Malaria remains a major Public Health problem in Nigeria and causes death and illness in children and adults, especially pregnant women. Malaria case management remains a vital component of the malaria control strategies. This entails early diagnosis and prompt treatment with effective antimalarial medicines. The objectives of this review is to enable health professionals to understand the magnitude of malaria treatment services in Nigeria, to improve knowledge for rational malaria management within different health system contexts with a view to improving access to malaria treatment. The review therefore looks at the following areas: clinical disease and epidemiology; the burden of malaria in Nigeria; objectives of treatment; antimalarial treatment policy; malaria diagnosis, treatment strategies/ National responses; treatment sources. The review concludes that for improved malaria treatment services in Nigeria, there is an urgent need to develop adequate strategies that will ensure better access to medicines by getting evidence-based and effective medicines to the people who need them, whether by reducing their costs, promoting equity in access, improving their distribution, increasing their efficacy and acceptability, or slowing down the development of antimicrobial resistance.

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Context:The Nigerian health system is characterized by chronic under funding. This has resulted in poor performance of the health sector evident from Nigerian's poor reproductive health indices. Objective: This review evaluates healthcare funding in Nigeria with respect to health budget and health expenditure, appraises the national health insurance scheme, and examines community health care financing as a plausible option to a more effective funding of healthcare in Nigeria. Pattern of health funding in Nigeria: Federal Government budget on health ranged from N 4, 835 million-N 17, 581. 9 million from 1996 to 2000. This amount represented only 2. 7%- 5. 0% of the total Federal Government budget. Nigerian's Total Health Expenditure (THE) as a percentage of Gross Domestic Product (GDP) is low ranging between 4. 3 %- 5. 5 % from 1996- 2005. General Government Health Expenditure (GGHE) as percentage of THE is also low ranging from 21. 8 %- 33. 5 %. Private sector expenditure on health as percentage of THE is high ranging between 66. 5 %- 78. 2 % from 19962005, with private households' out of pocket accounting for 90. 4 %- 95. 0 % over the period. Social security fund had no contribution to the general government expenditure over the 10-year period. The National Health Insurance Scheme (NHIS) currently covers only the formal sector of 4. 5 million people ( 3. 2 %) of the population. Community-based healthcare financing (CBHF): Community-based healthcare financing has been recognized as a community-friendly and community-driven initiative that has a wider reach and coverage of the informal sector especially if well designed. Experience with the Anambra State CBHF scheme, and a few other similar schemes in Nigeria indicate high acceptability of the people to CBHF scheme. Conclusion and Recommendations: Government and non-governmental organizations should collective develop various forms of CBHF to reach out widely to Nigerians.

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Malaria remains one of the highest contributors to the precarious maternal mortality figures in sub-Saharan Africa. At least 6 million women worldwide are at risk of malaria infection in pregnancy. Malaria contributes to at least 10, 000 maternal deaths and to at least 200, 000 newborn deaths annually. Malaria is a contributor or aetiologic factor in pregnancy complications including anaemia, spontaneous abortion, prematurity and stillbirths. Pregnancy results in increased incidence and severity of malaria. Cerebral malaria, acute renal failure and severe anaemia, rare complications in adults living in malaria endemic areas, may complicate malaria in pregnancy. Research implicate reduced maternal immunity from increased steroid levels in pregnancy, increased attractiveness of pregnant women to mosquito bites and increased adherence of parasitized erythrocytes to Chondroitin sulphate A expressed in the placentae. This is worse in the first and second pregnancies. With infection with the Human Immunodeficiency Virus [HIV], the effects of malaria in pregnancy are even worse. Over the decades, there have been concerted worldwide collaborative efforts, spearheaded by the World Health Organization [WHO] and including governments and allied agencies to tackle the scourge of malaria in pregnancy. The main thrusts of such efforts have been: to increase the use of insecticide treated mosquito bed nets [ITN]; intermittent preventive treatment of malaria [IPT]; and adequate case treatment of acute malaria attacks in pregnancy. While for IPT, Sulfadoxine-Pyrimethamine [SP] combination has been proven to be of benefit in preventing acute and latent malaria in pregnancy and its associated complications, the WHO has introduced the use of Artemisinin-Combination Therapy [ACT] for the first-line treatment of uncomplicated malaria in pregnancy, the need to confirm malaria before treatment and the enforcement of completion of therapy once started. The Roll Back Malaria [RBM] campaign was launched as a strategy to curtail the incidence and scourge of malaria especially in the vulnerable groups including pregnant women. The Millennium Development Goals [MDGs] offer a new hope if adequately pursued to achieving eradication of malaria and its complications in pregnancy. There is need to support research into effectiveness and utilization of established and newer control measures.

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I congratulate the Nigerian Medical Association on this Golden Jubilee celebration. It is my opinion that time is apt for us all to have to reappraisal of health care delivery in Nigeria and fashion a practical and achievable way forward for the betterment of the health of the poor Nigerian. I thank the association for inviting me to participate in this symposium on "50 years of oral health in Nigeria". It is my hope and prayer that deliberations at this meeting would signal the beginning of a well planned and structured oral health care delivery system for Nigeria. My brief is to discuss the implication of low oral health awareness in Nigeria.

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In Nigeria presently, dentistry and oral health issues are not receiving priority attention. There is a general low awareness and inadequate access to oral health care in Nigeria, consequently, the oral health of the populace is getting worse and the morbidity is high. For a broad-based approach to the problems of oral health care in Nigeria there is the need for concerted efforts among the Dentists, the Government and Non-Governmental Organizations.

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Nutrition represents a summation of intake, absorption, storage and utilization of foods by the tissues. Oral tissues are one of the most sensitive indicators of nutritional state of the body. Nutritional deficiencies are associated with changes in the integrity (health and appearance) of the oral structures/ tissues and these changes are frequently the first clinical signs of deficiency. Nutrition affects oral health and oral health affects nutrition. The effects of malnutrition can be seen in the oral structures in all stages of human growth and development from conception to old age. The consequence of certain oral diseases may compromise the nutrition by affecting the intake and mastication particularly in some vulnerable groups like people with severe caries, severe oral ulceration, advanced periodontal disease and the resulting edentulousness. The HIV pandemic has added another dimension to the issue of nutrition and oral health. Oral lesions are some of the earliest lesions seen in HIV/AIDS and 90% of HIV/AIDS patients will have oral lesions at a point in the course of the disease. These oral lesions are painful; disturb food intake and mastication thereby further compromising the nutrition of the affected individuals. In Africa, particularly the Sub-Saharan Africa, the burden of poverty, economic downturn and the HIV pandemic have added another dimension to the issue of food availability and nutrition. Malnutrition is a real problem in this area. This paper will examine the effects of compromised nutrition on oral health and the reverse.

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Tuberculosis (TB) is an important cause of childhood morbidity and mortality. The burden of childhood disease is not as well documented as that of adult disease, partly because of the difficulty of confirming the diagnosis. In Africa children have been estimated to account for 20-40% of TB case load. Children infected with M. tuberculosis have a high risk of progression to disease, the younger children being at highest risk. Infected children represent a reservoir of future adult disease. The incidence of childhood TB has increased in developing countries. This resurgence is partly attributed to the coexisting burden of human immunodeficiency virus (HIV) disease, which is most pronounced in Sub-Saharan Africa, Nigeria ranking third highest prevalence. The pattern of childhood HIV and TB infection mirror these epidemics in the adult population. The number of children co-infected with HIV and TB is rising, and so is the incidence of congenital and neonatal TB. In addition the emergence of multi-drug resistance TB and extensively drug-resistant TB has occurred within the context of a high prevalence of HIV and TB. The diagnosis of TB has always been difficult in children and is compounded by HIV co-infection. The clinical symptoms in both diseases are similar, and the radiological changes may be non-specific. Treatment of both conditions in children is a challenge due to drug interactions and problems with adherence. There are few stable syrup formulations of antituberculous and antiretroviral drugs in children, and hence division of tablets gives rise to unpredictable dosing and emergence of resistance. To reduce the morbidity and mortality of TB and HIV, existing childhood TB programs must be strengthened, and antiretroviral drug therapy and prevention of mother-to-child transmission programs scaled up. HIV prevalence in the adult population must also be reduced. An increased emphasis on childhood TB, with early diagnosis and treatment, must be a priority.

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Although it is widely acclaimed in the recent past that the Nigerian has healthy set of teeth and no oral health problems. Our findings show that over 2.3 million Nigerians between the ages of 3 and 70 years attend dental clinics yearly for treatment. In spite of this, provision of oral health care and services at the local outage is highly deficient. Just as the eyes may be the window to the soul, the mouth is a window to the body's health. The state of oral health can offer lots of clues about the overall health as these are more closely connected than one might realize. Oral Health is connected to many health conditions beyond the mouth, and indeed, sometimes the first sign of a disease may show up in the mouth. The mouth is normally teeming with bacteria, and some researchers believe that these bacteria and inflammation from the mouth are linked to other health problems including heart disease. Other diseases that affect the oral cavity include, but not limited to caries, infections of the gum and jaws, malformations, benign and malignant tumours, as well as diabetes. The general dental practitioner therefore has very important duties. These include early recognition and diagnosis of oral health problems, oral health promotion, education and provision of care and services. Dental professionals should make dental patients aware that oral health care can't wait. They should market their practice to increase business and oral health care awareness.

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Background : The most recent UNAIDS report on the global epidemic estimated the total number of people living with HIV in 2008 to be 33. 4 million ( 31. 1- 35. 8 million) worldwide, two-third of known carriers of HIV are living in sub-Saharan Africa. Although HIV prevalence appears to be stable, much remains uncertain about the direction of the epidemic. In the developed countries, the increased cancer risk among immunocompromised persons with HIV/AIDS (PHA) is well observed. Now a person diagnosed with HIV as a young adult in a resource rich country can expect to live for 30 or 40 years after infection because of public health education and community awareness in conjunction with advances in antiretroviral therapy. In recent, large scale cohort studies, the incidence of non-AIDS morbidity and mortality rivals that related to AIDS and these non-AIDS conditions including cancer occur at higher rates in those with on-going HIV replications and lower CD₄ cell count. Data Sources/Study selection: Information was obtained by searches of medical journals, examination of reference lists and web resources. Peer-reviewed articles on HIV/AIDS cancer and its impact on surgical practice from references were obtained. Data Synthesis/Conclusion: The severe immunodeficiency cause by advanced HIV infection has been recognized as capable of causing three types of malignancies: Kaposi's sarcoma (KS), non-Hodgkin's lymphoma (NHL) and cervical cancer. Kaposi's sarcoma and non-Hodgkin's lymphoma occur at exceptionally high incidence with relative risk being hundred-fold above those in uninfected populations. Cervical cancer is an AIDS-defining cancer when it occurs in HIV-infected woman and the relative risk is 5 to 10-fold. Although these are the only forms of cancer that have been designated as AIDS-defining, several other malignant diseases have been reported to occur more frequently following HIV infection than in its absence. The distribution of these cancers varies with the socio-demographic characteristics of the population studied indicating risk factors for cancer differs amongst populations. There remain some controversies as to why cancers occur at increased rates. In immunosuppressed PHA, risk of AIDS-related cancer generally increased with degree of immunosuppression. In Hodgkin's lymphoma, incidence has an inverse relationship with CD₄ count. Some tumours are observed more frequently in PHA because of lifestyles that expose them to specific carcinogens such as lung cancer. Other tumours have been reported to have marginal or inconsistent increases in PHA, and their associations are still controversial. Over the past 20years, AIDS has been transformed from a disease that was almost inevitably fatal to a chronic condition that is manageable. The longer survival will likely increase the importance of cancer as a clinical problem. In recognition of the increasing importance of cancer as a cause of mortality and mortality in PHA, managing persons affected according to standard practices regardless of HIV status is stressed. These practices should emphasize helping PHA avail high-risk lifestyles such as smoking and screening for early detection of cancers. Paying detail attention to safety survival practices and appropriating the right choice of procedures for HIV related cancer surgeries in addition to identification of preoperative chronic conditions such as diabetes and hypertension, etc. is important. With the population's geographic and social diversity, Nigeria also presents unique research opportunities relating to cancer for the surgeon that can be embedded in programs targeting HIV/AIDS.

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