Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study.

INTRODUCTION: Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State. MATERIALS AND METHODS: A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis. RESULTS: There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM. CONCLUSION: The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Patterns of Substance Use Disorders and Associated Co-occurring Psychiatric Morbidity among Patients Seen at the Psychiatric Unit of a Tertiary Health Center.

Background: Understanding the pattern of co-occurring mental illness in patients with substance use disorders (SUDs) is essential in improving the prevention and treatment of substance use-related problems. This study examined the pattern of SUDs, the associated co-occurring psychiatric morbidities, and associated factors among patients with SUDs managed at a tertiary health center. Methods: The records of patients who presented with SUDs between 2010 and 2019 were examined. Socio-demographics of interest were extracted from case files. Substance use diagnoses, as well as associated co-occurring mental illness, were extracted and entered into SPSS software. Bivariate analyses including the risk of developing co-occurring mental disorder were calculated. Findings: For most patients, the initiation of substance use was before the age of 21 years, while the onset of SUDs was between 21-30 years. Cannabis use disorders (CUDs), alcohol use disorders (AUDs), and nicotine use disorders (NUDs) were the commonest SUDs. Compared with those with CUDs, non-users of cannabis were significantly less likely to develop co-occurring mental illness [odds ratio (OR) = 0.25, 95% confidence interval (CI) =0.13-0.42, P = 0.001]. Those with tramadol use disorders (OR = 2.13, 95% CI = 1.03-4.41, P = 0.040) and those without pentazocine use disorders (P = 0.003) were more likely to have a comorbid mental illness. Patients with AUDs (P = 0.001), CUDs (P = 0.001), NUDs (P = 0.001), and tramadol use disorders (P = 0.045) were significantly more likely to be multiple substance users. Conclusion: Results suggest an association between SUDs and co-occurring mental illness, though differences in these associations were noticed across the categories of substances. This emphasizes a holistic approach to prevention and care of patients presenting with SUDs.

Comparison of Anxiety and Depression Among HIV-Positive and HIV-Negative Pregnant Women During COVID-19 Pandemic in Ekiti State, Southwest Nigeria.

Purpose: Coronavirus disease 2019 (COVID-19) pandemic is the significant public health crisis of the 21st century that has disrupted personal, local, and international territorial relationships. Earlier studies have shown that people with HIV were at least twice at risk of dying from COVID-19 than the general population. There are also deep concerns about the indirect impact of COVID-19 on women within the reproductive age group in Sub-Saharan Africa who were already struggling to access reproductive healthcare services. In addition, pregnant HIV-positive women have an increased rate of anxiety and depression. This study, therefore, examined depression and anxiety disorders in pregnant HIV-positive women in response to the COVID-19 pandemic. Patients and Methods: This cross-sectional study used a structured questionnaire containing sociodemographic information, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7 (GAD-7) assessment tools. Data obtained were analyzed using Statistical Package for Social Science version 26. Results: Ninety-nine (99) representing 78% of 127 pregnant HIV-positive women enrolled in the PMTCT program were eligible for this study. This number matched 99 randomly selected pregnant HIV-negative in the study areas as controls. Major depressive disorder (MDD) and severe anxiety disorder were significantly higher among the HIV-positive group than in the HIV-negative group (PHQ-9 Mean ± SD 8.0 ± 5.4 vs 2.3 ± 2.9; p = 0.000) and (GAD-7 Mean ± SD 5.9 ± 4.6 vs 1.2 ± 2.2; p = 0.000). Conclusion: Given the high prevalence of major depressive disorder and severe anxiety disorder among pregnant HIV-positive women, mental health care should be incorporated into the prevention with positive interventions and strategies to reduce the indirect consequences of the COVID-19 pandemic.

Comparison of self-esteem and depression among fertile and infertile women in a low resource setting.

This study aimed to explore the effect of infertility on self-esteem and depression, and to identify the sociodemographic and infertility characteristics associated with self-esteem and depression among infertile women in Ekiti State, Nigeria. Self-esteem and depression were assessed in 100 infertile women and 100 women seeking family planning (controls) using the Rosenberg Self-Esteem Scale (RSES) and Patient Health Questionnaire (PHQ-9), respectively. Infertile women had significantly lower RSES score (19.4 ± 4.5 vs. 20.7 ± 4.4, p=.038) and higher PHQ-9 score (5.1 ± 4.1 vs. 3.8 ± 3.5, p=.023) compared to controls. Among infertile women, marital status, being remarried, duration of infertility, and RSES score were associated with PHQ-9 score on simple linear regression. On multiple linear regression analysis, the RSES score had a negative association with the PHQ-9 score (ß= -0.32, p<.001). In conclusion, infertile women have lower self-esteem and higher depression scores. Mental health screening and management should be an integral part of care administered to infertile women.Impact StatementWhat is already known on this subject? Infertility is a global health problem with negative effects on the mental health and quality of life of couples, especially women.What the results of this study add? Infertile women have lower self-esteem and higher depression scores. The prevalence of major depressive disorder (MDD) is higher among infertile women. Longer duration of infertility, older age, ≤6 years of formal education, and low self-esteem are significant associations of MDD among infertile women.What the implications are of these findings for clinical practice and/or further research? Mental health screening and management should be included in the care given to women undergoing evaluation and treatment for infertility. Larger community-based studies evaluating other aspects of mental health among infertile couples are encouraged.

Substance Use among Adolescent High School Students in Nigeria and Its Relationship with Psychosocial Factors.

BACKGROUND: Despite the tremendous negative consequences of substances on the health and well-being of adolescents, studies continue to report the high rates of substance use among adolescents. We aimed to identify the pattern of substance use among high school students and its relationship with psychosocial factors. STUDY DESIGN: A cross-sectional study. METHODS: The study was conducted in Oct 2019 among students in the senior secondary school in Ado-Ekiti, Ekiti State; southwestern Nigeria. Participants were selected using random sampling, and data were collected using a socio-demographic questionnaire, the Kessler Psychological distress scale and an adapted version of the NIDA-Modified ASSIST. Bivariate analysis and multiple logistic regression were carried out to identify factors associated with psychological distress. RESULTS: Overall, 682 students participated in the study. The lifetime and current prevalence of any substance were 17.3% (95% CI: 14.7%, 20.5%) and 11.7% (95% CI: 9.0, 14.0), respectively. Although most substance use variables increases the risk of psychological distress, history of lifetime substance use AOR= 3.03 (95% CI: 1.19, 7.72, P=0.020) and absence of direct parental care AOR=2.04 (1.19, 3.48, P=0.009) significantly increases the risk of experiencing psychological distress. Parental substance use AOR=3.48 (95% CI: 1.57, 7.69, P=0.002), male gender AOR=2.97 (95% CI: 1.82, 4.83, P=0.001) significantly increased substance use risk while having married parents AOR=0.50 (95% CI: 0.27, 0.92, P=0.027) and living with parents AOR 0.39 (95% CI: 0.20, 0.75, P=0.005) were significant protective factors. CONCLUSION: The prevalence of substance use among these adolescents was substantial. Drug education initiated in primary school and services aimed at promoting the mental wellbeing of adolescents may go a long way in decreasing substance use among this population.

Survey of antiretroviral therapy adherence and predictors of poor adherence among HIV patients in a tertiary institution in Nigeria.

INTRODUCTION: Adherence is vital to effective antiretroviral therapy (ART) for reducing viral load and HIV/AIDS-related morbidity and mortality. This study was aimed at evaluating the adherence of HIV seropositive patients to ART in a tertiary institution in Nigeria. METHODS: A cross sectional observational study was conducted among 400 HIV seropositive patients. The study was carried out between December 2016 and February 2017 at the HIV clinic of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. RESULTS: The mean age of the HIV patients was 42.2±9.5 years with a predominant female gender (Male:Female = 1:2.8). The median CD4 counts increased from 302.1±15.0cells/mm3 at diagnosis to 430.8±13.3cells/mm3 at the time of the study. Majority of participants were unaware of their spouses' HIV status (59.3%) while 32.5% of participants had a serodiscordant spouse. Poverty was a major challenge as 73.3% earned less than 140 dollars per month. Depressive symptoms, anxiety disorder and insomnia were also reported in 40.7%, 33.2% and 47.2% respectively. Poor adherence to ART was observed in almost 20% of the patients. Logistic regression indicated that predictors of poor adherence were depression, anxiety and low CD4 counts. CONCLUSION: Adherence to anti-retroviral therapy was good amongst the majority of HIV seropositive patients. Depression, anxiety disorder and low CD4 count were however associated with poor adherence. This emphasizes the role of the psychology units as integral part of the HIV clinic to assist patients' adherence to anti-retroviral regimens.

Alcohol use and psychological wellbeing of health workers in a Nigerian Hospital: An exploratory study.

Background: The degree of alcohol use influences one's mental health and psychological wellbeing. Psychological well-being of health workers, however, is crucial to the quality of care their patients receive. Aims: The aim of this study was to determine the pattern of alcohol use and factors associated with psychological well-being of health care workers at a University Teaching Hospital. Methods: This was a cross sectional survey of health workers in the medical and surgical specialties at the State University Teaching Hospital in Nigeria. Socio-demographic questionnaire, the 10-items Alcohol Use Identification Test (AUDIT) and the 12-items General Health Questionnaire (GHQ-12) were used to assess socio-demographic, alcohol use and psychological well-being of the participants. Statistical analyses were done using the Statistical Package for Social Sciences (SPSS) version 16. Appropriate statistical tools were used to determine relationships between various variables. Results: A total of 256 participants were interviewed. Fifteen (5.9%) of the respondents were either hazardous or harmful drinkers. Psychological distress was reported among 17.2% of the respondents and this was significantly associated with marital status, years of practice, specialty of practice, presence of ongoing chronic illness, current stressors and level of alcohol use. Conclusion: A high proportion of the participants in the study were abstainers and a significant number were experiencing psychological distress. Psychological distress was however found to be significantly associated with harmful alcohol use, some socio-demographic variables, and work related factors. Efforts should be geared towards identifying these factors so as to ensure effectiveness and well-being of health workers.

Hazardous alcohol use among doctors in a Tertiary Health Center.

BACKGROUND: Doctors have been identified as one of the key agents in the prevention of alcohol-related harm, however, their level of use and attitudes toward alcohol will affect such role. AIM: This study is aimed at describing the pattern of alcohol use and the predictors of hazardous drinking among hospital doctors. SETTING: Study was conducted at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. DESIGN: A cross-sectional survey involving all the doctors in the teaching hospital. MATERIALS AND METHODS: All the consenting clinicians completed a sociodemographic questionnaire and alcohol use was measured using the 10-item alcohol use disorder identification test (AUDIT) and psychological well-being was measured by the 12-item General Health Questionnaire (GHQ-12). STATISTICAL ANALYSIS USED: Statistical analyses were done using the Statistical Package for Social Sciences version 16. Chi-square tests with Yates correction were used to describe the relationship between respondent's characteristics and AUDIT scores as appropriate. RESULTS: There were a total of 122 participants. Eighty-five (69.7%) of them were abstainers, 28 (23%) were moderate drinkers, and 9 (7.3%) hazardous drinkers. With the exception of age, there was no significant relationship between sociodemographic status, years of practice, specialty of practice, and hazardous alcohol use. Experiencing stress or GHQ score above average is significantly associated with hazardous drinking. CONCLUSION: Hazardous drinking among hospital doctors appears to be essentially a problem of the male gender, especially among those older than 40 years. Stress and other form of psychological distress seem to play a significant role in predicting hazardous drinking among doctors.

Assessment of Depression in a Primary Care Setting in Nigeria using the PHQ-9.

CONTEXT: Mental disorders are major contributors to the burden of diseases all over the world. In general practice, which provides essentially primary care, depression is the most common mental disorder seen and often goes unrecognized. AIMS: The aims of the study were to determine the prevalence of depression, the variables associated with depression, and the degree of recognition by the Physician in family medicine unit. SETTING AND DESIGN: A cross-sectional descriptive survey of consecutive patients who presented at the general medical out-patient unit of the State University Teaching Hospital, Ado-Ekiti, Nigeria was done. MATERIALS AND METHODS: Data were collected using a questionnaire incorporating sociodemographic variables and primary diagnosis made by attending Physician. Depression was assessed with the PHQ-9. RESULTS: Two hundred and seventy two patients were interviewed during the period of the study. Participants were mostly of 45 years or older (51.2%), female (59.9%), married (68.4%), and educated (85.7%). One hundred and thirty (47.8%) of the respondents had significant depressive symptoms with majority (49.2%) being classified as mild. Statistical analysis revealed significant association between depression and age, gender, marital status, and clinical diagnoses (P < 0.05). Over a quarter (28.7%) were presented with infectious diseases, other diagnoses made included cardiovascular disorders (15.8%), endocrine disorders (8.8%), psychiatric disorders other than depression (2.9%) and none had depression as primary diagnosis. CONCLUSIONS: The prevalence of depression among patients attending the general medical out-patient clinics is high and highly under-recognised.

Pattern and predictors of alcohol use disorders in a family practice in Nigeria.

BACKGROUND: Primary care has been identified as a key setting for the reduction of alcohol-related harm, while general practitioners are expected to play a significant role. The study aimed at identifying pattern of, and factors that are associated with alcohol use disorders (AUDs) among patients attending Family Medicine unit of State University Teaching Hospital. MATERIALS AND METHODS: Sample was selected through a random sampling from a population of patients, aged 18-65 years, attending the general medical out-patients unit of the hospital from January to April 2013. A pretested, semi-structured questionnaire was administered, incorporating sociodemographics and the diagnoses made by the attending Physician. The participants also completed the alcohol use disorders identification test (AUDIT) questionnaire and the patient health questionnaire-9. RESULTS: The prevalence of AUDs among the population of general out-patients was 9.7%. The AUDIT scores of the participants range from 0 to 29 with a mean of 1.3 (standard deviation = 4.08). AUDs were significantly associated with gender, level of education, occupational class, and the presence of significant depressive symptoms (P < 0.05). There was no statistically significant association found for age, employment status, marital status, and religion. CONCLUSION: The prevalence of AUDs among population studied was lower compared with a similar study in similar setting, but however, significant. AUDs were predicted by gender, lower education level, occupational group, and the presence of significant depressive symptoms mostly in the mild to moderate form. Identifying the group at risk in clinical setting may go a long way in reducing the adverse effect of AUDs in our society.

Olanzapine as a cause of urinary incontinence: a case report.

Olanzapine, an atypical antipsychotic, is one of the most commonly used antipsychotics. Though olanzapine is commonly associated with endocrine side effects, it is generally well tolerated by most patients and is rarely associated with urinary incontinence. This report highlights the case of a 23 -year old male patient with schizophrenia who developed severe urinary incontinence following the use of olanzapine. No medications were given to relieve the incontinence contrary to some other studies where ephedrine was used. Olanzapine was changed to trifluoperazine, and the patient's condition improved within two days. Urinary incontinence, though uncommon, is an embarrassing side effect of olanzapine which could negatively affect drug compliance. As such, clinicians should enquire about it in order to improve the patient's health.

Factors associated with caregiver burden in a child and adolescent psychiatric facility in Lagos, Nigeria: a descriptive cross sectional study.

BACKGROUND: Definitions of burden of care stress the effect of the patient's mental illness on the family. There are generally very few studies in this environment on caregiver burden in child/adolescent mental ill-health. This study aimed to identify patient and caregiver characteristics that are associated with caregiver burden. METHOD: Caregivers of patients attending the Child and Adolescent Clinic of the Neuropsychiatric Hospital, Yaba, Lagos [n = 155] were consecutively recruited over a one-month period. The caregivers were administered a sociodemographic questionnaire, the General Health Questionnaire, Zarit Burden Interview, and the Columbia Impairment Scale. Scoring on the Children's Global Assessment Scale was done by clinicians. RESULTS: Most caregivers observed in this study were females (80.5%), with mothers of the patients accounting for 78% of all the caregivers. A higher percentage of the patients were males (52.8%). Moderate to severe/severe burden was recorded among 25.2% of caregivers. Factors associated with caregiver burden were patient's level of functioning [r = 0.489, p < 0.001], psychiatric morbidity in the caregiver [r = 0.709, p < 0.001], level of impairment as assessed by the caregiver [r = 0.545, p < 0.001], and child's level of education [t = 3.274, p = 0.001]. Each one independently predicted caregiver burden. CONCLUSION: The study reveals a high level of burden among the caregivers of children and adolescents with mental health problems.

Comparison of catatonia presentation in patients with schizophrenia and mood disorders in lagos, Nigeria.

OBJECTIVE: To compare the clinical profile and pattern of catatonic symptoms of patients with schizophrenia and mood disorder. METHOD: Records of 13,968 patients seen between 1983-1985 and 2003-2005 were reviewed for symptoms of catatonia by resident doctors in psychiatry. Cases in which the diagnosis were schizophrenia or mood disorder were then noted. Socio-demographic and clinical features were described for each diagnosis. RESULTS: There were a total of 98 cases with catatonia out of the 13,968 case notes reviewed. Schizophrenia accounted for 82.5% and 53.4% in the two periods, while the proportion associated with mood disorders increased from 10% to 20.7%. Male to female ratio was 1.2:1 in schizophrenia and 1:3 in mood disorder. Those with schizophrenia were younger and with an earlier age of onset of symptoms than those with mood disorders. CONCLUSION: Catatonia associated with mood disorder was found to be increasing over the years when compared with schizophrenia. Differences were observed in socio-demographic characteristics and number of predominant catatonic symptoms. Having a separate category for catatonia due to the mood disorders in the current diagnostic guidelines (10(th) edition of the International Classification of Diseases and the 4(th) edition of the Diagnostic and Statistical Manual) will help in better diagnosis of catatonia.

Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria.

OBJECTIVE: The aim of this study was to assess the rate of adherence to medications amongst psychiatric outpatients in Nigeria and examine factors associated with medication nonadherence amongst this group. METHOD: Psychiatric outpatients (n=342) from three centres were assessed for medication adherence using the Morisky Medication Adherence Questionnaire. Details regarding sociodemographic variables (age, sex, education, religion, marital status, employment, income, medication cost), illness related variables (diagnosis, duration, number of episodes/admissions, insight, severity of symptoms, mental state, functional status), medication related variables (type, mode of administration, side effect, attitude to medication) and perception related variables (self-stigma, perceived causation and prognosis) were also obtained. RESULTS: There were 76 participants (22.2%) with good medication adherence, 102 (29.8%) with moderate adherence and 164 (48.0%) with poor adherence. The significant independent correlates of poor medication adherence included being employed [odds ratio (OR) 3.42, 95% confidence interval (95% CI) 2.17-5.39], poor social support (OR 5.86, 95% CI 2.87-12.17), high self-stigma (OR 4.70, 95% CI 2.24-9.96) and perceived spiritual causation of mental illness (OR 3.74, 95% CI 1.87-7.74). CONCLUSIONS: The majority of psychiatric outpatients in southwestern Nigeria had poor medication adherence. Our findings stressed the importance of patients' perception and social environment in determining treatment adherence and the necessity of educating the patient. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.