Forensic psychiatric assessment process and outcome in state patients in KwaZulu-Natal, South Africa

Background: Individuals who were charged with a serious offence may be referred by courts for forensic psychiatric assessment. The court may declare them as state patients if they are found unfit to stand trial or not criminally responsible because of mental illness or defect. In forensic psychiatry practice, there may be challenges in the forensic psychiatric observation process, and discrepancies may occur between the clinician report and the court's decision. Objectives: To describe elements of the forensic psychiatric observation and discuss the legal correlates associated with the admission of state patients. Method: A retrospective study of the forensic psychiatric observation records of 91 newly admitted state patients at a forensic unit in KwaZulu-Natal over a 3-year period. Results: A total of 71 state patients (78.02%) were found not fit to stand trial and 10 patients (10.99%) were not criminally responsible. Nine patients (9.89%) were fit to stand trial and criminally responsible but still declared state patients and 13 state patients (14.29%) did not commit a serious offence. There was correlation for diagnosis between the assessing and the treating psychiatrists. Conclusion: The findings of the forensic observation were not always considered by the courts. Individuals found fit to stand trial, those found criminally responsible and those who did not commit serious crimes were declared state patients. A better understanding of legal dispositions for mentally ill offenders and an active collaboration between judicial and mental health systems may contribute in developing national guidelines for observation and admission of state patients

Hypertension in rural communities in Delta State, Nigeria: Prevalence, risk factors and barriers to health care

Introduction: Hypertension is a global health challenge and its prevalence is increasing rapidly amongst adults in many African countries. Some studies on the prevalence and risk factors of hypertension have been conducted in Nigeria; but none within Delta State. We assessed the prevalence of hypertension and associated risk factors amongst adults in three villages in the Ibusa community in Delta State; Nigeria.Method: Homesteads were randomly selected and all consenting adults (= 18 years of age) were recruited for this cross-sectional study (134 individuals: 48 men; 86 women). Sociodemographic data and anthropometric measurements (weight; height and abdominal circumference) were recorded. Diagnosis of hypertension was based on blood pressure= 140/90 mmHg.Result: Hypertension prevalence in this rural community was 44%. Results from one village (Ogboli: 82%) and ethnic group (Ibo: 50%) were significantly higher than in others in the same variable category. Multivariate logistic regression analysis suggested increasing age; increasing body mass index and high salt intake as prominent risk factors for hypertension. Lack of funds and equipment shortage in clinics were most often reported as barriers to healthcare.Conclusion: A nutritional education programme to promote low-cholesterol and low-salt diets is recommended to specifically target people in higher-risk areas and of higher-risk ethnicity. Local barriers to accessing health care need to be addressed

Enhancing Policy Maker Decisions: a Framework to Assess Determinants and Space-Time Risk of Infant; Child and Adult Mortality in Rural South Africa and Elsewhere

"Reliable mortality data are essential for planning health interventions; yet such data are often not available or reliable in developing countries; especially in sub-Saharan Africa. Health and socio-demographic surveillance sites; such as Agincourt in South Africa; are often the only way to assess and prospectively understand health trends at a population level; and thus have the potential to address this gap. This article summarises the main findings from my PhD in which advanced methods were applied to better understand the dynamics of age-specific mortality both in space and time; to identify age-specific mortality risk factors which have a high ""impact"" at a population level; and to relate inequalities in risk factor distributions to observed spatial mortality risk patterns."