Prevalence and correlates of mental health problems among awaiting trial inmates in a Prison facility in Ibadan, Nigeria.

INTRODUCTION: Prevalence of mental health problems are frequently higher within the prison populations than the general population. Previous studies of prison mental health had focused on convict populations whereas, the awaiting trial segment of the prison population in Nigeria has gradually become the majority of the total lock-up. This study aimed to evaluate the prevalence and correlates of mental health problems among the awaiting trial inmates in a prison facility in Ibadan. METHODS: A cross sectional study design was employed to interview 725 awaiting trial inmates of Agodi Prison, Ibadan, Nigeria. A two phase procedure was utilized with initial screening using a socio-demographic questionnaire and the General Health Questionnaire (GHQ -12); followed by a second phase with all high scorers on the GHQ -12 and 10% of the low scorers using the MINI International Neuropsychiatric Inventory (MINI). RESULTS: A total of 394 respondents participated in the second phase of the study with a mean age of 31.1 years (SD = 8.7), with ages ranging from 18 - 70 years. The mean duration of incarceration at Agodi was 1.1 years (SD = 1.47), with a range of 1 week to 10 years. The prevalence of mental illness was 56.6% with the commonest conditions being depression (20.8%), alcohol dependence (20.6%), substance dependence (20.1%), suicidality (19.8%) and antisocial personality disorder (18%). CONCLUSION: There is a high prevalence of neuropsychiatric disorders among awaiting trial inmates but this does not appear to be significantly different from that of convict populations.

Elder abuse and neglect in Zaria northern Nigeria.

AIMS AND OBJECTIVES: The aim of this study was to determine the nature and extent of elder abuse and neglect among community dwelling elderly in Zaria, Nigeria. SUBJECTS AND METHODS: Community dwelling elderly in Zaria city North-western Nigeria were interviewed;. they were interviewed using a data collecting sheet designed to obtain socio-demographic data and an instrument designed to detect abuse and neglect in the elderly. The data obtained was analysed using Statistical Package for Social Sciences Version 13 for Windows. RESULTS: Three hundred and fifty one elderly people participated in the study out of which 211(60.1%) were females. The mean age of the participants was 73.90 years (95%CI=.72.96-74.84 years) There was no case of physical, financial or psychological abuse. However, 125(35.6%) participants suffered possible neglect in terms of personal care and hygiene. Increasing age, lack of formal education, receiving pension, not having a spouse and self reported poor health status were significantly associated with elder possible neglect in this community. CONCLUSION: Elder abuse was uncommon in this community like in other communities in the developing countries. However, possible neglect of personal care and hygiene of the elderly was common and that might be due to poor economic status of both the elderly and his other caregiver.

Neuropsychiatric symptoms in Nigerian patients with Parkinson's disease.

BACKGROUND: Neuropsychiatric symptoms are common in Parkinson's disease and may precede onset of motor symptoms. They are also known to increase caregiver's burden. OBJECTIVE: The aim of this study was to assess neuropsychiatric symptoms in a cohort of Nigerian patients with idiopathic Parkinson's disease and compare with systemic hypertension. METHOD: Fifty patients with idiopathic Parkinson's disease were compared with fifty demographically matched controls with systemic hypertension. Diagnosis of Parkinson's disease was based on the United Kingdom Parkinson Disease Society (UKPDS) Brain Bank Clinical diagnostic Criteria. Diagnosis of hypertension was based on recorded blood pressure of ≥140/90 mmHg on two different occasions. The Neuropsychiatric Inventory (NPI) was applied to caregivers of both patients and controls. RESULTS: There were significant differences in frequency of neuropsychiatric symptoms in patients and controls (P < 0.05). Significant differences were found in mean distress scores for some neuropsychiatric symptoms and the total mean distress score. In all cases, patients with Parkinson's disease had higher scores when compared with controls. Severity of motor symptoms, as measured by the UKPDS, correlated with total NPI severity scores (P = 0.000). CONCLUSION: Neuropsychiatric symptoms occur more frequently in Parkinson's disease than matched controls, and the presence of these symptoms is associated with caregivers' distress. There is a need for early and adequate treatment for motor and behavioural symptoms of Parkinson's disease.

Stroke lesions and post-stroke depression among survivors in Ibadan, Nigeria.

BACKGROUND: We aimed to determine the association between the neuro-radiological characteristics of stroke lesions and post-stroke major depression among survivors in Ibadan, Nigeria. This is in the background of a paucity of information on the clinico-pathological correlation of post-stroke emotional responses among African Survivors. METHOD: We studied 30 stroke survivors receiving physiotherapy. The radiological characteristics of the stroke lesions were documented using computerized tomography or magnetic resonance imaging scans in the acute phase of the stroke. While the presence of major depressive disorder meeting criteria in the fourth edition of the Diagnostic and Statistical Manual was assessed using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), between 3 months and 2 years after. The association between lesion characteristics and depression was explored using logistic regression analysis. RESULT: Nine (30.0%) stroke survivors met criteria for major depressive disorder. There were significant differences in their gender. The differences in the lesion types approached the set level of significance in survivors with or without major depressive disorder. There were however no differences when considering hemispheric lateralization or intra-hemispheric lesion location. Being female, but not the lesion characteristics was strongly associated with post-stroke major depressive disorder CONCLUSION: Lesion characteristics documented in the acute phase of stroke could not predict the occurrence of major depressive disorder during rehabilitation in this sample. The occurrence of depression among stroke survivors may ultimately be determined by a combination of factors.

Beliefs and attitudes towards dementia among community leaders in northern Nigeria.

BACKGROUND: Dementia is an important devastating disease in old age. The number of dementia cases is in increasing worldwide with majority of them living in developing countries; however awareness about this important disease is poor especially in these developing countries. OBJECTIVES: This study aimed at determining the beliefs and attitude of community leaders on dementia in Northern Nigeria. METHODS: A cross sectional descriptive study was done using a structured questionnaire answered in Yes or No pattern. The questions were derived from the informant section of Community Screening Interview for Dementia and Blessed Dementia Scale. Fifty seven traditional rulers and fourty three Islamic clerics were interviewed. Data obtained was analysed using SPSS for windows version 11.0. RESULTS: The mean age of the participants was 57.76 ± 11. 10 years and 28% were over the age off 65 years. The result showed that 77 (77%) of the subject believed that dementia is a normal process of aging. This was significantly associated with educational status but not age of the participants. The most recognisable symptoms are psychotic features of dementia (82%), while difficulty in dressing (56%) is the least recognisable symptom. Most of the participants would refer a person with features suggestive of dementia to see a physician. CONCLUSION: The study demonstrated that the belief dementia is a normal process ageing is common among these community leader. Therefore there is need to carry out awareness campaign to educate them.

Hypertension and incident dementia in community-dwelling elderly Yoruba Nigerians.

OBJECTIVES: To investigate the relationship between hypertension and dementia incidence in community-dwelling elderly Yoruba (aged 70 years and above) because of sparse information on dementia and its risk factors in developing countries. MATERIALS AND METHODS: Community-based, prospective study of consenting elderly Yoruba using two-stage design. Blood pressure was measured during the baseline evaluation at 2001 and hypertension was defined as BP ≥ 140/90 mmHg. Diagnosis of dementia and normal cognition was by consensus using standard criteria. Non-demented subjects from the 2001 evaluation wave were re-evaluated during the 2004 and 2007 waves for dementia. Logistic regression was used to examine the association of baseline hypertension and incident dementia, after adjusting for age, gender, education, and histories of stroke and smoking. P-values <0.05 were considered significant. RESULTS: During the 6-year follow-up, 120 individuals developed dementia, while 1633 remained non-demented. The frequency of hypertension in the demented group was significantly higher than in the non-demented (70.0% vs 60.2%, P = 0.034). Baseline hypertension was a significant risk factor for dementia (OR = 1.52; 95% CI 1.01-2.30). Higher systolic, diastolic or pulse pressure was associated with increased risk (P < 0.05). Participants with diastolic BP ≥ 90 mmHg were at a significantly greater risk than those with readings below 70 mmHg (OR = 1.65; 95% CI 1.01-2.69). CONCLUSIONS: Hypertension was associated with increased risk of dementia in elderly Yoruba and its appropriate treatment may lower the risk.

A comparison of cardiovascular disease risk factor biomarkers in African Americans and Yoruba Nigerians.

OBJECTIVE: Classical risk factors for coronary artery disease are changing in the developing world while rates of cardiovascular disease are increasing in these populations. Newer risk factors have been identified for cardiovascular disease, but these have been rarely examined in elderly populations and not those of developing countries. METHODS: This study was a cross-sectional comparison from a longitudinal, observational, epidemiologic study in which participants are interviewed at three-year intervals. The sample included 1510 African Americans from Indianapolis, Indiana, and 1254 Yoruba from Ibadan, Nigeria. We compared anthropomorphic measurements; biomarkers of endothelial dysfunction (plasminogen activator inhibitor type 1 [PAI-1 and E-selectin), inflammation (C-reactive protein), and lipid oxidation (8-isoprostane); and levels of lipids, homocysteine, folate, and vitamin B12. RESULTS: Cholesterol, triglycerides, and low-density lipoprotein cholesterol levels were higher in African Americans. For markers of endothelial dysfunction, E-selectin and homocysteine differed between men, and PAI-1 was higher in the Yoruba. C-reactive protein differed only in women, but 8-isoprostane was higher in the Yoruba. CONCLUSION: Higher lipid levels in African Americans are consistent with their Western diet and lifestyle. Oxidative stress appears to be higher in the Yoruba than in African Americans, which may be secondary to dietary differences. Whether these differences in classical and emerging risk factors account for the different rates of cardiovascular disease, dementia, or other morbidities in these two populations remains to be determined.

Caring for individuals with dementia: the Nigerian experience.

Recent epidemiological data, mainly from cross-cultural studies, have revealed that the burden of dementia and Alzheimer's disease (AD) the most common type, is significantly lower in developing than in the industrialized countries. Caring for individuals with dementia is a major consideration because most developing countries do not have the resources to provide comprehensive care in institutions. Home care that is practiced is ideal given the cultural scenario especially with the extended family support. Public policies on the care of the elderly however need to be well articulated and implemented. Hypertension was the most frequent medical co-morbidity of the demented subjects and about a third of subjects with AD were hypertensive, which may support vascular hypothesis in AD pathogenesis. The important behavioural disturbances experienced by caregivers and the associated stress levels were highlighted. The model used on the Indianapolis-Ibadan Dementia Study which involves periodic home visits, and empowerment of caregivers through regular meetings is envisaged to make caring for these individuals easier and adaptable in other African communities.

Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans.

OBJECTIVE: This article reports on a prevalence study of dementia and Alzheimer's disease among two groups of subjects with the same ethnic background but widely differing environments. METHOD: The study was conducted among residents aged 65 years and older in two communities: Yorubas (N = 2,494) living in Ibadan, Nigeria, and African Americans (N = 2,212 in the community and N = 106 in nursing homes) living in Indianapolis, Indiana. The study design consisted of a screening stage followed by a clinical assessment stage for selected subjects on the basis of their performance on the screening tests. RESULTS: The age-adjusted prevalence rates of dementia (2.29%) and Alzheimer's disease (1.41%) in the Ibadan sample were significantly lower than those in the Indianapolis sample, both in the community-dwelling subjects alone (4.82% and 3.69%, respectively) and in the combined nursing home and community samples (8.24% and 6.24%, respectively). The prevalence rates of dementia and Alzheimer's disease increased consistently with advancing age in both study groups. CONCLUSIONS: To the authors' knowledge, this is the first study, using the same research method at the two sites, to report significant differences in rates of dementia and Alzheimer's disease in two different communities with similar ethnic origins.

Prevalence of cognitive impairment: data from the Indianapolis Study of Health and Aging.

BACKGROUND: The epidemiology and natural history of cognitive impairment that is not dementia is important to the understanding of normal aging and dementia. OBJECTIVE: To determine the prevalence and outcome of cognitive impairment that is not dementia in an elderly African American population. METHOD: A two-phase, longitudinal study of aging and dementia. A total of 2212 community-dwelling African American residents of Indianapolis, IN, aged 65 and older were screened, and a subset (n = 351) received full clinical assessment and diagnosis. Subsets of the clinically assessed were seen again for clinical assessment and rediagnosis at 18 and 48 months. Weighted logistic regression was used to generate age-specific prevalence estimates. RESULTS: The overall rate of cognitive impairment among community-dwelling elderly was 23.4%. Age-specific rates indicate increasing prevalence with increasing age: 19.2% for ages 65 to 74 years, 27.6% for ages 75 to 84 years, and 38.0% for ages 85+ years. The most frequent cause of cognitive impairment was medically unexplained memory loss with a community prevalence of 12.5%, followed by medical illness-associated cognitive impairment (4.0% prevalence), stroke (3.6% prevalence), and alcohol abuse (1.5% prevalence). At 18-month follow-up, 26% (17/66) of the subjects had become demented. CONCLUSIONS: Cognitive impairment short of dementia affects nearly one in four community-dwelling elders and is a major risk factor for later development of dementia.

Healthcare for older persons, a country profile: Nigeria.

The Nigerian population is undergoing demographic transition, with an increasing population of older people. Nuclear and extended family members traditionally care for older persons at home. We have observed changes in home living conditions due to reduced family size, and urban migration for economic reasons are likely to affect the care of older people. The inadequately funded healthcare system has placed little emphasis on the care of older people because there are more-pressing health problems and funding for older people is limited. This paper advocates improved attention to the health needs of older people through improved budgetary allocation, revision of the training curriculum of all cadres of health staff to include geriatrics, and utilization of primary healthcare facilities.

Effect of oxidative stress on DNA damage and beta-amyloid precursor proteins in lymphoblastoid cell lines from a Nigerian population.

The epsilon 4 allele of apolipoprotein E (APOE) is strongly associated with late-onset Alzheimer's disease (AD) in Caucasian populations, but our studies suggest that APOE epsilon 4 is not a risk factor for AD in Nigerian blacks and is a weak risk factor in African-Americans. The prevalence of AD is lower in Nigerians than in African-Americans. Increased oxidative damage to macromolecules in brain tissue by reactive oxygen species (ROS) has been reported in AD. Here we examined the effects of endogenous and induced oxidative stress on total (nuclear and mitochondrial) DNA damage in lymphoblastoid cell lines (5 probable AD and 3 controls) from Ibadan, Nigeria. Cells were exposed to 200 microM t-butyl peroxide (a generator of ROS) for 4 hours. Total DNA was isolated and digested with nuclease P1 and alkaline phosphatase. DNA fragments were separated by HPLC and the levels of 8-hydroxy-2'-deoxyguanosine (OH8dG, an indicator of DNA damage) and deoxyguanosine (dG) determined. We did not detect a significant difference in the OH8dG/dG ratio in untreated or treated cell lines in the two groups, and this was independent of APOE genotype. We also examined, by Western blotting, the level of beta-amyloid precursor protein (APP) which is involved in AD. The level of the heat shock protein (HSP-70) was examined as a control. There was a slight decrease in levels of APP and HSP-70 following treatment. Studies in cell lines from Caucasian subjects have shown an increase in mitochondrial DNA damage following oxidative challenge. Our preliminary results suggest that African populations are less vulnerable to chemical-induced oxidative DNA damage.

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Profile of dementia in a Nigerian community--types, pattern of impairment, and severity rating.

Out of 2494 subjects screened in a Nigerian community, 28 patients with dementia were identified. Alzheimer's disease was diagnosed in 18 patients (64.3%), 16 of whom had probable Alzheimer's disease. Eight patients (28.6%) had vascular dementia while one patient each had parkinsonism with dementia and depression with dementia. Patients with Alzheimer's disease were significantly older, predominantly females and illiterates. Cognitive deficit commonly took the form of memory and judgment impairment while financial mismanagement was the most frequent impaired activity of daily living. More than half of the cases had mild disease on severity rating and were comprised mainly of Alzheimer's disease subjects. These results confirm the higher frequency of Alzheimer's disease over the other types as reported in other communities.

The pattern of medical illness in a community of elderly Nigerians.

A community survey of Nigerians aged 60 years and above was carried out. Nine hundred and fifty one subjects were interviewed by trained nurses. Seven hundred and fifty nine (79pc) had physical examination carried out on them. It was found that musculoskeletal, dental, ocular and cardiovascular disorders were the commonest problems in this group of people. Poor dental hygiene, anaemia and goitre were problems significantly associated with living in rural areas, while hypertension was commoner in urban areas, but this did not reach significance at five pc level. The results show that about one out of five elderly Nigerians suffer from chronic disabling conditions such as osteoarthritis and 2.4pc of them were diabetic. The impact of these chronic diseases on the health of the elderly Nigerians is discussed and suggestions made for health promotion interventions and treatment programmes.

Typhoid fever masquerading as functional psychosis.

While acute confusional states are frequently encountered in typhoid fever, initial manifestation of this illness as "functional psychosis" is very rarely encountered. We describe our experience of three patients seen within a 15-month period, who initially presented as various forms of psychiatric disorders with little evidence of impairment of consciousness, well before the appearance of pyrexia which led to the correct diagnosis. The possible role of less severe or self limiting organic conditions in the genesis of "functional" psychosis in the African population is discussed. The importance of a high index of suspicion in the functional-type psychosis, that might be due to typhoid fever and the need to institute therapy for typhoid fever while investigating (the late appearing fever) in such cases are emphasized.

Morbidity pattern in a sample of elderly Nigerians resident in Idikan community, Ibadan.

We documented the pattern of medical illnesses in 613 elderly Nigerians (398 females and 215 males) resident in Idikan community in Ibadan city. Their ages ranged from 65 to 110 years with a mean of 76.2 years. Medical disorders diagnosed either singly or in combinations were diagnosed in 364 (59.4%) subjects and there was no gender association. Cardiovascular problems were the commonest and high blood pressure (27.8%) was the most frequent diagnosis. Only 5 of the hypertensive subjects were aware of that diagnosis and were on regular medications. The complications presented with included heart failure and stroke. Visual impairment (12.1%) mainly due to cataracts and osteoarthritis (6.7%) in that order were next in frequency. The most frequent neurological disorders were hearing impairment and movement disorders. The other conditions encountered were similar to the findings in previous studies in this environment, and the usual findings in studies focusing on this age-group in other countries. The presence of morbidity was significantly associated with increasing age and poor performance on screening. The latter increased the probability of being selected for clinical examination with detection of medical problems or could suggest associated cognitive impairment. The prevalence of systemic hypertension was not different from findings in other communities in people of similar age groups. This study emphasises the role of hypertension as a major cause of morbidity in this community and stresses the need for increased health awareness especially with regards to regular checking of blood pressure so as to avoid complications.

The CERAD Neuropsychological Test Battery: norms from a Yoruba-speaking Nigerian sample.

One-hundred normal, healthy, Yoruba-speaking Nigerian men and women aged 65 and above completed the Consortium to establish a Registry for Alzheimer's Disease-Neuropsychological Battery (CERAD-NB), a cognitive screening battery used in the evaluation of elderly patients with suspected dementia. Correlational analyses indicated pervasive education-influences on test performance. Gender-effects on the CERAD-NB were accounted for by education and there were essentially no age-effects. Education-stratified normative data are presented for all tests. Factor analysis revealed a one factor solution which accounted for 54.7% of the variance.