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Background: The high maternal death burden in developing countries when compared to the developed could be attributed to differences in use of antenatal and skilled delivery care., Aim: To assess the differences in utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria., Methods: A cross-sectional comparative study design was used. Two stage (cluster) sampling technique was used to select 660 women in 4 of 13 local government areas in the state. The respondents were women who were permanent residents of communities and have delivered in last one year. Outcome measure was good utilization of antenatal and delivery services and was assessed by proportion of respondents who obtained antenatal and delivery from a skilled provider and also made at least four antenatal visits., Results: The mean age of respondents was urban, 29.6 ± 6.2 and rural, 28.6 ± 5.1 years. Majority in urban, 51.8% utilized tertiary health facility for antenatal care while in rural, 77.9% used primary health centers (P < 0.001). Comparable proportions in urban, (77.3%) and rural, (79.1%) had good use of antenatal and delivery services (P = 0.572). Predictors of good use of antenatal and delivery services in urban included having one child (AOR = 4.8; 95%C1: 1.4--17.0), having attained tertiary education, (AOR = 2.6; 95%C1: 1.2--5.5), being in low socioeconomic class, (AOR = 0.4; 95%C1: 0.2--0.7), and having good knowledge of danger signs, (AOR = 2.6; 95%C1: 1.3--5.4). In rural, predictors included having one child, (AOR = 2.8; 95%C1:1.1--7.1), being unmarried, (AOR = 0.3; 95%C1: 0.1--0.9), and having good knowledge of danger signs (AOR = 3.7; 95%C1: 1.8--7.5)., Conclusion: Utilization of antenatal and delivery services in health facilities in study area was high but there is room for improvement. There is need to plan specific interventions aimed at improving utilization of maternal health services by some groups like urban poor and unmarried mothers, especially teenagers. Emphasis should also be placed on improving community understanding of danger signs of pregnancy., Competing Interests: None

Objective: To determine the emigration plans after graduation of clinical medical students of Ebonyi State University Abakaliki, Nigeria., Methods: A descriptive cross-sectional study design was used. All clinical medical students of the University willing to participate were included. Information was obtained using a pre-tested self-administered questionnaire. Outcome measure included proportion of students willing to emigrate and those willing to practice in rural areas after graduation., Results: A total of 285 students participated in the study, (response rate, 92.5%). Majority, 93.3% intend to pursue specialist training after graduation. Minor proportion, 13.9% intend to specialize in Nigeria, whereas 74.4% prefer to specialize outside Nigeria. Major reasons for preferring specialist training abroad included good equipment/facilities, 33.8%, better remuneration/quality of life, 27.8%; and improved skills, 18.7%. Countries of interest for training outside Nigeria included Canada, 28.3%; United Kingdom, 23.2%; and the United States of America, 18.2%. Minor proportion, 17.2% intend to practice in rural area after graduation. Predictors of willingness to emigrate included being in 400 level class, (adjusted odds ratio (AOR) =2.0, 95% CI = 1.1-4.1), being single, AOR = 4.0, 95% CI = 1.2-13.3) and having decided on specialty of choice, (AOR = 2.6, 95% CI = 1.5-4.5). Predictors of willingness to serve in rural area included family residence in urban area, (AOR = 0.2, 95% CI = 0.2-0.8) and intention to specialize in Nigeria, (AOR = 3.7, 95% CI = 1.6-8.5)., Conclusions: Majority of students intend to pursue specialist training and prefer training abroad. Minor proportions were willing to specialize in Nigeria and serve in rural areas. The students may have perceived medical practice in Nigeria as serving in rural areas hence students willing to work in rural areas were more likely to specialize in Nigeria. This may adversely affect health service delivery in Nigeria if left unchecked. Nigerian authorities should ensure that medical graduates willing to practice in Nigeria are not deterred. Also, plans to encourage doctors to practice in Nigeria should receive desired attention., Competing Interests: None

Background: Breast cancer is the most common female cancer in both developed and developing countries. This study was designed to determine the predictors of practice of breast self-examination among female undergraduate students of Ebonyi State University, Abakaliki, Nigeria., Methodology: This was a descriptive cross-sectional study. A three-stage sampling design was used to select 365 female students of the university. Data were collected using a pretested self-administered questionnaire. Completion of one academic year qualified students for inclusion. Good knowledge of breast self-examination was determined by proportion of respondents who scored 50% and above of 15 variables used to assess knowledge., Results: The mean age of the students was 22.1 ± 2.5 years. Majority (76.4%) were aware of breast self-examination and health workers; 37.0% were the major source of information. A minor proportion (5.8%) have had their close relatives diagnosed with breast cancer. Majority (55.3%) had good knowledge of breast self-examination. Majority (63.6%) have ever-practiced breast self-examination; however, only 15.9% of the respondents examined their breasts on a monthly basis. Predictors of ever-practiced breast self-examination included having good knowledge of breast self-examination (adjusted odds ratios [AOR] =6.4, 95% CI: 3.9-10.4), having a close relative diagnosed with breast cancer (AOR = 4.0, 95% CI: 1.1-15.1), and mother of respondent being self-employed (AOR = 0.5, 95% CI: 0.5-1.5)., Conclusions: Awareness of breast self-examination and practice were high among the respondents; however, only a minor proportion practiced breast self-examination every month. Having good knowledge of breast self-examination was associated with its practice. Having a close relative diagnosed with breast cancer encouraged the respondents to prevent the occurrence of breast cancer, thus enabling the practice of breast self-examination. Moreover, the practitioners of breast self-examination taught and encouraged others to examine their breasts. There is a need to increase knowledge of breast self-examination through public health education using the media., Competing Interests: None