Diagnostic and Therapeutic Roles of Microdochectomy and Subareolar Ducts Excision for Pathological Nipple Discharge in Lagos.

BACKGROUND: Pathological nipple discharge (PND) comprises less than 10% of presentation in breast clinics. Data on the management of nipple discharge (ND) in our environment are scarce. AIM: To review management outcome in cohorts of patients with PND in our institution between December 2010 and October 2020. METHODOLOGY: This is a retrospective review of consecutive patients managed for PND between 2010 and 2020. Demographical characteristics, clinical features, investigation results and management outcome were retrieved from the clinical records for analysis. A cross-sectional survey via telephone conversation/clinic consultation was carried out to monitor patients for post-operative complications and recurrence. RESULTS: There were 25 patients (18 microdochectomies and 7 subareolar duct excisions) in the study with a median age of 44 (37.5-49.5) years. The median duration of symptoms before presentation was 3 (2.5-5.5) months. The major characteristics of ND in the study cohort were: single duct orifice in 18 patients (72%) spontaneous ND in 14 patients (56%); right ND in 15 patients (60%); and bloody ND in 21 patients (84 %). Only one patient had a family history of breast cancer. Intraductal papilloma diagnosed in 9 patients (36%) was the most common cause of PND. Breast cancer was an underlying aetiology in 28% of patients in the series. Six out of 7 patients with breast cancer diagnosis were <50years. CONCLUSION: Most women with PND in our practice were young with predominance of spontaneous bloody discharge. Intraductal papilloma was the most common cause of PND in this study. Breast cancer accounted for about a third of cases.

CONTEXTE: L'écoulement mamelonnaire pathologique (EMP) représente moins de 10 % des cas présentés dans les cliniques du sein. Les données sur la prise en charge de l'écoulement mamelonnaire (EM) dans notre environnement sont rares. OBJECTIF: Examiner les résultats de la prise en charge dans des cohortes de patientes présentant un écoulement mamelonnaire pathologique dans notre établissement entre décembre 2010 et octobre 2020. MÉTHODOLOGIE: Il s'agit d'une revue rétrospective des patientes consécutives prises en charge pour un DP entre 2010 et 2020. Les caractéristiques démographiques, les caractéristiques cliniques, les résultats des examens et les résultats de la prise en charge ont été extraits des dossiers cliniques pour analyse. Une enquête transversale par conversation téléphonique/consultation en clinique a été réalisée pour surveiller les complications post-opératoires et les récidives chez les patients. RÉSULTATS: L'étude a porté sur 25 patients (18 microdochectomies et 7 excisions du canal sous-aréolaire) dont l'âge médian était de 44 ans (37,5-49,5). La durée médiane des symptômes avant la consultation était de 3 (2,5-5,5) mois. Les principales caractéristiques de la MN dans la cohorte de l'étude étaient les suivantes : orifice unique dans 18 patients (72 %), MN spontanée chez 14 patients (56%), MN droite chez 15 patients (60 %) et MN sanglante chez 21 patients (84 %). Une seule patiente avait des antécédents familiaux de cancer du sein. Le papillome intraductal diagnostiqué chez 9 patientes (36 %) était la cause la plus fréquente de la MN. Le cancer du sein était une cause sous-jacente chez 28 % des patientes de la série. Six des sept patientes chez qui un cancer du sein a été diagnostiqué avaient moins de 50 ans. CONCLUSION: Dans notre pratique, la plupart des femmes souffrant de DPN étaient jeunes, avec une prédominance d'écoulements sanglants spontanés. Le papillome intraductal était la cause la plus fréquente de DPN dans cette étude. Le cancer du sein représentait environ un tiers des cas. Mots-clés: Cancer du sein, Écoulement, Mamelon, Pathologique.

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.

DELAYED DIAGNOSIS OF AVM PRESENTING WITH STROKE AND SEIZURES IN A YOUNG NIGERIAN: A CASE REPORT.

Background: Brain arteriovenous malformations (BAVM) are a cause of intracerebral haemorrhage (ICH) and seizures especially in young patients. ICH due to BAVMs seem to have relatively better neurologic outcomes compared to other causes of spontaneous ICH as patients often recover fully. In this report we highlight a case of delayed diagnosis of BAVM in a young man who presented with seizures and stroke. Case summary: A 36-year-old man was referred on account of focal, secondarily generalized tonic clonic convulsions. He had suffered a right ICH 3 years before the index presentation. His general physical and neurologic examination were normal. Electroencephalography revealed right sided focal epileptiform discharges and brain MRI revealed a right parieto-occipital AVM. The seizures were controlled with carbamazepine and he was referred for neurosurgical evaluation. Conclusion: BAVMs are an important cause of intracerebral haemorrhage and attendant neurologic morbidity especially in young individuals. Neuroimaging plays a central role in BAVM diagnosis and MRI is of great value where facilities and expertise for conventional angiography do not exist. In some instances, delayed presentation of BAVM cases may be due to relatively better neurologic outcomes in BAVM-related ICH.

Delirium in Elderly Patients:Frequency and Precipitants in a Tertiary Hospital Setting.

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.

Cerebral Venous Thrombosis, Protein S Deficiency and Pregnancy Triad:A Case Report.

BACKGROUND: Cerebral venous sinus thrombosis (CVT) is an uncommon cause of stroke that is more prevalent among young adults and more so among women. Being an unusual site for venous thrombosis, its occurrence usually implies the presence of a thrombophilic disorder, inherited or acquired. Occasionally, multiple inherited or acquired risk factors for hypercoagulability may co-exist. In this report we present a case manifesting the triad of protein S deficiency, pregnancy and imaging-confirmed extensive CVT. CASE PRESENTATION: A 28-year-old primigravid woman presented with acute onset of severe headache, protracted vomiting, reduced consciousness, spastic quadriparesis and bilateral papilloedema. The serum D-Dimer assay was markedly elevated and brain computerized tomography scan revealed extensive thrombus involving superior and inferior sagittal sinuses, the straight sinus, the confluence of sinuses as well as the left transverse sinus. A hypercoagulability panel revealed protein S deficiency. She was treated with cerebral decompression and subcutaneous enoxaparin with remarkable clinical improvement in muscle power and consciousness level. Her pregnancy and delivery were otherwise normal. CONCLUSION: Hypercoagulability should be suspected in a pregnant woman presenting with stroke and a high index of suspicion is needed in making accurate diagnosis. The case highlights the importance of brain imaging in confirming the diagnosis.

Anti-microbial locks increase the prevalence of Staphylococcus aureus and antibiotic-resistant Enterobacter: observational retrospective cohort study.

BACKGROUND: Anti-microbial lock solutions (AML), in conjunction with systemic antibiotics, may successfully treat tunnelled haemodialysis catheter-related bloodstream infections (CR-BSI). It is unknown whether AML promote anti-microbial resistance. METHODS: This is a retrospective cohort study of all CR-BSI (2003-2006) in our dialysis unit. Controls (n = 265) were treated with systemic vancomycin and gentamicin. In addition to the systemic antibiotics, the study group (n = 662) received AML containing vancomycin and gentamicin during inter-dialytic periods. Antibiotic sensitivity/resistance profiles of all organisms were analysed. Changes in the incidence of infection (chi-square test) and resistant organisms (Fisher's exact test) were calculated. RESULTS: The incidence of CR-BSI decreased from 8.50/1000 catheter days (controls) to 3.80 (study group; P < 0.0001), and the incidence of relapses decreased (P = 0.0027). The number needed to treat to prevent subsequent bacteraemia using an AML adjunct is 3 ± 0.4. The proportion of Gram-positive cultures increased (P < 0.0001), including Staphylococcus aureus (P = 0.03), but the proportion of methicillin-resistant S. aureus (P = 0.87) and vancomycin resistance (P = 0.90) did not. Increased gentamicin resistance (P < 0.0001) and ciprofloxacin resistance (P = 0.04) were observed in Gram-negative cultures. Gentamicin resistance [relative risk (RR) > 15.29; P < 0.0001] and ciprofloxacin resistance (RR = 6; P = 0.007) increased in Enterobacter species, but not Pseudomonas or Escherichia coli species. CONCLUSION: AML decrease CR-BSI incidence, although proportions of S. aureus and anti-microbial-resistant Enterobacter are increased.

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

Knowledge and Perception of e-Health and Telemedicine among Health Professionals in LAUTECH Teaching Hospital; Osogbo; Nigeria

Depression is a complex but treatable disorder if diagnosed appropriately. However; despite the advances in the understanding of the molecular basis of this disorder and the vast range of medication; psychotherapy and electroconvulsive therapy; very safe and effective drug to treat this disease is still being sought. Several studies suggest that St.John's wort (Hypericum perforatum L.) has phloroglucinol derivative; hyperforin; exhibiting antidepressant activity. This bioactive component can be exploited to create a major shift in the safer treatment of depression

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

Does the surgeon's experience impact on radiocephalic fistula patency rates?

Establishing successful long-term hemodialysis access remains a major challenge. The primary aims of this study were to determine whether primary success and primary and secondary patency rates of a series of consecutive radio-cephalic fistulae (RCF) were affected by the experience of the surgeon. The secondary aims were to assess complications, and to compare results with patency rates from the literature. All native fistulae (AVF) created in our unit between January 1, 2002 and December 31, 2005 were analyzed retrospectively. The RCF were identified and divided into group A (RCF fashioned by the consultant surgeon), and group B (fashioned by the junior surgeons within the unit). Demographic characteristics, risk factors, primary success rate (patent fistula at discharge), and primary and secondary patency rates were compared between each group using chi-squared test. During this period, 552 AVF were created. Of the 195 RCF, there were 153 fistulae in group A and 42 in group B. Median follow-up was 22 months for both groups. There was no difference with regards to age, sex ratio, prevalence of diabetes, and cardiovascular disease. The primary success rate in group A and B was 94.2% and 81%, respectively (p < 0.01). Primary and secondary patency rates at 22 months were 80%, 93%* and 74%, 81%* in group A and B, respectively (*p < 0.025). Even within group B, these results compare very favorably with the published literature. These results suggest that the placement of a RCF should be performed by the most experienced member of a team dedicated to vascular access creation or at least under his supervision.

A comparison of quality-of-life in schizophrenia and affective disorder patients in a Nigerian tertiary hospital.

This study determined the degree of satisfaction with various aspects of life in patients with affective disorders and schizophrenia in a Nigerian tertiary hospital. We compared quality-of-life (QOL) at onset-of-illness (first episode) with QOL at time of study and identified sociodemographic and clinical variables that may predict QOL. All consenting patients with ICD-10 compatible diagnosis of schizophrenia (n = 100) and affective disorders (n = 35) receiving treatment in the study center during the study period were interviewed. The WHOQOL-Bref was used to assess respondents' subjective QOL, and a data-collection sheet assessed objective domains of QOL. Respondents with schizophrenia and affective disorders had a good outcome in terms of objective QOL scores. In both groups, however, the subjective ratings were poor as the illness progresses. We conclude that in Nigerian hospital cases, patients with schizophrenia andaffective disorders have a good outcome in terms of objective QOL scores, which are not in consonance with their subjective ratings. Marital status and employment status are predictive of QOL.

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.