Changing stigmatisation of leprosy: an exploratory, qualitative life course study in Western Nigeria.

INTRODUCTION: Renewed interest in health-related stigma has invigorated calls to understand factors and processes underlying stigma. However, few empirical studies explore the influences of structural discrimination and moral status on leprosy-related stigma. We investigated how sociocultural context and organisational policies and practices influenced the connotations of leprosy, sources of stigma and the changing social responses to leprosy in Western Nigeria. METHODOLOGY: Ethnographic research conducted between 2008 and 2012 combined documents review with life history interviews of 21 individuals affected by leprosy and semistructured interviews with 26 community members in Western Nigeria. Interviews were audiotaped, transcribed verbatim and coded. Theoretical frameworks used to deepen social understandings of leprosy and responses to stigma included Link's and Phelan's conceptualisation of stigma and the concepts of structural discrimination and moral status. RESULTS: Findings showed that connotations of leprosy in Yorùbá culture included the following: (i) perception of leprosy as the most shameful and detested condition and (ii) symbolic association with filth and immoral behaviour that is dishonouring to Yorùbá identity. Secondary analysis of archival materials revealed four sources of stigma: cultural beliefs about leprosy, health promotion messages embedded in primary school books, religious teachings about leprosy and campaigns conducted by the leprosy service in 1950s. Contrary to the portrayal of Yorùbá attitudes to leprosy as entirely negative, we identified that people affected by leprosy were creating new life courses to counter existing cultural accounts of marginalisation. Emerging narratives of inclusion outlined five facilitators of acceptance namely, antileprosy treatment, good moral character, supportive family networks, livelihoods, and contribution to community survival. CONCLUSION: Gaps highlighted by this study suggest that the global target of zero stigma and discrimination of leprosy will remain unattainable without better understanding of cultural significance(s) of leprosy and the local sources and underlying drivers of stigma that are crucial for developing context-specific stigma reduction interventions.

The state of readiness of Lagos State Primary Health Care Physicians to embrace the care of depression in Nigeria.

Globally there is a huge treatment gap for common mental disorders such as depression. Key to improving access to treatment will be the attitudes held towards depression by those physicians who work in Primary Care. This study aimed to explore Lagos State's Primary Care Physicians' attitudes towards depression and their views regarding their current working practices. A survey of 41 (82%) Primary Care Physicians in Lagos State who, after written consent, completed the Depression Attitude Questionnaire which assessed their knowledge and attitude towards the causes, consequences and treatment of depression. The largest part of the sample (37.5%) estimated that between 5 and 10% of the patients they saw over a 3 months period would have depression while one in four perceived rates of depression seen to be between 31 and 40%. Close to half (40%) of them felt that fewer than 5% of these depressed patients they saw would need antidepressants and a large part (82.9 %) of them agreed that becoming depressed is a way that people with poor stamina deal with life difficulties. About half (41.6%) of them believed it was not rewarding to look after depressed patients. Our study suggests that the current knowledge, attitudes and practices of most Lagos State primary health care physicians may be a barrier to patients with depression accessing appropriate care.

Factors associated with antenatal mental disorder in West Africa: a cross-sectional survey.

BACKGROUND: Maternal mental illness is likely to have a profound impact in less developed parts of the world. A mother experiencing mental illness in a low income setting is at risk of providing sub-optimal care for her offspring which can have grave consequences in an environment where poverty, overcrowding, poor sanitation, malnutrition, tropical diseases and a lack of appropriate medical services may be pronounced. Given the profound consequences of antenatal and postnatal mental illness on maternal mental health, foetal wellbeing and childhood growth and development the factors associated with mental illness in a Sub-Saharan setting merit clarification and investigation. METHODS: A prospective survey design was conducted in Lagos. Self reporting questionnaire 20 items - SRQ20 - assessed the presence of mental illness. The WHO Multi-country Study on Women's Health and Domestic Violence Questions assessed women's exposure to violence. Numerous variables potentially associated with mental illness including maternal socio-economic factors, maternal characteristics, obstetric variables and the characteristics of previous children were recorded. Direct logistic regression was performed to assess the impact of a number of variables on the likelihood of presence of mental disorder in the population. RESULTS: 189 women were surveyed. 7% met the criteria for experiencing a common mental disorder according to their score on the SRQ-20. Of variables examined only the number of female children and the presence of inter personal violence predicted being a case of mental illness (OR = 3.400; 95%CI = 1.374 - 8.414 and OR = 5.676; 95%CI = 1.251 - 25.757 respectively). CONCLUSIONS: Rates of mental disorder found in our study were lower than those previously observed internationally and in Africa, perhaps reflecting stigma about disclosing symptoms. The predictive nature of violence on mental disorder is in keeping with international evidence. Our study demonstrated that exposure to inter personal violence within the last 12 months and increasing numbers of female children predict the presence of mental illness in a sample of pregnant Nigerian women. Training and education for primary health care and obstetric health workers should highlight these areas.

The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria.

BACKGROUND: A high level of adherence to prescribed antiretroviral (ARV) regimens is required to achieve and maintain suppression of human immunodeficiency virus (HIV) replication and prevent drug resistance. OBJECTIVE: This study aimed to determine the possible relationship between psychopathology and ARV medication adherence in Nigeria. METHOD: Persons with HIV infection (N=182) completed various questionnaires on sociodemographic and clinical details, general psychopathology, self-esteem, and medication adherence. RESULTS: Low medication adherence was reported in 26.9% of the participants; significant correlates included presence of psychopathology and perceived poor social support. CONCLUSION: The success of any intervention policy for HIV-infected persons in sub-Saharan Africa must consider both low level of medication adherence and its associated factors.

Post-traumatic stress disorder (PTSD) after stigma related events in HIV infected individuals in Nigeria.

BACKGROUND: One of the most distressing concerns of many people living with HIV in sub-Saharan Africa is the stigma. Intense stigma may be traumatic. This study aimed to investigate the probability and correlates of Posttraumatic stress disorder (PTSD) following intense stigmatizing events and situations in HIV infected individuals in Nigeria. METHODS: Adult sero-positive attendees of an HIV care centre (N = 190) completed questionnaires regarding sociodemographic and clinical details; the 12-item General Health Questionnaire (GHQ-12) and the Rosenberg's Self-Esteem Scale. The clients were then interviewed for the presence of stigma related PTSD with a modified version of the mini international neuropsychiatry interview (MINI). RESULTS: About 2/3 of the participants had experienced at least an intense HIV-related stigmatizing event or situation. The rate of HIV-stigma related PTSD was 27.4%. Independent predictors of HIV stigma-related PTSD included past history of traumatic events (Single event, OR 2.28, 95% CI 1.08-4.73; Multiple events, OR 9.47, 95% CI 2.97-32.20), low self esteem (OR 6.52, 95% CI 2.59-16.55), poor level of social support (OR 3.33, 95% CI 1.24-9.79) and presence of general psychopathology (OR 2.18, 95% CI 1.07-4.44). CONCLUSION: PTSD may not be specific to traumatic events alone. There is a possibility of PTSD after an intense stigmatizing event or situation. While the validity for the validity of HIV-stigma related PTSD warrants further investigation, stigma needs to be considered when planning rehabilitation strategies for HIV infected individuals in sub-Saharan Africa. A closer attention to self esteem, level of social support and presence of psychopathology is needed in these individuals.

Relationship between depression and quality of life in persons with HIV infection in Nigeria.

OBJECTIVE: Despite the fact that two-thirds of all the people with HIV live in sub-Saharan Africa, little is known about the emotional state and quality of life (QOL) of subjects with HIV in this region. The objective of this study was to evaluate the association between clinical depression and quality of life in a group of HIV sero-positive subjects in Nigeria. METHODS: Subjects with HIV infection (n = 87) completed a questionnaire detailing sociodemographic and HIV related variables. The subjects were assessed for the diagnosis of depression using the Mini International Neuropsychiatric Interview (MINI) and their subjective health related quality of life (QOL) was assessed using the short version of the WHO quality of life scale (WHOQOL-BREF). RESULTS: There were 25 (28.7%) subjects with diagnosis of depression. Lower educational level correlated with poorer QOL in all the domains of WHOQOL-BREF except the "social relationship" domain. Also, poor social support correlated with poorer QOL scores on domains of "physical health" and "social relationship" and presence of medical problems was significantly associated with poorer scores on domains of "physical health" and "psychological health." Diagnosis of depression was significantly correlated with poorer QOL in all domains except the "social relationship" domain. CONCLUSION: Poorer health related QOL in Nigerian subjects with HIV was associated with depression, lower educational and socioeconomic levels, and poor social support. Early identification and referral of patients with depression needs to be incorporated into intervention programs designed for HIV infected individuals in this region.

Impact of postnatal depression on infants' growth in Nigeria.

BACKGROUND: The contribution of maternal postnatal depression to infant growth and under-nutrition in Africa has not been well studied. This study aims to examine the impact of postnatal depression (PND) on infants' physical growth in the first 9 months of life in Nigeria. METHODS: A longitudinal case controlled study in which 242 women (consisting of 120 depressed and 122 matched non-depressed postpartum women) had their infants' weight and length measured at the 6th week, 3rd month, 6th month and 9th month after delivery. Discontinuation with breastfeeding and illnesses like diarrhoea, persistent vomiting, fever and cough were also recorded at these periods. RESULTS: Infants of depressed mothers had statistically significant poorer growth than infants of non-depressed mothers at the 3rd month (weight OR 3.41, 95% CI 1.30-8.52; length OR 3.28, 95% CI 1.03-10.47) and the 6th month postpartum (weight OR 4.21, 95% CI 1.36-13.20; length OR 3.34, 95% CI 1.18-9.52). Depressed mothers were more likely to stop breastfeeding earlier and their infants more likely to have episodes of diarrhoea and other infectious illnesses. LIMITATIONS: Psychiatric interview was conducted only once (at 6 weeks postpartum), our sample size was moderate and we did not account for mothers who had been depressed in pregnancy. CONCLUSION: Prevention of postnatal depression and close monitoring of the growth of infants of depressed mothers should be integrated into maternal and child health policies in this region.

The 12-month prevalence of DSM-IV anxiety disorders among Nigerian secondary school adolescents aged 13-18 years.

AIMS: To estimate the 12-month prevalence of DSM-IV-specific anxiety disorders among Nigerian secondary school adolescents aged 13-18 years. METHOD: A representative sample of adolescents (n=1090) from senior secondary schools in a semi-urban town in Nigeria was assessed for the 12-month prevalence of DSM-IV-specific anxiety. RESULTS: The 12-month prevalence for all anxiety disorders was 15.0% (females=19.6%; males=11.4%). There were significant gender differences in the prevalence for all anxiety disorders (P<0.001; OR 1.96, 95% CI 1.35-2.65) and social anxiety disorder (P=0.035; OR 1.82, 95% CI 1.03-3.19) and significant age difference in the prevalence of separation anxiety disorder (P=0.045; OR 2.43, 95% CI 0.99-5.96). CONCLUSION: The prevalence of anxiety disorders in Nigerian secondary school adolescents was comparable to the rates found in the western world. Health policies must integrate adolescents' anxiety as a disorder of public health significance. Further studies are needed to evaluate the factors associated with anxiety disorders amongst adolescents in this region.

Psychiatric disorders among the HIV-positive population in Nigeria: a control study.

OBJECTIVE: This article estimates the point prevalence of psychiatric disorders in a sample of HIV-positive subjects in Nigeria in comparison with normal HIV-negative controls and evaluates the possible sociodemographic and clinical correlates of psychiatric disorders in HIV-positive subjects. METHODS: HIV-positive subjects (n=88) and HIV-negative healthy controls (n=87) were assessed for their current diagnosis of DSM-IV psychiatric disorders via the Mini International Neuropsychiatric Interview. Sociodemographic and clinical details were also obtained. RESULTS: The rate of psychiatric disorders in subjects with HIV was 59.1% compared to 19.5% in subjects without HIV infection [odds ratio (OR)=5.95, 95% confidence interval (CI)=3.02-11.75]. The subjects with HIV had significantly higher rates of affective disorders (OR=3.58, 95% CI=1.44-8.94), anxiety disorders (OR=3.57, 95% CI=1.65-7.72), and psychotic disorders (OR=1.10, 95% CI=1.01-1.12) than healthy controls. The factors significantly associated with psychiatric disorders include poor level of social support and stage of the disease. CONCLUSION: Psychiatric disorders are common in our Nigerian subjects with HIV, and the rates are significantly higher when compared to the healthy general population. Proactive identification and treatment of mental disorders should be integrated into HIV intervention policies in this region.

Prevalence of major depressive disorders and a validation of the Beck Depression Inventory among Nigerian adolescents.

AIM: The aims of this study are to estimate the prevalence of major depressive disorder (MDD) in a representative sample of Nigerian adolescents, and to assess the validity of Beck Depression Inventory (BDI) in screening for depressive symptoms among adolescent population in Nigeria. METHOD: A total of 1095 adolescents aged 13-18 years attending senior secondary schools completed the BDI. The presence of MDD in the adolescents was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Epidemiological Version 5 (K-SADS-E). RESULT: The prevalence of MDD was 6.9%. (male = 5.5%, female = 8.9%). The difference between the rates for MDD in males and females was statistically significant (P = 0.028), but no age or age-gender-interaction difference was found. The BDI has good psychometric properties in screening for depression in adolescents. At a cut off score of 18 and above, the BID has a sensitivity of 0.91, specificity of 0.97, positive predictive value (PPV) of 0.88 and negative predictive value (NPV) of 0.98. CONCLUSION: The prevalence of MDD in Nigerian adolescents is comparable to those found in western culture and the BDI is a valid instrument for screening for MDD among Nigerian adolescents. Health policies in developing countries must integrate adolescents' depression as a disorder of public health significance.

Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students.

OBJECTIVES: Sleep-related problems and detection of them remain largely an unidentified public health issue, especially among university students. This study aims to assess the validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. METHODS: Five hundred and twenty students completed the PSQI, the 12-item General Health Questionnaire (GHQ-12) and questionnaires pertaining to socio-demographic details. The students were then interviewed for the diagnosis of insomnia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) and the International Classification of Sleep Disorders, revised criteria (ICSD-R). RESULTS: The PSQI was of moderate value in screening for insomnia, with the best cut-off score at 5 (sensitivity 0.720, specificity 0.545, overall correct classification rate 0.554). The correlation between the PSQI and the GHQ-12 was 0.252 (p<0.001). A 3-factor model was generated by principal component analysis. CONCLUSION: The psychometric value of PSQI in screening for insomnia among Nigerian students was moderate compared to what has been obtained in Western cultures. Nonetheless, it is still a useful instrument in the detection of sleep problems in this population.

Can ultrasound fetal biometry predict fetal hyperinsulinaemia at delivery in pregnancy complicated by maternal diabetes?

OBJECTIVE: The aim of this study was to determine whether there is an association between ultrasound fetal biometry and amniotic fluid insulin levels at delivery in women with pre-existing diabetes or impaired glucose tolerance in pregnancy. STUDY DESIGN: This retrospective cohort study identified 93 women who had amniotic fluid insulin levels measured at time of delivery. Standardised estimated fetal weight and fetal growth velocity were calculated from serial third trimester fetal ultrasound measurements. RESULTS: Women with pre-existing diabetes had significantly greater mean growth velocity [1.39 (95% CI: 0.43-2.23) versus 0.39 (95% CI: -01.7-0.95); p=0.04], significantly greater mean estimated fetal weight (EFW) Z score prior to delivery [2.36 (95% CI: 1.82-2.9) versus 1.38 (95% CI: 1.02-1.74); p=0.002] and greater mean birthweight centile [82 (95% CI: 0.74-0.89) versus 67 (95% CI: 58-76); p=0.02] than those with GDM/IGT. Amniotic fluid insulin levels demonstrated a similar significant difference between the pre-existing and GDM/IGT groups [20.5 (95% CI: 12.9-28.1) versus 8.5 (95% CI: 5.4-11.7); p=0.001]. An association between fetal growth and size and amniotic fluid insulin was observed in women with pre-existing diabetes. Positive likelihood ratios were 1.67 and 2.08, respectively, for the prediction of liquor insulin greater than the 95th centile in women with pre-existing diabetes. CONCLUSION: Ultrasound measures of fetal size and growth used in this study are not sufficiently accurate to predict those infants likely to be at risk from the adverse effects of fetal hyperinsulinaemia.

Prevalence and correlates of depression in late pregnancy among Nigerian women.

The objectives of this study were to estimate the prevalence of depressive disorder in late pregnancy in a group of Nigerian women and to examine the associated factors. One hundred and eighty women in late pregnancy completed a questionnaire on sociodemographic and obstetrical details. They also completed the Edinburgh Postnatal Depression Scale (EPDS). A proportion of them were then assessed for the DSM-IV diagnosis of depressive disorder. Fifteen (8.3%) women met the current (2 weeks) DSM-IV diagnosis of depressive disorder. The factors independently associated with depression included being single [odds ratio (OR)=16.67, 95% confidence interval (CI)=3.17-87.76], divorced/separated (OR=11.11, 95% CI=1.55-19.65), polygamous (OR=3.92, 95% CI=0.94-16.33), and having a previous history of stillbirth (OR=8.00, 95% CI=1.70-37.57) and perceived lack of social support (OR=6.08, 95% CI=1.42-26.04). Depression is common in late pregnancy among Nigerian women, with the significant correlates including mainly social and family factors. Such factors should be considered when planning health care services or formulating a predictive model. Interventions aimed at reducing the occurrence of antenatal depression need further research.

Relationship between depression and quality of life in Nigerian outpatients with heart failure.

OBJECTIVE: Our objective was to evaluate the relationship between depression and health-related quality of life (QoL) in Nigerian outpatients with heart failure (HF). METHODS: We used a cross-sectional study in which outpatients with HF (n=100) completed the WHO Quality of Life Scale-Brief Version to assess their subjective QoL. The patients were also assessed for the diagnosis of major depressive disorder (MDD) in accordance with the Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition. RESULTS: The factors independently associated with poor QoL include disability due to illness, presence of MDD, younger age, and longer duration of illness. Patients with MDD had worse QoL than patients without MDD on dimensions of physical health, psychological health, and environment. CONCLUSION: Depression adversely affects the QoL of patients with HF. Programs designed to improve the QoL of patients with HF need to incorporate the early identification and treatment of depression. Future studies are warranted to investigate the impact of improved depression management on QoL in patients with HF.

Prevalence and correlates of major depressive disorder in Nigerian outpatients with heart failure.

This study aims to estimate the prevalence and correlates of major depressive disorder (MDD) in Nigerian outpatients with heart failure. Authors assessed patients with heart failure (N = 102) for DSM-IV diagnosis of MDD and obtained sociodemographic and clinical data. MDD was found in 28 (27.5%) of the patients. The significant correlates predicting MDD included unemployment and disability due to the illness, more severe illness (NYHA class), age younger than 60 years, and not being married. These factors should be considered in planning further studies and in screening and intervention programs for patients with heart failure.

Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students.

BACKGROUND: The common self-rated depression scales are lengthy, old and do not reflect the current diagnostic classifications criteria of depressive disorders. This study aimed to validate the Patient Health Questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. METHODS: A representative sample of university students (n=512) completed the PHQ-9 and the Beck's Depressive Inventory (BDI). They were also interviewed for clinical diagnoses of depressive disorders using the Mini International Neuropsychiatric Interview (MINI). RESULTS: The internal consistency of questions within the PHQ-9 was 0.85. The PHQ-9 had good concurrent validity with the BDI (r=0.67, P<0.001). It also had a good (r=0.894, P<0.001) one month test-retest reliability. Using the Receiver Operating Characteristic (ROC) curve, the optimal cut-off score for minor depressive disorder is 5 (sensitivity 0.897, specificity 0.989, Positive Predictive Value - PPV 0.875, Negative Predictive Value - NPV 0.981 and Overall Correct Classification - OCC rate 0.973) while for major depressive disorder only is 10 (sensitivity 0.846, specificity 0.994, PPV 0.750, NPV 0.996 and OCC rate 0.992). LIMITATIONS: The study limitations include use of a specific group in community, moderate sample size and screening for only minor and major depressive disorders while neglecting other depressive disorders. CONCLUSIONS: The PHQ-9 has good psychometric properties amongst Nigerian university students. Because of its validity, reliability, brevity and ease of administration, the PHQ-9 will be a valuable tool for estimating depression amongst college students in Nigerian community. More studies are needed to test the usefulness of the translated local language versions of this instrument amongst the community in sub-Saharan Africa.

Gender differences in the relationship between alcohol use and anxiety symptoms among Nigerian college students.

Few studies have addressed the effect of gender on the relationship between alcohol and anxiety. Students in a Nigerian university, grouped into five separate categories of alcohol use completed the Zung's Self Rating Anxiety Scale. Although a non-linear "J shaped" relationship was found between alcohol use and anxiety symptoms among males, a linear relationship was found among females. Women tend not to share the positive effect moderate alcohol use confers on anxiety status. This gender difference may be an important consideration when planning preventive strategies for alcohol related problems in Nigerian youths.