Attitude towards psychiatric treatment and referral pattern in the University of Maiduguri Teaching Hospital- A preliminary report

Objective: There is a paucity of literature on consultation-liaison psychiatry, in northern Nigeria. This study aimed to determine both the pattern of psychiatric referrals, and the attitudes of doctors toward the treatment of mental disorders in a teaching hospital, in northeast Nigeria. Method: In this cross-sectional survey, we used a modified version of the self-rated Kumar 12-item questionnaire and a basic socio-demographic questionnaire to assess a non-random convenient sample of 100 postgraduate resident doctors (with a response rate of 70%) from the University of Maiduguri Teaching Hospital (UMTH). We subjected the dataobtained to descriptive statistical analysis, using EPI info (2003), to report averages. Results: A relatively low percentage (57.1%) of doctors acknowledged treating patients with mental disorders in their practice, with a higher proportion acknowledging referral (75%). Nearly one in five (17.6%) of the respondents were unaware that patients with functional illness could have psychological disorders. We found more awareness for psychotherapy (44.1%) than other non-pharmacological treatment interventions, while10.3% were ignorant of non-pharmacological forms of treatment for psychological problems. Conclusion: Although this is a preliminary report, the research reported here demonstrated that doctors in the teaching hospital concerned recognized the need for psychiatric consultation and referral. It is difficult to draw further conclusions because of the limitations of this study.Keywords: Consultation; Liaison; Psychiatry; northern Nigeri

Prevalence and Factors Responsible for Stigmatization of the Mentally Ill among Student Nurses in North-Eastern Nigeria

Introduction: There is poor knowledge about mental illness, which contributes to stigmatization. The extent of the problem have been studied across cultures and found to be common(Gureje et al, 2005; Adewuya, 2007; Aghukwa, 2010) The impact of the stigma associated with mental illness is negative and pervasive; affecting patients, their family members, health care givers and the wider community. There is a need to determine the extent and factors associated with the tendency to stigmatize the mentally ill among future health care providers such as student nurses, who are potential community health educators.Aim: The study aimed to find the prevalence and the factors associated with stigma due to psychosis among student nursesMethods: It was a comparative cross sectional study of the prevalence of, and factors associated with mental illness stigma among student nurses using the Osgood semantic differential and World Psychiatric Association questionnaire on psychiatric stigma.Results: A total of 126 subjects participated in the study. The average age of the respondents was 23.7 years (SD=3.7), with an intra centre average of 23.0 and 24.6 for the Maiduguri and Damaturu centres respectively. The study demonstrated that in both study groups there was a general negative attitude (78-88.1% thought the mentally ill patients were dangerous; 78-88.5% would not marry people who had mental illness) and relatively good knowledge (29- 36% believed in a magical/ spiritual aetiology of mental disorders) about mental illness.Conclusion: Overall generally high levels of psychiatric stigma exist amongst the students' nurses, with very few socio demographic variables being associated with the levels of stigm

Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review

Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs.We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review.Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors.This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches

Different Points of a Continuum? Cross Sectional Comparison of the Current and Pre-contact Psychosocial Problems among the Different Categories of Adolescents in Institutional Care in Nigeria

<p>Abstract</p> <p>Background</p> <p>The combination of adverse social indicators and a predominantly youthful population puts Nigeria, and indeed many countries of sub-Sahara Africa, at the risk of explosion in the number of youth coming in contact with the juvenile justice system. Despite this risk, custodial childcare systems in the region are still poorly developed with both juvenile offenders and neglected adolescents coming in contact with the systems being kept in the same incarcerating facility. The needs of these different groups of adolescents may be different. Knowing their common and unique needs can inform common prevention strategies and ensure that specific service-needs of different categories of adolescents in institutional custody are met.</p> <p>Methods</p> <p>Data on the family background, pre-contact social circumstance, neurological and anthropometric profiles, and certain aspects of mental health of adolescents drawn from two juvenile justice institutions in Nigeria were obtained. The results for the adolescents on ‘criminal code’ and those admitted as a case of child neglect were compared using chi-square and odd ratios.</p> <p>Results</p> <p>Participants were 211 adolescents comprising of 158 on ‘criminal code’ and 53 declared as ‘neglected’. A lot of similarities were found. For instance, the prevalence of parental separation, family transition, experience of street-life and lifetime exposure to traumatic events and posttraumatic stress was equally high among the two groups of adolescents. The adolescents on ‘criminal code’ however had significantly higher prevalence of conduct and alcohol/substance use disorders while the child neglect group had poorer anthropometric profiles and higher prevalence of neurological disorders.</p> <p>Conclusions</p> <p>Child neglect and juvenile delinquency in Nigeria may truly be different points of a continuum. There are however fundamental differences that can warrant specific prevention strategies and tailor-made service provision while in custodial care.</p

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially