Culture–bound syndromes and the neglect of cultural factors in psychopathologies among Africans

One of the major problems in psychiatric practice worldwide is inability to reach a consensus as regards a globally acceptable classificatory system for the different psychopathologies. Consequently, apart from the WHO’s International Classification of Diseases (ICD) that is expected to be universally applicable there are regional-based classificatory systems in some parts of the world. In Africa, a number of culture bound syndromes (CBS) have been described which have not been given international recognition. The possible consequences of this non-recognition are highlighted in this paper. Unfortunately there are serious constraints such as the relatively small number of psychiatrists on the continent, and inadequate funding for mental health research, which militate against producing an African classificatory system. Nevertheless, it is proposed that reports of African psychiatrists emanating from their research and clinical experience should be accorded adequate recognition in the WHO so as to assign these CBS their rightful placement in the International classificatory system.Key Words: Culture-Bound Syndromes; African Psychiatry; Classification; Recognition

Substance use among secondary school students in an urban setting in Nigeria: prevalence and associated factors

Objective: Substance use continues to be major risk behaviour among youth, with consequent physical and /or mental health complications. The current study aimed to establish the prevalence and associated factors of substance use among selected secondary school students in Lagos. Method: This was a cross-sectional and descriptive study among selected secondary school students in Lagos. Permission was obtained from appropriate school authorities; as well as consent from each participant. The WHO Students’ Drug Use Questionnaire which had been previously validated in the country was used to obtain the drug use information from the subjects. Analysis of the data was conducted using Epi-info version 5. Results: A total of 402 students were studied - of whom 43.5% (n=175)were males and 56.5% (n=227) females. The mean age was 15.9 years. 83.1% (n=334) lived with their parents, 7.6% (n=31) with their relatives and 7.2% (n=29) with friends. The commonest substances used by the subjects were caffeine (kolanut and coffee), mild analgesics (paracetamol and aspirin) and the antimalarials, most especially chloroquine with lifetime use prevalence rates of 85.7%, 73.8% and 65.7% respectively. Generally, the prevalence rates for lifetime use of the substances varied from 3.8% (n=14) for Heroin and Cocaine to 85.7% (n=344) for psychostimulants; and for current use varying from 2% (n=8)to 56.5% (n= 213). For the so called “gateway drugs”: alcohol and tobacco, their lifetime use prevalence rates were 9.2% (n=34) and 5.2% (n=19) while the lifetime use prevalence rate for cannabis was 4.4% (n=16). In terms of gender, the prevalence rates for males were generally higher than for their female counterparts except for antibiotics, analgesics, heroin and cocaine. Reasons for using substances included relief from stress, 43.5% (n=175), self medication to treat illness, 23.8% (n=96), and to stay awake at night to study, 14.9% (n=60). Conclusion: Substance use was found to be prevalent among students in this study involving over-the-counter and socially acceptable substances as well as the abuse of illicit substances. It is advocated that there is a need to review existing health educational programmes.Key words: Substance use; School; Prevalence; Nigeri

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Objective: In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3±16.5 years with age range of 18-92 years. The average length of stay was 11.4±15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51,

Ten-year mortality review in a pioneer psychiatric hospital in West Africa

Objective: To determine the mortality among admitted patients in the study centre, a pioneer psychiatric facility in the West African sub-region. Design: A detailed retrospective study of the records of all deaths among the inpatients during the ten-year period of January, 1991 to December, 2000. Setting: Psychiatric Hospital Yaba, Lagos, Nigeria; established in 1907 with present bed status of 535 and patronage from Lagos and it's environ, including the neighbouring Benin Republic. Subjects: Ninety six patients that died while on admission in the centre during the study period. Results: A total of 96 patients died over the ten-year period, giving an annual rate of 9.6. The age range was 14-87 years, and mean of 44.4 (SD ±16.8) years. The male: female ratio was 1:1.6. Schizophrenia (26%) and major depression (25%) constituted the main psychiatric diagnoses at the time of admission among the cohort. The commonest cause of death included infections/infestations, most especially malaria and septicaemia (44% of the cohort). Conclusion: It is concluded that the major psychotic disorders, schizophrenia and depression continue to constitute the highest psychopathologies diagnosed psychiatric mortality study. Finally, infections/infestations still continue to play leading role as major causes of death in the West African sub-region. East African Medical Journal Vol.80(7) 2003: 379-38

Clinical neuropsychiatric correlates and EEG findings among children with developmental disorders in Lagos, Nigeria

Objective: Developmental disorders with or without associated neuropsychiatric complications continue to be one of the major health problems in Africa. The grossly inadequate management/ rehabilitative facilities further worsen this. A prospective study aimed at finding the types of developmental disorders and associated neuropsychiatric complications among children aged ≤15 years that presented with developmental disorder in the study centers over 36 month study duration. Methods: The study was carried out in the paediatric and child psychiatric clinics as well as the Electroencephalographic (EEG) unit of two major health facilities in Lagos, Nigeria: Lagos University Teaching Hospital (LUTH) and Psychiatric Hospital, Yaba, Lagos. For each subject, socio-demographic data was obtained and appropriate clinical evaluation was carried out to obtain the necessary data and clinical diagnoses. Furthermore, each of the subjects had waking EEG recording using 20-channel computerized Medelec® EEG machine. The EEG interpretation was blinded to the clinical history of the subjects. Results: Overall, one hundred and eleven (111) subjects were evaluated over the 36 month study period. The cohort was made up of 63 (56.8%) males and 48 (43.2%) females. The mean age was 4.8 (±3.9) years, with most subjects falling in the age group of 0-5 years(69.4%). Mixed specific developmental disorders were most common (55%) followed by that of specific developmental disorders of speech and language (34.2%). Forty-one (36.9%) subjects suffered from one or more types of complications, with seizure, 22(19.8%) being the most common. The waking EEG recording was normal in 22 (19.8%) subjects; while abnormal epileptiform activities were found in 85 (76.6%) of recordings. No statistically significant relationship existed between EEG abnormalities and the factors of age and clinical diagnoses (i.e developmental abnormalities). Conclusion: The small number of subjects in this study is a major hindrance to drawing a general conclusion. However, it has been shown that a number of the cohort in addition to their developmental disorders suffered from such complications as seizures, hyperactivity etc. Furthermore, a significant proportion had EEG abnormalities of the epileptiform types possibly reinforcing the previously known fact of prevalent subtle brain damage among African children. The need for preventive health care is therefore emphasized. Keywords: Developmental disorders; Associated complications; EEG abnormalities.African Journal of Psychiatry Vol. 11 (2) 2008 pp. 123-12

Burden and psychological effects : caregiver experiences in a psychiatric outpatient unit in Lagos, Nigeria

Objective: Worldwide, research into experiences of care givers are gradually increasing and their central role in community care is being acknowledged. Caregivers experience a multidimensional range of problems, often associated with their caregiving role. It becomes important to identify these areas of burden and provide necessary support. The study sought to determine the prevalence of psychological distress and experience of burden of care among the caregivers of mentally ill patients. Method: A cross sectional descriptive study. Eligible consecutive subjects were recruited to the study over a 6 month period. Fifty three caregiver relatives of patients diagnosed with a psychiatric illness were assessed using the General Health questionnaire version 12, an Adapted Burden of Care (BOC) Schedule and a Sociodemographic questionnaire. Results: The caregivers were 51% male and 49% female. Most were above 35years in age (66.1%). They were either parents (38.8%), siblings (18.4%), uncle/aunt (14.3%), first cousin (12.2%) or other extended relatives (16.3%). Almost half of the relatives had psychological distress (43.8%) and most of which (63%) had more burden. The mean score on the BOC among the caregivers was 41 (±18.68SD), with scores ranging from 0.00-89.00, and 45.3% of relatives experiencing more than average burden of care. Conclusion: There is a significant level of burden and psychological distress experienced by caregivers in this study location. It is recommended that effectively planned interventions are targeted at  alleviating this burden and at improving the ability of caregivers to cope, within the Nigerian mental health service delivery system.Key Words: Caregiver; Burden; Patients; Psychiatry; Nigeri

Duration of Lactation, Maternal Metabolic Profile, and Body Composition in the Norwegian EBBA I-Study

Objective There is conflicting evidence as to whether duration of lactation may decrease the risk of subsequent development of an unfavorable maternal metabolic profile including overweight and obesity. We hypothesized that duration of lactation is associated with a more favorable metabolic profile and healthier anthropometrical measurements. Methods 98 parous women from the Norwegian EBBA I-study (Energy Balance and Breast cancer Aspects-study), a cross-sectional study of healthy premenopausal women aged 25–35 years, historical lactation data were collected, anthropometrical measurements were taken, fasting blood samples (serum glucose, triglycerides, total cholesterol and HDL-cholesterol) were drawn and women were asked to fill in a pre-coded food diary. Results Mean time since last birth was 4.7 years, mean number of children was 1.9, mean total duration of lactation was 19 months and average length of lactation per child was 10.3 months. Women who on average lactated for less than 10 months per child had higher mean levels of fasting serum glucose (5.2 mmol/L vs. 5.0 mmol/L, p = 0.04), serum triglyceride (0.91 mmol/L vs. 0.66 mmol/L, p = 0.001) and serum cholesterol (4.78 mmol/L vs. 4.32 mmol/L, p = 0.004), and a higher waist-to-hip ratio (0.81 vs. 0.77, p = 0.001) than women who lactated for 10 months or more per child. The inverse association between average length of lactation per child and waist-to-hip ratio persisted after adjustment for potential confounders. Conclusions These results support the hypothesis that duration of lactation may be associated with a healthier metabolic profile and healthier anthropometrical measurements, especially lipid levels and waist-to-hip ratio even years after weanin

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective and multicentre cohort study

Background: Bundled interventions usually reduce surgical site infection (SSI) when implemented at single hospitals, but the feasibility of their implementation at nationwide level and their clinical results are not well established. Materials and methods: Pragmatic interventional study to analyse the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of: antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation (MBP), laparoscopy, normothermia, and a wound retractor. Control (CG) and Intervention (IG) groups were compared. Overall SSI, superficial (S-SSI), deep (D-SSI) and organ/space (O/S-SSI) rates were analysed. Secondary endpoints included microbiology, 30-day mortality and hospital stay (LOS). Results: A total of 37,849 procedures were included, 19,655 in the CG and 18,194 in the IG. In all, 5,462 SSIs (14.43%) were detected: 1,767 S-SSI (4.67%), 847 D-SSI (2.24%) and 2,838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), OR 0.503, [0.473-0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), OR 0.602, [0.556-0.652]. The overall SSI rate was 16.71% when no measure was applied and 6.23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR 0.331; CI95 0.242, 0.453), and also O/S-SSI rate (OR 0.643; CI95 0.416, 0.919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and MBP were related with a decrease in O/S-SSI. Laparoscopy, wound retractor and OAP decreased overall SSI and O/S-SSI in the multivariate analysis. Conclusions: In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible, and resulted in a significant reduction in overall and O/S-SSI rates in elective colon and rectal surgery. The OR for SSI fell between 1.5 and 3 times after the implementation of the bundle

Exposing and Overcoming Limitations of Clinical Laboratory Tests in COVID-19 by Adding Immunological Parameters; A Retrospective Cohort Analysis and Pilot Study

BackgroundTwo years since the onset of the COVID-19 pandemic no predictive algorithm has been generally adopted for clinical management and in most algorithms the contribution of laboratory variables is limited. ObjectivesTo measure the predictive performance of currently used clinical laboratory tests alone or combined with clinical variables and explore the predictive power of immunological tests adequate for clinical laboratories. Methods: Data from 2,600 COVID-19 patients of the first wave of the pandemic in the Barcelona area (exploratory cohort of 1,579, validation cohorts of 598 and 423 patients) including clinical parameters and laboratory tests were retrospectively collected. 28-day survival and maximal severity were the main outcomes considered in the multiparametric classical and machine learning statistical analysis. A pilot study was conducted in two subgroups (n=74 and n=41) measuring 17 cytokines and 27 lymphocyte phenotypes respectively. Findings1) Despite a strong association of clinical and laboratory variables with the outcomes in classical pairwise analysis, the contribution of laboratory tests to the combined prediction power was limited by redundancy. Laboratory variables reflected only two types of processes: inflammation and organ damage but none reflected the immune response, one major determinant of prognosis. 2) Eight of the thirty variables: age, comorbidity index, oxygen saturation to fraction of inspired oxygen ratio, neutrophil-lymphocyte ratio, C-reactive protein, aspartate aminotransferase/alanine aminotransferase ratio, fibrinogen, and glomerular filtration rate captured most of the combined statistical predictive power. 3) The interpretation of clinical and laboratory variables was moderately improved by grouping them in two categories i.e., inflammation related biomarkers and organ damage related biomarkers; Age and organ damage-related biomarker tests were the best predictors of survival, and inflammatory-related ones were the best predictors of severity. 4) The pilot study identified immunological tests (CXCL10, IL-6, IL-1RA and CCL2), that performed better than most currently used laboratory tests. ConclusionsLaboratory tests for clinical management of COVID 19 patients are valuable but limited predictors due to redundancy; this limitation could be overcome by adding immunological tests with independent predictive power. Understanding the limitations of tests in use would improve their interpretation and simplify clinical management but a systematic search for better immunological biomarkers is urgent and feasible