Psychosocial Factors Associated with Substance Use among Secondary School Students in Ilorin, Nigeria.

BACKGROUND: Adolescent substance use is a global concern. Identifying factors associated with it can help in preparing prevention programmes. OBJECTIVES: The objectives were to determine the sociodemographic factors associated with substance use and the prevalence of associated psychiatric morbidity among secondary school students in Ilorin. MATERIALS AND METHODS: Instruments used were a sociodemographic questionnaire, a modified WHO Students' Drug Use Survey Questionnaire, and the General Health Questionnaire-12 (GHQ-12) which was used to determine psychiatric morbidity, using a cut-off score of 3. RESULTS: Substance use was associated with older age groups, male gender, parental substance use and poor relationship with parents, and urban location of school. Reported religiosity did not confer protection against substance use. The overall prevalence of psychiatric morbidity was 22.1% (n= 442). Psychiatric morbidity was more common among users of opioids, organic solvents, cocaine and hallucinogens, with current opioid users having ten times the odds of psychiatric morbidity. CONCLUSION: Factors influencing adolescent substance use serve as a substrate for interventions. A good relationship with parents and teachers are protective factors, while parental substance use calls for holistic psychosocial support. The association of substance use with psychiatric morbidity highlights the need to incorporate behavioural treatment in substance use interventions.

CONTEXTE: La Consommation de Substances Psychoactives chez les Adolescents est une Préoccupation Mondiale. L'Identification des Facteurs qui y sont Associés Peut Aider à Préparer des Programmes de Prévention. OBJECTIFS: Déterminer les facteurs socio-démographiques associés à la consommation de substances psychoactives chez les élèves du secondaire à Ilorin. Déterminer la prévalence de la morbidité psychiatrique chez les étudiants et son association avec la consommation de substances. MATÉRIAUX ET MÉTHODES: Les instruments utilisés étaient un questionnaire sociodémographique, un questionnaire modifié de l'enquête de l'OMS sur la consommation de drogues par les étudiants, et le Questionnaire de santé générale-12 (GHQ-12) qui a été utilisé pour déterminer la morbidité psychiatrique, en utilisant un score seuil de 3. RÉSULTATS: La consommation de substances psychoactives était associée à des groupes d'âge plus élevés, au sexe masculin, à la consommation de substances psychoactives par les parents et à une mauvaise relation avec les parents, ainsi qu'à la localisation urbaine de l'école. La religiosité déclarée ne confère pas de protection contre la consommation de substances. La prévalence globale de la morbidité psychiatrique était de 22,1% (n= 442). La morbidité psychiatrique était plus fréquente chez les consommateurs d'opioïdes, de solvants organiques, de cocaïne et d'hallucinogènes, les consommateurs actuels d'opioïdes ayant dix fois plus de chances de souffrir de morbidité psychiatrique. CONCLUSION: Les facteurs qui influencent la consommation de substances psychoactives chez les adolescents servent de substrat aux interventions. Une bonne relation avec les parents et les enseignants sont des facteurs de protection, tandis que la consommation de substances par les parents nécessite un soutien psychosocial global. L'association entre la consommation de substances et la morbidité psychiatrique souligne la nécessité d'intégrer un traitement comportemental dans les interventions en matière de consommation de substances. Mots clés: Santé des adolescents, médecine des adolescents, services de santé mentale en milieu scolaire, consommation d'alcool avant l'âge légal, toxicomanie, oral, pédopsychiatrie. Traduit avec.

Comparative study of the haemodynamic effects of propofol and thiopentone in modified electroconvulsive therapy in Nigerians.

BACKGROUND: Electroconvulsive therapy provokes abrupt changes in systemic haemodynamics. We compared the effects of propofol and thiopentone on haemodynamic responses of patients scheduled for ECT between September 2008 and March 2009 in two Nigerian tertiary hospitals. METHODS: In a prospective, randomized study, 40 patients scheduled for ECT were allocated into 2 groups of 20 each. Anaesthesia was induced with either 1mg/kg propofol (PG) or 5 mg/kg thiopentone (TG) and 0.5mg/kg suxamethonium prior to ECT. Heart rate (HR), blood pressure- systolic (SBP), mean arterial (MAP) and diastolic (DBP) were taken before ECT and at 1 and 5 minutes postictal. The means of the increases in haemodynamic parameters were compared. RESULTS: There were significant increases in mean HR in both groups at 1 and 5 min and the increases were comparable between the 2 groups (p = 0.784). The increases in SBP were not significant in both groups and were comparable (p = 0.988). The increases in mean DBP were not significant in both groups but it was significantly greater in TG (p = 0.012). Increase in MAP was significantly greater in the TG at 1 min (p = 0.028). CONCLUSION: Propofol at 1 mg/kg and thiopentone at 5 mg/kg used for modified ECT in this study resulted in significant increases in heart rates. However, a significant increase in mean arterial pressure with thiopentone and a significantly greater increase in diastolic blood pressure when the two agents are compared confer some superiority on propofol over thiopentone in attenuating haemodynamic responses to ECT.

Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria.

OBJECTIVE: To determine the psychosocial and clinical factors that are associated with psychiatric morbidity among women with infertility attending a Nigerian gynaecology clinic. METHOD: Over a four month period, 320 respondents (160 in the study group and 160 in the control group) were interviewed using a proforma (designed by the authors) and a screening instrument, General Health Questionnaire version 30 (GHQ-30). All probable cases with a score of 5 or more on GHQ-30 were interviewed using the Present State Examination (PSE). Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10). RESULTS: The infertility rate among the study group was found to be 25.8% with primary and secondary infertility rates constituting 21.9% and 78.1% respectively. The prevalence of psychiatric morbidity among women with infertility (48.8%) was significantly more than that in the control group (11.2%) (chi(2) = 51.80, p < 0.0001). Lack of support from husband (chi(2) = 15.31, p < 0.001), lack of support from husband's relatives (chi(2) = 39.60, p < 0.0001), discrimination (chi(2) = 69.91, p < 0.0001) and history of induced abortion (chi(2) = 30.40, p < 0.0001) were found to be significantly associated with psychiatric morbidity among patients with infertility when compared with the fertile control population. There was no significant difference in the rate of psychiatric morbidity between women with primary infertility and those with secondary infertility (chi(2) = 0.03; p = 0.87). CONCLUSION: Psychiatric morbidity is significantly more common among patients with infertility as compared with those without. There was a significant association between psychiatric morbidity and absence of support from husband and his relations, presence of discrimination, and a history of induced abortion. We suggest more public enlightenment on the need for moral/psychosocial support to women with infertility. In addition, more efforts should be made towards early screening and identification of cases of psychiatric morbidity among patients with infertility.

Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria

Objective: To determine the psychosocial and clinical factors that are associated with psychiatric morbidity among women with infertility attending a Nigerian gynaecology clinic. Method: Over a four month period, 320 respondents (160 in the study group and 160 in the control group) were interviewed using a proforma (designed by the authors) and a screening instrument, General Health Questionnaire version 30 (GHQ-30). All probable cases with a score of 5 or more on GHQ-30 were interviewed using the Present State Examination (PSE). Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10). Results: The infertility rate among the study group was found to be 25.8% with primary and secondary infertility rates constituting 21.9% and 78.1% respectively. The prevalence of psychiatric morbidity among women with infertility (48.8%) was significantly more than that in the control group (11.2%) (c2 = 51.80, p < 0.0001). Lack of support from husband (c2 = 15.31, p < 0.001), lack of support from husband's relatives (c2 = 39.60, p < 0.0001), discrimination (c2 = 69.91, p < 0.0001) and history of induced abortion (c2 = 30.40, p < 0.0001) were found to be significantly associated with psychiatric morbidity among patients with infertility when compared with the fertile control population. There was no significant difference in the rate of psychiatric morbidity between women with primary infertility and those with secondary infertility (c2 =0.03; p = 0.87). Conclusion: Psychiatric morbidity is significantly more common among patients with infertility as compared with those without. There was a significant association between psychiatric morbidity and absence of support from husband and his relations, presence of discrimination, and a history of induced abortion. We suggest more public enlightenment on the need for moral/ psychosocial support to women with infertility. In addition, more efforts should be made towards early screening and identification of cases of psychiatric morbidity among patients with infertility

Management of perceived mental health problems by spiritual healers: a Nigerian study.

OBJECTIVE: Anecdotal reports and research findings have suggested that religious healers are widely consulted by many Nigerians in time of mental health crisis.The study aimed at examining the knowledge, attitude and practice of mental health care among a syncretic Church's healers, and their readiness to cooperate with Psychiatrists. METHOD: A modified, pilot-tested, selfcompleted questionnaire was used to obtain information from consenting spiritual healers who satisfy the inclusion criteria. Focus group discussions (FGDs), Participatory Observation (PO) and Key Informant Interviews (KII) were used to corroborate or refute the findings. RESULTS: The respondents' knowledge of mental disorders was limited to psychotic disorders; their explanatory model was similar to beliefs of the populace. In practice, they combined some modern medical approach, some native methodology and some eclectic religious practices such as prophecy, trance and dream. Only 6% of them ever referred their clients to medical practitioners. CONCLUSION: Religious healers still constitute an important route to access mental health care providers to some Nigerians.

Management of perceived mental health problems by spiritual healers : a Nigerian study

Objective : Anecdotal reports and research findings have suggested that religious healers are widely consulted by many Nigerians in time of mental health crisis. The study aimed at examining the knowledge; attitude and practice of mental health care among a syncretic Church's healers; and their readiness to cooperate with Psychiatrists. Method : A modified; pilot-tested; self-completed questionnaire was used to obtain information from consenting spiritual healers who satisfy the inclusion criteria. Focus group discussions (FGDs); Participatory Observation (PO) and Key Informant Interviews (KII) were used to corroborate or refute the findings. Results : The respondents' knowledge of mental disorders was limited to psychotic disorders; their explanatory model was similar to beliefs of the populace. In practice; they combined some modern medical approach; some native methodology and some eclectic religious practices such as prophecy; trance and dream. Only 6of them ever referred their clients to medical practitioners. Conclusion : Religious healers still constitute an important route to access mental health care providers to some Nigerians

Public stigma towards psychiatric patients in a South-Western Nigerian town.

BACKGROUND: Stigma is still a strong barrier to provision and utilisation of mental health services and every effort should be made to reduce it. Since there have been contradicting reports about the level of stigma in Africa and developing nations, more studies are needed to assist stakeholders to address the challenges. AIMS AND OBJECTIVES: The study strives to determine the level of stigma (stereotypes, prejudices and discriminating behaviours) among residents of a traditional Nigerian town of Osogbo to psychiatric patients. It also attempts to proffer ways of further reducing stigma, if any, in the studied population. METHOD: During a three-month period, a semi-structured interview schedule was administered to a stratified random sample of all consenting eligible adults in the study area. FINDINGS: It was found that a significant proportion of the 84 respondents had less stigmatising attitude towards people with psychiatric illness. Respondents' age, levels of education and belief in causation of mental illness were found to be significantly associated with their responses as regards stigma. CONCLUSION: In spite of the limitations of sample size and the relatively high level of education of the respondents (as compared with the national literacy rate), the study showed that public stigma towards psychiatric patients in Osogbo is generally low. While this finding is in keeping with some earlier reports, it was suggested that future studies should employ larger sample size and wider geographical coverage in order to put to rest the conflicting opinions about the level of stigma towards psychiatric patients among Nigerians and Africans as compared to western countries.

Perceived stress factors among resident doctors in a Nigerian teaching hospital.

AIM: The study was aimed at identifying psychological factors that are perceived stressful by resident doctors at the University of Ilorin Teaching Hospital. METHOD: A self-administered questionnaire was given to 84 eligible residents. Only 57(67.9%) properly completed and returned the questionnaire. The questionnaire sought information on sociodemographic variables, factors perceived as stressful and the degree of perception. RESULT: High patient load, poor work environment, distant accommodation and lack of recreational facilities within the hospital premises were identified as stressors. Age, gender and number of dependants had no correlation with perception of stress. CONCLUSION: It was concluded that stakeholders in postgraduate medical education should, in keeping with their resources and level of development, employ more residents, improve work environment and provide accommodation and recreational facilities. These will go a long way in improving the quality of residents trained and the services rendered.

A cost comparison of traditional and orthodox mental health care.

This study examines whether cost is a factor in determining the choice of therapy in patients with mental illness. The focus therefore is to compare the cost of therapy (and not scientific basis or efficacy of treatment), in the short term, of traditional with orthodox mental health care. Sixty patients comprising 23 and 28 patients receiving therapies at orthodox and traditional psychiatric facilities respectively were interviewed. Information was obtained in the areas of sociodemographic data, duration of illness before presentation, duration of therapy, costs of consultation, medication, accommodation and feeding among others. It was found that traditional mental health care, in the short run, was three times more expensive than orthodox mental health care. Future health campaign programs should emphasize the fact that traditional mental health care is not just less effective, but costlier than orthodox mental health care. This might further discourage people from patronizing traditional mental health practitioners.

Mental laws in Nigeria: the case of the State Versus I. A.

The article focuses on providing medico-legal education for psychiatrists in the area of mental laws in Nigeria. This was done through the presentation of a recently concluded case of The State Versus I.A in which the author appeared in court to give evidence. A summary of the procedure before trial, the briefs of the prosecution and the defence, and the judgement were given. Some relevant sections of the Penal Code were quoted. Finally, salient points in the trial were also discussed. It was concluded that a good understanding of the mental laws by psychiatrists and medical personnel would lead to better presentation of evidence in court. Furthermore, a conference of stakeholders in mental health is also advocated.

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.

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.