A 5-year review of physical and verbal aggression in a psychiatric ward in Ilorin, Nigeria

Objective: Violence on psychiatric wards is increasing globally. Its consequences are not just on the ward staff, but also other patients, relations and hospital facilities. There is a need for more studies especially in developing countries, where not many of such studies have been documented. The study aimed at determining the prevalence of aggression and its clinical and psychosocial factors in a tertiary psychiatric facility in Nigeria.Method: A review of medical records of all patients admitted to the psychiatric ward, over a 5-year period in the study location.Result: The prevalence of aggression was found to be 3.6% with Staff Observation Aggression Scale-Revised (SOAS-R) score of 18.1±2.3. Aggression was significantly associated with the male gender (÷2=11.5; p=0.001), first 10 days of admission (÷2=8.0; p=0.005), first 20 minutes of verbal aggression (÷2 = 11.5; p=0.001), and during the evening shift as compared with morning and night duties (÷2=25.3; df=2; p=0.000). At bed occupancy of ≥50%, the chance of physical aggression increased to 84% (÷2=20.5; p=0.000). There was no significant relationship between aggression and patient's religion (÷2=0.5; p=0.8), who patient's delusion is directed at (÷2=0.32; p=0.6) and previous episode of mental illness in patient (÷=00; p=1.0).Conclusion: The obtained prevalence of 3.6% may be a reflection of under-reporting of aggression. It was suggested that the thrust of management of aggression should be preventive with attention paid to staff training and continuous improvement of ward culture, staff-to-staff and staff-to-patient dynamics and environment.Keywords: Violence; aggression; psychiatry uni

ALCOHOL AND PSYCHOACTIVE SUBSTANCE USE AMONG MEDICAL STUDENTS OF THE UNIVERSITY OF ILORIN, NIGERIA

The study was aimed at determining the prevalence and predictive factors associated with alcohol and other psychoactive substance use among medical students of the University of Ilorin. A self administered interview schedule consisting of WHO Students Drug Use Survey Questionnaire, and the General Health Questionnaire-12 were administered to a weighted proportionate sample of the respondents. The most currently used substances were mild stimulants (19.4%), alcohol (12.5%), hypnosedatives (3.4%), tobacco (1.7%), cannabis (1.7%), opioids (0.9%) and organic solvents (0.4%). Parents’ alcohol use, respondents perceived harm of alcohol use, level of religiosity, peers’ influence were found to have significant association with current alcohol use. There was no significant association between respondent’s perceived harm of substance use and current use of tobacco, hypnosedatives, mild stimulants and cannabis. Eighty five percent of respondents had a GHQ score of 0-2 (negative) while 14.7% had a score of 3-12 (positive). There was no significant association between psychiatric morbidity on one hand and current or lifetime substance use on the other. We concluded that while the prevalence of current use of some psychoactive substances has reduced over the past 6 years, others have increased. It was suggested that planners of medical education should continue to lay emphasis on the risks of psychoactive substance use as part of the medical school curriculum. Other governmental and non-governmental bodies should also continue to plan and implement campaigns against substance use, not only among medical students, but the society in general

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Factors associated with psychiatric morbidity among patients with Cancer in a Nigerian tertiary hospital

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Assessment of breastfeeding practices of working mothers in Ilaro, Ogun State

Background: Exclusive breastfeeding (EBF) is important for optimal growth and development of infant. However, increase in women involvement in labor sector may pose a great barrier to this. Thus, this study assessed the breastfeeding practices of working mothers in Ilaro. Methods: A cross-sectional study involving 200 working mothers selected from Ilaro community using multistage sampling. Semi-structured and self-administered questionnaire was used to elicit data on socio demographic and economic characteristics, job description, belief on breastfeeding and breastfeeding practices of the respondents. Data was analyzed using SPSS version 25.0. Result: More than half (59.0%) of the respondents were employed in private organizations and 41.0% were civil servants. Majority (72%) of the respondents work between 8am- 4pm daily. Nearly all the respondents (93.0%) breastfed their babies their infant from birth, 76.5% gave colostrum and 50% do breast feed their baby only when demanded. Four out of five breastfeed their infant during the working hour while 5.5% and 10.5% expressed their breast milk and gave infant formula respectively during the working hour. More than half (63%) of the respondents had good breastfeeding practices while 23% and 13% were rated fair and poor respectively. Significant associated (p< 0.05) was observed between respondent's breastfeeding practices and some socio demographic characteristics, job description and belief on breast feeding practices. Conclusion: Good breastfeeding practices were observed among the study population and this was significantly associated with factors like age, estimated monthly income, place of work and some belief on breastfeeding

TRADITIONAL MENTAL HEALTH PRACTITIONERS IN KWARA STATE, NIGERIA

Objectives: To assess the knowledge, practice and attitude of traditional mental healthpractitioners (TMHPs) in four 1,ocal Government Areas (L.GAs) in Kwara State, Nigeria, onmental health care; to organise training sessions aimed at ~mproving their knowledge base,practice and; to evaluate such training after allowing for a period of practice.Study design/intervention: Pre-training evaluation phase: 'I'MHPs were assessed in the areaof knowledge, attitude and practice of mental health, with the use of a questionnaire. Theywere then trained in the coricepts of normality and abnormality, types of mental illness,treatment of mental illrles5 including follow up, after-care, relapse prevention, otherprimary preventive measures, and some introductory talks on some sub-specialties ofpsychiatry, for example, child psychiatry, old age psychiatry, forensic psychiatry, drug andalcohol abuse and; after a free-practice period of two months, the TMHPs were again reassessedfor the impact of the training.Results: Pre-intervention phase: TMHPs could easily recognise most symptoms of mentalillness except undue sadness. The TMHPs also expressed 5trong belief in the supernaturalfactor as a cause of mental illnes.;. Some of them beat their patients for therapeutic reasonsand; Post-intervention phase: there was a widening of the sense of recognition of TMHPs ofimportant mental symptom5 such as undue sadness, social withdrawal and elation. Therewas a better understanding of the aetiological concepts of mental illness. There was also areduction in the habit of beating their patients as a form crf treatment.Conclusions: The use of information, education and communication intervention techniquescould lead to more positive and less hazardous forms of practice among TMHPs and; Thehigh level of cooperation achieved in this study would indicate a bright chance for futurecollaborative activities between orthodox and traditional healthcare providers

Educational status and other socio-demographic correlates of current use of psychoactive substance among Nigerian adolescents

Background: The spate of psychoactive substance use is unprecedented. The determination of associated factors will be critical to tackling this  menace. However, most studies were conducted in school which would have excluded the population of out-ofschool children. Thus, this studyassessed the correlates of adolescents’ psychoactive substance use at the community level.Methods: A cross-sectional study conducted among 500 adolescents (258 male and 242 female) in  Ilorin West LGA between December 2016 and October 2017. A stratified multistage sampling technique was used for subject selection and a pretested WHO substance use questionnaire wasused to collect data. Descriptive, bivariate and multivariate logistic regressions were employed to identify the predictors of substance use.Results: The lifetime prevalence of psychoactive substance use is 43.4% while the prevalence of current use is 31.2%. The most commonly used substances were stimulants (caffeine); 14.4%, codeine- containing cough syrup; 10.4% and alcohol; 10.2%. Socioeconomic class and the use of substances by friends were predictors of current use. The current use of alcohol and opiates is significantly higher among in-school subjects (p = 0.001, 0.042). Current use of cannabis, alcohol, hallucinogen, cocaine, correlated positively with educational status of respondents in school.Conclusions: The current use rate of psychoactive substance is high among the adolescents with socioeconomic class, use of substance by friends and educational status as its predictors. Urgent multipronged measures are therefore, crucial to curb this trend. Keywords: Psychoactive substances, Adolescents, current use, lifetime use, educational statu

Psychosocial correlates of menopausal symptoms among women in Ilorin, Nigeria

Background: The increasing rate of social involvement among African women has made menopause of high concern today. The aim of thisstudy was to identify some psychosocial factors that determine how severely women in Ilorin, Nigeria perceive menopausal symptoms. Method: Women who attained menopause naturally between 40-60 years of age were interviewed using structured questionnaires to obtain certain demographic and psychosocial information following informed consent. Perception of menopausal symptoms was assessed using the Menopause Rating Scale (MRS). The psychosocial parameters were then correlated with MRS scores. Data were analysed using SPSS software version 22. Associations between categorical variables were tested using the chi-square (÷2), the student-t test was used for the continuous variables (p <0.05) while linear regression was used to identify independent determinants. Results: Three hundred and eighty-five women aged 51.3±0.3 years on the average participated in the study, 331(86%) were Yoruba, 16 (4.2%) were Ibo, 3 (0.8%) Hausa and 35 (9%) were of other ethnic minorities. The total Menopause rating score was 14.02±0.44 out of a maximum score of 44 which indicated a generally mild perception. Joint pain ((1.77±0.16) was however the most perceived symptom. There is a significant association between all the psychosocial parameters assessed and MRS scores (p < 0.05). However societal support was the only independent determinant of menopause severity. Conclusion: Social support is by far the most important determinant of menopausal symptom severity in our study subjects. Effort to enhancesocial support in Nigeria will help the women cope better with menopausal symptoms and improve their overall quality of life. Keywords: Nigeria; Women; Menopause; Quality of Life; Social Suppor

Primary caregivers of the mentally ill experience more burden: A comparative study of mental versus physical illness

Background: Caring for patients with chronic illnesses whether mental or physical imposes a burden on caregivers. Schizophrenia and Type 2 Diabetes Mellitus (DM) are both chronic illnesses which require long term care, though they differ in pathophysiologic concepts. Planning strategies for improving the quality of life of caregivers of these patients will require that clinicians answer the pertinent question of who experiences more burden.Objective: This study assessed and compared the burden of care in caregivers of patients with schizophrenia and Type 2 DM, determined caregiver and patient characteristics that predict burden in both groups.Design: Cross-sectional study.Setting: Endocrinology and Psychiatry outpatient clinics of the University of Ilorin Teaching Hospital, Ilorin, Nigeria.Participants: One hundred patients with schizophrenia and 100 patients with Type 2 DM, along with their primary caregivers.Outcome measures: Caregiver burden was assessed using the ZBI. Results: Caregivers of schizophrenia patients experienced significantly higher burden than caregivers of Type 2 DM (p=0.025). Predictors of burden in schizophrenia patients’ caregivers were caregiver age (OR=2.088), being a lone caregiver (OR=1.39), perceiving caregiving as problematic (OR=6.194), GHQ-12 scores of caregiver (OR=7.46) as well as the presence of psychopathology (OR=2.61). The predictors of burden in Type 2 DM patients’ caregivers were caregiver gender (OR=4.049) presence of physical complications (OR=1.547). Conclusion: Caregivers of patients with schizophrenia were found to experience significantly higher levels of burden and psychological distress and this is important in planning care strategies for this group of patients