This is responsible for the high cost attributable to transportation in our report. Because of the younger age of our subjects, HF in our setting is, therefore, associated with longer disability adjusted life years and by extension a huge cost to the society at large. With the changing demographic and epidemiological landscape in Nigeria coupled with the rising burden of cardiovascular risk factors and noncommunicable diseases in the country, the rate of HF is predicted to rise if preventive measures are not put in place at all levels. This will put a lot of strain in an already weak health system. The high cost of surgical interventions and procedures is out of the reach of the average Nigerian. Prevention of conditions requiring this mode of care such as rheumatic heart disease, tuberculosis and coronary artery Compound Library citations disease should be a priority for the country at large. Furthermore the need for a functional, effective and efficient social health insurance system in the country cannot be overemphasized considering the fact that majority of those afflicted by HF are poor and are not likely to sustain the treatment of their illness for a long time. There is also need to develop community based HF care in the country as this will reduce the cost of outpatient care which is largely contributed by the cost of frequent transport to-and-from the health facility. Alcohol exposure during pregnancy causes fetal alcohol spectrum disorder in the offspring characterized by various neural developmental deficits, growth retardation and facial abnormalities. A common endophenotype of fetal alcohol exposed offspring is an elevated neuroendocrine response of the HPA axis, particularly an increase in circulating ACTH and corticosterone, which has been suggested to be due, at least in part, to the deleterious effects of alcohol exposure on hypothalamic bendorphin producing neurons. During the stress response, hypothalamic peptides are released through several signaling cascades, such as the release of corticotropin-releasing hormone followed by the release of various POMC-derived peptides. POMC is a relatively large peptide that is cleaved into multiple biologically active subunits, including b-endorphin and a-melanocyte stimulating hormone. Upon stimulation, bendorphin synthesis, primarily within the arcuate nucleus of the hypothalamus, is activated by CRH release from terminals emerging from the paraventricular nucleus of the hypothalamus, which is in turn inhibited by b-endorphin release. POMC-derived neuropeptides play a vital role in many other processes such as energy homeostasis, stress response, immune functions and the brain reward system. POMC system abnormalities have been associated with stress dysregulation, metabolic diseases, cancer and alcohol drinking. The molecular regulatory mechanism controlling POMC expression with fetal alcohol exposure is not clearly understood. Aberrant epigenetic changes in response to environmental exposure in the uterus during fetal development are considered a potential mechanism. Epigenetic alterations including DNA methylation, histone code modifications and micro RNAs play an important role in regulating gene expression.