Prospective study of psychiatric follow-up default and medication compliance after discharge at a psychiatric hospital in Nigeria.

We report a prospective follow-up of 81 patients recently discharged from the hospital. Their hospital attendance pattern, medication compliance, mental state and social functioning were measured. Defaulters were followed up in the community. At 3 months, 49.4% had defaulted, while 51.5% were medication noncompliant. Clinical outcome was best for the Non-Defaulter-Medication Compliant (ND-MC) group, worst for the Defaulter-Medication Non-Compliant (D-MNC) group. Reasons for default include feeling well, financial difficulty, medication side effects and stigma. Medication non-compliant patients were more likely to reside more than 20 km away from hospital. There is an urgent need to provide community psychiatric services to improve patients' access to services and medication compliance.

Psychosocial impact of sickle cell disease in children seen at University of Ilorin Teaching Hospital, Ilorin, Nigeria.

BACKGROUND: The increased risk of psychological disorders constitutes one of the complications of sickle cell disease (SCD) in Nigeria. This subject has received insufficient attention. OBJECTIVES: To assess the psychosocial impact of SCD on affected children and two control samples. DESIGN: A cross-sectional controlled study. SETTING: University of Ilorin Teaching Hospital, Ilorin, Nigeria. SUBJECTS: One hundred children affected with sickle cell disease (SCD children) consituted the study sample, while the controls comprised of 75 children with bronchial asthma (asthmatics) and 75 with some acute medical illness (AMI). RESULTS: Sickle cell disease (SCD) children (sicklers) were significantly more likely to report social impairment such as restriction in their play and domestic activities, feeling inferior to others, having bad luck, fear of under-achievement in life and fear of potential early death than the control groups. On the Rutter Scale A2, the SCD children were more likely than the controls to report neurotic symptoms but less likely than controls to bully other children. SCD children (30%) were more likely to be identified as probable cases with psychological problems than asthmatics (25%) and AMI children (20%). These differences were, however, not statistically significant. CONCLUSION: This study further substantiates earlier findings of the link between chronic childhood illnesses such as SCD and psychosocial morbidity. The authors, therefore, recommend that comprehensive and affordable psychosocial care should be provided for children suffering from these conditions.

A prospective analysis of in-patient consultation-liaison psychiatry in a Nigerian teaching hospital.

OBJECTIVES: To determine the pattern of psychiatric referrals over a six-month period categorise the psychiatric referrals into clinical syndromes and describe the nature of psychiatric intervention and outcome of such intervention on discharge and within the first three months after discharge. DESIGN: A descriptive prospective study. SETTING: University of Ilorin Teaching Hospital (UITH), Ilorin Nigeria. SUBJECTS: Forty seven inpatients (26 females and 21 males) referred to the psychiatric department from other specialist units of the hospital between May and October 2001. RESULTS: The mean (+/-SD) of patients was 33.9+/-18 years. The highest rate of referral came from the internal medicine department. The most common psychiatric disorders referred were acute organic brain syndrome (32%) and neurological disorders (15%). Psychiatric interventions included medication in about two-thirds of the patients and counselling in about a quarter. Half of the discharged patients out rightly defaulted on their first outpatient clinic department appointment. CONCLUSION: The study indicate the need for greater inter-departmental liaison learning and training activities, the need to emphasize training in organic psychiatry, as well as the need to establish community-based outreach services as a means of ensuring continuity of care for discharged patients.

5-yearly monitoring of trends of substance use among secondary school students in Ilorin, Nigeria, 1988-1998.

This report describes the trends of substance use among youths by comparing data collected among senior secondary school students in Ilorin metropolis, Kwara State, Nigeria at 5-yearly intervals (1988-1998). In 1998, data were collected from 750 senior secondary school students from six secondary schools in the study area using a self-report 117-item questionnaire based on the World Health Organization (WHO) guidelines for student substance-use surveys. Substances investigated in the survey were alcohol, cigarettes, cannabis, strong and mild stimulants, hypnosedatives, antibiotics, cocaine, heroin, organic solvents and hallucinogens. These data were compared with similar ones collected from students with similar characteristics, and from the same six schools in 1988 and 1993. It was found that high use substances were mild stimulants, antibiotics and alcohol, while cigarettes, cannabis, heroin and cocaine remained low-use substances. Most current users of all the substances were occasional users, except for cigarettes and cannabis where more frequent (daily and weekly) usage was reported. There was also a significant increase in the use of alcohol, organic solvents, mild stimulants and hypnosedatives, and a significant reduction in cigarette smoking over the three data waves. No gender difference was recorded for alcohol, hypnosedatives and cocaine use in the three data waves. It was concluded that although some substances recorded significant increases in their usage over the three data waves, the current use rates were still generally low and comparable to those of other Nigerian studies. Substances used were those employed mainly for study purposes (mild stimulants and hypnosedatives), and most students used the substances only on occasional basis. Nonetheless, in view of the rapidly changing socio-economic life of Ilorin City, it has become imperative to continue with the 5-yearly monitoring of trends.

Traditional mental health practitioners in Kwara State, Nigeria.

OBJECTIVES: To assess the knowledge, practice and attitude of traditional mental health practitioners (TMHPs) in four Local Government Areas (LGAs) in Kwara State, Nigeria, on mental health care; to organise training sessions aimed at improving their knowledge base, practice and; to evaluate such training after allowing for a period of practice. STUDY DESIGN/INTERVENTION: Pre-training evaluation phase: TMHPs were assessed in the area of knowledge, attitude and practice of mental health, with the use of a questionnaire. They were then trained in the concepts of normality and abnormality, types of mental illness, treatment of mental illness including follow up, after-care, relapse prevention, other primary preventive measures, and some introductory talks on some sub-specialties of psychiatry, for example, child psychiatry, old age psychiatry, forensic psychiatry, drug and alcohol abuse and; after a free-practice period of two months, the TMHPs were again reassessed for the impact of the training. RESULTS: Pre-intervention phase: TMHPs could easily recognise most symptoms of mental illness except undue sadness. The TMHPs also expressed strong belief in the supernatural factor as a cause of mental illness. Some of them beat their patients for therapeutic reasons and; Post-intervention phase: there was a widening of the sense of recognition of TMHPs of important mental symptoms such as undue sadness, social withdrawal and elation. There was a better understanding of the aetiological concepts of mental illness. There was also a reduction in the habit of beating their patients as a form of treatment. CONCLUSIONS: The use of information, education and communication intervention techniques could lead to more positive and less hazardous forms of practice among TMHPs and; The high level of cooperation achieved in this study would indicate a bright chance for future collaborative activities between orthodox and traditional healthcare providers.

Current status of traditional mental health practice in Ilorin Emirate Council area, Kwara State, Nigeria.

Twenty-seven traditional mental health practitioners (TMHPs) and 16 patients' relatives (PR) were studied with a view to gaining an understanding of the current status of traditional mental health practice in five local government areas in Ilorin Emirate Council Area, Kwara State, Nigeria. Data was collected using Practitioners' Questionnaire (PQ), Patients' Relatives' Questionnaire (PRQ), Focus Group Discussions (FGDs) and observation of TMHPs in their clinics. Factors which affect utilization of traditional mental health services were also reviewed. We found that TMHPs still enjoy considerable patronage from the populace, are more in numerical strength, and are more widely and evenly dispersed in the community than orthodox mental health practitioners (OMHPs). About 74% of TMHPs expressed interest in attending seminars aimed at improving their skills. Most of the patients' relatives expressed the belief that only traditional healers can understand the supernatural aetiological basis of mental disorders, and can therefore offer more effective care than OMHPs. Some of the negative practices observed were (i) infliction of corporal punishment and physical restraints on patients by some TMHPs resulting in wounds, which often become septic (ii) low level of hygiene at the clinics and (iii) lack of adequate follow-up care. In conclusion, since TMHPs still play a major role in the treatment of the mentally ill in this environment, OMHPs should assist them in improving on some of the negative practices identified. Thus, there is an urgent need to organize a training programme for TMHPs to expose them to the general rules of hygiene in medical care, basic principles of orthodox mental health practice, including human treatment of the mentally ill.

Epidemiology of childhood behavioural disorders in Ilorin, Nigeria--findings from parental reports.

We report the findings of a survey aimed at determining the prevalence, pattern and psychosocial correlates of childhood psychiatric disorders among primary school pupils in Ilorin, Kwara State. Eight hundred and forty-six parents completed the 31-item Rutter scale A2 and an additional pro-forma on the developmental and family history of their children. The most commonly reported symptoms were headache, vomiting, tempertantrums, restlessness, disobedience and fearfulness. Using Rutter's cut off point of 13, 157 (18.6%) qualified as cases: neurotic disorders (7.3%), antisocial disorders (8%) and undifferentiated disorders (3.3%). Males were over-represented, albeit non-significantly, among the neurotic and antisocial groups. Mothers of high scorers (HSs) reported significantly more physical and emotional problems during pregnancy. HSs were significantly more likely to (i) have had delayed developmental milestones (ii) have suffered a major illness during childhood (iii) come from broken homes, and (iv) attend school located in the rural area. Our prevalence rate compares well with those reported in Africa and elsewhere. To address the identified unmet needs of children in this environment, we suggest the need to establish a comprehensive child mental health package, which could be incorporated into the existing primary health care programme. The package should encompass the three tiers of prevention, and involve the active participation of parents, teachers, educational, as well as health professionals.

Rehabilitation of heroin and cocaine abusers managed in a Nigerian psychiatric hospital.

Eighty patients, managed primarily for heroin and cocaine dependence at the Drug Rehabilitation Unit of Psychiatric Hospital, Yaba, Lagos, were followed up monthly for a period of 12 months post-discharge and assessed with regard to continued substance use, employment status and illegal activities. The management package included full assessment, detoxification, treatment of associated physical conditions, group therapy sessions, occupational and vocational rehabilitation. The sample was predominantly male (91%), young adults (mean age 29.1 years; SD 5.99) and single (58%). Although 95% had some formal education, many were school drop-outs, and only 31.3% were gainfully employed. The majority (84%), used a combination of heroin and cocaine, almost all on a daily basis, mainly by smoking and "chasing the dragon" (95%). Other substances reportedly used preadmission were alcohol (22.5%), cannabis (76.3%) and tobacco (97.5%). Less than one half (43.8%) completed the minimum one month required for inpatient treatment. Only seven (8.7%) attended the follow-up clinic regularly, but all defaulters were assessed in their homes. The level of heroin, cocaine and cannabis use, as well as report of illegal activities, dropped sharply from the first month post-discharge, but started to rise again (albeit slowly) by the second half of the follow-up period. There was only a slight insignificant gain in employment status of patients during the follow-up period. The community-based management approach is strongly advocated as a way of addressing the several factors identified in this study as militating against the successful management of substance abusers.

Trends in prevalence and pattern of substance use among secondary school pupils in Ilorin, Nigeria.

We present trends data on the prevalence and pattern of substance use among secondary school pupils in Ilorin, derived from comparing the finding of two consecutive cross-sectional surveys. From a sample of six schools, 1041 and 848 pupils 1988 and 1993 respectively, completed anonymously a 117-item WHO self-report substance-use questionnaire. The analyses cover responses on the current and lifetime use of eleven substances, their frequency of use, and the effect of gender and school location on use trends. Although a significant increase in current use rates was recorded for alcohol, cannabis, mild stimulants and hypnosedatives, all of these substances (except stimulants) showed a shift towards less frequent use in 1993. The only consistent gender effect was found for smoking, which remained significantly a male activity. The significant increases found in the current use of cocaine, organic solvents and hallucinogens are difficult to substantiate, thus prompting the suggestion for further corroborative qualitative studies. There was a trend towards greater involvement of the rural school's respondents in substance use in general. The implications of the findings with respect to policy issues on substance-use prevention programmes for youths in the Ilorin metropolis are discussed within the context of the limitations of the study design.

Psychosocial correlates of substance use among undergraduates in Ilorin University, Nigeria.

The consistency of psychosocial correlates of alcohol, cigarettes and cannabis use was evaluated among undergraduates of a Nigerian University. The correlates were derived from repeat cross-sectional surveys conducted in 1988 and 1993, when 649 and 859 respondents respectively completed a standardised WHO substance-use questionnaire. Information provided on substance use patterns were correlated with socio-demographic variables, familial and best friend's usage, perceived availability and perceived harmfulness. Consistency was found in the significant correlations between the following: (i) lack of religiosity and the use of the three substances; (ii) drinking and the presence of study difficulty, strained relationship with teachers and belonging to the Christian religion; (iii) smoking and the male gender, and self-reported poor mental health; (iv) cannabis use and belonging to the older age group; (v) respondents' use of the substances and use in the peer group, siblings, and parents in that order; (vi) perception of substance as harmful and low use rates; (vii) perception of easy availability and high use rates. Some correlates were inconsistent, while some new ones emerged. The significance of the correlates in terms of packaging intervention programmes is discussed, against the background of the inherent limitations of the study design.

Lagos "area boys and girls" in rehabilitation: their substance use and psychosocial profiles.

We report on the psychosocial and substance use profiles of the 55 "Area Boys and Girls" (ABG) admitted to a Rehabilitation Camp in Lagos between March and May 1993 under the main auspices of the People's Bank of Nigeria. The majority were males (73%); young adults (mean age/SD: 30.6/6.3); unemployed (73%); not married (80%); of low educational standing (87%) and from low socio-economic background (over 70%). Almost all were current users of heroin (89%) and cocaine (87%), procured with a substantial amount of money and administered mainly through smoking and "chasing the dragon". None of the clients reported injecting the drug. These findings have highlighted the intricate nature of the problems of ABG and the need for a comprehensive rehabilitation package encompassing general medical, psychological and psychiatric care. Such programmes, ideally free, should be a joint venture between the government, international agencies, non-governmental organizations and the community as a whole. The key emphasis should be on equipping the clients with occupational skills for life-long economic sustenance. To curtail the growing numbers of displaced young people in the country, the government should give due attention to the root causes of the multiple social ills in the society.

Needs assessment in demand reduction programmes with special reference to African countries.

Drug abuse trends in African countries indicate an urgent need for intensive demand reduction packages to address the problem. However, enormous obstacles exist as many of these countries lack the necessary resources to assess the basic needs essential to implementing empirically-based and cost-effective programmes. This article reviews general principles of needs assessment and provides some practical guidelines appropriate to the African context. Effective cooperation and collaboration at the local, national and the international level is needed to attain the desired goals of needs assessment in these countries.

Caring for people with AIDS in a Nigerian teaching hospital: staff attitudes and knowledge.

Health workers (HWs) play a pivotal role in preventative programmes being implemented to combat the steady increase in the prevalence of HIV infection and AIDS in Nigeria. We report on a questionnaire survey conducted in October, 1993 among 111 doctors, 92 nurses and 53 non-health workers at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The aim was to assess their knowledge of AIDS (for all groups) and the attitude of the HWs only towards the care of patients with AIDS (PWAs). Although important gaps in knowledge were found in all groups, doctors performed significantly better than non-health workers on 22 out of 23 knowledge items, and more than nurses on 8 of such items. Nurses scored significantly higher than non-health workers on 18 of the knowledge items and more than doctors on one knowledge item. About one in three nurses would hesitate to nurse a PWA, while half would not participate in birth delivery. Also, about a quarter of doctors would hesitate to treat a PWA while one in three would not carry out surgery despite adequate precautions. The findings compare favourably with those reported from other countries. However, they still indicate the need for a comprehensive AIDS education package to improve the knowledge base and allay fears for all groups and to prepare HWs for the important task of caring for PWAs.

PIP: In October 1993 in Nigeria, 111 physicians, 92 nurses, and 53 non-health workers at the University of Ilorin Teaching Hospital completed a questionnaire designed to allow researchers to compare levels of respective/relative knowledge about HIV/AIDS and to determine the attitudes of the physicians and nurses towards caring for persons with AIDS (PWAs). Physicians and nurses were more likely to have correct knowledge than non-health workers. In all but one of the 23 items, physicians scored significantly higher than non-health workers (p 0.001-0.01). The one item was no known cure for AIDS. Significantly more nurses than physicians and non-health workers knew that there is no known cure for AIDS (98% vs. 85% and 87%, respectively; p 0.01). Nurses had significantly higher knowledge scores than non-health workers on 18 items (p 0.001-0.05). Few respondents in all three groups (47% for physicians, 38% for nurses, and 21% for non-health workers) knew that HIV is not transmitted through kissing. 35% of nurses would hesitate to nurse PWAs. 24% of physicians would hesitate to treat PWAs. Most physicians and nurses (75% and 93%, respectively) believed PWAs should be isolated. 35% of physicians would not perform surgery on PWAs, even if they took adequate precautions. These findings suggest that health workers were not prepared to deal with an increased work load of PWAs. They also indicate a great need for a comprehensive AIDS education program geared towards all health workers to improve adequate knowledge about HIV/AIDS, to ease fears, and to prepare them for caring for PWAs.

Psychosocial correlates of alcohol, tobacco and cannabis use amongst secondary school students in Ilorin, Nigeria.

The psychosocial correlates of alcohol, cigarette and cannabis use were examined in a population of secondary school students in Ilorin, Nigeria, using a 117-items substance use questionnaire. Current alcohol use was found to be significantly associated with urban location of schools, self-reported study difficulty, self-reported poor mental health and having fathers who are highly skilled professionals. Current cigarette use was found to be positively correlated with rural location of school, male sex, older age group and self-reported poor mental health. Lifetime cannabis use was found to be significantly associated with male sex, self-rated poor academic performance and self-reported poor mental health. Perceived availability of alcohol, cigarette and cannabis by the respondents was found to be related to the rate of use of these drugs while perceived harmfulness did not appear to serve as a sufficient deterrent against substance use in the student population. These findings indicate the need for preventive strategies that emphasize school based drug education programmes, parent and teacher education, and national health policies that control availability and accessibility to these substances by Nigerian youths.

Pattern of substance use amongst secondary school students in Ilorin, northern Nigeria.

One thousand and forty one Senior secondary School Students in Ilorin, Kwara State, Nigeria were surveyed using a 117-items self-administered substance use questionnaire in May 1988. Males constituted 56.6% and Females 43.5% of the study population. The mean age was 16.8 years (S.D. 1.84). The most currently used substances were found to include salicylate analgesics (56.2%), antibiotics (23.6%), stimulants (21.6%), alcohol (12.0%) and cigarette (4.4%). Current use of alcohol, antibiotics and salicylate analgesic was significantly more common in the rural school. Current use of cigarette and cannabis occurred significantly more in the male population while no significant sex differences were noted for the other drugs surveyed. For many students, initiation into substance use started at primary school level. The need to monitor the pattern of substance use at all levels of our educational system (primary, secondary and post-secondary) and to develop adequate preventive programmes for the student population was emphasized.

Reliability and validity of the Westminster Substance Use Questionnaire among Lancashire adolescents.

The reliability and validity of the Westminster Substance Use Questionnaire (WASQ) was examined in a pilot study involving a sample of secondary school pupils in Blackburn borough, Lancashire, UK. The questionnaire performed well on all the indices tested and the findings of the exercise facilitated a fairly accurate and meaningful interpretation of the prevalence data obtained in the main study. The instrument is thus recommended for use in adolescent substance use surveys in the UK and elsewhere although further validation or slight modification may be necessary to suit local needs.

Psychosocial correlates of alcohol, tobacco and cannabis use: findings from a Nigerian university.

The possible correlates of alcohol, tobacco and cannabis use were investigated in a survey conducted among undergraduate students of the University of Ilorin, Nigeria. Factors that emerged as common correlates to the three substances investigated were peer influence, self-reported poor mental health, religiousity, parental/guardian supervision, perceived availability and perceived harmfulness. In addition, drinking and smoking were found to be commoner among the male sex and among respondents who reported study difficulty. There was also a significant positive relationship between cannabis use and a polygamous family background and belonging to an older age group. Although the data used in the analysis is limited due to its cross-sectional nature, the observations made are useful enough for the formulation of primary prevention strategies. A further and more elaborate longitudinal study is, however, suggested.

Nigerian secondary school teachers: a pilot survey of views and knowledge about drug abuse.

The views and knowledge level of 135 randomly selected Secondary School teachers in the Abeokuta Local Government area of Ogun State on drug abuse were sought through a self report anonymous questionnaire. They were mostly male teachers (59.3%) under the age of 30 years (89.6%). The majority (59.3%) were never exposed to drug education as students whilst less than 20% have been exposed since qualifying as teachers. 72.6% do not currently teach their students Drug education. Although the majority had a good concept of the definition of drug abuse, their view on the potential drugs of abuse and the concept of "drug dependence" were inadequate. Respondents recently exposed to drug education were more likely to identify salicylate analgesics as potential drugs of abuse at a statistically significantly level (p less than 0.05). 85.9% of the respondents chose "guidance counselling" as the approach to the management of student drug abusers despite the dearth of this professional cadre in the schools. The disquieting implications of these findings in relation to the National Campaign aimed at stemming the increasing tide of drug abuse among youths in the country were discussed and suggestions proffered on ways of rectifying these. Finally the authors gave suggestions on the pattern and content of teacher-targetted formal drug education programme in the light of the findings.

Prevalence and pattern of substance use among undergraduates in a Nigerian University.

The prevalence and pattern of substance use was investigated among undergraduate students of the University of Ilorin, Kwara State, Nigeria in June 1988. Six hundred and forty-nine students completed a 117-item self-report questionnaire 636 of which were analysed. Mean age and S.D. of respondents was 23 +/- 3.7 years; 69% were males. The most commonly used substances with their 'lifetime' prevalence rates were as follows: salicylate analgesics, 95.2%; alcohol, 77%; stimulants, 69.2%; antibiotics, 63.3%; hypno-sedatives, 49.4% and cigarettes, 37.4%. The corresponding 'current use' rates were relatively lower. Low use was recorded for cannabis, organic solvents, hallucinogens, cocaine and narcotic analgesics. Majority of the 'current users' use the substances on an occasional basis except for cigarettes where more than half reported weekly or daily use. Males were significantly more of 'current' users of cigarettes and alcohol while females tend to use stimulants more. The use of most of the substances started in primary school. The need for a comprehensive demand-reduction programme in Nigeria based on this and other local findings was advocated. Continuous monitoring, particularly of hard drug use, appears imperative.

Rehabilitation and follow-up issues in drug abusers managed at the Neuropsychiatric Hospital, Abeokuta, Nigeria.

The authors report on sixty two (62) patients treated at the drug abuse unit of the Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria over a 17-month period (June 1985-October 1986). Drugs mainly abused were marijuana (53.5%, alcohol (28.2%) and hard drugs (mainly heroin and cocaine) which accounted for 14.3%. All the patients went through a programme of assessment, detoxification, individual counselling, group psychotherapy and rehabilitation. Their length of stay in the hospital was (mean +/- SD) 64 + 44 days. Factors that militated against successful rehabilitation were the severity of the patients' illness at presentation, unemployment coupled with poor educational status and distance from the hospital of patient's normal abode. Sixty seven percent had defaulted 6 months after discharge from the hospital. Non-defaulters at 2 months performed well on some parameters assessed. Possible ways of ensuring proper rehabilitation and follow-up of this group of patients are discussed.