Scaling up numbers and competency of graduating medical and dental students in Nigeria: Need to improve medical trainers' competency in teaching.

Background: With the increasing medical brain drain in Nigeria, there is a need to train and graduate more doctors to fill in the gaps created to mitigate the effects. To meet this goal, the trainers need to evolve and have the competency to deliver quality training for many more enrollees in medical schools. Aim: This study aimed to gather information about the perception of medical teachers' need to obtain certification in medical education and what this will achieve in scaling up the competency and number of graduating medical doctors. Subjects and Methods: Medical teachers in Nigeria participated in this mixed (quantitative and qualitative) study. Four hundred medical consultants and teachers were randomly selected and sent a semi-structured pre-validated questionnaire; also, a panel discussion was conducted with six medical teachers with other special assignments in universities and postgraduate colleges. Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) 24, differences in proportions were calculated using the Chi-square test, and P values <0.05 were considered significant. Results: Two hundred and thirty-eight (59.5%) participants completed the form, 63 (26.5%) had practiced for <5 years, and 114 (47.9%) had >10 years of practice experience. A majority of 168 (70.6%) were physician lecturers in federal or state universities, and 15.5% had obtained certifications of any kind in medical education. Over 80% perceived that medical education training should not be a prerequisite to teach, but a similar percentage believed that faculty medical education training can help scale up the training competency and the number of graduating medical doctors. Conclusion: To scale up the number and competency of graduating medical doctors, medical teachers need to acquire core teaching competency. The respondents and discussants believe that when these core teaching competencies have been fully developed, it will be easier to increase the number of medical students' enrollees, teach them their curriculum through innovations, and graduate them with improved competencies.

Serum copeptin and its diagnostic performance in schizophrenia.

BACKGROUND: Inappropriate arginine vasopressin (AVP) secretion has been reported in schizophrenic patients. However, there is lack of information on serum level of copeptin and its diagnostic performance in schizophrenia. This study therefore, evaluated serum copeptin and its diagnostic performance in schizophrenic patients. METHODS: Sixty subjects (30.02 ± 7.17 years) with schizophrenia (19 drug naïve [DNS] and 41 schizophrenics on treatment [SOT]) and 30 healthy individuals (33.62 ± 9.05 years) with no history of schizophrenia were enrolled into this study. Schizophrenia was diagnosed using the Tenth edition of the International Classification of Diseases and Related Health Problems (ICD-10). Estimation of serum copeptin, plasma electrolytes (potassium, sodium and chloride) and uric acid was done using ELISA, Ion-Selective electrode (ISE) and enzymatic method respectively. RESULTS: Copeptin was significantly higher while uric acid, potassium and sodium levels were significantly lower in patients with schizophrenia compared with controls. Similarly, copeptin was significantly higher while sodium, potassium and uric acid levels were significantly lower in DNS and SOT compared with controls. However, insignificant elevation in copeptin level and insignificant reduction in sodium, potassium, chloride and uric acid levels were observed in DNS compared with SOT. The Area under the curve (AUROC) for copeptin was 0.686 (P = 0.004). CONCLUSION: There is elevated copeptin level in patients with schizophrenia and that copeptin levels might be a valuable tool in the diagnosis of schizophrenia.

Do patients on antipsychotics know the role of anti-cholinergic drugs in their treatment? Reports from an outpatient clinic in south-west Nigeria.

BACKGROUND: In a developing country like Nigeria where prohibitive cost and availability limits the use of atypical antipsychotics, a large number of patients on antipsychotics are expected to be on conventional antipsychotics. Studies have shown that more than half of patients on conventional antipsychotics are also prescribed anti-cholinergic drugs. There are reports that psychiatric patients may not know important aspects of their treatments. Such audits of psychiatric services are uncommon in Nigeria. METHODS: Socio-demographic data and views about the specific role of Benzhexol in treatment were obtained from all patients whose case records showed that they were concurrently prescribed Benzhexol alongside antipsychotics. RESULTS: 200 participants met inclusion criteria. A third (n = 60; 30%) reported not knowing the role of Benzhexol in their treatment as against 70% (n = 140) who claimed to know. Of those who claimed to know, 64% (n = 89) gave responses that reflected no understanding. Majority (n = 66; 74%) of such responses were adjudged to have potentially deleterious implications on their health and outcome. Only 18% (n = 36) reported having ever been educated about the role of Benzhexol in their treatment. CONCLUSION: The study provides some evidence that a large number of the patients may not be well informed about the specific role of BenzhexoI in their treatment and that that some of their assumptions may portend danger for their health and outcome. Health workers may also have neglected to educate them. There is a need to intensify patient education in our clinics.

Frontotemporal dementia in a Nigerian woman: case report and brief review of the literature.

Frontotemporal lobal degeneration (FTLD) is a clinically heterogeneous group of sporadic and familial neurodegenerative diseases characterized by dementia, alteration in language and/or behaviour, loss of executive skills and sometimes Parkinsonian features resulting from degeneration predominantly affecting the anterior frontal and temporal regions of the brain. Three main clinical subtypes including frontotemporal dementia (FTD), semantic dementia (SD) and progressive non-fluent aphasia (PNFA) have been described depending on the clinical phenomenology, the areas of the brain where the disorder begins and where the most extensive degeneration occurs. We describe a case of frontotemporal dementia in a 58 year old Nigerian woman and also review the current literature. Recent genetic studies have expanded the frontiers of knowledge about FTD while the search for appropriate drug treatments continues.

Partnership for mental health development in Sub-Saharan Africa (PaM-D): a collaborative initiative for research and capacity building.

AimsIn low- and middle-income countries (LMIC) in general and sub-Sahara African (SSA) countries in particular, there is both a large treatment gap for mental disorders and a relative paucity of empirical evidence about how to fill this gap. This is more so for severe mental disorders, such as psychosis, which impose an additional vulnerability for human rights abuse on its sufferers. A major factor for the lack of evidence is the few numbers of active mental health (MH) researchers on the continent and the distance between the little evidence generated and the policy-making process. METHODS: The Partnership for Mental Health Development in Africa (PaM-D) aimed to bring together diverse MH stakeholders in SSA, working collaboratively with colleagues from the global north, to create an infrastructure to develop MH research capacity in SSA, advance global MH science by conducting innovative public health-relevant MH research in the region and work to link research to policy development. Participating SSA countries were Ghana, Kenya, Liberia, Nigeria and South Africa. The research component of PaM-D focused on the development and assessment of a collaborative shared care (CSC) program between traditional and faith healers (T&FHs) and biomedical providers for the treatment of psychotic disorders, as a way of improving the outcome of persons suffering from these conditions. The capacity building component aimed to develop research capacity and appreciation of the value of research in a broad range of stakeholders through bespoke workshops and fellowships targeting specific skill-sets as well as mentoring for early career researchers. RESULTS: In the research component of PaM-D, a series of formative studies were implemented to inform the development of an intervention package consisting of the essential features of a CSC for psychosis implemented by primary care providers and T&FHs. A cluster randomised controlled trial was next designed to test the effectiveness of this package on the outcome of psychosis. In the capacity-building component, 35 early and mid-career researchers participated in the training workshops and several established mentor-mentee relationships with senior PaM-D members. At the end of the funding period, 60 papers have been published and 21 successful grant applications made. CONCLUSION: The success of PaM-D in energising young researchers and implementing a cutting-edge research program attests to the importance of partnership among researchers in the global south working with those from the north in developing MH research and service in LMIC.

Complementary and alternative medicine contacts by persons with mental disorders in 25 countries: results from the World Mental Health Surveys.

AIMS: A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders. METHODS: In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18-100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction. RESULTS: An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6-17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both. CONCLUSIONS: CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.

ADDICTION OR PSEUDOADDICTION IN SICKLE CELL DISEASE PATIENTS: TIME TO DECIDE - A CASE SERIES.

OBJECTIVE: The objective of this report is to highlight the background factors associated with opioid abuse among Sickle Cell Disease (SCD) patients. PATIENTS: Eleven patients aged 13-53 years (mean, 26.1yrs) which included six female and five male were seen in the last six year at a tertiary health facility. The modes of abuse ranged from obtaining analgesic prescription from multiple sources, injecting analgesics and sharing analgesics between patients in the hospital. RESULTS: Five female had either avascular necrosis of the femoral head or pathological fracture secondary to chronic osteomyelitis, so were classified as pseudoaddiction while five male and one female without any identifiable cause of chronic pain were adjudged to be addicted to opioids. The role of a dysfunctional family background in the response of SCD patients to pain treatment and substance abuse is highlighted. CONCLUSION: These cases reveal drug abuse as an emerging or understudied problem among SCD patients and its association with chronic pain in some patients. It is therefore necessary for pain physicians and SCD experts to address the use of opioid in chronic sickle cell pain and provide alternatives and a suitable guideline for their use.

Features of isolated sleep paralysis among Nigerians.

BACKGROUND: There is paucity of studies on isolated sleep paralysis (ISP). OBJECTIVES: To explore the relationship of variables for ISP sufferers, and clarify factors predictive of ISP health behaviour (IHB--doing something to prevent further attacks). DESIGN: Cross-sectional study. SETTING: General population. MEASUREMENT: 24-item ISP questionnaire completed by respondents. SUBJECTS: One hundred and ten (38.2%m, aged 30.9 years). RESULTS: Mean ISP frequency in the lifetime, past year and past month, were respectively, 6.7, 2.02, and 0.5; average duration of episodes was four minutes, and 63.6% experienced it while awakening from sleep. Using ICSD criteria, 2.7% had severe experience (i.e. at least once per week), 18.2% moderately severe (once per month) and 75.5% mildly severe (less than once per month), with no significant demographic associations. 56.4% were afraid of the experience, 76.4% had little/no worries that something was seriously wrong with their bodies; 39.1% cited supernatural causes, 35.5% cited physiological/psychosocial causes; and 44.5% described a hallucinatory experience. 1.8% took medical measures, and 7.3% consulted a faith healer; 44.5% resorted to prayers and 41.8% did nothing to prevent further attacks. The primary determinant of IHB was being afraid of ISP. CONCLUSION: These findings have public mental health education, treatment and research implications.