Pattern of mental ill health morbidities following hysterectomy for benign gynaecological disorders among Nigerian women

<p>Abstract</p> <p>Objective</p> <p>to compare the pre and post hysterectomy mental ill health (MIH) status and also, to determine whether there is any association with the surgical indication.</p> <p>Methodology</p> <p>An observational study, conducted among women scheduled for hysterectomy at the University College Hospital, Ibadan from January till June 2005. The MIH morbidities were assessed using a validated general health questionnaire (GHQ) before and after the surgery by trained research assistant. The score of 4 and above was used as the cut off. Cross tabulations were performed to detect any association and also to compare pre and post hysterectomy mental health status. The level of statistical significance was set at P < 0.05.</p> <p>Results</p> <p>Of the 50 women recruited, 45 participated in the study. The age range of the participants was 35 to 63 years with a mean of 48.6 (SD = 0.6) years. Anxiety related disorder was present in 20 (44.4%), and depression in 3 (6.7%) before hysterectomy. Post surgery, there was significant increase in those with anxiety by 6.8% and a reduction in the proportion of depressive illness by 2.3%. Uterine fibroid as a preoperative diagnosis, had significant association among those with anxiety related disorder (68.4%) and depression (10.5%).</p> <p>Conclusion</p> <p>This study suggests that mental ill health may complicates hysterectomy for benign uterine pathology among Nigerian women, and that anxiety related disorders increases after operation with the highest proportion in those with clinical diagnosis of Uterine Fibroid. We recommend adequate preoperative counseling using properly trained psychologists when affordable to minimize these morbidities.</p

Psychological complications of childhood chronic physical illness in Nigerian children and their mothers: the implication for developing pediatric liaison services

<p>Abstract</p> <p>Background</p> <p>Pediatric liaison services attending to the psychological health needs of children with chronic physical illness are limited or virtually non-existent in Nigeria and most sub-Saharan African countries, and psychological problems complicate chronic physical illness in these children and their mothers. There exist needs to bring into focus the public health importance of developing liaison services to meet the psychological health needs of children who suffer from chronic physical illness in this environment. Sickle cell disease (SCD) and juvenile diabetes mellitus (JDM) are among the most common chronic physical health conditions in Nigerian children. This study compared the prevalence and pattern of emotional disorders and suicidal behavior among Nigerian children with SCD, JDM and a group of healthy children. Psychological distress in the mothers of these children that suffer chronic physical illness was also compared with psychological distress in mothers of healthy control children.</p> <p>Methods</p> <p>Forty-five children aged 9 to 17 years were selected for each group of SCD, JDM and controls. The SCD and JDM groups were selected by consecutive clinic attendance and the healthy children who met the inclusion criteria were selected from neighboring schools. The Youth version of the Computerized Diagnostic Interview Schedule for Children, version IV (C- DISC- IV) was used to assess for diagnosis of emotional disorders in these children. Twelve-item General Health Questionnaire (GHQ – 12) was used to assess for psychological distress in mothers of these children and healthy control children.</p> <p>Results</p> <p>Children with JDM were significantly more likely to experience DSM – IV emotional disorders than children with SCD and the healthy group (p = 0.005), while children with JDM and SCD were more likely to have 'intermediate diagnoses' of emotional disorders (p = 0.0024). Children with SCD and JDM had higher rates of suicidal ideation when compared to healthy control children and a higher prevalence of maternal psychological distress was found in their mothers when compared to the mothers of healthy children (p = 0.035).</p> <p>Conclusion</p> <p>The higher prevalence of emotional disorders and suicidal ideation among children with SCD and JDM points to a need for development of liaison services in pediatric facilities caring for children with chronic physical illness to ensure holistic approach to their care. The proposed liaison services would also be able to provide family support interventions that would address the psychological distress experienced by the mothers of these children.</p

The World Federation of ADHD International Consensus Statement:208 Evidence-based conclusions about the disorder

Background: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. Methods: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. Results: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. Conclusions: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.</p

Unmet Need for Sexuality Education among Adolescent Girls in Southwest Nigeria: A Qualitative Analysis

This study utilises a qualitative approach to elicit the reproductive health concerns of girls at a Christian summer camp with a view to making recommendations on how to improve the content and process of future sessions. The girls asked questions anonymously about various aspects of their sexuality, which were analysed to identify emergent themes. There were 75 participants with ages ranging from childhood to late adolescence (7-21 years). The different levels of cognitive development are clearly illustrated in the types of questions asked. The late adolescents focused on coping with relationships and demands for sex. The early and middle adolescents focused on their feelings, relationships, menstruation and breast size. Those in childhood (7-11 years) appeared totally ignorant about parts of their body. Myths and misconceptions were identified in all age groups. Future sessions should address the peculiar needs of these different age groups. Christian and other religious groups should work with health educators to develop realistic teaching guidelines that focus on the everyday concerns of the youth. (Afr J Reprod Health 2004; 8[3]:27-37

Psychosocial attributes of orphaned youths in Ibadan Metropolis: implications for reproductive health

Context: The HIV mortality surge in Sub-Saharan Africa has brought a new focus on the plight of orphaned youths. Objective: To determine the prevalence of orphans and associated psychosocial and reproductive health factors in rural and urban secondary school youths in Southwest Nigeria across two age groups, adolescents aged 17 years and below and youth aged 18-24 years. Methods: A total of 1850 youth from 20 schools in 3 urban and 2 rural school districts in South-western Nigeria had the self-administered instruments: Global School Health Questionnaire to assess reproductive and other health indices and the Culture Free Self Esteem Inventory. Results: The overall prevalence of orphans was 10.1 % (15.5% in rural and 8.2% in urban areas}. Most differences between orphans and non-orphans were found in the 9-17 year age group where orphans were more likely to live in rural areas, emerge from polygamous families, have parents with no formal education and have to work. In this group also, orphans were more likely to have 'ever had sexual intercourse' than non-orphans (24% versus 16.7%; xsup>2= 4.13; df:1; p = 0.042) and were also more likely to 'have had sexual intercourse in the past 12 months' (15.8% versus 9.2%; x2= 5.4; df:1; p = 0.020). For the 18-24 year age group, there are no significant differences in sexual behaviour. Conclusion: Policy makers and implementers need to draw up programmes to address the reproductive health needs of orphans, particularly those aged 17 years and under. Keywords: orphans, youth, psychosocial, reproductive health Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 54-6

Obstetric Risk Factors and Subsequent Mental Health Problems in a Child Psychiatry Clinic Population in Nigeria

Background: Studies suggest that obstetric complications are associated with several child psychiatric conditions. In planning for child psychiatric services it is important to monitor patterns of morbidity and associated risk factors. Identifying obstetric risk factors in a newly opened child psychiatric clinic population with provide crucial information for future planning and collaboration. Objective: To determine the prevalence and pattern of obstetric risk factors and associations with morbidity found in a child psychiatric clinic population. Method: The study population consisted of all attendees at a newly opened child and adolescent psychiatric clinic at the University College Hospital, Ibadan. All attendees had a standardised comprehensive psychiatric assessment and an obstetric history was obtained from mothers. Results: In the period under study, 144 children and adolescents were referred to this clinic. Obstetrical complications were found in 32 (29%) of the 112 children from whom this history was obtained. The commonest complications were birth asphyxia (11%), and emergency caesarean sections (6%). Delivery complications were associated with unskilled fathers\' (x2 =8.4; p=0.015) and mothers above 40 years of age, (x2 =9.5; p=0.011). Children with mental retardation were more likely to have suffered birth injuries (x2 =14.05; p=0.000). The highest number of obstetric complications occurred in children with disruptive behaviour disorder (42.9%), and autistic disorder (33.3%). No statistically significant relationship was found between specific groups and obstetric complications. Conclusion:This descriptive study illustrates that obstetric complications are a contributing factor to mental health problems in children. Many of the complications could have been prevented with better health care. Further studies may also want to compare obstetric complications in this child psychiatric clinic population with a sample of children in the general population. Key Words: obstetric risk factors, child psychiatric disorders. [Trop J Obstet Gynaecol, 2004;21:15-20