Bola A. Ola

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian women.

This study aimed to examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for depression in late pregnancy among Nigerian women. A total of 182 women in late pregnancy (32–36 weeks) completed either the English or the translated Yoruba language version of the EPDS and a proportion of them were then assessed for the presence of DSM-IV major and minor depressive disorders using the MINI International Neuropsychiatric Interview. A cut-off score of 10 on the EPDS was found to be the best for screening for both major and minor depression (sensitivity = 0.867, specificity = 0.915, Diagnostic Likelihood Ratio for a positive result = 10.200). When screening for major depression only, a cut-off of 12 was found to the most appropriate (sensitivity = 1.000, specificity = 0.961, Diagnostic Likelihood Ratio for a positive result = 25.641). The EPDS is a valid and useful instrument in screening for depression in late pregnancy among Nigerian women.

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.

Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women.

Objective: Studies from the Western culture have emphasized psychosocial risk factors for the development of postnatal depression (PND). In Africa, poor obstetrics practice and sociodemographic factors may contribute significantly to the risk of PND. The goal of this study was to examine sociodemographic and obstetric risk factors for postnatal depressive symptoms in a Nigerian community. Methods: 876 women recruited at 6 weeks postpartum from the postnatal and infant immunization clinics of 5 participating health centers were screened with the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and obstetric information were also obtained through a structured questionnaire. Results: The mean EPDS score was 5.66 (SD = 4.20). Depression was diagnosed in 128 (14.6 %) of the postpartum women. The predictors of PND include hospital admissions during the pregnancy (OR 3.95, CI 2.57-6.07), female sex of the baby (OR 2.74, CI 1.87-4.03), preterm delivery (OR 4.21, CI 2.78-6.39), instrumental delivery (OR 3.32, CI 1.79-6.16), Cesarean section (OR 3.58, CI 1.72-7.48), and being single (OR 3.44, CI 2.15-5.53). Conclusion: Although the prevalence of PND symptoms seems to be the same across cultures, risk factors differ significantly. This study identified certain sociodemographic and obstetric risk factors for postnatal depressive symptoms in an underdeveloped community. These factors must be taken into consideration when planning intervention and preventive strategies for these women.

Anxiety disorders among Nigerian women in late pregnancy: a controlled study

SummaryThis study aimed to investigate the rate and type of anxiety disorders among Nigerian women in late pregnancy. Women in late pregnancy (n = 172) and a non-pregnant control group were assessed for DSM-IV anxiety disorders. The rate of any anxiety disorder in the pregnant women was 39.0% compared with 16.3% in the non-pregnant population (p < 0.001). Although all the anxiety disorders were more common, only the rate of social anxiety disorder was significantly higher among the pregnant than non-pregnant population. Correlates of anxiety disorder in the pregnant population include age less than 25 years (OR 4.62, 95% CI 2.39–8.92), primiparity (OR 3.90, 95% CI 2.00–7.59) and presence of medical conditions (OR 3.60, 95% CI 1.28–10.12). More research is needed in this field to ascertain the specific association between pregnancy and anxiety disorders.

Attitude towards antipsychotics among out-patients with schizophrenia in Nigeria

Objective:  The study aim to assess the attitude of patients with schizophrenia attending out‐patient clinics in Nigeria towards antipsychotic medication and examine the factors associated with such attitude.

Quality of Life and Associated Factors among Adults with Epilepsy in Nigeria

Objective: Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment. Method: Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE), and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings. Results: The mean age of the 51 respondents was 27.7years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life included being female (p < 0.05), seizure frequency (p < 0.01), using more than 1 anti-epileptic drugs (AEDs) (p < 0.01), GHQ-30 score (p < 0.01), high anxiety score (p < 0.001), and high depression score (p < 0.01). Multiple regression analysis showed that depressive symptoms were the single most important factor explaining low QOL. Other factors were GHQ-30 score, seizure frequency, and being a woman. Conclusion: Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptics.

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.

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

BackgroundMaternal 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.MethodsA 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 Womens Health and Domestic Violence Questions assessed womens 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.Results189 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).ConclusionsRates 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.

Preparedness for Management and Prevention of Violence Against Women by Nigerian Health Professionals

The objective of this study was to determine the knowledge, attitude and actions of health professionals in Nigeria towards women experiencing spousal violence. A descriptive survey of 134 randomly selected respondents out of 572 health professionals in a tertiary health institution in South Western. Nigeria was carried out. Data were analyzed using descriptive statistics, tests of significance, factor and item analyses. Thirty eight percent of cases of violence against women (VAW) may not be identified and 42% of the identified cases would not be properly managed. Majority (87.5%) of the respondents have at least one form of wrong attitude towards victims of IPV. The knowledge of nurses and doctors in South Western Nigeria on the management of VAW is generally inadequate. Capacity building, through re-training of staff, strengthening education on IPV at both undergraduate and postgraduate levels, is imperative.

School children's stigmatising attitude towards peers with epilepsy in Nigeria

Very few studies have examined stigmatising attitudes towards epilepsy by school children in Africa. We explored attitude towards epilepsy among 205 secondary school students in Lagos, Nigeria. Stigmatising attitude was measured by a modified Bogardus Social Distance Scale. A significant proportion of the students endorsed negative attitudes towards peers with epilepsy. For example, only 24% thought most students would invite an affected person to their birthday party and only 31% thought most students would like to study together with a person with epilepsy. Whereas 40% believed that epilepsy is caused by evil spirits, 24% believed it is infectious. Also, 37% believe their families consider epilepsy shameful, and 29% believe their families would not approve of friendship with a peer with epilepsy. Regression analysis identified significant predictors of increased stigmatising attitude as follows: perceived negative family attitude, limited familiarity with epilepsy and belief that epilepsy is caused by evil spirits. Our finding that the childrens perception of their familys negative attitude predicted their own stigmatising attitude towards epilepsy is unique. It suggests that interventions to reduce negative attitudes towards epilepsy by school children in this region may be more effective if the strategies include their families. Such intervention should include provision of accurate information on epilepsy.