FACULTY OF CLINICAL SCIENCES

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HERPES TYPE-2 VIRUS AND CARCINOMA OF THE CERVIX UTERI IN NIGERIANS: IMMUNOVIROLOGICAL STUDIES
(1976-03) ADELUSI, B.
In the search for the etiology of carcinoma of the cervix uteri, various factors have been implicated by various workers. The disease has been shown to have a venereal origin, following on its significant association with coital characteristics. These include early Initiation into hetero-sexual acts and frequency of coitus, multiplicity of coital Partners, multiparity, low socio-economic standards, venereal diseases and circumcision. Extensive epidemiologic studies have indicated that a "venoreally transmitted factor" might be responsible for the introduction of the squamous cell variety of the malignant disease. Recently, a strain of Herpes Simplex virus, antigenically distinct from the strain commonly associated with oral lesions, and designated Genital Herpes or Herpes Type-2 (HT-2) virus, was shown to be venereally transmitted, and might have oncogenic potentialities on the cervix. At the time the present studies were contemplated, little was documented about the clinical and histopathologic presentation of Carcinoma of the cervix in Ibadan. There was also no knowlege of the prevalence of Herpes Type-2 virus antibodies in the population, nor of the precise relationship, if any, of the virus to carcinoma of the cervix uteri in Ibadan. It was clear however, as a result of the work Edington and Maclean (1965) that carcinoma of the cervix uteri is very common in Ibadan, where it was shown to form the commonest female malignancy. Clinical, cytologic, histopathologic and immuno-virologic studies were undertaken to see if indeed carcinoma of the cervix uteri has a venereal origin, and to ascertain whether or not there is any association between the malignancy and HT-2 virus infection in Ibadan. In addition, sero-epidemiologic studies were also undertaken to determine the prevalence of HT-2 virus antibodies in various sectors of the Population. Evidence was provided to show that coital practice was a significant correlate of carcinoma of the cervix in Ibadan. Furthermore, Imuno- fluorescence and complement fixation tests were two Parameters used to provide evidence that Herpes Type-2 virus is associated with the disease, in that carcinoma of the cervix patients possessed significantly levels of antibodies against HT-2 virus as compared with patients having extra-cervical pelvic, and extra-pelvic malignancies and healthy Controls. In addition, HT-2 virus antigens were detected by immunofluorescence tests in the exfoliative cervical cells from all patients with carcinoma of the cervix, whereas no such virus antigens were found in exfoliated cervical cells from healthy Controls. In was concluded, that the observed association between HT-2 virus and carcinoma of the cervix in agreement with other studies, and the fact that the virus was not associated with other extra-cervical malignancies in this environment, indicate a significant relationship. Even though this may not necessarily be an etiologic one, the precise relationship of the virus and the malignancy would have to await further investigation.
A STUDY OF LEADERSHIP STRUCTURES IN AIYEDADE AND IMPLICATIONS FOR LOCAL INVOLVEMENT AND PARTICIPATION IN COMMUNITY DEVELOPMENT PROGRAMMES FOR HEALTH PROMOTION
(1981-09) ABABIO, E. N. K.
The power and influence of traditional leaders over their subjects need to receive attention if they (the tradional leaders) are to assume new leadership roles as agents of comn1unity health workers in rallying general participation in community based programmes. The effectiveness of traditional leaders in these roles would vary from community to community. It would also depend to a large extent on how close or how remote they are connected w.ith decision-making in the community and the nature of community participation required. This is because the amount of power leaders exercise over their followers can be measured by their ability to make or influence decisions that affect the day-today activities of the subjects. Also, if participation of the general community is the goal of a community based health programme, then, the chiefs must be popular with more than half the population of the community. With regard to the power of the chiefs, one thing is important. It is this, new decision-making structures have been established in the Aiyedade community. But as power and influence have come to depend on other variables, (education, wealth, occupation) and the chiefs position is based on the traditional kinship relations, the power and influence of the chief will depend on his possession of some of these new variables. In the Aiyedade community, the chiefs almost match other leaders on occupational and social background but to the extent that he sometimes lacks the more modern forms of power base such as education and wealth his traditional monopoly of leadership is open to serious challenges. In the final analysis the degree of popularity a leader enjoys is a function of individual qualities of the leader as opposed to his position or status, qualities such as trustworthiness, service to the community and identification with the wishes and aspirations of the people lead to an individual's popularity with community members. But it is one thing being identified with these qualities and another thing being in a position to direct government resources to satisfy the needs of the people. The latter is the function of the key decision makers in the community. In the Aiyedade community the traditional leadership was not found to constitute the key decision - making body representing the central government. It was also observed that even though the traditional ruling elite was still popular, it had no monopoly of this popularity in the community. As the traditional leadership roles have been eroded by the newly emerged leaders it is no longer appropriate to organize popular following around the chiefs alone. Also as community based programmes may need resources other than the resources of community members alone, it is essential that persons controlling outside resources are involved jointly and simultaneously with other community members. This study then shows that if general community participation is the goal of the health educator in Aiyedade then the chief is only one of the leaders around whom popular Loll owing could be rallied.
FOOD WRAPPING PRACTICES AND THE REFUSE DISPOSAL PROBLEM IN A RURAL SETTING
(1982-07) ADEBAYO, O.
It is the aim of this study to investigate the food wrapping methods of the people in Igbo-Ora (a developing rural area). It has been observed that often, the type of materials used in wrapping food determines the nature of refuse being generated. The food wrapping materials form a great bulk of the refuse. The traditional method of food wrapping consists of wrapping the food in leaves. It is well documented in the literature that the bulk of refuse being generated in rural and urban areas consist mainly of leaves. This fact has contributed immensely to poor environmental sanitation, the consequence of which may include disease endemicity, occasional epidemics, and a contributing factor to flood and fire disasters. In order to combat refuse disposal problem both local and state governments have been spending large sum of money, but with little or no positive effect. Furthermore, policy makers e.g. state governors and many authorities have made remarks about the refuse components, i.e. that leaves used for wrapping food constitute the major component of the refuse. Co-incidentally this study endeavours to investigate the opinions of the people on the different types of materials used to wrap food and their preferences in using them. This study would be useful to Waste Disposal Boards, Plastic/Polyethylene manufacturing Industries and all organizations or individuals interested in better environmental sanitation in our communities.
CIRCULATING TUMOUR ASSOCIATED ANTIGENS AS AID TO EARLY DIAGNQSIS OF CARCINOMA OF CERVIX
(1982-10) ADELUSI, B.
Earlier studies by this author in 1976 provided evidence of an association between an infective, sexually transmitted agent, the Herpes Simplex Virus Type-2 (HSV—2) and human carcinoma of the cervix, irrespective of geographic location or ethnic origin of the individuals. Similarly, HSV-2 related antigens were demonstrated by the indirect immuno-fluorescent technique in desquamated cells of carcinoma of the cervix tissues from tumour bearing patients. To highlight the Potentials of the detection of tumour antigens in tumour-faearing patients as aid to early diagnosis of the cancer, Isolation and purification of the Tumour Associated Antigens (TAA) of human cancer of the cervix were attempted by immunological and physicochemical procedures in this study. Two antigen preparations, one the Soluble Antigens (SA), and the other, the Membrane Bound Antigens (MBA) were prepared from a pool of cancer of the cervix (CaCx) tissues. The soluble antigens were extracted by homogenization in Earle’s Balanced Salt Solution (EBSS) containing antibiotics, and the membrane-bound antigens were solublised by 3-molar potassiurn Chloride (3 Molar KCl). For isolation and purification of TAA, procedures for the purification of proteins were explored. These include physicochemical stepwise ammonium sulphate fractionation, sephadex ion exchange chromatography, sephacryl S-200 gel filtration, and affinity chromatography to eliminate the normal tissue components of the antigen fractions. Hyperimmune rabbit sera were then prepared against the partially purified TAA. Immunodiffusion studies, employing hyperimmune rabbit sera prepared against the partially purified TAA were used to demonstrate tumour associated antigens in the various cancer antigen preparations, and Circulating Tumour Associated Antigens (C-TAA) in the sera of tumour- bearing patients. The TAA in the cancer tissues showed lines of identity with the C-TAA in patients sera. Techniques involving adsorption by immuno-precipitation-in-gel with Normal Cervix (NCx) tissue antigen preparations, and pooled Normal Human Sera (NHuS) were utilized for the removal of antibodies to NCx and NHuS in the rabbit sera, after which there were no reactions with NCx indicating the specificity of TAA for CaCx. A comparison of the soluble and 3 Molar KCl extracts of the cancer antigens by immuno-precipitation reaction, using adsorbed hyperimmune rabbit sera prepared against the partially purified CaCx TAA, demonstrated three TAA (TAA-1, close to the central antisera well, TAA-2, intermediate and TAA-3, close to and curving towards the peripheral antigen well) in the soluble antigen preparation. Only one TAA (probably identical to the TAA-3 of the soluble antigen) was demonstrated in the 3 Molar KCl extract. Using the rabbit antisera against the partially purified CaCx TAA, adsorbed with NCx and NHuS, results of coded sera showed that immunodiffusion reaction was able to detect circulating TAA in 75.0 per cent of patients with cancer as compared with 5.6% in women with benign gynecological diseases, 1.4% in pregnant women and 0.0% in healthy control women. The result indicates that the test has great potential for immunodiagnosis of cancer of cervix. Although the sensitivity of the test method was low, the specificity was high, and could provide a means of early diagnosis of neoplastic changes in the cervix. The detection of Circulating-TAA as tumour markers in sera of patients, may someday become routine, and thus make earlier diagnosis of cancer possible. Indications are that immuno-diagnostic procedures can be designed in ways that are reproducible, simple and reliable. Such serological tests would extend our present ability for detection and monitoring of malignancies.
CHILDHOOD NEPHROTIC SYNDROME IN KADUNA STATE
(1985-01) ABDURRAHMAN, M. B. M. B.
The clinicopathological features of childhood nephritic syndrome in tropical Africa are different from those in temperate countries of Europe and America. However, detailed clinicopathological features of the disease have not been comprehensively described in all parts of Africa. Plasmodium malariae has been shown to be strongly associated with the disease in some parts of Africa, and the association has been postulated to be causal. Childhood nephrotic syndrome was studied in Kaduna State of Nigeria in an attempt to define the clinicopathological features of the disease. In particular, the study set out to assess the role of P. malariae in the aetiology or pathogenesis of childhood nephrotic syndrome, and to look for other possible aetiological factors. One hundred consecutive children with nephrotic syndrome who had had no treatment previously were studied. In addition to routine biochemical and haematological investigations, malaria parasitaemia, protein selectivity index, serum hepatitis B surface antigen and percutaneous renal biopsy were done. As described in other parts of tropical Africa, children with nephrotic syndrome presented with massive oedema, prominent ascites, and very low serum proteins. P. malariae parasitaemia was present in 31% of nephrotic children, compared with 7% in the control group of children. The frequency of P. malariae parasitaemia was 40% in patients with membranoproliferative glomerulonephritis, 40% in quartan malarial nephropathy, and 21% in proliferative glomerolunephritis. Serum hepatitis B surface antigen was positive in the sera of 31% of patients compared with 30% in control but the concentration of antigen was stronger in the patients. Schistosoma mansoni ova were found in the stool or rectal snip of six patients: histology of renal biopsy showed membranoproliferative glomerulonephritis in four of these patients. Protein selectivity index was determined by comparing the clearances of albumin and immunoglobulin IgG. The index was good in 34% of patients. However, the test was not found useful in identifying those lesions likely to respond to corticosteroid therapy. Percutaneous rena1 biopsy was successful in 98 of the 1OO patients. By light microscopy, the most common histological diagnoses were membranopro 1iferative glomerulonephritis (25 cases), quartan malarial nephropathy (20), and proliferative glomerulonephritis (19 cases). Together they formed 65% of the biopsies. Immunofluorescence was abnormal in 92%: there were deposits of immunoglobulins, C3, P. malariae and hepatitis B surface antigen. Schistosome antigens were not looked for. Short-term prognosis of the disease was not as good as in children in Europe or North America, but did not seem to be as poor as in children studied in Ibadan. Quartan malarial nephropathy was not the predominant type of childhood nephritic syndrome seen in Kaduna State, since it accounted for less than a quarter of the cases studied. This is in contrast to the finding in Ibadan where quartan malarial nephropathy was responsible for over 80% of cases of childhood nephrotic syndrome. There was some evidence that hepatitis B surface antigen could also play a role in the aetiology or pathogenesis of the disease in Kaduna State. There is still no satisfactory treatment for childhood nephrotic syndrome in tropical Africa. Eradication or control of infectious diseases should result in reduced incidence of the disease.
AN ASSESSMENT OF THE TRAINING AND SERVICES OF COMMUNITY-BASED DISTRIBUTION (CBD) WORKERS IN OYO STATE
(1985-08) ADEDOYIN, E. O. O.
The study attempted to assess the effectiveness of the Community Based Distribution (CBD) programme of low-cost Family Planning, Maternal and Child Health Services. This was established in 1979 by the Fertility Research Unit of the Department of Obstetric and Gynaecology, University College Hospital, Ibadan in collaboration with Oyo State Ministry of Health the Pathfinder Fund of Boston; and the Centre for Population and Family, Columbia University both in the United States of America, The C.B.D., an innovative programme, consists of the training and utilization of Traditional Birth Attendants (TBAs) and Voluntary Health Workers (VHWs) to provide Primary Health Care to the door steps of the rural communities who live on the out-skirts of the main stream of sophisticated health technology. The pilot project site was Akinyele Local Government, a rural area, North of Ibadan with a population of 89,900. It was found that the programme was successful because within two years of its implementation, the population served increased from an initial 89,900 to 238,696 and the number of Zones from one to five. At the request of the Oyo State Ministry of Health officials, the project was extended to other Health Zones in Oyo State: Oyo, Oshun, Ife/ljesha Health Zones. The study assessed the training of the CBD workers with particular emphasis on the educational components of the training curriculum and also the educational activities of the CBD workers and their impact on their client community. The CBD training curriculum findings indicate that as designed presently, has enough contents which are relevant to the training objectives. However, it will be more useful, if it is developed into a standard training manual with clearly stated objectives, training methodologies and an evaluation instrument which will set an acceptable level of attainment for a trainee to qualify as a CBD worker. In relation to the application of the training, most of the CBD workers to a large extent were found to perform well on what they were taught to do - knowledge of educational tasks, performance of educational task and effectiveness of educational task. The response and support of the community members especially the clients, to the educational activities of the CBD workers was found to be positive. However, the CBD workers advocate that the government should re—introduce the monthly incentives because the CBD workers in carrying out their activities, incur tangible and intangible cost.
Adie's syndrome as a cause of amblyopia
(Slack Incorporated, Medical Publisher, New Jersey, 1987) Agbeja, A. M; Dutton, M. D.
Adie's syndrome comprises a tonic pupil, which may be associated with impairment of accommodation, in the presence of diminished or absent deep tendon reflexes. We report a case of a 4-year-old boy with Adie's syndrome in which latent hypermetropia was made manifest by accommodative paresis and resulted in reversible amblyopia
Conjunctival incisions for trabeculectomy and their relationship to the type of bleb formation-A Preliminary Study
(1987-04) Agbeja, A. M.; Dutton, G. N.
The bleb which develops following trubeculectomy may be diffuse or cystic in nature. Cystic blebs can he complicated by infection, leakage of aqueous, astigmatism and problems related to contact lens wear, whereas diffuse blebs are not associated with such problems. We report a preliminary prospective photographic evaluation of bleb formation following each of three types of conjunctival incision: (a) fornix bascd (b) straight limbus based and (c) curved limbus based. The vascular patterrn and morphology of the drainage bleb formed was dependent upon the type of conjunctival incision made. The fornix based flap was found most likely to give rise to a diffuse bleb with a normal vascular pattern.
THE DEVELOPMENT OF A SCALE FOR PREDICTING MOTHERS COMPLIANCE IN THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI)
(1989-08) ADEMOLA, A. H.
The apparent high drop out rate in Expanded Programme on Immunization (EPI) is constituting a major barrier in the break-through of the child survival programme especially in developing countries of the World (Alakija, 1986). This cross-sectional, descriptive and explorative study was carried out in Obokun Local Government Area (LGA), Oyo State of Nigeria between October, 1987 and July, 1988. The study population consists of mothers who attended EPI clinics for their children’s immunization under the Expanded Programme on Immunization. Respondents were mothers whose children bad taken the first doses of diphtheria, pertussis, tetanus and Oral polio vaccines (DPT/OPV) between October 1987, and January, 1988. These mothers were classified as compliers if by the end of July, 1988 they had completed the three doses of DPT/OPV schedules. Those who had not completed these three doses were termed non-compliers. Out of 121 mothers used in the study, 65 were compilers while 56 were non-compliers. Data gathering tools used included questionnaire to explore demographic, attitudinal and cognitive factors in these mothers which may affect compliance with EPI appointment schedules. In addition, observational check-list was used to probe into factors which may affect compliance due to clinic settings or arrangements. After analysis of the data, the identified compliance factors were scored to form a predicting scale that can be used to identify those that are likely not to comply with appointment schedules among mothers in EPI Programme so that measures that will make them comply can be instituted from the start. The result showed that the respondents in both compilers and non-compilers were similar in such demographic characteristics as age, marital status and parity. They however differ significantly in demographic characteristics such as educational levels, occupation, income and religion. Also, there were more compilers among mothers who attended orthodox form of ante-natal services, those who had institutionalized deliveries and mothers who brought their children to have first contacts of immunization within their six months of lives. The risk factors that can determine non-compliance with appointments in EPI based on the findings of the study are low- educational level, low income, semi-skilled and non-occupation, non attendance of Orthodox ante-natal services in pregnancy, no immunization during pregnancy, non-institutionalized deliveries, long distance from home to EPI centres, giving herbs as protection to children, delaying the first immunization till children reached ages six months and lastly religions of mothers in which case muslims can default more than Christians. Based on the findings from the study, it is recommended that the health education approach in EPI be modified to include local communication system for rural women since effective communication is the key to implementation of health education activities. In addition future studies should focus on production of predictor scale that will enable the identification of non- compliance among urban/cities mothers.
Sebaceous gland carcinoma of the eyelid: case report
(1990) Agbeja, A. M.; Osuntokun, O.; Ogunniyi, J.
This paper reports a case of sebaceous adenocarcinoma of the meibomian gland in a 69-yearold man. The tumour was excised and histopathological examination revealed the characteristic features of sebaceous adenocarcinoma should then consist of wide excision, with preparation of frozen sections during the operation to ensure tumour-free borders.
One year study of CT scan in patients with visual field loss
(1990-07) Agbeja, A. M.|; Dutton, G. N.
19 patients from the Neuro-Ophthalmology clinic of the Western Infirmary, were found during a one year period, to have various types of visual field loss and on the basis of this were sent for CT Scanning. 12 out of the 19 patients had positive CT Scans, the other 7 had no demonstrablepathology on CT Scan.
Ocular complications of head injury in children
(Springer-Verlag, 1991) Shokunbi, T.; Agbeja, A.
Ocular complications occurred in 28%, of children with head injury. Neuro-ophthalmological lesions made up one-third or these complications, mostly involved the optic nerve, and were associated with other focal neurological signs more frequently than non-neural ocular complications. Lesions or the posterior visual pathways were rare but tended to be permanent.
Ocular gun-shot injuries in Ibadan
(1991) Agbeja, A. M; Osuntokun, O.
Twenty patients with eye injuries resulting from gun-shots were admitted to the University College Hospital, Ibadan, over a 10-year period. Three of the patients had involvement of both eyes, making a total of 23 eyes. Seven eyes had contusion injuries, while 16 had perforating injuries. Eight of the perforating group had primary evisceration, two refused evisceration and six had repair of corneal! corneo-scleral wounds. All seven eyes in the contusion group were treated conservatively and four retained a vision of better than 6/36. Seven out of the 20 patients were shot by someone else, six of whom were armed robbers. The other 13 patients were shooting animals while hunting, when the gun either backfired or exploded in their faces.
BREAST SELF-EXAMINATION (BSE) PRACTICES AMONG FEMALE STUDENTS IN HIGHER INSTITUTIONS IN IBADAN: IMPLICATIONS FOR CANCER EDUCATION
(1992-01) ADEGOKE, F. R.
This study assessed the knowledge, attitude and existing breast self-examination practices among six hundred and ninety female students of the University of Ibadan and the Ibadan Polytechnic, Oyo State, Nigeria; using a set of questionnaire. Results showed that 66.1% had ever practiced breast self-examination. However, only 77% reportedly carried out monthly examination of their breasts in the last six (6) months, although 84.6% were aware of it and 33.3% knew that it should be carried out monthly. Knowledge of the correct sequence of breast self-examination and the symptoms to look for was low. The major source of information on breast self- examination was through the mass media. There was a generally positive attitude toward the behaviour. In light of these findings, some breast self- examination information packages and progammes are proposed for the students. In addition, suggestion regarding the examination of breast, self-examination materials for completeness, accuracy and appropriateness before dissemination to the public were made.
Rehabilitation of the blind: A review
(1992-06) Agbeja, A. M; Cookey-Gam, A. I.
Rehabilitation of the blind is an active process whereby the blind person is helped to become an independent and useful member of the community. Rehabilitation thus improves the psychological wellbeing of the blind person as well as making him a happy, contributing member of the society.
Socio-economic implications of the surgical treatment of hydrocephalus
(1993) Afolabi, A. O.; Shokunb1, M. T.
Between July 1987 and June 1991, 38 patients presented to our service for the surgical treatment of hydrocephalus. The average age at presentation was nine months and the sex ratio was M:F = 1:2: 1. Majority of the patients presented at advanced stage of the disease with gross head enlargement, psychomotor retardation and optic atrophy. Despite the willingness of the parents to have surgical treatment, there was an average delay of six weeks between confirmation of diagnosis and treatment, because of socioeconomic reasons.
Intraocular lens implantation, the Nigerian experience
(1994) Agbeja, A. M.
Between April 1989 and December 1990, 51 patients underwent cataract extractions with implantation of intraocular lenses. A preliminary report of encouraging results is given inspite of limitations of equipment for microsurgical procedures
Astigmatism in post-operative cataract patients
(1994-12) Agbeja-Baiyeroju, A. M.; Oko, H. O.
The aim of the study was to find out the various degrees of post-operative refractive astigmatism in our cataract patients, causes of the astigmatism and ways of minimising this problem. The total number of post-operative refractive astigmatism was determined in patients following cataract surgery. 22% of the patients had an astigmatism of greater than 2 diopters although only 1.9% had the more intolerable astigmatism of greater than 4 diopters. Associated causes for the astigmatism included intraoperative vitreous loss, wound dehiscence, pterygium and corneal scars. With the advent of microsurgery and better magnification, suggestions are made as to how to minimise this condition which, if high proves very intolerable for the patient.
Non-retrobulbar anaesthesia for trabeculectomy
(1995) Agbeja, A. M
A prospective clinical trial using sub-conjunctival (Sub- Tenon's) anaesthesia for trabeculectomy is reported. Forty-one eyes of 22 consecutive patients with glaucoma had trabeculectomy performed using the sub-conjunctival method of local anaesthesia. The effectiveness of the anaesthetic, intra-operative and post-operative complications were recorded. Sub-conjunctival injection of local anaesthesia was found to be painless and free from the complications associated with retrobulbar injections. Surgery was also found to be easier as a conjunctival bleb was already raised allowing easy access to the sub-conjunctival space. Voluntary eye movements remained but did not interfere with surgery.
POST-TRAINING ASSESSMENT OF DIARRHOEA MANAGEMENT WITH SALT SUGAR SOLUTION BY COMMUNITY-BASED DISTRIBUTION WORKERS IN AKINYELE LOCAL GOVERNMENT AREA, OYO STATE
(1995) ADEKOLA, O.
Studies in a number of pilot Community Based Distribution (CBD) programmes have shown that CBD workers can deliver modern contraceptives and safe maternal and child health services (including treatment or management of common childhood diseases such as diarrhoea) in their communities (Weiss, 1985). CBD workers have been active in Akinyele Local Government Area (LGA) and a high number of diarrhoea episodes have been managed by them. Most efforts have been on the general assessment of service delivery and also certain issues such as increasing availability of contraceptives have been addressed by CBD workers. One major problem is lack of specific post-training assessment of CBD workers' skill in preparing and use of some of the innovative training packages especially the use of salt sugar solution (SSS) in the management of children diarrhoea diseases. A descriptive study was carried out in five CBD centres of Akinyele LGA between June 1990 and October 1990. All the CBD workers identified were 91 but after four visits to each home, a sample of 77 was found and was interviewed and observed. Baseline information on CBD workers who had managed diarrhoea cases were obtained from records at CBD office. The ammended final draft of the questionnaire after pretest at Ajia in Afijio Local Government Area was administered to the 77 workers. In addition observation with a checklist was used to assess workers' ability to prepare SSS. The respondents were similar in age, occupation (other than CBD work) religion. Though while all Traditional Birth Attendants (TBAs) were female and aged above 45 years, Village Health Workers (VHWs) included both male and female and some aged less than 45 years. All the workers, irrespective of either VHWs or TBAs recognised diarrhoea as a servere case and could relate the causes and management but only 9.1% (2 TBAs, 5 BHWs) could assert the correct preventive measures. All the categories of workers asserted that they have heard of SSS but 14.3% (6 VHWs, 5 TBAs) of the workers could state the correct measurements of SSS though 72.7% used it in diarrhoea management, however 27.3% workers have never used it. More than one third (36.7%) of the workers stated that SSS stops diarrhoea rather than preventing dehydration which was mentioned by only 16.3%. All the workers (100%) mentioned that the ingredients - salt and sugar are expensive though they will continue to use it in future unless there is a new technological breakthrough. However, the workers (97.4%) do not teach mothers who utilize their services. Results from observation study revealed that all the workers (100%) did not have SSS corner and sugar was readily accessible in 48.1% of the homes. The workers' preparation of SSS revealed inadequacy in the skills. The study has demonstrated that operation research can reveal hidden facts which could have been overlooked if research was on a general scope. Based on findings, the researcher recommends that workers undergo refresher training which will emphasise measurements of SSS ingredients, SSS use and preparation. Workers should also have SSS corner in their homes where they can teach mothers and should be compensated financially or in kind as this will motivate workers to be dedicated. Specifically, future study should focus on the diarrhoea occurrence among under five children in the five CBD centres of Akinyele Local Government.