Economic Cost of Asthma and Psychiatric Morbidity in Nigerian Patients with Asthma.

BACKGROUND: Asthma is known to constitute a huge economic burden to its sufferers and their carers. There is a dearth of studies documenting this burden among asthmatics in Nigeria. OBJECTIVE: This study assessed the relationship between economic cost and psychiatric morbidity among stable Nigerian patients with asthma. METHODS: 85 patients with asthma completed a socio-demographic and illness-related questionnaire, the modified Economic Cost Questionnaire and General Health Questionnaire 12 (GHQ 12). Associations between socio-demographic characteristics, illness related variables, psychiatric morbidity and the direct, indirect and total costs in relation to asthma were assessed. RESULTS: The average annual total, direct and indirect cost were $309, $190.65 and $118.34 respectively per patient for subjects with asthma. Direct cost constituted 62.7% while the indirect cost was 38.3% of the total cost for asthma. Drugs and hospitalisation were leading contributors to direct costs for asthma. Psychiatric morbidity was found to be present in 35% of subjects with asthma, those with psychiatric morbidity had a higher economic burden. CONCLUSION: The economic cost of asthma is high, psychiatric morbidity increases this cost. The cost is largely due to drugs and hospitalisations for exacerbation. There is an urgent need to optimize means of helping to minimize this cost and increase measures for detecting and treating psychiatric morbidity.

Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia.

PURPOSE: Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors. METHODS: One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale. RESULTS: There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains. CONCLUSION: Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.

Impact of intimate partner violence on anxiety and depression amongst women in Ile-Ife, Nigeria.

Research into intimate partner violence in the Nigerian environment has been limited. The objective of this study was to determine, amongst a sample of women attending the Enuwa Primary Health Care Center, Ile-Ife, the association between intimate partner violence and anxiety/depression. A descriptive cross-sectional study was conducted amongst 373 women who attended the antenatal clinic and welfare units of a primary health centre in Ile-Ife using the Composite Abuse Scale, the Hospital Anxiety and Depression Scale and a socio-demographic scale as instruments. Slightly over a third (36.7 %) reported intimate partner violence within the past year, 5.6 % had anxiety and 15.5 % were depressed. Anxiety and depression in the respondents were significantly associated with intimate partner violence. Women were ten times more likely to report being depressed and 17 times more likely to report anxiety if they were in violent relationships. This research has shown that the magnitude of intimate partner violence within the study population is comparable to those found in the developing countries. There are significant associations between intimate partner violence, anxiety and depression amongst the study population and this fact undoubtedly has implications for the mental health of the Nigerian woman.

Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates.

OBJECTIVE: Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one's particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. METHOD: Out-patients with Schizophrenia (n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. RESULTS: Overall, 21 patients (21.2%) were categorised as having 'good' and 36 (36.4%) as having 'poor' subjective QOL. 'Poor' subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93-11.48), comorbid medical problems (OR 4.75, 95% CI 1.43-16.33), unemployment (OR 3.75, 95% CI 1.25-11.72) and poor social support (OR 4.60, 95% CI 1.49-14.28). CONCLUSION: Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment.

Health benefits of selected global breastfeeding recommendations among children 0-6 months in Nigeria.

The survey examined the appropriateness of selected global breastfeeding recommendations in an environment where the recommendations contradicted local knowledge and culture. Specifically, the survey assessed the implications of pre-lacteal feeding, feeding of colostrum, exclusive breastfeeding for the first 6 months of life and the use of feeding bottles for child health. Eligible mother-infant pairs were recruited for the survey by cluster sampling technique. Data was collected about the mother-infant pairs with the aid of a pre-designed questionnaire that sought information on the social and demographic characteristics of the mothers and infants, current breastfeeding practices and illnesses that the index infants had in the 2 weeks preceding the survey day. Information was canvassed from 2466 mother-infant pairs. All the infants were aged 0-6 months. Compliance with the selected recommendations were: 74.4% reported exclusive breastfeeding; 87.5% did not give pre-lacteal feeds, 78.3% were not using feeding bottles while 92.9 gave colostrum. Mothers who reported compliance with the recommendations also reported fewer episodes of the common signs of illnesses surveyed. The study confirmed the appropriateness and relevance of the selected recommendations in the study area.

The first six month growth and illness of exclusively and non-exclusively breast-fed infants in Nigeria.

OBJECTIVE: To compare the growth and illness pattern of infants who were exclusively breast fed for six months with those of infants commenced on complementary feeding before the age of six months and ascertain reasons for the early introduction of complementary feeding. DESIGN: A comparative prospective study. SETTING: Urban Comprehensive Health Centre (UCHC), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. SUBJECTS: Three hundred and fifty-two mothers and their normal birth weight babies, weighing 2.500kg or more, and aged less than 14 days were serially recruited into the study. MAIN OUTCOME MEASURES: Mean/median monthly weights in the first six months of life, history/outpatient presentation for illnesses. RESULTS: Of the 352 mother-infant pairs recruited into the study, 345 (98%) were successfully followed up for the first six months of life. At six months, 264 (76.5%) were exclusively breast-fed, 45 (13.1%) were started on complementary feeding, between the ages of four and six months while 36 (10.4%) commenced complementary feeding before the age of four months. Infants who were exclusively breast-fed for six months had median weights above the 50th percentiles of the WHO/NCHS reference that is currently used in the national "road to health" (growth monitoring) cards. Furthermore, the mean weight of these babies at age six months was above those of babies who started complementary foods before six months. They also reported fewer symptoms and had fewer illness episodes (0.1 episodes per child) compared to those who started complementary feeding before six months. Infants who commenced complementary feeding before four months reported more symptoms and had more illness episodes (1.4 episodes per child) compared to those that commenced complementary feeding between four and six months (1.2 episodes per child). Common symptoms/illnesses seen or reported during the study among the groups were fever, diarrhoea and cough. Reasons given for early introduction of complementary foods include insufficient breast milk, thirst and convenience. CONCLUSION: It is concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the infants studied. Early introduction of complementary foods did not provide any advantages in terms of weight gain in our environment, it was frequently associated with illness episodes and growth faltering. Many mothers however require support, encouragement and access to health care providers to breastfeed exclusively for the first six months of life.

Emotional distress and strain in relatives of patients with severe mental disorders: a comparative study.

The levels of emotional distress and strain were examined in two groups of relatives of psychiatric patients using standard instruments. The dementia group had more GHQ--30 cases than the schizophrenic group. Even though the schizophrenic relatives had higher distress and strain scores than the dementia relatives, they did not reach significant levels when the two groups were compared.

Attitudes toward kidney donation.

The Renal Unit of Obafemi Awolowo University Teaching Hospital Ile-Ife in Southwest Nigeria intends commencing a kidney transplantation program. This cross-sectional study aimed at examining the willingness of Nigerians to be living-related kidney donors. Three hundred and sixteen Nigerians (96 first-degree relatives of end-stage renal disease patients, 69 rural dwellers and 151 health workers) were interviewed regarding their willingness to donate kidneys using an interview schedule designed to elicit socio-demographic information, knowledge about kidney transplantation and attitude toward kidney donation. Sixty-two percent of health workers, 52.1% of the patients' relatives and 27.1% of rural dwellers expressed willingness to donate. Higher proportions of health workers and patients' relatives--compared with the rural dwellers--were willing to donate a kidney to their children, full-siblings and parents (P<0.05). The level of awareness about kidney transplantation was highest among health workers and least among rural dwellers (P<0.001). Altruism was the primary motivation for those willing to donate a kidney. The most important reason for refusal to donate was fear of adverse health consequences. Among the rural dwellers, never-married persons were more willing than the married to donate (P<0.05). Programs aimed at increasing awareness about the safety of kidney donation, reducing adverse beliefs about kidney donation, and encouraging altruistic tendencies will increase the availability of kidney donors.

A controlled trial of modified electroconvulsive therapy in schizophrenia in a Nigerian teaching hospital.

The efficacy of ECT in the treatment of Schizophrenia was investigated in a double blind controlled trial. The ICD-10 criteria for Schizophrenia were fulfilled by the 20 patients who entered the trial. Consecutive individuals who satisfied the inclusion criteria were randomly allocated to a course of (bilateral) six real or simulated ECTs each as applicable. Sixteen patients completed the ECT treatment and 20 weeks follow up period. Analysis of measures of clinical change (BPRS and SANS Scores) showed that both groups of patients improved, but the improvement of patients receiving ECT was not significantly greater than that of the control group.

Growth pattern of exclusively breast-fed infants during the first six months of life in Ile-Ife, Osun State, Nigeria.

Several studies to determine the growth pattern of exclusively breast fed infants have provided varying conclusions as to the sufficiency of breast milk alone to support adequate growth for the first six months of life. Disagreement exists concerning the optimal timing of introduction of complementary foods to exclusively breast fed infants. This prospective study thus examined the adequacy of breast milk alone to support normal growth during the first six months of life in our environment. The overall objective was to propose a scientifically sound national recommendation on the appropriate timing for the introduction of complementary feeding in Nigeria. Three hundred and fifty-two mother/infant pairs were serially recruited into the study; all babies were aged 14 days or less and weighed 2.5 kg and above. Three hundred and forty-five (98%) were successfully followed up till the infants were six months old. By six months, 264 (76.5%) were exclusively breast-fed, while 81 (23.5%) had commenced complementary feeding. Growth curves of exclusively breast-fed infants showed increasing weight from birth to six months. Although the 50th percentile birth weight for both boys and girls were the same (3.2 kg), boys gained weight faster than the girls from the age of one month to six months and were heavier at six months. Additionally, the 50th percentile curves of these infants (both genders) for the first six months were above the 50th percentile curve of the World Health Organisation and National Centre for Health Statistics (WHO/NCHS) reference currently used on our national "road to health" (growth monitoring) cards. It was concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the children studied and that our national recommendation that infants be introduced to complementary feeding at six months is appropriate.

Open comparative randomised study of moclobemide versus amitriptyline in major depressive illness (DSM IIIR) in Nigeria.

In a multi-centre study, 60 patients (20 males and 40 females aged 43 +/- 15 and 37 +/- 15 years respectively) with a DSM-IIIR diagnosis of major depressive disorders were randomly assigned to treatment with either Moclobemide (maximum dose 600 mg per day) or Amitriptyline (maximum dose 150 mg per day) for eight weeks. Patients were evaluated pretreatment and over the 8 weeks treatment period using Hamilton Depression Rating Scale (HDRS) and the clinical global impressions (CGI). The Adverse Drug Effects Schedule, clinical, haematological and biochemical status were also evaluated pre, during and post treatment. Of the 60 patients enrolled for the study 54 were found evaluable for efficacy whilst all 60 were evaluated for safety (Adverse Event). On the HDRS and CGI scale there was no significant difference in the therapeutic outcome between the two treatment groups. In the overall clinical assessment rating at the end of treatment 94.1% of patients in the Moclobemide group were rated 'very good to good' and 94.4% with Amitriptyline. Moclobemide appeared to have a slightly better safety profile, the incidence of adverse event was 9.0% compared to 19.0% with Amitriptyline. The drop out rate was 16.7% and 26.7% for moclobemide and amitriptyline respectively. These differences were however not statistically significant. It was therefore concluded that moclobemide is an effective and safe alternative to amitriptyline, with attractive potential for out patients management of depressive illness.

Non-puerperal induced lactation in a Nigerian community: case reports.

Six Nigerian women aged from 22 to 56 years who had not recently been pregnant were successfully relactated by breast suckling alone. All of them produced enough milk to exclusively breastfeed 'motherless' infants. All except one child have continued to breastfeed up to the time of this report and show adequate growth.

PIP: In developing countries such as Nigeria, breast feeding is essential to child health and survival. Since almost 8 of every 1000 pregnant women in Nigeria die in childbirth or from its complications, breast feeding by surrogate mothers is an important child health intervention. This article presents six case studies from the Irepodun Local Government Area of Osun State of successful induction of lactation by breast suckling alone in women who had not recently been pregnant. Surrogate mothers ranged in age from 22 to 56 years. The 6 infants of mothers who had died or abandoned their baby were 1 week to 2 months of age when surrogate breast feeding was commenced. Surrogate mothers were instructed to initiate lactation by suckling the infants repeatedly at least 10 times a day for at least 10 minutes on each breast. Afterward, the infants were fed with artificial milk given by cup or spoon. Successful relactation was considered to have been achieved when the infants could be sustained on breast milk alone. Milk secretion following suckling appeared on the fourth through seventh day, while complete lactation was achieved after 21-25 days. All surrogate mothers were able to produce adequate amounts of breast milk without any nutritional supplementation, even though they were of low socioeconomic status. 4 of the infants were malnourished before relactation was commenced and 3 had episodes of severe diarrhea. With establishment of full breast feeding, all 6 infants gained weight and achieved satisfactory weight for age. The one death in this series involved an infant who developed severe gastroenteritis after the surrogate mother introduced supplementary feeds at 4.5 months of age.

National health management information system: issues of funding and support.

Information Technology has made a substantial inroad into Nigerian society, particularly since the late 1980s. It is, however, already being applied in the health sector. The Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), lle-lfe, Nigeria has adopted a systematic approach to the development of a Health Information System (HIS) for a typical specialist hospital. A review of the existing HIS in OAUIHC is presented, highlighting its attributes, problems, and limitations. In addition, the options of funding HIS on a national scale are identified and discussed. Finally, strategies to ensure ongoing support of a national HIS are presented.

Socio-cultural parameters in Yoruba Nigerian patients with affective disorders.

One hundred and ten consecutive new patients presenting with major affective disorders were divided into five categories according to pattern of presentation: recurrent manic disorder, recurrent depressive disorder, bipolar disorder, single episodes of manic disorder, and single episodes of major depressive disorder. Manic patients predominated, and recurrent manic disorder was much more frequent than either recurrent depressive or bipolar disorder. The manic and bipolar patients were younger. Females predominated in all five groups of patients. The two manic groups were less likely to be married, but this was probably a reflection of their younger age. No differences were demonstrated with regard to educational status or occupation. There were no significant differences with regard to sibship position, family size, or polygamous/monogamous parents. Manic patients were more likely to have suffered permanent separation from one or both parents before the age of 12 years. A relatively low proportion of the patients had a positive history of mental disorder among first- or second-degree relatives. Manic and bipolar patients tended to present in hospital relatively early in their illness.

Effects of antimalarial agents on plasma levels of chlorpromazine and its metabolites in schizophrenic patients.

The plasma content of chlorpromazine (CPZ) and its two metabolites 7-OH-chlorpromazine (CPZ-OH) and chlorpromazine sulphoxide (CPZ-SO) were measured in the blood of schizophrenic patients established on chlorpromazine therapy. Administration of the commonly used antimalarial agents chloroquine sulphate, amodiaquine hydrochloride and Fansidar one hour before the first dose of chlorpromazine for the day led to marked increases in CPZ and CPZ-OH over control levels. There were no consistent changes in CPZ-SO levels. The implications of these findings are discussed, first with regard to possible therapeutic relevance for the management of schizophrenia and more particularly, with regard to the possible toxic effects of concurrent administration of antimalarial agents and chlorpromazine.

The DSM-III concepts of schizophrenic disorder and schizophreniform disorder. A clinical and prognostic evaluation.

Consecutive new patients presenting at a Nigerian psychiatric unit over a 14-month period and fulfilling the DSM-III criteria for schizophreniform disorder, (active) schizophrenia and residual schizophrenia were studied. There were no differences between the three groups with respect to background social data. The schizophreniform patients had a lower incidence of previous psychotic episodes. There were no differences between the first two groups with respect to the distribution of PSE symptoms and signs, Schneider's First Rank Symptoms, or severity of psychopathology. Initial clinical outcome, and longer-term clinical and social outcome, assessed 25-38 months after index presentation, was best in the schizophreniform patients and worst in the patients with residual schizophrenia. The findings are consistent with schizophreniform disorder lying on a spectrum of schizophrenic disorders. They also highlight inadequacies in mental health services in Nigeria and other developing countries.

Yoruba traditional healers in psychiatry. I. Healers' concepts of the nature and aetiology of mental disorders.

Twenty Yoruba traditional healers specializing in mental disorders were studied. Two main groups of mental disorders were identified, asinwin (psychotic disorders) and ode ori (a less severe disorder with prominent somatic symptoms). The further sub-categorization of mental disorders was largely on an aetiological basis. The most important aetiological factors identified were: the actions of enemies with major emphasis on the deployment of supernatural forces; self-induced disorders, of which cannabis abuse was the most frequently quoted example; soponna (small-pox) and 'hereditary' factors. The healers' beliefs regarding mode of hereditary transmission of mental disorders were very different from those of modern medicine.

Yoruba traditional healers in psychiatry. II. Management of psychiatric disorders.

The methods of management of mental disorders employed by twenty Yoruba traditional healers were studied. Paranormal and pharmacological therapeutic agents were given prominence; psychological treatments were not employed to any great extent. The different types of medication employed could be differentiated into two groups, one in which pharmacological influences may be most important, and one in which paranormal influences may be more relevant (from the healers' points of view). Other forms of treatment that could be classified as paranormal are also described. One hundred and sixty-three plants were named by the healers as being used; of these only forty-eight were named by a quarter or more of the healers and only nine by half or more of the healers. The root bark of Rauwolffia vomitoria was employed by all healers. Animals and other agents employed were also identified.

"Ode Ori": a culture-bound disorder with prominent somatic features in Yoruba Nigerian patients.

Thirty patients diagnosed by Nigerian Yoruba traditional healers as suffering from a condition termed "Ode Ori" are described. The chief complaints were of a crawling sensation in the head and body, noises in the ears, palpitations and various other somatic complaints. Anxiety and depressive symptoms were prominent in all the patients and indeed the most common DSM-III diagnoses were of depressive and anxiety disorders. The significance of the disorder and its features is discussed in the context of the socio-cultural background of the patients.