Socio-economic correlates of relapsed patients admitted in a Nigerian mental health institution.

BACKGROUND: Relapse in psychiatric disorders is highly distressing, costly and engenders burn-out syndrome among mental-health workers. AIMS: To study the socio-economic factors associated with relapse in individual admitted with psychiatric disorders and the pattern of socio-economic impact of relapse in those groups. METHODS: A cross-sectional survey of all relapsed patients without cognitive deficit admitted into the federal Neuro-Psychiatric Hospital, Lagos, Nigeria between June and October 2007 was conducted using a self-validated Structured Interview Schedule (Relapse Socio-economic Impact Interview Schedule) and Key Informant Interview Guide. Secondary data were elicited from the patient folders, case notes, ward admission registers and nominal rolls. Data were summarised using mean, standard deviation, frequency and percentiles. Pearson's moment correlation coefficient was used to test the association among variables. The Mann-Whitney U-test was used to compare the pre-morbid and the post-morbid states. RESULTS: This study involved 102 respondents. Their mean age was 36.5 ± 9.8 years, mainly of male gender (72.5%) suffering from schizophrenic disorder (37.8%). Relapse and re-admission ranged between 2 and 12. Unemployment rate, marital separation and divorce increased more than 5-fold from pre-morbid to morbid states. Few (4.9%) could still settle their hospital/drug bills on their own, while most (95.1%) depended on family, philanthropist and government/waivers to pay for their bills. Their social relationships were negatively influenced with most of them expressing social isolation and low quality of life. There were significant relationships (P<0.05) between age, sex, number of relapses, number of admissions, pre-morbid marital status, morbid state marital status, pre-morbid state occupational status and morbid state occupational status. There was significant change (P= 0.00) in the quality of life, societal integration/acceptability, economic status, employment status and marital status of the respondents between the pre-morbid and post-morbid periods. The illness significantly affected the emotional status of the participants. CONCLUSION: Relapse and readmission in psychiatric patients have a negative impact on socio-economic well-being of patients, family and the society. Efforts should be taken to provide early interventions.

Seroepidemiology of human immunodeficiency virus infection in Borno State of Nigeria by sentinel surveillance.

A serosurvey for human immunodeficiency virus (HIV) infection was carried out in three well-separated population centers in Borno State of Nigeria in 1989-1990. The study subjects were 1,259 made up of sexually transmitted disease (STD) clinic attenders, pregnant women, female prostitutes, and blood donors. Sera were screened by enzyme-linked immunosorbent assay and confirmation was done by Western blotting. The overall seroprevalence was 1.67% (21/1,259), with no significant differences from one population center to another. There were, however, significant differences among the population groups studied: prostitutes, 4.24%; STD clinic attenders, 1.67%; blood donors, 0.71%; and pregnant women, 0.24%. Of the 21 seropositives, 18 were positive for HIV-1 only; 1 was positive for HIV-2 only; and 2 were positive for both HIV-1 and HIV-2. All three HIV-2-positive sera were from prostitutes. Prevalence rates found in this study showed marked increases from 2 to 3 years earlier. There is therefore the need for a vigorous and sustained intervention program.

A survey for antibodies to Lassa virus among health workers in Nigeria.

A study was conducted among 552 health workers at 6 health facilities in Nigeria. Lassa virus immunoglobulin (Ig) G antibody was detected in 12.3%, using an enzyme-linked immunosorbent assay. Antibody prevalence in the 6 health centres ranged from 1.2% to 27.3%. Prevalences were higher in primary and secondary health facilities than in tertiary centres. Seroprevalences ranged from 1.7% to 23.7% among different occupational groups of health workers; the highest observed antibody prevalence was among ward aids. Lassa virus IgM antibody, indicating recent infection, was present in 6 of the health workers, 5 of whom were ward aids and one was a nurse. All of the health workers with specific IgM came from a single facility in Lafia, sampled during an outbreak of Lassa fever.

Urban yellow fever epidemic in western Nigeria, 1987.

A large epidemic of urban yellow fever occurred in April and May 1987 in Oyo State, western Nigeria. The principal vector was Aedes aegypti, breeding in domestic water containers. The 1987 outbreak followed an epidemic of sylvatic yellow fever in eastern Nigeria the previous year, and probably resulted from introduction of the virus by viraemic travellers. The outbreak in Oyo State ended in early July, by which time 805 cases and 416 deaths had been officially notified. However, surveys of 3 villages in the epicentre, a region with over 4 million inhabitants, indicated an infection rate of approximately 20%, a clinical attack rate of 2.9% and a mortality rate of 0.6%, suggesting that the true incidence of cases and deaths far exceeded the official reports. Yellow fever virus was isolated from persons with fully developed yellow fever as well as mild febrile illness. One virus isolate was made from blood of an individual with mild illness, who had received 17D vaccine 5 d earlier; monoclonal antibody analysis showed that the isolate was a wild-type virus. Larval indices of Ae. aegypti were very high; however, low vector competence of the Ae aegypti population may have provided a constraint on spread of the epidemic. In late 1987 a third epidemic appeared in Niger State, northern Nigeria, with 644 reported cases and 149 deaths. The vector(s) involved is (are) unknown.

Stability of viability and immunizing potency of lyophilized, modified equine arteritis live-virus vaccine.

The Bucyrus strain of equine arteritis virus, previously modified to avirulence and vaccinal virus by 131 serial passages in primary cell cultures of horse kidney followed by 111 passages in primary cell cultures of rabbit kidney, was further passaged in cultures of the E. Derm (NBL-6) cell line, a continuous diploid cell line. Pools of the 16th and 25th passages of the virus in this last equine dermal cell line were lyophilized and stored in lots at 37 C, 23 to 28 C, 4C, and -20 C. The viability of the vaccinal virus deteriorated rapidly during storage at 37 C and at 23 to 28 C, but was relatively stable at 4 C and at -20 C for at least 1 year. The vaccine stored at 4 C for 9 months protected 2 horses, subsequently inoculated with avirulent virus, from arteritis, whereas the 2 nonvaccinated control horses inoculated simultaneously developed severe signs of the disease and died of acute arteritis.

Hepatitis B virus infection among blood donors and pregnant women in Maiduguri, Nigeria.

Hepatitis due to hepatitis B virus (HBV), and sequelae such as hepatocellular carcinoma (HCC) are very common in the Maiduguri area of Nigeria. In a serological survey of 287 blood donors (all males) and 224 pregnant women, we found that 22.0% of the blood donors and 11.6% of the pregnant women were positive of HBsAg. For HBeAg the prevalence rates were 6.64% and 1.39% respectively. These findings make it imperative that all blood donations and pregnant women be screened for HBsAg. All positive blood units should be discarded and all children born to positive women be vaccinated against hepatitis B, preferably during the first year of life. In addition, a more extensive programme against hepatitis B needs to be undertaken. It is suggested that HBV vaccination be included in the expanded programme of immunization, so that all children, irrespective of the serological status of their mothers, will be vaccinated against hepatitis B.

Presentation and outcome of HIV-1 infection in hospitalised infants and other children in north-eastern Nigeria.

There is limited information on HIV infection in children in West Africa. This prospective case series study was done to determine the size of the problem and the feasibility of selective screening for infection based on clinical presentation. It involved infants and other children admitted to the Children's Emergency Ward and Paediatric Medical Ward of the University of Maiduguri Teaching Hospital, Nigeria, from the beginning of September 1992 to the end of September 1994. Clinical evaluation followed by serologic tests (ELISA and Western blot techniques) was undertaken. Descriptive study; frequencies were compared using chi 2 test for Fisher's exact test as appropriate. One hundred and ninety nine (10.9%) of 1,822 admissions were screened. One hundred and fifty eight (79.4%) were ELISA negative and 17 (8.6%) ELISA and WB positive; a further 10 (5%) were ELISA positive but WB indeterminate and 14 (7%) were ELISA positive but WB negative in 12 or untested in two. All the infections were HIV-1. Sixteen (39%) patients (nine WB positive, three WB indeterminate and four ELISA positive only) are dead, 14 from HIV-related illnesses, two (4.9]) are alive and 23 (56.1%) lost to follow up; 11 of the HIV-related deaths involved infants. Presence of persistent diarrhoea, prolonged fever, oral thrush, hepatosplenomegaly, diagnosis of tuberculosis and severe malnutrition with gastroentereritis, and multiple (> 3) diagnosis on admission were significantly (p < 0.05) associated with WB confirmed HIV-1 seropositivity and could serve as indicators for selective screening. HIV-1 infection in hospitalised infants and children has become an important problem in Nigeria, presentation in infancy is associated with a high case fatality rate, and the practice of selective screening based on clinical presentation would appear to be feasible.

Establishment of reference values of CD4 and CD8 lymphocyte subsets in healthy Nigerian adults.

A total of 2,570 apparently healthy human immunodeficiency virus-negative adults from the six geopolitical zones in the country were enrolled in our study in 2006. The samples were assayed using the Cyflow technique. Data were analyzed using the Statistical Package for Social Scientists (SPSS). The majority (64%) of the participants had CD4 counts within the range of 501 to 1,000 cells/microl. The reference range for CD4 was 365 to 1,571 cells/microl, while the reference range for CD8 was 145 to 884 cells/microl.

Anti-measles IgM in healthy adult Nigerians.

Measles is a common and serious disease of children in Nigeria. In the present study sera from healthy adult Nigerians were titrated for anti-measles haemagglutination inhibiting antibody, and for levels of anti-measles HI IgM antibody. Of those tested, 43.6% showed anti-measles antibody activity without specific IgM, while 30.8% showed both total antibody and specific IgM activity. The presence of anti-measles IgM implies recent contact with the virus. The implication of such recent subclinical infections of adults in the transmission of the virus to susceptible children is discussed.

Expression of vaccinia virion surface tubule protein as a virus specific cell surface antigen.

The sequential expression of a vaccinia virus specific antigen on the surface of infected cells has been followed by 125I-labelled anti-vaccinia IgG. After an initial drop (during the first 30 minutes of infection) the amount of viral antigen at the cell surface increased steadily for the 12 hours tested. The expression of the antigen was found to depend on protein and RNA synthesis from the start, but dependent on DNA synthesis only after 4 hours. The senitivity of the phenomenon to ultraviolet light irradiation of the virus suggests that the genetic information needed for the expression of the antigen resides in the viral genome. The antigen has been identified as the virion surface tubule, a tubule-like structure on the surface of the intact virion. It is known that vaccinia virus infection of cells starts with the fusion of the virion envelope with the host plasma membrane. It is here proposed that initially tubule from input virus is detected as viral antigen on the cell surface. Subsequently, virus tubule protein synthesised de novo migrates and is detectable as the virus specific cell surface antigen.

Optimal age for vaccinating Nigerian children against measles. I. Neonatal antibody profile and subsequent susceptibility to measles.

The decline of maternally acquired haemagglutination inhibiting antibodies against measles virus in Nigerian children born in Lagos was studied. At birth all the 303 children whose cord blood serum was tested had measurable antibodies. The antibody titre remained detectable in all the children up to four months of age, and in over 90% at five months of age. At six months 65% of the children were without detectable antibodies. At seven and eight months the proportion of children without measurable antibodies was reduced to 50% and 42% respectively, indicating a slight but progressive improvement in the immune status of the children. These findings provide a serological basis for starting anti-measles immunization of Nigerian children at six months.

Optimal age for vaccinating Nigerian children against measles. II. Seroconversion to measles vaccine in different age groups.

Ninety-eight children between five and nine months were given measles vaccine. Bloodsamples were taken before and again six to eight weeks after immunization and tested for haemagglutination inhibition antibodies to measles virus. It was found that the sero-conversion rate was significantly lower (p less than 0.05) in infants under seven months than over this age. The results suggest that although some immunized at six months of age show seroconversion, the proportion is too small to justify extensive immunization at this age. It is proposed that children in Lagos should be immunized from the age of eight to nine months.

Prevalence of human immunodeficiency virus-infection among pregnant women attending ante-natal clinic in Maiduguri, north-eastern Nigeria.

A seroepidemiological survey conducted among 1,059 pregnant women in Maiduguri, North-eastern Nigeria from September, 1988 to April, 1990 showed that 5 women or 0.47% were positive for HIV antibodies. Three of the women (0.28%) were positive for HIV-1 while 2 others (0.19%) were positive for HIV-2; this is consistent with the known fact that both viruses are active in West Africa, a sub-region of which Nigeria is part. Detailed information available on 4 of the 5 seropositive women and their husbands did not reveal any known risk factor favouring HIV-infection. In addition to the 5 confirmed seropositive women, 10 others (0.94%) gave Western blot patterns that were neither HIV-1 nor HIV-2. The significance of this observation, if any, needs to be clarified.

Anti-rabies treatment of dog-bite victims in Lagos, Nigeria: trial of suckling mouse brain and fetal bovine kidney cell rabies vaccines.

Human rabies is common in Nigeria, a country known for rabies endemicity. Yet the supply of anti-rabies vaccines for human use (adult sheep brain origin, produced locally, and duck embryo and human diploid cell vaccines, imported) is grossly inadequate. This study involved controlled treatment of dog-bite victims with suckling mouse brain (SMBV) or fetal bovine kidney (FBKV) rabies vaccines in an effort to determine which type to recommend for production and use in Nigeria. Dog-bite victims treated were aged three to 74 years, with about equal numbers of males and females. Of the 136 patients, 116 (85.3%) completed at least the primo-series of vaccinations, and all have survived without any evidence of clinical rabies. Recipients of the SMBV showed local and generalized reactions in 11.1% and 2.5% of the cases, respectively. Recipients of the FBKV administered subcutaneously showed local and generalized reactions, in 12.5% and 9.4% of cases, respectively. There were no side effects attributable to the vaccine among patients who received the FBKV intramuscularly. By day 7, 26.7% of SMBV recipients and 28.6% of FBKV recipients showed antibody response, with titres of at least one Equivalent Unit ml-1. These percentages increased to 95.1 and 81.1, respectively, by day 14, and by day 20 (for SMBV recipients) or day 30 (FBKV recipients) the response was 100%. Titres dropped by day 90, but in no case to below 1 EU ml-1. We have concluded that both vaccines are equally efficacious and well tolerated. In view of the simple technology required, and the resultant lower cost, the SMBV is being recommended for production and use in Nigeria.

HIV infection among pregnant women. A worsening situation in Maiduguri, Nigeria.

A serosurvey of 1,233 pregnant women aged 15-41 years, and attending antenatal clinics in Maiduguri, Nigeria from July 1991 to February 1993 showed that 28 (2.3%) of the women were positive for HIV antibodies. Twenty-four (1.9%) were positive for HIV-1 only, 1 (0.08%) was positive for HIV-2 only and 3 (0.24%) were reactive for both HIV-1 and HIV-2. The overall seroprevalence rose gradually from 2.1% in 1991 to 2.3% in 1992, and to 2.6% so far in 1993. From July 1992 to February 1993 6 children aged 24 hours to 8 months were found HIV-positive in the same hospital where this survey was carried out. The only known risk factor for HIV infection applicable to the pregnant women studied was heterosexual intercourse.

PIP: In northeastern Nigeria between July, 1991, and February, 1993, health workers took blood samples from 1233 15-41 year old pregnant women attending the prenatal clinic at the University of Maiduguri Teaching Hospital to compare HIV prevalence with rates from the same hospital during September, 1988-April, 1990. Researchers did not test any of the partners for HIV infection. Overall HIV prevalence was 2.3%. This was 4.83 times higher than that of the earlier period. Yaounde, Cameroon, has experienced a similar increase in HIV infection among pregnant women (0.9-2.2%, in 1989-1991). In 1989-1990, HIV infection among pregnant women in Abidjan, Ivory Coast, was 8%. The significant increase in HIV prevalence in Maiduguri was comparable with the HIV prevalence of infants less than 24 hours to 8 months old in the same hospital between July, 1992, and February, 1993. 4, 1, and 1 of the 280 pregnant women who were tested in 1991 were positive for HIV-1, HIV-2, and both HIV-1 and HIV-2, respectively. These figures for 1992 (838 women) were 17, 0 and 2. They were 32, 0, and 0 in 1993 (115 women).

Trial of economical regimens of suckling mouse brain rabies vaccine for postexposure prophylaxis in Lagos, Nigeria.

The suckling mouse brain rabies vaccine, recommended for production and routine use in Nigeria from our previous study, was investigated in the present study in an effort to reduce the cost of antirabies treatment in the country. This is needed for economic reasons. Instead of seven daily doses followed by three boosters, we tried five daily doses followed by three boosters, with or without equine hyperimmune serum given on day 0 (40 IU per kg body weight). Fifty dog-bite, victims, aged 3-81 years, were placed on this regimen, 25 with serum and 25 without serum, according to the history of the case. The serum had no effect on the kinetics of antibody development and both serum and vaccine were well tolerated. The geometric mean titres (GMTs) of antirabies antibodies in the sera of recipients of vaccine alone on days 10, 28 and 90 were 3.05 equivalent units ml-1 (EU ml-1), 4.35 EU ml-1 and 2.54 EU ml-1 respectively. Among those who had received antiserum and vaccine the titres were respectively 3.19 EU ml-1, 4.35 EU ml-1 and 3.02 EU ml-1. Of the 50 subjects, 49 showed detectable antibodies by day 28, and all the 50 survived. This regimen is therefore recommended for further trial in countries where rabies is endemic but potent antirabies vaccines are scarce and expensive. Another 23 subjects, considered not to be at risk of rabies, were given a one-tenth dose, two-site intradermal inoculation of the same vaccine on days 0, 3, 7, 14, 28 and 90.(ABSTRACT TRUNCATED AT 250 WORDS)

Increasing risk of transfusion-associated AIDS as the pandemic spreads: experience in Maiduguri, Nigeria.

Complacency and financial considerations have led many hospitals in developing countries with low HIV antibody prevalence to disregard the importance of pre-screening for HIV antibodies blood meant for transfusion. This report shows that during the year 1987 in which mandatory screening of donated blood was introduced at the University of Maiduguri Teaching Hospital, HIV antibody prevalence in donated blood units was 0%. However, four years later the prevalence had risen to 2.76%. This observation underlines the increasing risk to which transfusion recipients are exposed if given unscreened blood as HIV spreads with time. This spread can be rapid.

PIP: Based on screening of all blood units donated to a Nigerian hospital using enzyme linked immunosorbent assay (ELISA) and Western blot, the prevalence of human immunodeficiency virus (HIV) rose from 0% in 1987 to 2.76% in 1991 (Western blot positives only). The prevalence in intervening years was .33% in 1988, .38% in 1989, and .94% in 1990. Western blot indeterminates rose from 0% in 1987 to 2.05% in 1991. The percentage of blood units which were ELISA positive but Western blot negative plus ELISA borderline rose from .90% in 1987 to 2.87% in 1991. Overall, the percentage of donated units that had to be discarded, because of a positive or borderline ELISA, rose from .90% in 1987 to 7.67% in 1991. Donors were male residents of Maiduguri, Nigeria, between the ages of 18 and 55. Positive units were from donors between the ages of 22 and 45 who did not belong to any high risk groups. All positives were for HIV-1 only. In view of these findings, screening of blood donations, although expensive, is recommended, even in areas such as Nigeria where the overall prevalence of HIV is low. Because of expense, pooling of sera for testing may be necessary and transfusions should be limited to imperative situations only. Also, fees can be charged for screening.