Clinical implication of smoking among patients with schizophrenia at a Tertiary Institution in South East Nigeria

Background: The chronic and debilitating nature of schizophrenia creates a disease with marked clinical and economic consequences. Smoking in schizophrenia appears to be associated with increased psychopathology and disability.Objective: The aim of this study was to determine if cigarette smoking in schizophrenia is associated with increased disability and psychopathology.Materials and methods: This was a cross-sectional descriptive study in which 367 out-patients with International Classification of Diseases (ICD) 10 diagnosis of schizophrenia were recruited. Socio-demographic questionnaire, Present State Examination (PSE) 10, Positive And Negative Syndrome Scale (PANSS) and World Health Organization Disability Assessment Schedule (WHODAS) were administered. Data was analyzed using a software package SPSS version 15.Results: There was no significant difference in the mean PANSS scores of smokers and non-smokers. Current smoking was associated with increased disability (F=5.39, p=0.02). Total PANSS score significantly predicted disability F(3,71=5.60, p=0.002, R2=0.19). There was no significant association between positive or negative symptoms and being a smoker or non-smoker.Conclusion: The results of this study revealed that smoking in Nigerian schizophrenia patients is associated with significant disability. Measures should be put in place to discourage cigarette smoking among Nigerian patients with schizophrenia.Keywords: Schizophrenia, smoking, psychopathology, disability, Nigeria

Sexual Behavior and Abuse: A Case Study of University Undergraduates in Tertiary Institutions in Imo State, Nigeria

Introduction: In young people including adolescents, risky sexual behavior has been recognized as an important health, social and demographic concern in the developing world. Aim: To assess sexual behaviors and their association with current and life-time occurrence of sexual abuse among female undergraduates in tertiary institutions in Imo State, Nigeria. Methodology: This was a school based cross sectional study involving 600 female students selected from tertiary institutions in Imo State Nigeria, using the multistage sampling technique. Data was collected using a semi-structured, self-administered questionnaire and analyzed using a data software (EPI-INFO version 3.3.2). Descriptive variables were presented using summary indices, frequency tables/percentages, and graph while associations between variables were done using the Chi-square and binary regression. A p-value of 0.05 was considered significant. Results: The mean age of the students was 21.73.2 years. About 65.2% of the respondents have initiated sexual intercourse and of this proportion, 75.6% were sexually active in the last one year preceding survey. The mean age at initiation of sexual debut among the students was 18.93.8 years and the commonest form of sexual act practiced was penile/vaginal sex. About 15.2% of the students had been currently abused. Predictors of current sexual abuse were; ever had sexual intercourse (OR.4.63), being within 14-19 years of age at first sexual initiation, (OR: 0.42), had first sexual exposure with a casual partner (OR: 12.38), and being sexually active in the last 1 year preceding study, (OR: 2.16). Conclusion: Risky sexual behaviors were prevalent and were found to influence the occurrence of sexual abuse, among the students. Thus, there is need to institute appropriate prevention strategies to limit risky sexual behaviors and it consequences among adolescents and young adults

Depression and experience of incarceration in North Central Nigeria: a situation analysis at Makurdi medium security prison

Abstract Background Human rights watchdogs have described conditions in Nigerian correctional facilities and detention centers as damaging to the physical and mental health of inmates. While the prevalence of mental disorders is high, access to appropriate healthcare is grossly inadequate. Understanding the current state of prison inmates’ mental health and well-being is an essential first step to addressing this important issue. This study aims to document the mental health and experiences of incarceration of inmates of the largest medium security prison in Nigeria’s Benue State. Methods A cross-sectional survey and descriptive analysis was carried out with a random sample of 381 prison inmates of Benue State Makurdi Medium Security Prison. Survey tools included: (1) a structured questionnaire on participants’ experiences in prison, and (2) the Patient Health Questionnaire (PHQ-9), a screening tool for depression. Results Most participants were young men (95.5%, mean age 27.95) and had completed secondary school (63.5%). While prison authorities had identified only 27 participants as having a mental disorder, 144 (37.8%) screened positive for depression. Twenty six had received professional counseling while in prison. Of the six participants who were already taking a psychotropic medication at the time of imprisonment, four received medication after being imprisoned. Approximately half, (52%) of participants were dissatisfied with prison health care. Conclusions Despite the high prevalence of depression among prison inmates, few cases are detected and treated. Prison staff may not recognize depression as a mental disorder, and the mental health care available is generally poor. Inadequate mental health and social care not only affects prison inmates’ well-being, but may also impact recidivism and health outcomes upon release. Prison inmates should be screened routinely for depression and other less-commonly recognized mental health conditions, and appropriate treatment made available. </jats:sec

Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of the HAPPINESS intervention

Abstract Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) intervention is a multicomponent, community-based, mobile technology-supported intervention that integrates mental health into primary health care centers in Nigeria using the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). This study evaluates its implementation and patient-level clinical impact using a quasi-experimental design (single cohort with pre- and post-measures). Findings The HAPPINESS intervention implementation demonstrated high feasibility with 84% adoption rate (% of participating primary health centers that completed its roll out) and 81% fidelity (% of clinicians who completed required intervention components according to the protocol). Retention rate in care at 12 months was 86%. Among patients with complete clinical records analyzed (n = 178), there was a statistically significant reduction in 9-item Patient Health Questionnaire scores from baseline (Md = 9.5) to 6 months (Md = 3.0) post-intervention (z = 80.5, p < 0.001), with a large effect size (r = 0.8) and statistically significant reduction in Brief Psychiatric Rating Scale scores from baseline (Md = 36.0) to 6 months (Md = 17.0) post-intervention (z = 128.5, p < 0.001), with a large effect size (r = 0.9). Implications Mobile technology-enhanced, mhGAP-IG-based efforts to scale-up mental health services in Nigeria are feasible and effective

Agreement between clinicians' and care givers' assessment of intelligence in Nigerian children with intellectual disability: 'ratio IQ' as a viable option in the absence of standardized 'deviance IQ' tests in sub-Saharan Africa

<p>Abstract</p> <p>Background</p> <p>There may be need to assess intelligent quotient (IQ) scores in sub-Saharan African children with intellectual disability, either for the purpose of educational needs assessment or research. However, modern intelligence scales developed in the western parts of the world suffer limitation of widespread use because of the influence of socio-cultural variations across the world. This study examined the agreement between IQ scores estimation among Nigerian children with intellectual disability using clinicians' judgment based on International Classification of Diseases, tenth Edition</p> <p>(ICD - 10) criteria for mental retardation and caregivers judgment based on 'ratio IQ' scores calculated from estimated mental age in the context of socio-cultural milieu of the children. It proposed a viable option of IQ score assessment among sub-Saharan African children with intellectual disability, using a ratio of culture-specific estimated mental age and chronological age of the child in the absence of standardized alternatives, borne out of great diversity in socio-cultural context of sub-Saharan Africa.</p> <p>Methods</p> <p>Clinicians and care-givers independently assessed the children in relation to their socio-cultural background. Clinicians assessed the IQ scores of the children based on the ICD - 10 diagnostic criteria for mental retardation. 'Ratio IQ' scores were calculated from the ratio of estimated mental age and chronological age of each child. The IQ scores as assessed by the clinicians were then compared with the 'ratio IQ' scores using correlation statistics.</p> <p>Results</p> <p>A total of forty-four (44) children with intellectual disability were assessed. There was a significant correlation between clinicians' assessed IQ scores and the 'ratio IQ' scores employing zero order correlation without controlling for the chronological age of the children (r = 0.47, df = 42, p = 0.001). First order correlation controlling for the chronological age of the children showed higher correlation score between clinicians' assessed IQ scores and 'ratio IQ' scores (r = 0.75, df = 41, p = 0.000).</p> <p>Conclusion</p> <p>Agreement between clinicians' assessed IQ scores and 'ratio IQ' scores was good. 'Ratio IQ' test would provide a viable option of assessing IQ scores in sub-Saharan African children with intellectual disability in the absence of culture-appropriate standardized intelligence scales, which is often the case because of great diversity in socio-cultural structures of sub-Saharan Africa.</p

Perspectives of mental healthcare providers on pathways to improved employment for persons with mental disorders in two lower middle-income countries

Background: Mental disorders affect employment and the ability to work, and mental healthcare providers are important in the promotion of health and employment for affected individuals. The objective of this study is to explore the perspectives of mental healthcare providers on pathways to improved employment for persons with mental disorders in two lower middle-income countries. Methods: Our study participants included mental healthcare providers (psychiatrists, occupational physicians, psychologists, and social care workers) from Kenya and Nigeria. Qualitative interviews and a focus group discussion were conducted with 15 professionals in Kenya and online questionnaires were completed by 80 professionals from Nigeria. Results: The study participants suggested that work is important for the recovery and wellbeing of persons with mental disorders. A complex interplay of factors related to the health of persons with mental disorders and the socioeconomic system in their setting were identified as barriers to their work ability and employment. Participants proposed four pathways to improved employment: Including information on reducing stigma, better healthcare, policy advocacy in employment, and government commitment to healthcare and social welfare. Public education to reduce stigma and better healthcare were the highest reported facilitators of employment. Conclusions: Persons with mental disorders require multilevel support and care in obtaining and retaining employment. A better mental healthcare system is essential for the employment of persons with mental disorders

Dyslipidaemia and Medical Outcome (Health Related Quality of Life) in Patients with Schizophrenia Taking Antipsychotics in Enugu, Nigeria

Aim. Determine association between use (and type) of antipsychotics and dyslipidaemia in newly diagnosed schizophrenia patients attending Federal Neuropsychiatric Hospital, Enugu. Methods. From sixty antipsychotic naive patients with schizophrenia and sixty first-degree relatives matched for gender and age, fasting blood lipid profiles were measured at baseline and after twelve weeks. Medical Outcome Study Short Form General Health Survey was administered to patients on both occasions. Fasting lipid profile changes of both groups were compared. Results. Mean endpoint of total cholesterol (TC), low density lipoprotein (LD), and triglycerides (TG) in mmol/l for cases was significantly higher than initial values (TC 4.5 versus 4.3, t=4.3, p<0.0001), (LDL 2.8 versus 2.6, t=14.3, p<0.0001), and (TG 1.3 versus 1.0, t=12.1, p<0.0001). Mean endpoint of high density lipoprotein (HDL) in mmol/l for cases was significantly lower than initial values (1.1 versus 1.2, t=12.1, p<0.0001). Prevalence of dyslipidaemia for cases was 13%. Mean endpoint of TC, LDL, TG, and HDL in mmol/l for controls was not significantly different from initial values (TC 4.30 versus 4.27, t=1.09, p=0.279), (LDL 2.49 versus 2.46, t=1.28, p=0.205), (TG 0.96 versus 0.94, t=1.27, p=0.207), and (HDL 1.37 versus 1.38, t=1.61, p=0.113). Subjects on atypical antipsychotics had higher risk for dyslipidaemia. Conclusion. Use of antipsychotics was significantly associated with dyslipidaemia

Knowledge about childhood autism and opinion among healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders in Nigeria

<p>Abstract</p> <p>Background</p> <p>In designing programs to raise the community level of awareness about childhood autism in sub-Saharan Africa, it is logical to use the primary healthcare workers as contact point for education of the general public. Tertiary healthcare workers could play the role of trainers on childhood autism at primary healthcare level. Assessing their baseline knowledge about childhood autism to detect areas of knowledge gap is an essential ingredient in starting off such programs that would be aimed at early diagnosis and interventions. Knowledge of the healthcare workers on availability of facilities and law that would promote the required interventions is also important. This study assessed the baseline knowledge about childhood autism and opinion among Nigerian healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders.</p> <p>Method</p> <p>A total of one hundred and thirty four (134) consented healthcare workers working in tertiary healthcare facilities located in south east and south-south regions of Nigeria were interviewed with Socio-demographic, Knowledge about Childhood Autism among Health Workers (KCAHW) and Opinion on availability of Facilities and Law caring for the needs and rights of children with Childhood Autism and other developmental disorders (OFLCA) questionnaires.</p> <p>Results</p> <p>The total mean score of participated healthcare workers on KCAHW questionnaire was 12.35 ± 4.40 out of a total score of 19 possible. Knowledge gap was found to be higher in domain 3 (symptoms of obsessive and repetitive pattern of behavior), followed by domains 1 (symptoms of impairments in social interaction), 4 (type of disorder autism is and associated co-morbidity) and 2 (symptoms of communication impairments) of KCAHW respectively among the healthcare workers. Knowledge about childhood autism (KCA) as measured by scores on KCAHW questionnaire was significantly associated with age group distribution of the healthcare workers, with those age group of fourth decades and above more likely to have higher mean score (p = 0.004) and previous experience of managing children with autism spectrum disorders (ASD) (p = 0.000). KCA showed near significant association with area of specialty, with those healthcare workers in psychiatry compared to pediatrics having higher mean score (p = 0.071) and also with years of working experience of the healthcare workers (p = 0.056). More than half of the healthcare workers subscribed to the opinion that facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders are lacking in Nigeria.</p> <p>Conclusion</p> <p>The correlates of KCA may help in selection of those tertiary healthcare workers that would best fit the role of trainers. It is important to update the knowledge gaps of those healthcare workers who scored low in different domains of KCAHW questionnaire. It is imperative for policy makers in Nigeria to advocate and implement multidisciplinary healthcare service system that would ensure early diagnosis and interventions. Nationally representative baseline epidemiological data that would guide policy and planning are also desirable.</p