Attitudes toward kidney donation.

The Renal Unit of Obafemi Awolowo University Teaching Hospital Ile-Ife in Southwest Nigeria intends commencing a kidney transplantation program. This cross-sectional study aimed at examining the willingness of Nigerians to be living-related kidney donors. Three hundred and sixteen Nigerians (96 first-degree relatives of end-stage renal disease patients, 69 rural dwellers and 151 health workers) were interviewed regarding their willingness to donate kidneys using an interview schedule designed to elicit socio-demographic information, knowledge about kidney transplantation and attitude toward kidney donation. Sixty-two percent of health workers, 52.1% of the patients' relatives and 27.1% of rural dwellers expressed willingness to donate. Higher proportions of health workers and patients' relatives--compared with the rural dwellers--were willing to donate a kidney to their children, full-siblings and parents (P<0.05). The level of awareness about kidney transplantation was highest among health workers and least among rural dwellers (P<0.001). Altruism was the primary motivation for those willing to donate a kidney. The most important reason for refusal to donate was fear of adverse health consequences. Among the rural dwellers, never-married persons were more willing than the married to donate (P<0.05). Programs aimed at increasing awareness about the safety of kidney donation, reducing adverse beliefs about kidney donation, and encouraging altruistic tendencies will increase the availability of kidney donors.

Fiji norms and a cross-cultural clinical validation of the General Health Questionnaire (GHQ 20).

Norms are presented for the 20-item version of the General Health Questionnaire (GHQ 20) that were obtained from a non-clinical group of the Fiji population. The data was required to give meaning to the results that had been obtained from a group of former hostages and the families of hostages that were still in custody. With the omission of two items, the outcome endorsed the robust psychometric properties of the instrument in terms of reliability and factor structure, and supported its use with quite a different cultural population from that for which originally it was designed. A validation study also showed expected differences between the normative group and the hostage group, with members of the hostage group classified after clinical interviews showing the most significant stress and receiving the highest scores on all four subscales as well as the full scale.

The psychometric cross-cultural validation of the Impact of Event Scale.

Data is presented from a sample drawn from the general Fiji population to standardise the Impact of Events Scale (IES) and to prepare percentile tables from which validating comparisons could be made with the scores of two target groups from a previous Fiji study. Detailed statistical analyses gave strong support for a general factor and marginal support for the two specified subscale/factors of the measure. Comparisons of group mean scores, and others using the percentile tables, gave confidence that the full IES rating scale was appropriate for the purpose for which it was used, and indicate that clinicians in Fiji might use the IES confidently to validate the judgments of traumatic stress they make from their interviews--presently they have no such psychometric tool available.

Patients attitude towards asthma in Ile-Ife.

BACKGROUND: There seems to be a paucity of data concerning the attitude of asthmatics towards asthma, its treatment and its effects on their lives in most developing countries. Inadequate attention paid to the psychological and social aspects of asthma could be a significant factor responsible for increase in morbidity and mortality from asthma despite major advances in our understanding of the pathophysiology of the disease. This study aimed at investigating the attitude of asthmatics to the disease (using an asthma dislike questionnaire) to form the basis of a more comprehensive health education programme for asthmatics. METHODS: An asthma-dislike questionnaire was administered to asthmatic patients who were invited for an Asthma Education Programme. This was done prior to the commencement of the lectures. Information elicited was on dislike of physical condition, emotional dysfunction, dislike of psychosocial effects, public-life interference and dislike of medication. RESULTS: Two-third of the asthmatics complained of interference with physical activities. Over 25% indicated being more intolerant towards others. 50% of the patients expressed the fear of dying from sudden asthmatic attack. Two-thirds of the patients expressed concern over the increasing cost of medication and adverse effects of asthma on their public lives. CONCLUSION: This study confirmed that asthma is not just a physical condition, but also has psychosocial components, which varies from person to person. The use of a biopsychosocial approach to augment asthma therapy is advocated.

A psychometric evaluation and cross-cultural validation of the 21 item Hopkins Symptom Checklist.

Data relating to the standardisation of a short version of the 21 item Hopkins Symptom Checklist (HSCL 21) is presented. It confirms the presence of three factors, and provides group means and percentile scales that enable comparisons to be made between the scores of a non-clinical sample and those of two separate target groups that had been under stress. These comparisons give confidence that the rating scale is appropriate for the purpose for which it was used, and suggest that the HSCL 21 could be a useful tool for clinicians in Fiji to use as an adjunct to standard interviews in the assessment of the effects of trauma.

Attempted suicide by drug overdose and by poison-ingestion methods seen at the main general hospital in the Fiji islands: a comparative study.

OBJECTIVE: This study examined the prevalence and the characteristics of deliberate self-poisoning patients seen at the main general hospital in the Fiji Islands. METHOD: Thirty-one consecutive patients with deliberate drug-overdose and 27 others with nonoverdosed self-poisoning were compared on sociodemographic and clinical variables. RESULTS: Deliberate self-poisoning cases represented 0.3% of the hospital admissions, and had a rate of 25.9 per 100,000 population. The overdose group was significantly older (P<.05), whereas the poison-ingestion group had significantly greater proportion of males (P<.03). The rate of psychiatric morbidity was significantly higher in the overdose group (P=.04), whereas the history of alcohol abuse was significantly higher in the other group (P=.04). Paracetamol (35.5%) and paraquat (29.7%) were the most commonly used agents. CONCLUSIONS: Age, gender, rate of psychiatric morbidity, or history of alcohol abuse could be predictive of whether drug overdose or poison ingestion would be used for deliberate self-poisoning. This information could be relevant in the formulation of suicide preventive strategies.

Correlates of psychiatric morbidity in typhoid fever in a Nigerian general hospital setting.

This study explored factors associated with psychiatric morbidity in typhoid fever in a Nigerian general hospital. Information such as sociodemographic characteristics, symptom manifestations, results of investigations, neuropsychiatric symptoms, outcome and disposal were obtained from the case files of patients admitted for typhoid fever over a period of six years. The patients with psychiatric morbidity conspicuous enough to be documented by the attending physicians-mostly internists-were compared with those with no documented psychiatric morbidity on sociodemographic and clinical indices. Of the 136 cases, 26 (19.1%) had psychiatric morbidity. This included delirium (73.1%), generalized anxiety disorder (3.8%), depressive episode (3.8%), schizophrenia like disorder (3.8%) and monosymptomatic neuropychiatric manifestations such as apathy, hallucinations and irrelevant talking (15.5%). The clinical and sociodemographic indices that were significantly associated with psychiatric morbidity were diarrhea, blood biochemical imbalance and age (P<.05). Adolescents and young adults were more predisposed to developing psychiatric complications. Some factors potentially associated with psychiatric morbidity in typhoid fever have been identified. There is the need to prospectively assess the burden from psychiatric morbidity and identify interventions that may reduce it.

Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital.

OBJECTIVE: The goal of this study was to explore specific psychiatric morbidity among chronic obstructive pulmonary disease (COPD) patients in Nigeria. METHOD: The mental status of 30 COPD patients was compared with those of 30 uncomplicated hypertensive patients and 30 apparently healthy controls using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE). The sociodemographic characteristics of the three groups were also compared. RESULTS: The COPD population was significantly least educated and predominantly subsistent farmers. Thirty percent of the COPD population, 13.3% of the hypertensive patients and 3.3% of apparently healthy controls had psychiatric morbidity (P<.05). The COPD population, with psychiatric diagnoses consisted of 16.7% depressive episode, 10% generalized anxiety disorder and 3.3% delirium. This pattern is similar to data from industrialized countries. No sociodemographic factors were significantly associated with psychiatric morbidity. CONCLUSION: Improving the psychiatric knowledge of the primary physician will result in better management of the COPD patient.

Recurrent unipolar mania in a psychiatric hospital setting in the Fiji Islands.

This study aimed to determine the rate of unipolar mania and compare its characteristics with those of other bipolar affective disorders in a psychiatric hospital in the Fiji Islands. Fifty-one patients with unipolar mania seen between January 1999 and October 2000, had their diagnosis confirmed using the Schedules for Clinical Assessment in Neuropsychiatry and the International Classification of Diseases, 10th edition. Their demographic and clinical characteristics were compared with those of 31 manic-depressive patients seen during the period under review. Unipolar mania constituted 47.2% of the bipolar affective disorders in this sample. The frequency of episodes, duration of affective illness, mean age at onset, gender distribution, marital status, employment status and race were not significantly different for the unipolar manic and manic-depressive groups (p > 0.05). Family history of major psychiatric morbidity was 9.8% for the unipolar manic patients and 22.6% for the manic-depressive group (p > 0.05). Recurrent unipolar mania may be considered a useful category based on its high rate, although its demographic and clinical characteristics do not clearly distinguish it from manic-depression.

The characteristics of suicide attempters admitted to the main general hospital in Fiji Islands.

OBJECTIVE: To study the characteristics of suicide attempters attending the main general hospital in Fiji Islands. METHOD: Consecutive suicide attempters were clinically evaluated, and their sociodemographic and clinical characteristics were compared with those of other patients seen in the psychiatric service between January 15, 1999 and January 14, 2000. RESULTS: Thirty-nine suicide attempters were seen, representing 36.8% of all the cases referred to the psychiatric service. The prevalence of attempted suicide in the Greater Suva Area was 34.8 per 100,000. Majority (56.4%) were young (16-25 years), Indians (59%), female (61.5%), students (41%), never married (74.4%) and of Hindi faith (48.7%). The commonly used methods were ingestion of drugs and pesticides. The intention to die was present in 20 (51.3%) of the population. Social problems and/or psychiatric comorbidity were present in over 60% of cases. Suicide attempters were significantly younger, more of single persons (P<.0001), and fewer were in employment (P<.001) than nonsuicidal cases seen. The difference was not significant when the two groups were compared regarding gender, race or religion. CONCLUSIONS: Young people attempt suicide in disturbed psychosocial milieu, using available poisoning methods with strong desire to die. Apparently, high proportion of female Indians in this group reflects high rate of service utilization by them. Unemployment is an insignificant predisposing factor.

Factors influencing compliance in patients with tuberculosis on directly observed therapy at Ile-Ife, Nigeria.

BACKGROUND: Increased morbidity and mortality of tuberculosis have been blamed on neglect of the human dimension of tuberculosis control. One of such factors included in human dimension is non-compliance, a behavioural parameter, which has led to the emergence of multi-drug resistant tuberculosis, and poor treatment outcome. OBJECTIVE: To explore the impact of directly observed therapy (DOT) on compliance and the factors influencing it. DESIGN: A retrospective study. SETTING: Chest clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. METHODS: Directly observed therapy (DOT) was employed. Records of the socio-demographic characteristics, treatment categories, complications developed, results of investigations, level of compliance and treatment outcome for the patients were kept. The data for the patients seen between May 1996 and April 1997 were retrieved and analysed. Those that complied were compared with those that did not comply. RESULTS: One hundred and ninety nine patients comprising ninety one males and 108 females, were seen during the period. They were mostly between the ages of 16 years and 45 years (mean +/- SD = 31.7+/-14.98). One hundred and fifty eight (73%) complied and all of them were cured. The only factor that significantly influenced rate of compliance was proximity to the chest clinic. CONCLUSION: DOT improves the rate of compliance. No socio-demographic factors considered significantly influenced the rate of compliance under DOT, and as such they are not reliable predictive factors. Locating chest units in the existing primary health care facilities will improve the rate of compliance with antituberculosis therapy. More attention should be paid to behavioural aspect of tuberculosis control.

Sociodemographic factors in mental disorders associated with infertility in Nigeria.

The mental status of 37 female patients with infertility and that of 37 healthy controls was evaluated using General Health Questionnaire, Present State Examination, and clinical assessment. An interview schedule, designed to elicit information on sociodemographic, psychiatric predisposing, and obstetric factors, was also administered. A significantly higher proportion (29.7%) of the patients was found to have diagnosable psychopathology, mainly depressive episode and generalized anxiety disorder. Compared with the control group, the infertile women experienced poorer marital relationships, had a significant family history of infertility, were more negatively predisposed to child adoption. and had a greater history of surgery and induced abortion. Polygamy was found to have a close association with psychopathology in the sample of infertile women. The implications of these findings and ways of improving the mental status of the infertile woman are discussed.

Demographic/socioeconomic factors in mental disorders associated with tuberculosis in southwest Nigeria.

In spite of the high prevalence of tuberculosis worldwide, there are few studies on its psychiatric complications. The mental state of 53 patients with pulmonary tuberculosis seen in a Nigerian chest clinic was examined using the 30-item General Health Questionnaire (GHQ-30), the Present State Examination (PSE), and a clinical evaluation based on the International Classification of Disease, tenth edition (ICD-10). Results were compared with two comparison groups: (1) a group of 20 long-stay orthopedic patients with lower limb fractures; and (2) a group of 20 apparently healthy controls. The sociodemographic characteristics of the groups were also compared. A significantly higher prevalence of psychiatric disorders was found in the tuberculosis group (30.2%) than in the orthopedic group (15%) and the apparently healthy controls (5%). The types of psychiatric disorders encountered included mild depressive episode, generalized anxiety disorder, and adjustment disorder (ICD-10). Psychiatric morbidity was higher in tuberculosis patients with low educational attainment, and did not show a statistically significant relationship with other sociodemographic parameters. Ways of improving the mental health of tuberculosis patients are discussed.

Psychiatric complications of hemodialysis at a kidney center in Nigeria.

The mental state of 20 consecutive hemodialysis patients investigated at a Nigerian renal unit was assessed using the 30-item General Health Questionnaire, Present State Examination, and clinical evaluation using the Diagnostic and Statistical Manual, revised third edition (DSM-III-R). Findings were compared with those of orthopedic patients and apparently healthy controls. A standard interview was used in eliciting sociodemographic data from the subjects. A significantly higher prevalence of psychiatric disorders was identified in hemodialysis patients (55%) than in orthopedic patients (20%) and apparently healthy controls (0%). The psychiatric disorders encountered in this hemodialysis population included major depressive episode (35%) and generalized anxiety disorder (20%). The probable reasons for the higher prevalence of psychiatric morbidity in this hemodialysis population, compared with those in Western societies, are discussed. Psychiatric morbidity was higher in patients with low levels of education, and did not show statistically significant relationship with other sociodemographic variables.

Consultation-liaison psychiatry in a general hospital setting in west Africa.

This study examined the pattern of psychiatric consultation-liaison service in a West African general hospital setting over a period of five years. Cases seen were recorded in a register and later analysed. The rate of referral was found to be lower than those of Britain and USA. Most of the patients seen were young persons between the ages of 16 and 45 years. The predominant physical disorders complicated by psychopathology were infective disorders, neurological disorders, cardiovascular, and obstetric conditions. The commonest psychiatric syndromes encountered were acute brain syndrome, brief reactive psychosis, depressive disorder and dementia. A negative attitude towards patients with psychiatric co-morbidity was identified. Areas of improving consultation-liaison psychiatric services in West Africa are suggested.