Condom use and other HIV risk issues among Nigerian soldiers: challenges for identifying peer educators.

Most Nigerian soldiers acknowledge the usefulness of condoms in HIV prevention, but few use them in sexual relationships. Identification of soldiers low in HIV-risk behaviours, particularly regular condom use, to function as peer educators appears desirable. We therefore sought to identify HIV-risk issues among a group of Nigerian soldiers. Male soldiers were more likely to be older, married and living alone than their female counterparts. Female soldiers had had better education than the males but, in spite of that, alcohol use and sexual relationships in the context of alcohol were widespread with no difference between the genders. However, alcohol abuse as detected in 22-27% of the soldiers was more likely to be a male problem. Having more than one sex partner did not distinguish the male soldiers from the females. Consistent condom use was uncommon, found in only 16-20%, with no difference between genders. Married persons (more likely to be males) were more guilty of no or inconsistent condom use. Although this study has failed to recognise who might be potential peer educators based on their non-risky behaviours, it has highlighted some important inadequacies in the Army health education campaign programme with respect to HIV/AIDS issues. Large-scale interventions, including more extensive condom promotion, training large numbers of peer educators, promoting ingenious ways of female self-protection from the highly dominant males and encouraging further research have been advocated.

Post-traumatic stress disorder, survivor guilt and substance use--a study of hospitalised Nigerian army veterans.

OBJECTIVES: To investigate the prevalence of post-traumatic stress disorder (PTSD) and survivor guilt in a sample of hospitalized soldiers evacuated from the Liberian and Sierra-Leonean wars in which Nigerians were involved as peace keepers. The relationships between PTSD, survivor guilt and substance use were also investigated. DESIGN: A socio-demographic data questionnaire, the PTSD checklist and a validated World Health Organization substance use survey instrument were used to obtain data from the subjects. SETTING: The study took place at the 68 Nigerian Army Reference Hospital, Lagos, Nigeria, which was the base hospital for all casualties from the Liberian and Sierra-Leonean operations. SUBJECTS: All hospitalised patients from the military operations during a 4-year period (1990-1994) who were physically capable of being assessed were included in the study. RESULTS: The prevalence rate for PTSD was found to be 22% and survivor guilt was found in 38% of the responders. PTSD was significantly associated with long duration of stay in the mission area, current alcohol use, lifetime use of an alcohol/gunpowder mixture, and lifetime cannabis use. Survivor guilt was significantly associated with avoidance of trauma-related stimuli but not duration of combat exposure. CONCLUSIONS: Although the sample studied was specific, PTSD might be quite common and probably undetected among Nigerian military personnel engaged in battle in Liberia and Sierra-Leone. Detection of such persons through deliberate screening in military community studies should help to alleviate the symptoms since good intervention methods are now available. Primary prevention efforts with regard to alcohol and cannabis use should help to reduce the incidence of PTSD.

Somatic symptoms in depression: evaluation of their diagnostic weight in an African setting.

BACKGROUND: Somatic symptoms are extremely common features of depression and other mental disorders in African countries such as Nigeria, but their weight in the diagnosis of depression is not certain. AIM: To determine what weight should be assigned to these symptoms in comparison with other well-known symptoms in the diagnosis of depression. METHOD: A sample of 829 persons completed the Patient Health Questionnaire which was earlier modified by the inclusion of the somatic symptoms being studied. Using principal component analysis and a logistic regression model, the contributions of these symptoms in comparison with others were determined. RESULTS: Core depressive symptoms accounted for most of the total variance for depression. The somatic symptoms studied loaded separately from the core depressive symptoms and were not as good predictors of depression. A cognitive factor emerged as well as some somatic factors. CONCLUSIONS: Although somatic symptoms may be florid among patients with depression, they have considerably less weight than core depressive symptoms in the diagnosis of depression. The emerging cognitive factor could be similar to that described by previous authors.

Auditory hallucinations in schizophrenic and affective disorder Nigerian patients: phenomenological comparison.

Although auditory hallucinations are universal phenomena, they show cultural and ethnic variation. We set out to study some differences between auditory hallucinations in Nigerian patients and their foreign counterparts. We also investigated the usefulness of auditory hallucinations in distinguishing between schizophrenia and affective disorders. A semi-structured interview was used to obtain information from 89 patients with auditory hallucinations who met ICD-10 criteria for either schizophrenia or affective psychoses and 10 others with organic mental disorders. Responses were compared with respect to the frequency, form and content of the hallucinatory voices as well as the languages spoken. In this sample, voices speaking exclusively in a foreign language were uncommon. Voices commanding and those discussing patients in the third person were the commonest in schizophrenic patients but not as frequent as in a similar group of patients in the UK studied by other authors. In patients with schizophrenia, voices were more likely to discuss the patient, whereas in affective disorders, voices were more likely to evoke fear, and patients were more likely to carry out commands. In conclusion, only three features of auditory hallucinations distinguished between schizophrenic and affective psychoses patients. Auditory hallucinations may be less harassing in Nigerian schizophrenic patients than in their UK counterparts. These hallucinations are most often perceived in the individual's mother tongue, with or without additional use of English, even when the patients have been 'westernized' through education and religion.

Two depression rating instruments in Nigerian patients.

Having been developed in a foreign culture, the extent to which items on the Hamilton Depression Rating Scale (HDRS) and the Zung Self-Rating Scale (ZS) reflect the features of depression as obtained in clinical interviews in Nigeria is uncertain. Also, items predictive capabilities for the severity of depression and the extent of concurrence between the two scales in assessing depression need to be ascertained. Seventy- eight patients who met the ICD 10 criteria for major depressive disorder completed the ZS and had the HDRS completed on them. These patients, (in addition to six others) had their case records examined and their symptoms of depression extracted. The predictive values of each item on the scales to the overall severity of depression, the intra-scale and inter-scale items correlations were calculated. Sleeplessness, somatic symptoms and sad mood were the commonest symptoms reported by patients with major depressive disorder. The Zung Scale showed that joylessness, lack of clarity of the mind, and difficulty taking decisions were also very common. The HDRS had better access to somatic symptoms than the Zung Scale, although items on the Zung Scale generally had better predictive value of the overall severity of depression than items on the HDRS. The HDRS had a moderate inter-scale correlation (r=0.43) relative to the Zung Scale, but only three equivalent items (depressed mood, suicide and impaired appetite) on the two scales had moderate and significant correlations. The HDRS and the ZS are very useful rating scales in depression but some modifications and additions will make them more applicable.

Inhibition of NO synthesis enhances chronic cardiovascular and renal actions of leptin.

Acute studies suggest that leptin has pressor and depressor actions, including stimulation of sympathetic activity as well as increased release of NO from the vascular endothelium. The goal of this study was to examine the role of NO in modulating the chronic blood pressure, heart rate, and renal responses to hyperleptinemia, comparable to that found in obesity-induced hypertension. Male Sprague-Dawley rats were implanted with arterial and venous catheters, and mean arterial pressure and heart rate were monitored continuously 24 h/d. After a 4-day control period, the rats were infused with isotonic saline vehicle (n=6) or N(G)-nitro-L-arginine methyl ester (L-NAME, 10 microgram/kg per minute; n=9) to inhibit NO synthesis for 7 days. After 7 days of vehicle or L-NAME administration, leptin was infused intravenously for 7 days at a rate of 0.5 microgram/kg per minute, followed by a leptin infusion at 1.0 microgram/kg per minute for 7 days, along with vehicle or L-NAME. A 21-day infusion of L-NAME alone (n=6) served as a control for the L-NAME+leptin rats. Although the low dose of leptin alone did not significantly elevate arterial pressure, it raised the heart rate by 18+/-3 bpm. The higher leptin infusion rate raised arterial pressure from 96+/-3 to 104+/-3 mm Hg but did not increase the heart rate further. L-NAME+leptin increased arterial pressure by 40+/-6 mm Hg and heart rate by 79+/-19 bpm compared with pretreatment levels. In control L-NAME rats, mean arterial pressure increased by 31+/-4 mm Hg, whereas the heart rate was not altered significantly compared with pretreatment levels. Neither chronic leptin infusion alone nor L-NAME alone altered the glomerular filtration rate or renal plasma flow significantly, but L-NAME+leptin reduced glomerular filtration rate by 27+/-11% and renal plasma flow by 47+/-9%. These results indicate that impaired NO synthesis mildly enhances the chronic renal hemodynamic and hypertensive effects of leptin but markedly amplifies the tachycardia caused by hyperleptinemia.