An approach to heroin use disorder intervention within the South African context: A content analysis study

<p>Abstract</p> <p>Background</p> <p>The field of heroin use disorder intervention has been in transition in South Africa since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin users' use of supplementary intervention services and intervention outcomes, heroin use disorder intervention programmes in South Africa generally fail to meet international research-based intervention standards.</p> <p>Methods</p> <p>Semi-structured interviews with ten heroin use disorder specialists were conducted and the interviews were subjected to content analysis.</p> <p>Results and Discussion</p> <p>In terms of theory and practice, findings of the study suggest that the field of heroin use disorder intervention in South Africa remains fragmented and transitional. Specifically, limited strategic public health care polices that address the syndromes' complexities have been implemented within the South Africa context.</p> <p>Conclusions</p> <p>Although many interventions and procedures have begun to be integrated routinely into heroin use disorder clinical practice within the South African context, comorbidity factors, such as psychiatric illness and HIV/AIDS, need to be more cogently addressed. Pragmatic and evidence-based public health care policies designed to reduce the harmful consequences associated with heroin use still needs to be implemented in the South African context.</p

Context and culture associated with alcohol use amongst youth in major urban cities: A cross-country population based survey

Background: Alcohol consumption patterns are dependent upon culture and context. The aim of this study was to interview people aged 18–34 year old living in four cities in different regions of the world to explore differences in a range of alcohol measures to assist in determining culturally appropriate alcohol initiatives for this age group. Method: Multistage random sampling was consistent across the four cities (Ilorin (Nigeria), Wuhan (China), Montevideo (Uruguay) and Moscow (Russia)). The questionnaire was forward and back translated into relevant languages and face-to-face interviewing undertaken. The data were weighted to the population of each city. Uni-variable analysis (ever consumed, first time consumed, age when drunk for first time, number of days consumed, type consumed) and logistic regression modeling were undertaken. The final model for each city was adjusted for age, sex, marital status, highest education and employment status. In total 6235 interviews were undertaken (1391 in Ilorin, 1600 in Montevideo, 1604 in Moscow and 1640 in Wuhan). Results: Alcohol was consumed by 96.4% in Montevideo, 86.1% in Moscow, 53.4% in Wuhan and 33.3% in Ilorin. There was very little difference by gender except Ilorin males were more likely to consume alcohol than females. Alcohol was consumed on more days for Ilorin males; Wuhan females consumed alcohol on the least number of days; Ilorin had the most abstainers; Montevideo and Moscow the highest proportion of light drinkers; Ilorin and Montevideo the highest proportion of heavy drinkers. Differences by type of alcohol were also apparent. The final logistic regression model provided different models including higher alcohol consumption rates for males, 25–34 years of age, divorced/separated marital status and employed part time for Ilorin respondents; males and higher educated for Montevideo; males, 25 to 29 years of age and higher educated for Moscow; and 25–29 years of age, non-married and vocationally trained for those in Wuhan. Conclusion: Alcohol consumption in these four cities does not increase with age as found in most high income countries. The alcohol consumption patterns during this stage of the life cycle are important to assess so that high level, as well as country-specific, planning and interventions can be implemented

Oral health behavior patterns among Tanzanian university students: a repeat cross-sectional survey

PURPOSE: This study examines oral health behavioral trends and the development of sociodemographic differences in oral health behaviors among Tanzanian students between 1999 and 2000. METHODS: The population targeted was students attending the Muhimbili University College of Health Sciences (MUCHS) at the University of Dar es Salaam (UDSM), Dar es Salaam, Tanzania. Cross-sectional surveys were conducted and a total of 635 and 981 students, respectively, completed questionnaires in 1999 and 2001. RESULTS: Cross-tabulation analyses revealed that in 1999, the rates of abstinence from tobacco use, and of soft drink consumption, regular dental checkups, and intake of chocolate/candy were 84%, 51%, 48%, and 12%, respectively, among students of urban origin and 83%, 29%, 37%, and 5% among their rural counterparts. The corresponding rates in 2001 were 87%, 56%, 50%, and 9% among urban students and 84%, 44%, 38%, and 4% among rural ones. Multiple logistic regression analyses controlling for sex, age, place of origin, educational level, year of survey, and their interaction terms revealed a significant increase in the rate of soft drink consumption, implementation of oral hygiene measures, and abstinence from tobacco use between 1999 and 2001. Social inequalities observed in 1999, with urban students being more likely than their rural counterparts to take soft drinks and go for regular dental checkups, had leveled off by 2001. CONCLUSION: This study provides initial evidence of oral health behavioral trends, that may be utilized in the planning of preventive programs among university students in Tanzania

Global, regional, and national levels of maternal mortality, 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.Peer reviewe

A prospective analysis of in-patient consultation-liaison psychiatry in a Nigerian teaching hospital

Objectives: To determine the pattern of psychiatric referrals over a six-month period categorise the psychiatric referrals into clinical syndromes and describe the nature of psychiatric intervention and outcome of such intervention on discharge and within the first three months after discharge. Design: A descriptive prospective study. Setting: University of Ilorin Teaching Hospital (UITH), Ilorin Nigeria. Subjects: Forty seven inpatients (26 females and 21 males) referred to the psychiatric department from other specialist units of the hospital between May and October 2001. Results: The mean (+/-SD) of patients was 33.9±18 years. The highest rate of referral came from the internal medicine department. The most common psychiatric disorders referred were acute organic brain syndrome (32%) and neurological disorders (15%). Psychiatric interventions included medication in about two-thirds of the patients and counselling in about a quarter. Half of the discharged patients out rightly defaulted on their first outpatient clinic department appointment. Conclusion: The study indicate the need for greater inter-departmental liaison learning and training activities, the need to emphasize training in organic psychiatry, as well as the need to establish community-based outreach services as a means of ensuring continuity of care for discharged patients. East African Medical Journal Vol.81(12) 2004: 620-62

Psychosocial impact of sickle cell disease in children seen at University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background: The increased risk of psychological disorders constitutes one of the complications of sickle cell disease (SCD) in Nigeria. This subject has received insufficient attention. Objectives: To assess the psychosocial impact of SCD on affected children and two control samples. Design: A cross-sectional controlled study. Setting: University of Ilorin Teaching Hospital, Ilorin, Nigeria. Subjects: One hundred children affected with sickle cell disease (SCD children) consituted the study sample, while the controls comprised 75 children consituted the study sample, while the controls comprised of 75 children with bronchial asthma (asthmatics) and 75 with some acute medical illness (AMI). Results: Sickle cell disease (SCD) children (sicklers) were significantly more likely to report social impairment such as restriction in their play and domestic activities, feeling inferior to others, having bad luck, fear of under-achievement in life and fear of potential early death than the control groups. On the Rutter Scale A2, the SCD children were more likely than the controls to report neurotic symptoms but less likely than controls to bully other children. SCD children (30%) were more likely to be identified as probable cases with psychological problems than asthmatics (25%) and AMI children (20%). These differences were, however, not statistically significant. Conclusion: This study further substantiates earlier findings of the link between chronic childhood illnesses such as SCD and psychosocial morbidity. The authors, therefore, recommend that comprehensive and affordable psychosocial care should be provided for children suffering from these conditions. East African Medical Journal Vol.82(2) 2005: 74-7

Disorders Of Sexual Preference Among Secondary School Teachers In Ilorin, Nigeria

Background: In Nigeria, there is a dearth of data on Disorders of Sexual Preference (DSP), which is due to the unwillingness by most people to volunteer information on such issues. In spite of this, anecdotal evidence suggests strongly that DSP exist in Nigeria. Aims and objectives: This study was aimed at determining the prevalence and pattern of DSP in a sample of teachers in Ilorin, Nigeria. Method: Using a stratified random sampling method, all eligible and consenting respondents were interviewed. A pilot-tested, self-administered questionnaire containing items on sociodemographic and clinical variables and the General Health Questionnaire-30 (GHQ-30) were used for the interview. Results: From a sampling frame of 2,176 teachers, 450 teachers were interviewed but only 408 responses were analyzable. Eighty-nine respondents had ICD-10 compatible DSP giving a combined prevalence rate of 21.8%. The commonest disorder was voyeurism (9.6%) while the least common were paedophilia (0.98%), and exhibitionism (0.74%). Generally, DSP were significantly associated with increased age, male gender, and psychiatric caseness (GHQ score of 4 and above). Conclusion: DSP may not be as rare in Nigeria as currently perceived. Efforts should therefore be made to increase their level of recognition by the public and medical personnel and to encourage those affected to access available help in appropriate treatment facilities. Keywords: Sexual Preference, Disorders, Secondary School Teachers, Nigeria. Nigerian Journal of Psychiatry Vol. 6 (1) 2008: pp. 26-3