�World Health Organization.

AIM: Drug promotions use multifaceted approaches incorporating hospital and office detailing by marketing representatives. Very few studies exist on their influence on doctors’ prescription pattern in Nigeria. We examined the scope and effects of marketing strategies on the prescription habits of doctors in Enugu, South East Nigeria. METHOD: This was a cross-sectional study; 210 self-administered structured questionnaires were distributed among doctors in six major hospitals in Enugu. Ethical approval was obtained from the University of Nigeria Teaching Hospital Ethics Committee, Enugu. RESULTS: There was 88% response rate, with more males than females (M:F= 2.2: 1). Most were residents-in-training/ house officers (69%) while consultants were 7.1% of the group. Stickers, drug presentations/ launches and personal souvenirs were most commonly employed marketing strategies. Most doctors (60%) attending a drug presentation felt influenced. While 87.5% appreciated the benefits of marketing strategies, about 70% would consider patients’ socioeconomic status before prescribing. Continuing medical education and stiff competition were reasons adduced for the marketing strategies. CONCLUSION: Pharmaceutical companies in Nigeria adopt varied strategies to influence doctors’ prescriptions. Often this aim is achieved. The practice is accepted by most who nevertheless will consider other factors when deciding on what to prescribe. [TAF Prev Med Bull 2010; 9(1.000): 1-6]

Anemia is common in chronic kidney disease (CKD) and contributes to adverse clinical outcomes. African Americans have a 3-fold increased likelihood of anemia compared with whites. Little is known about the prevalence of anemia of CKD among Nigerians. This study investigated the prevalence of anemia in all stages of CKD and the relationship of anemia to the etiology of CKD. Consecutive predialysis patients in all stages of CKD from 2004 to 2008 at first evaluation in a tertiary hospital renal clinic, and sex and age matched control subjects, were studied. Demographic data, and results of biochemical and hematologic indices cause of CKD were extracted from patients' records and analyzed using SPSS version 15. All tests were two-tailed, and P

Objective/Background This study aims to determine the prevalence of primary headache disorders using the second edition of international classification of headache disorders among urban slum dwellers. Headache is a common neurological disorder and one of the most common reasons for visiting the neurology clinics in Nigeria. Low socioeconomic status has been linked with primary headaches. Factors that may precipitate and sustain headaches are common in Africa especially in urban slums. There are limited population based data on the prevalence of headache from Nigeria and other African countries. Methods A 3 phase cross-sectional descriptive study was done to survey at least 40% of the adult population (Igbos) living in an urban slum using the International Classification of Headache Disorders 2nd Edition (ICHD-I) criteria using a validated Igbo language adaptation (translation and back-translation into Igbo language) of a World Health Organization protocol for screening neurological disorders in the community. Results The lifetime prevalence of headache of any type was 66.7% (95% confidence interval [CI] 64.2-69.2), significantly higher in females (70.2% [95% CI 67.0-73.4]) than in males (62.3% [95% CI 58.5-66.1]; P = .0.002). The prevalence of primary headaches was also significantly lower in males than in females (44.9% [95% CI 45.5-53.3] vs 53.2% (95% CI 49.3-57.1), P = .002). Female (52.1%) drinkers had a statistically higher prevalence of primary headaches than male drinkers (43.6%; P = .004). The prevalence of migraine was 6.4% (95% CI 5.1-7.7); 7.5% (95% CI 5.6-9.4) in females and 5% (95% CI 3.3-6.7) in males (P = .058). Migraine with aura was similar in both males and females. Migraine without aura was significantly higher in females (5.7%) than males (3.1%) (P = .022). Tension-type headache (TTH) had an overall prevalence of 13.8% (95% CI 11.3-16.3), males 12.2% (95% CI 9.7-14.7), and females 15.1% (95% CI 12.6-17.6; P = .118.) The peak decade for all primary headaches was 20-29 years for males (49.8%) and 60-69 years for females (57.5%). Conclusion Headache is a common health problem in an urban slum in Enugu south east Nigeria where 66.7% of participants had experienced headache in their lifetime, and 49.4% had experienced primary headaches. The prevalence of migraine and TTH were 6.4% (5% in males and 7.5% in females) and 13.8% (12.2% in males and 15.1% in females), respectively. The peak ages of migraine and tension-type headache were 30-39 and 60-69 years, respectively. The prevalence of primary headaches was significantly higher among subjects who used alcohol significantly.

Sylvester Chuks Nwokediuko,1 Uchenna N Ijoma,1 Olive Obienu,1 Gideon E Anigbo,1 Okechukwu Okafor21Department of Medicine, 2Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku/Ozalla Enugu, NigeriaBackground: Functional dyspepsia (FD) is a heterogeneous disorder associated with diverse pathophysiological mechanisms, including immune activation and low-grade mucosal inflammation. Genetic factors, physiological functions, and environmental factors may determine the relative importance of various pathophysiological mechanisms. This study was designed to determine the histological alterations in the duodenal mucosa of Nigerian patients with FD.Methods: Consecutive patients with dyspepsia seen over a 27-month period in two gastrointestinal endoscopy facilities in Enugu, South-East Nigeria were further evaluated with upper gastrointestinal endoscopy and duodenal mucosal biopsies if no lesion was found in the upper gastrointestinal tract. Patients with heartburn and/or regurgitation who did not have any dyspeptic symptoms and did not have any lesion in the upper gastrointestinal tract on endoscopy were presumed to have non-erosive reflux disease (NERD) and they served as controls. The control subjects also had duodenal biopsies. The histopathological findings in the cases and controls were compared.Results: There were 68 patients with FD and 52 patients with NERD. The total inflammatory score was 242 in FD and 66 in NERD (Mann-Whitney U =1168, P=0.0011). Similarly, the scores for chronic inflammation, gastric metaplasia, neutrophilic activity, eosinophilic infiltration, and Helicobacter pylori were significantly higher in FD than NERD.Conclusion: Functional dyspepsia is associated with a high degree of inflammation in the duodenal mucosa. This may reflect the high prevalence of gastrointestinal infections in a tropical environment such as Nigeria. These findings may have therapeutic potential that further studies might elucidate.Keywords: functional dyspepsia, duodenitis, Nigerians

Background. The prevalence of hypertension is increasing globally, and is higher in black patients. In Nigeria the estimated prevalence is 17.6% and affects about 21 million people. End organ damage associated with hypertension is more prevalent and more severe in black patients. Adequate control of blood pressure reduces and sometimes prevents the development of end organ damage associated with hypertension. The use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in addition to control of blood pressure delays the development of end organ damage associated with hypertension. This study was undertaken to investigate the efficacy and safety of telmisartan as monotherapy in Nigerian black patients with mild to moderate hypertension. Methods. Adult patients (18 years and above) of both sexes, who were newly diagnosed with mild to moderate hypertension were studied. Results. There was significant reduction in both systolic and diastolic blood pressures at 4 weeks (9 mmHg and 3 mmHg respectively, p < 0.006), and at 12 weeks (7 mmHg and 6 mmHg respectively, p < 0.016). However only 6 out of 19 (32%) patients who completed the study achieved target blood pressure of ≤ 140/90 mmHg (complete responders). At the end of the study there were 10 (53%) systolic responders (Systolic BP

Background. Functional dyspepsia is the prototype functional gastrointestinal disorder. This study was designed to determine its prevalence, subtypes, and risk factors associated with the subtypes.Method. Patients with upper gastrointestinal symptoms who presented for endoscopy were administered a questionnaire containing the functional dyspepsia and irritable bowel syndrome modules of the Rome III diagnostic criteria.Results. Of 192 patients who had functional dyspepsia, epigastric pain syndrome, postprandial distress syndrome, and combination of the two subtypes accounted for 79.2%, 62.5%, and 50%, respectively. Multivariate analysis of the risk factors showed that independent predictors of postprandial distress syndrome were alcohol and irritable bowel syndrome while irritable bowel syndrome was independent predictor of epigastric pain syndrome. Alcohol, smoking, and use of nonsteroidal anti-inflammatory drugs were independent predictors of cooccurrence of postprandial distress syndrome and epigastric pain syndrome.Conclusion. Functional dyspepsia accounts for 62.5% of dyspepsia in a population of black African patients. Regarding symptomatology, epigastric pain syndrome, postprandial distress syndrome, and combination of the two subtypes account for 79.2%, 62.5%, and 50%, respectively. Risk factors for functional dyspepsia are irritable bowel syndrome, alcohol, smoking, and use of nonsteroidal anti-inflammatory drugs.

Background Non-erosive reflux disease (NERD) is a variant of gastroesophageal reflux disease (GERD) in which patients with typical reflux symptoms have no evidence of erosive esophagitis at endoscopy. An objective diagnostic tool for NERD remains an unmet need for clinicians and researchers. This study was designed to determine the types of histological alterations seen in Nigerian patients with NERD. Methods This was a prospective cross-sectional study in which mucosal biopsy was taken from the lower esophagus in patients with NERD. Similar biopsy was also taken from patients with nonulcer dyspepsia who served as controls. The materials were processed and examined histologically. Results There were 68 patients with NERD and 60 patients with nonulcer dyspepsia. Intraepithelial neutrophil infiltration was significantly more frequent in patients with NERD compared to those with nonulcer dyspepsia (47.1% vs 13.3%, P = 0.0326). Epithelial proliferative chnges in the form of basal cell hyperplasia and papilla elongation were minimal (11.8% and 3.3% respectively). Conclusions Nigerian patients with NERD have a high degree of esophageal intraepithelial neutrophil infiltration and a low prevalence of epithelial proliferative changes. This may be related to the relative rarity of Barrett's esophagus in Nigerians.

Background and Aim : Estimation of the glomerular filtration rate (GFR) is important for the evaluation of patients with kidney disease. Some studies suggest that GFR estimated from serum cystatin C (Cys C) is more accurate than that from serum creatinine (SCr). For Cys C to be used for this purpose, normal values need to be determined for various populations. This study determined the serum Cys C levels and reference intervals (RIs) of a Nigerian population. Materials and Methods : Three hundred and four healthy adult subjects were analysed. Serum Cys C and SCr were determined by particle enhanced turbidimetric immunoassay and modified Jaffe kinetic method respectively. Data were analysed using the Statistical Package for Social Sciences version 17.0 (SPSS for Windows Inc., Chicago, IL, USA). Estimation of RIs was done as per the International Federation of Clinical Chemistry guidelines. Results : The RIs for Cys C were 0.65-1.12 mg/L (median 0.86) for males, 0.62-1.12 mg/L (median 0.85) for females and 0.64-1.12 mg/L (median 0.86) for all the subjects. The RIs for SCr were 73-110 μmol/L (median 89) for males, 65-102 μmol/L (median 82) for females and 66-106 μmol/L (median 86) for all the subjects. There was no significant gender difference in the RIs for serum Cys C, (P > 0.05). The SCr levels and RI were significantly lower in females than in males (P < 0.001). Conclusion : This study has determined the serum Cys C levels and RI of an indigenous healthy adult black population in Nigeria. Key words : Cystatin C, reference value, Nigerian population

Today more than ever there is the necessity to deal with the meaning of a word and, at the same time, a concept, “resilience”, which has gradually become the “key-concept of an era” due to its symbolic and evocative value, in a time when its most frequent interpretation has been connected to an other word: “crisis”. 2015 has been defined “the year of resilience” by the heads of the United Nations Office for Disaster Risk Reduction (UNISDR). Twenty years after the terrible Kobe earthquake, which led in 2005 (during the UN Conference at Hyogo in Japan) to the Definition of the Framework for Action 2005-2015: Building the resilience of nations and communities to disasters, the international community wonders what lessons can be drawn from the new crises and catastrophes, and identifies the resilience as the key-concept in order to face these challenges. In fact, the resilience implies elasticity and the ability to adapt by the corpora, the passions, the entire siystems and territories. These qualities today more than ever are valuable to get out of the trap represented by a crisis, an epochal crisis which arose from the financialisation of the economy and the globalization of markets. Globalization has betrayed, in fact, our expectations of prosperity and economic stability. It has produced innumerable positive effects, but has also brought much fragility and vulnerability, aggravating the problem of the struggle for resources and survival, rather than solving it, as Keynes foresaw and hoped for his grandchildren. Nowadays, “the grandchildren of Keynes” – or should we say his “great-grandchildren”, because since the first edition (1931) of the famous essay Economic Possibilities for Our Grandchildren have already elapsed more than eighty years – undoubtedly live in a bigger and more open world than the one in which their illustrious ancestor lived, but the only result which they have obtained is to make it much more dangerous, uncertain and unstable. It is enough to look around to realize it: the technological revolution overwhelms the economic and social systems; societies are increasingly complex and sophisticated, but also more unequal, more expulsive and more exposed to the meltdown; the economic crisis weakens the people and impoverishes countries; natural disasters, still rising, are often caused by the direct or indirect human action and produce devastating physical and economic damages; the progressive decrease in births and the aging population put a strain on the sustainability of welfare and health care systems in the rich and industrialized countries. The traditional political solutions, namely the creation of corporative and universalistic national welfare systems, have gradually become unsustainable because of the spending review. Moreover, the progressive evolution towards regional and liberal welfare systems undermines their redistributive and inclusive function, especially because of the progressive change in the composition of the population determined by migration. The government of these processes is entrusted to a public sector in continuous evolution because of the reorganization of local government, which in the name of subsidiarity and adequacy is taking shape in some big European countries. It is necessary therefore a change, a new approach to the problems of the world, leading to a reversal or, alternatively, to a recovery of the original push, which could eventually lead to safety the “Keynes’s grandchildren”, outside the trap in which they remained imprisoned. However, to achieve this goal it is necessary that contemporary societies become aware of the ongoing changes and adapt to them quickly and consistently. The key to everything, the path to salvation, is now more than ever the resilience, and the ability to respond to the uncertainty and changes by implementing adaptive strategies and constantly creating new forms of equilibrium, other than that of departure. This is the only method which can help us to “tame the beast” and persuade it to change the trajectory, forcing it to do what we want, that is, to increase the welfare and improve the living conditions of the people inhabiting the world, especially of the poorest, without prejudice to democracy and social justice. This paper focuses, in a socio-economic and multilevel perspective, on the applicability of a resilience approach to public policies.

The techniques offered by the analysis of social networks have rapidly increased in the last years in the study of criminal networks and their results influence the construction of policies to defeat them. In this way, the concept of social network was applied to the study of crime and to the several forms in which it operates and organizes its activities, but above all to the analysis of transnational crime and terrorist networks. As it is well known criminal organizations covert social networks to pursue illegal purposes concealing their shady businesses and maximizing their utility function. The members of criminal networks trust one another and look for protection or for a privileged access to certain social as well as economic resources, often through the mediation of individuals who offer their services in a “non-transparent” or irregular way. Therefore, they cannot be considered as simple networks of interpersonal relationships among individuals operating “in the shadow”, or anyway in a criminal contest. In fact, criminal networks have peculiar characteristics which cannot be underestimated or ignored in trying to develop effective preventive and contrast measures and tools to combat them. Several studies highlighted how criminal and terrorist organizations carry out their activities in dynamic contexts, in which the competitive pressure and repressive intervention by the governments constantly test their existence. This is the reason why, in order to survive and keep on growing up, they had to develop a high resistance ability as well as a high adaptability to the changing conditions of the environment they operate in. The nature and source of such abilities of criminal and terrorist organizations have been deeply analysed in several researches. In fact, such organizations, due to their topological characteristics, are considered as an extreme and very interesting case of failure resilient networks, i.e. networks which are resilient towards the so-called “cascade failures”. This paper will focus on this topic analysing the structure and resilience ability of three criminal networks, the first one set up for international drug and psychotropic substance trafficking, the second one operating in the field of the provision of public services (Healthcare) and the third composed for the aggression of public contracts for the restoration of public monuments of architectural value. The analysis is carried out using an interdisciplinary approach as well as the typical techniques and concepts of the Social Network Analysis in order to develop a reliable indicator of Criminal Network Resilience. Obviously, the use of this indicator requires an adaptation of Criminal Investigation Knowledge Systems or Criminal Investigation Expert Systems where they already exist, or their ex novo introduction in the countries where they are missing.

This paper is a first pioneering attempt to apply the concept of resilience to the analysis of the public finance systems of local governments, a concept already used and “abused” in various disciplines and fields of science. In particular, it proposes an attempt to estimate the recovery capacity of Italian Municipalities in a crucial period of our country’s financial history, between 1992 and 2000, or between the currency crisis and the introduction of the Euro. However, the analysis also involved the subsequent trends, in order to demonstrate that the current vulnerability of the municipal public finance system, in particular of the Municipalities of Southern Italy, depends not only on the economic cycle but also on the continuous and incessant changes in the financing mechanisms of local governments established by the central government. The analysis showed a lower financial resilience of the Municipalities of the Mezzogiorno (island and continental) compared to those of the Center-North. The determinants of this phenomenon were found, for one part, through the analysis of the financial data of the Italian Municipalities – as presented by the SVIMEZ in its annual reports on the economy of the Mezzogiorno – and, for another part, through the critical synthesis of significant economic events which occurred during the period examined.