Healthcare users' knowledge and experiences regarding the management of scabies in the Deder district, Ethiopia

Background. Scabies is an ectoparasitic, highly contagious skin disease caused by a human itch mite infes tation of the skin, and it is the leading cause of morbidity and disease burden in developing countries. The purpose of this study was to investigate healthcare users' current knowledge and experiences with scabies management provided at primary healthcare facilities. Materials and Methods. A qualitative research design was used to address the research objectives. Focus group interviews with 58 health care users were used to collect data. Thematic analysis was performed on the verbatim transcriptions using Tesch's approach. Results. The findings showed that the knowledge of healthcare users who participated in the study on scabies, its management, prevention, and control was limited. Health care users experience different chal lenges regarding scabies and the management thereof. Five themes emerged after data analysis. These were knowledge regarding scabies, knowledge regarding the management of scabies, knowledge regarding the prevention of scabies, perceptions regarding receiving treatment for scabies, and recommendations regarding the availability of materials and medication. Conclusions. Healthcare users in the area had limited knowledge and experienced different challenges regarding scabies and their management. These challenges contribute to low quality health services with undesir able health outcomes. To narrow this gap, consistent and programed health education was provided to the community through different modalities by using the existing health system to increase awareness regarding scabies. Following the implementation of community awareness, each commu nity member was positioned to prevent and control scabies.

THe characteristics and costs of severe theophylline toxicity in a tertiary critical care unit in Eastern Cape Province, South Africa

Severe theophylline toxicity requiring haemodialysis accounts for approximately one-third of drug toxicity cases admitted to the Livingstone Tertiary Hospital (LTH) intensive care unit (ICU) in Gqeberha, South Africa, imposing a significant resource burden.Objectives. To investigate the characteristics and burden of severe theophylline toxicity in an Eastern Cape Province tertiary hospital adult ICU.Methods. A retrospective review of all severe theophylline toxicity admissions to the ICU from 1 January 2013 to 31 December 2018 was conducted. Demographic and clinical data were captured and analysed. The National Department of Health 2019 fees schedule was used to calculate costs based on duration of ICU stay and number of haemodialysis sessions received.Results. Of the 57 patients included in the study, 84% were cases of deliberate self-harm. The majority were aged <40 years (77%) and female (79%). The mean (standard deviation (SD)) initial serum theophylline level was 612 (269) µmol/L. Complications included convulsions (n=12; 21%), arrhythmias (n=9; 16%), need for mechanical ventilation (n=7; 12%) and death (n=4; 7%). The main risk factors for these complications were age ≥30 years, an inappropriately normal or elevated initial serum potassium level, an elevated serum creatinine kinase level and an elevated initial serum theophylline level. Receiver operator characteristic curve analysis assessing the initial serum theophylline level as a discriminator for life-threatening complications produced an area under the curve of 0.71 for serum theophylline >400 µmol/L (sensitivity 88%, specificity 12%). All the 4 patients who died had an initial serum theophylline level >1 000 µmol/L. The mean (SD) cost per admission amounted to ZAR16 897 (10 718), with a mean of one 4-hour dialysis session per admission.Conclusion. Severe theophylline toxicity, usually in the context of deliberate self-harm, is a preventable yet life-threatening toxicity encountered at LTH. Demographic risk factors include young females from certain areas in and around Gqeberha. Risk factors for complications include older age, paradoxically normal or elevated serum potassium levels, elevated serum creatinine kinase levels and an initial serum theophylline level >400 µmol/L. Patients with these clinical features should be closely monitored and treated timeously at an appropriate level of care. The need for ICU admission and dialysis, both limited resources, makes the treatment of severe theophylline toxicity costly. Further studies of the underlying psychosocial drivers, local prescribing practices and preventive interventions related to severe theophylline toxicity are required.

Economic burden of obstetric fistula among patients in the National Obstetric Fistula Centre, Nigeria

Background: Obstetric fistula (OF) continues to be a major health problem in developing countries such as Nigeria. It is a communication between the vagina and bladder/rectum following prolonged obstructed labor that leads to urine/and fecal leakage per vaginam. There is a paucity of information on cost of accessing care by women with OF. Objective: The study was to evaluate the cost implications of accessing care and treatment among women with OF in the National Obstetric Fistula Centre, Ningi Bauchi, state. Materials and Methods: A prevalence-based cost-of-illness approach was employed in this study to estimate the cost of fistula treatment from the patients' perspective. Data on costs of health-care utilization of services rendered to the patients in the facility and indirect costs were estimated. The data were analyzed with the Statistical Package for the Social Sciences (SPSS V21). Results: A total of 75 women participated in the study. The total costs incurred by all the 75 patients amounted to Nigerian Naira (NGN) 8211640.00 (USD 26923.41). The average cost of accessing care for fistula per patient was NGN109488.50 (USD 358.98). Direct cost accounted for 5751740.00 (USD 18858.16), whereas the indirect cost was 2785600.00 (USD9133.11). There was a significant difference in cost of care between patients that were teenagers compared to those who were not (P = 0.04) and the type of treatment (P < 0.001). Conclusions: The cost of illness of OF is high in the studied area, and the patients are from the low socioeconomic background. Both the direct and indirect costs were high relative to the national minimum wage in Nigeria. The age of the patients and the type of treatment received by the patient accounted for the differences in cost of illness between the patients.

Prise en charge des patients atteints de COVID 19: analyse des prescriptions médicamenteuses au CHU Gabriel Touré / Management of patients with Covid 19: analysis of prescription drugs at Gabriel Touré University Hospital

La COVID-19 est une infection virale qui s'est propagé dans tout le monde. Pour la prise en charge des cas, le Mali a créé des sites de traitement dont celui du CHU Gabriel Touré. Objectif : C'était d'analyser les prescriptions médicamenteuses pour le traitement de la COVID-19 au CHU Gabriel Touré. Méthodologie : L'étude était rétrospective et descriptive et a concerné la période d'avril à septembre 2020. Elle s'est déroulée au Centre de Traitement COVID-19 du CHU Gabriel Touré et à la Pharmacie Hospitalière de cet hôpital. Les ordonnances et les registres d'hospitalisation ont servi à collecter les données. Résultats : Au total, 29 patients ont été hospitalisés. L'âge médian était de 44ans, 75,90% des patients présentaient au moins une pathologie associée à la COVID-19. Le nombre d'ordonnances était de 333 comportant 870 lignes de prescriptions dont 33,21% de traitements standards et 66,79% pour les pathologies associées avec 86,23% disponibles à la Pharmacie Hospitalière. Le phosphate de chloroquine, dosé à 250mg, était administré à 500mg deux fois quotidiennement. Dans les directives nationales le phosphate de chloroquine était à 100mg pour 200mg trois fois quotidienne. La vitamine C non prévue dans les directives a été prescrite à tous les patients. La classe des médicaments du sang et des organes hématopoïétiques a été les plus prescrits (31,49%). Le coût moyen des traitements était de 65602±106858 FCFA avec maximum de 567860 FCFA. Une évaluation des prescriptions dans les autres sites de traitement est nécessaire.

COVID-19 was declared a pandemic in March 2020. For case management, Mali has created several treatment sites including the site of the CHU Gabriel Touré. Aims: The objective of the study was to analyse drug prescriptions for the COVID-19 treatment at the CHU Gabriel Touré. Methods: We performed a retrospective and descriptive study from April to September 2020. Drug prescriptions and hospital records were used to collect data. Prescriptions and hospital records were used to collect data. Results: A total of 29 patients were hospitalized. The median age was 44 years, 75.90% of patients had at least one pathology associated with COVID-19. The number of prescriptions was 333 comprising 870 lines of prescriptions including 33.21% for standard treatments, and 66.79% for associated pathologies. with 86.23% available at the Hospital Pharmacy. Chloroquine, dosed at 250mg, was administered at 500mg twice a day. The national guidelines from the treatment of COVID19 recommends 200mg of chloroquine in two doses. Vitamin C was prescribed for all patients although not included in the national guidelines. The class of drugs for the blood and blood-forming organs was the most prescribed (31.49%). The average cost of treatments was 65,602 ± 106,858 FCFA with a maximum of 567,860 FCFA. An evaluation of prescriptions in other treatment sites is necessary.

Caregivers' Perceptions of Burden and Health- Promoting Behaviours among Informal Caregivers of Cancer and Stroke Patients Attending Tertiary Care Facilities in South- South Nigeria

Family caregivers' role in cancer and stroke care is overly burdensome. Studies have considered burden and predictors of burden but the influence of caregiving burden on health - promoting behaviours among cancer and stroke family caregivers in Nigeria is scarce. The purpose of this study was to determine the influence of caregivers' perceptions of burden and health-promoting behaviours on informal caregivers of cancer/ stroke patients attending tertiary care facilities in South- South Nigeria. A descriptive cross-sectional survey was employed among 410 purposively selected cancer/ stroke patients' family caregivers in tertiary care facilities, South- South Nigeria. A standardized Zarit burden interview scale and structured questionnaire were used to measure burden and determine health-promoting behaviours respectively. Descriptive (means, standard deviation and percentages) and inferential (ANOVA) statistics with a Fisher's protected t- test at 0.05 level of significance were used for data analysis. The respondents experienced severe (F= 14.02; P= 0.810) burden in caregiving to cancer/ stroke patients. The influence of health- promoting behaviours (primary, secondary and tertiary preventions) among caregivers of cancer/ stroke is significantly high in the tertiary care facilities, South-South, Nigeria. Caregivers of cancer and stroke patients experienced severe levels of burden and health-promoting-behaviours in terms of prevention at the primary, secondary and tertiary activities were significantly high among respondents. This calls for knowledge mobilization and dissemination in Nigeria and beyond.

Early detection of Pre-XDR TB with line probe assay in a high TB burden country

Background - Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria. Methods - This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL). Results - Mean age was 38.6 ± 13.4 years with peak age at 35-44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive. Conclusion - Multidrug resistant TB and its severe forms (Pre-extensive & extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment.

Experiences of grandmothers caring for female adolescents living with HIV in rural Manzini, Eswatini: a caregiver stress model perspective

The HIV pandemic has immense effects on the Eswatini population. The burden of caregiving rests on women, typically grandmothers who are elderly and dealing with chronic diseases themselves. The purpose of this study was to explore and describe the experiences of grandmothers in Eswatini caring for female adolescents living with HIV. The study draws on phenomenological fieldwork of six case studies of grandmother­granddaughter pairs who were purposively sampled. Data were collected through in-depth individual interviews that commenced with broad questions: "How is it for you to care for a female adolescent living with HIV?" for the grandmothers, and "How is it for you to live with HIV?" for female adolescents. Data were transcribed verbatim and analysed thematically following the elements of the caregiver stress theory. Drawing on the caregiver stress model, grandmothers and female adolescents experienced input stimuli of financial difficulties related to daily provisions for food and transport fare. Control processes experienced by grandmothers and female adolescents related to feelings of loss, grief, fear, hopelessness and isolation along with suicidal ideation for female adolescents. Regarding output stimuli, grandmothers and female adolescents developed psychological unrest related to difficulty accepting the HIV diagnosis and concerns about the future. Grandmothers experienced ill health due to the demands of the caregiving role. It is recommended that family, financial and psychological support be made available for grandmothers to lighten the duty of caregiving

Drivers of cost of treatment for traumatic spinal cord injury in ibadan, Nigeria

Background:Traumatic Spinal Cord Injury (TSCI) is a costly condition in human and economic terms. Yet, studies on direct cost of treatment for TSCI in resource-constraint countries are sparse.Objective:To estimate the direct cost of treatment for patients with TSCI at the University College Hospital (UCH), Ibadan, Nigeria using an incidence-based costing approache Methods:All new cases of TSCI admitted in the hospital from January, 2009 to December, 2013 were identified and reviewed. Direct costs of in-patient and out-patient treatments over the first year of injury were estimated.Results:114 individuals with TSCI (73 males; 41 females) were admitted and discharged home alive from the hospital. The largest cost driver to the patients and the National Health Insurance Scheme was cost of consultations by neurosurgeons which constituted about a third (34.4%) of the total costs of treatment. Less than a fourth (24.2%) of the total cost of in-patient treatment was spent on therapeutic interventions (surgery, drugs and physiotherapy). There was a significant relationship between the direct cost of treatment and each of the severity of traumatic spinal cord injury and length of hospital stay (p = 0.01). Level of injury was not significantly associated with direct cost of treatment (p=0.89).Conclusion:Direct cost of treatment for individuals with TSCI in Ibadan, Nigeria is substantial. This high cost underscores the need for novel service models with potential for minimizing cost for patients with TSCI in Nigeria

Controlling hepatitis C in Rwanda: a framework for a national response

With the introduction of direct-acting antiviral drugs, treatment of hepatitis C is both highly effective and tolerable. Access to treatment for patients, however, remains limited in low- and middle-income countries due to the lack of supportive health infrastructure and the high cost of treatment. Poorer countries are being encouraged by international bodies to organize public health responses that would facilitate the roll-out of care and treatment on a national scale. Yet few countries have documented formal plans and policies. Here, we outline the approach taken in Rwanda to a public health framework for hepatitis C control and care within the World Health Organization hepatitis health sector strategy. This includes the development and implementation of policies and programmes, prevention efforts, screening capacity, treatment services and strategic information systems. We highlight key successes by the national programme for the control and management of hepatitis C: establishment of national governance and planning; development of diagnostic capacity; approval and introduction of direct-acting antiviral treatments; training of key personnel; generation of political will and leadership; and fostering of key strategic partnerships. Existing challenges and next steps for the programme include developing a detailed monitoring and evaluation framework and tools for monitoring of viral hepatitis. The government needs to further decentralize care and integrate hepatitis C management into routine clinical services to provide better access to diagnosis and treatment for patients. Introducing rapid diagnostic tests to public health-care facilities would help to increase case-finding. Increased public and private financing is essential to support care and treatment services

Peptic ulcer Disease drugs usage patterns and its economic burden in a tertiary health institution in Niger Delta, Nigeria

Background: Drug utilization evaluation for peptic ulcer disease and its cost implication are rare in Niger Delta. The objective of the study was to evaluate drug usage pattern in peptic ulcer diseases as well as its cost implications.Methods: The cross sectional drug use evaluation study involving the use of questionnaire and patient case notes was carried out in a tertiary health institution. The validated pretested questionnaire was interviewer administered to 300 patients sampled consecutively followed by a retrospective review of their respective case notes between April to November 2013. Information collected include risk factors, prescribed drugs, Helicobacter pylori assay test results among others. Cost of each drug and therapy were then computed appropriately. Data was analyzed using Statistical package for Social Sciences (SPSS) version 20, Microsoft Excel and Graph Pad Prism for windows Instat Version 3.Results: Out of the 300 patients, H. pylori test was conducted in 262 (87.3%) while the presence or absence of the organisms could not be confirmed in the remaining 38 subjects. Out of the 262 patients with H. pylori test results, only 166 representing 63.4% were positive. History of non-steroidal anti-inflammatory drugs (NSAID) usage was very high among the subjects (250; 83.3%) and highest for ibuprofen 146 (48.7%). The most prescribed drugs were antacids (268; 89.3%), amoxicillin (165; 55.0%), and a combined formulation of omeprazole, tinidazole, and clarithromycin in 140 (46.7%) subjects, followed by omeprazole alone (125; 41.7%).The national direct cost implication for the estimated 17.6 million is in the range of NGN186,849,000,000.00 ($958,200,000.00), out which NGN109,867,000,000.00($563,420,513.00) was for PUD drugs (50.9%) and NGN32,698,575,000.00 ($167,685,000.00) for H. pylori tests (17.5%), while the remaining 31.7% valued at NGN59,231,133,000.00 ($303,749,400.00) was for non-ulcer drugs, personnel and transportation.Conclusion: The pattern of drugs usage is consistent with standard treatment guidelines. Peptic ulcer drugs for the 300 subjects constituted NGN1,618,641 ($8300.72) which represents 73.0% of the total amount spent on drugs. The national direct cost of PUD is close to NGN200 billion ($1.04 billion). Updated information on drug usage and their costs is needed for improved usage and system efficiency

The Impact of a Change in Referral Pathway on a Paediatric Short-Stay Ward in Cape Town; South Africa

Background. The opening of the new Khayelitsha District Hospital in April 2012 coincided with a change in referral pathway to Tygerberg Hospital (TBH) for children requiring specialist care. Objective. To determine the disease burden impact of the referral pathway change on paediatric short-stay ward admissions at TBH. Methods. A retrospective cohort study; analysing routine health information as captured in ward admissions registers over two similar seasonal periods: 1 April - 30 September 2011 (prior to referral change) and 1 April - 30 September 2012 (post referral change). Results. Paediatric short-stay ward admissions remained similar; but a statistically significant increase in the number of admissions from Khayelitsha sub-district (SD) (p0.001) was seen. The median age was 13 months over the two time periods.Children from Khayelitsha (median age 9.49 months for 2011 and 5.2 months for 2012) were; however; significantly younger than those from other SDs (median age 26.31 months in 2011 and 26.44 months in 2012) (p

The End of AIDS: Possibility or Pipe Dream? A Tale of Transitions

Globally; in the last 20 years health has improved. In this generally optimistic setting HIV and AIDS accounts for the fastest growing burden of disease. The data show the bulk of this is experienced in Southern Africa. In this region; HIV and AIDS (and tuberculosis [TB]) peaks among young adults. Women carry the greater proportion of infections and provided most of the care. South Africa has the dubious distinction of having the largest number of people living with HIV in the world; 6.4 million. HIV began spreading from about 1990 and today the prevalence among antenatal clinic attendees is 29.5. A similar situation exists in other nations of the region. It is an expensive disease; requiring more resources than are available; and it is slipping off the global agenda; both in terms of attention and international funding. Those halcyon days of the decade from 2000 to 2010 are over. This paper explores the concept of three transition points: economic; epidemiological and programmatic. The first two have been developed and written about by others. We add a third transition point; namely programmatic; argue this is an important concept; and show how it can become a powerful tool in the response to the epidemic.The economic transition point assesses HIV incidence and mortality of people infected with HIV. Until the number of newly infected people falls below the number of deaths of people living with HIV; the demand for treatment and costs will increase. This is a concern for the health sector; finance ministry and all working in the field of HIV. Once an economic transition occurs the treatment future is predictable and the number of people living with HIV and AIDS decreases. This paper plots two more lines. These are the number of new people from the HIV infected pool initiated on treatment and the number of people from the HIV infected pool requiring treatment. This introduces new transition points on the graph. The first when the number of people initiated on treatment exceeds the number of people needing treatment. The second when the number initiated on treatment exceeds the new infections.That is the theory. When we applied South African data from the ASSA2008 model; we were able to plot transition points marking progress in the national response. We argue these concepts can and should be applied to any country or HIV epidemic

The Economics; Financing and Implementation of HIV Treatment as Prevention: What will it Take to Get there?

"The 2013 Lancet Commission Report; Global Health 2035; rightly pointed out that we are at a unique place in history where a ""grand convergence"" of health initiatives to reduce both infectious diseases; and child and maternal mortality - diseases that still plague low income countries - would yield good returns in terms of development and health outcomes. This would also be a good economic investment. Such investments would support achieving health goals of reducing under-five (U5) mortality to 16 per 1 000 live births; reducing deaths due to HIV/AIDS to 8 per 100 000 population; and reducing annual TB deaths to 4 per 100 000 population. Treatment as prevention (TasP) holds enormous potential in reducing HIV transmission; and morbidity and mortality associated with HIV/AIDS - and therefore contributing to Global Health 2035 goals. However; TasP requires large financial investments and poses significant implementation challenges. In this review; we discuss the potential effectiveness; financing and implementation of TasP. Overall; we conclude that TasP shows great promise as a cost-effective intervention to address the dual aims of reducing new HIV infections and reducing the global burden of HIV-related disease. Successful implementation will be no easy feat; though. The dramatic increases in the numbers of persons who need antiretroviral therapy (ART) under a TasP approach will pose enormous challenges at all stages of the HIV treatment cascade: HIV diagnosis; antiretroviral (ARV) initiation; ARV adherence and retention; and increased drug resistance with long-term enrolment on ART. Overcoming these implementation challenges will require targeted implementation; not focusing exclusively on TasP; most-at-risk population (MARP)-friendly services for key populations; integrating services; task shifting; more efficient programme management; balancing supply and demand; integration into universal health coverage efforts; demand creation; improved ART retention and adherence strategies; the use of incentives to improve HIV treatment outcomes and reduce unit costs; continued operational research and tapping into technological innovations."

The Cost of Nephroblastoma Treatment in South Africa: A Very Cost-Effective Investment with Guidelines for the Rest of Africa

Background. Nephroblastoma is one of the most common childhood malignancies in Africa; but with a survival rate significantly lower than in developed countries. In African countries with a small gross domestic product (GDP) per capita; the cost of treating nephroblastoma may be prohibitive. Objectives. To determine the direct costs of treatment of nephroblastoma in South Africa (SA) and to propose a more cost-effective approach to investigations and treatment for the disease in Africa. Methods. Data from 2000 - 2010 from two SA paediatric oncology units were retrospectively analysed. The costs included investigations; chemotherapy and radiotherapy; comparing early-v. advanced-stage disease. In both units; the nephroblastoma International Society of Paediatric Oncology (SIOP) protocol was used. Results. Stage I disease was the most common; followed by stage IV. The total cost of diagnosis; staging and treatment of stage I disease was ZAR9 304.97 (EUR882.80 or USD1 093.40); compared with a five-times higher cost for stage IV (ZAR48 293.62 (EUR4 581.9 or USD5 674.9)). Treating one patient averted more than 32 disability adjusted life years. The investigation and treatment of early- and advanced-stage disease is very cost-effective when compared with the local GDP per capita. Conclusion. The cost of investigation and treatment of nephroblastoma remains a challenge everywhere; but especially in Africa. However; it is a very cost-effective disease to treat and children in Africa should not be denied treatment

The Burden of Non-Communicable Diseases in Nigeria; in the Context of Globalization Highly Accessed Article

This paper highlights the tenets of globalization and how its elements have spread to sub-Saharan Africa; and Nigeria in particular. It assesses the growing burden of non-communicable diseases (NCDs) in Nigeria and its relationship with globalization. It further describes the conceptual framework on which to view the impact of globalization on NCDs in Nigeria. It assesses the Nigerian dimension of the relationship between the risk factors of NCDs and globalization. Appropriate recommendations on tackling the burden of NCDs in Nigeria based on cost-effective; culturally sensitive; and evidence-based interventions are highlighted

Information systems for monitoring the burden of chronic diseases in public reference health facilities in Rwanda; Burundi and Eastern DRC

Chronic diseases are an increasingly important cause of death in sub-Saharan Africa. Diseases such as cancer; diabetes and arterial hypertension remained for years in the background; in the shadow of pandemics such as malaria; HIV / AIDS and tuberculosis. In the past 6 years; 4 reference hospitals of Kisangani; Bukavu; Kigali and Bujumbura implemented hospital information systems enabling sophisticated analysis of the diagnostic variance of out-patient visits and in-patient admissions. Important volumes of chronic disease data have been collected in a period between 2006 and 2012; demonstrating that the problem of chronic diseases also grows rapidly in the Great Lakes region and therefore urgent steps must be taken; both by governments (Rwanda; DRC and Burundi); by the international donor community and by local hospital boards

Stigmatising attitudes towards the mentally ill: a survey in a Nigerian university teaching hospital

Background. The burden of mental illness is particularly severe for people living in low-income countries. Negative attitudes towards the mentally ill; stigma experiences and discrimination constitute part of this disease burden.Objective. The aim of this study was to investigate knowledge of possible causes of mental illness and attitudes towards the mentally ill in a Nigerian university teaching hospital population.Method. A cross-sectional descriptive study of a convenience sample of 208 participants from the University of Uyo Teaching Hospital; Uyo; Nigeria; using the Community Attitudes towards the Mentally Ill (CAMI) scale. Information was also obtained on beliefs about possible causes of mental illness.Results. The respondents held strongly negative views about the mentally ill; mostly being authoritarian and restrictive in their attitudes and placing emphasis on custodial care. Even though the respondents appeared to be knowledgeable about the possible role of psychosocial and genetic factors in the causation of mental illness; 52.0 of them believed that witches could be responsible; 44.2 thought mental illness could be due to possession by demons; and close to one-third (30) felt that it could be a consequence of divine punishment.Conclusions. Stigma and discrimination against the mentally ill are widespread even in a population that is expected to be enlightened. The widespread belief in supernatural causation is likely to add to the difficulties of designing an effective antistigma psycho-educational programme. There is a need in Nigeria to develop strategies to change stigma attached to mental illness at both institutional and community levels