The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model - RETRACTED.

Mental health services for youths within the juvenile justice system remain a contemporary global discourse. To bring perspectives from under-resourced regions, we examine the current limitations of some globalised models for mental health services within the juvenile justice system in Nigeria. The important, multi-systemic steps needed to adapt the system for modern mental health promotion and services are highlighted.

The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model - RETRACTION.

[This retracts the article DOI: 10.1192/bji.2017.14.].

Determinants of Adherence among Patients on Highly Active Anti-Retroviral Therapy in Lagos State, Nigeria.

BACKGROUND: Poor medication adherence in HIV treatment is a public health problem as it leads to increased morbidity and mortality, as well as the development of drug resistance. There is limited information on the determinants of adherence among people living with HIV/AIDS especially in sub-Saharan Africa. This study aimed at assessing the determinants of adherence to HAART among people living with HIV/AIDS in Lagos State, Nigeria. METHODS: A descriptive cross-sectional survey was conducted among 302 respondents selected from three public health facilities across the state. The study instrument was an interviewer-administered questionnaire adapted from the Medication Adherence Report Scale (MARS). Data analysis was performed using Epi Info software. Logistic regression analysis was used to identify the determinants of adherence. Level of significance for all the tests was set at p-value <0.05. RESULTS: Seventy percent of respondents reported being adherent to medication. There were statistically significant associations between respondents' age, having children, good knowledge of HIV and medication adherence. In addition, it was observed that the type of anti-retroviral (ARV) drug schedule, never missing an appointment, belonging to a support group and disclosure of status were associated with HAART adherence. Controlling for other variables, those that had disclosed their status were twice as likely to adhere to HIV medication (aOR: 2.3; 95% CI: 1.1-4.8). Also, those who had never missed a clinic appointment were three times more likely to adhere to prescribed medication (aOR: 3.4; 95% CI: 1.7-6.5). CONCLUSION: Disclosure of HIV status and clinic attendance were key determinants of adherence among patients on HAART in Lagos, Nigeria.

RÉSUMÉ: La mauvaise adhésion aux médicaments dans le traitement du VIH est un problème de santé publique car elle entraîne une augmentation de la morbidité et de la mortalité, ainsi que le développement d'une résistance aux médicaments. Il existe peu d'informations sur les déterminants de l'adhésion chez les personnes vivant avec le VIH/SIDA, en particulier en Afrique subsaharienne. Cette étude visait à évaluer les déterminants de l'adhésion au HAART chez les personnes vivant avec le VIH/SIDA dans l'État de Lagos, au Nigéria. MÉTHODES: Une enquête transversale descriptive a été menée auprès de 302 répondants sélectionnés dans trois établissements de santé publics à travers l'État. L'instrument de l'étude était un questionnaire administré par l'intervieweur, adapté de la Medication Adherence Report Scale (MARS). L'analyse des données a été réalisée à l'aide du logiciel Epi Info. Une analyse de régression logistique a été utilisée pour identifier les déterminants de l'adhésion. Le niveau de signification pour tous les tests a été fixé à une valeur p < 0,05. RÉSULTATS: Soixante-dix pour cent des répondants ont déclaré être adhérents aux médicaments. Il y avait des associations statistiquement significatives entre l'âge des répondants, le fait d'avoir des enfants, une bonne connaissance du VIH et l'observance du traitement. De plus, il a été observé que le type d'horaire des médicaments antirétroviraux (ARV), ne jamais manquer un rendez-vous, appartenir à un groupe de soutien et la divulgation du statut étaient associés à l'adhésion au HAART. En contrôlant les autres variables, ceux qui avaient divulgué leur statut étaient deux fois plus susceptibles d'adhérer aux médicaments anti-VIH (aOR : 2,3 ; IC à 95 % : 1,1­4,8). De plus, ceux qui n'avaient jamais manqué un rendez-vous à la clinique étaient trois fois plus susceptibles de respecter les médicaments prescrits (aOR : 3,4 ; IC à 95 % : 1,7-6,5). CONCLUSION: La divulgation du statut VIH et la fréquentation de la clinique étaient des déterminants clés de l'adhésion chez les patients sous HAART à Lagos, au Nigeria. MOTS CLÉS: Déterminants, compliance médicamenteuse, Thérapie antirétrovirale, PVVIH.

The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model.

Mental health service provision for youth within the juvenile justice system remains a topic of contemporary global discourse. To bring perspectives from under-resourced regions, we examine the current limitations of some globalised models for mental health services within the juvenile justice system in Nigeria. The important multi-systemic steps needed to reposition the system for modern mental health promotion and services are highlighted.

Burnout among Nigerian doctors: a systematic review

Burnout among physicians is a global phenomenon which has been under-reported in middle and low-income economies. The importance of burn-out on the physicians' well-being, patient care and overall health care system cannot be overemphasized. In Nigeria, few studies are specific to burnout, with most of the available studies exploring psychosocial issues at physicians' workplace stress and job dissatisfaction. This present review of literature is assessing burnout among Nigerian Physicians. This review is designed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The review identified observational, review, longitudinal and experimental studies on Nigerian physicians between 1970- 2017, which have the full text in the English language. The articles were searched from online databases such as PUBMED, Directory of Open Access Journals (DOAJ), African Journals Online (AJOL) and Google Scholar by researchers. The keywords used include "Physician", "Nigeria", "burn-out" syndrome. The prevalence of 23.6% to 51.7% burnout was reported among physicians in the selected studies, with young age being a strong predictor for burnout. High burden of emotional exhaustion, depersonalization and personal accomplishment were reported in the study carried out among resident doctors who are early career doctors. The prevalence of burnout reported from these studies in Nigeria is very high, although they are within the globally reported range of physician burnout. Nevertheless, there is a dearth of information on the subject matter among Nigerian Physicians. There is a need to carry out more studies on burnout among Nigerian Physicians

Cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale across 11 world-wide societies.

BACKGROUND: In order to compare estimates by one assessment scale across various cultures/ethnic groups, an important aspect that needs to be demonstrated is that its construct across these groups is invariant when measured using a similar and simultaneous approach (i.e., demonstrated cross-cultural measurement invariance). One of the methods for evaluating measurement invariance is testing for differential item functioning (DIF), which assesses whether different groups respond differently to particular items. The aim of this study was to evaluate the cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale (RCADS) in societies with different socioeconomic, cultural, and religious backgrounds. METHODS: The study was organised by the International Child Mental Health Study Group. Self-reported data were collected from adolescents residing in 11 countries: Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestinian Territories, the Philippines, Portugal, Romania and Serbia. The multiple-indicators multiple-causes model was used to test the RCADS items for DIF across the countries. RESULTS: Ten items exhibited DIF considering all cross-country comparisons. Only one or two items were flagged with DIF in the head-to-head comparisons, while there were three to five items flagged with DIF, when one country was compared with the others. Even with all cross-culturally non-invariant items removed from nine language versions tested, the original factor model representing six anxiety and depressive symptoms subscales was not significantly violated. CONCLUSIONS: There is clear evidence that relatively small number of the RCADS items is non-invariant, especially when comparing two different cultural/ethnic groups, which indicates on its sound cross-cultural validity and suitability for cross-cultural comparisons in adolescent anxiety and depressive symptoms.

Service and Policy implication of substance use disorders among adolescents in juvenile correctional facilities in Lagos, Nigeria.

BACKGROUND: Lack of relevant data has continued to militate against the development of policy and practice toward identification and treatment of alcohol/substance abuse among adolescents coming in contact with the juvenile justice system in Nigeria. This study aims to provide such data, including its policy/practice implications. METHODS: One hundred and seventy eight (178) adolescents, who are representative of adolescents within the youth correctional services of Lagos jurisdiction, were interviewed using the alcohol and substance abuse section of the Kiddies' Schedule for Affective Disorders and Schizophrenia. RESULTS: The lifetime prevalence rate of abuse of/dependence on any of alcohol or other substances was 22.5% (alcohol, 12.3%; illicit substance, 17.9%). Males were overrepresented among those with any substance use disorder, with gendered prevalence rate as high as 35%. Having had a lived-experience of being a street-child was the single most significant independent factor (Odds ratio (OR), 8.4; p = 0.007) associated with lifetime alcohol substance use disorder. CONCLUSIONS: Substance use disorder is highly prevalent among adolescents within the juvenile justice systems in Lagos Nigeria. There is need for deliberate incorporation of alcohol and substance abuse screening and intervention as part of individual care plan in youth correctional facilities in Nigeria. Practical steps toward achieving this were drawn from local reality and international best practices.

Suicidal ideation: Are refugees more at risk compared to host population? Findings from a preliminary assessment in a refugee community in Nigeria.

Among the serious mental health problems that may be associated with being a refugee is suicidal behavior. This study aimed to assess the prevalence and correlates of suicidal ideation among African refugees in Oru-Ijebu Nigeria. Suicidal ideation was assessed using appropriate section in the Mini-International Neuropsychiatric Interview while the brief version of the WHO Quality of Life was used to assess quality of life as a clinical variable. Study involved 444 refugees and 527 non-refugee member of host community. Result showed that the prevalence of suicidal ideation was significantly higher among the refugees than the non-refugee comparison group (27.3% vs. 17.3%; p<0.001). Social status and quality of life was significantly poorer among the refugees compared with their non-refugee members of same community. Quality of life was the only factor independently associated with suicidal ideations among refugees. In conclusion, the study shows that the prevalence of suicidal ideation is significantly higher among the refugees than the non-refugee members of the host community and calls for innovative ways of extending mental health services to refugees at the study site.

Cross-cultural child and adolescent psychiatry research in developing countries.

Mental disorders are currently a major source of morbidity among children and youth globally. The bulk of the epidemiological data about childhood mental health morbidity currently comes from the industrialized countries which paradoxically host a small (about 20%) proportion of global children and youth population. As the world seek to generate more data on the mental health of the teeming children and youth population in low- and middle-income countries (LMICs), cross-cultural issues need be considered. This consideration is imperative for reasons which include the high level of ethno-diversity in LMICs; the contextual issues in the conceptualization of normal (and abnormal) childhood across cultures, the cross-cultural nuances in risk and protective factors, and the plurality of nature and expression of childhood psychopathology. As much as it is imperative to do so, advancing cross-cultural child and adolescent research in LMICs will need to overcome challenges such as inclusive sampling and cultural validation of instruments developed in the industrialized countries of the West. Funding, technical resources, and publication bias are other potential challenges. These issues are appraised in this narrative review and some ways forward are proffered.

State of the Nigerian child - neglect of child and adolescent mental health: a review.

BACKGROUND: As most child health initiatives in Nigeria lack a child and adolescent mental health (CAMH) strategy, CAMH issues have remained obscure to the country's policy-makers. The lack of current and representative epidemiological data on the mental health of Nigerian children continues to be a barrier to advocacy for CAMH policy initiatives. In view of the importance of CAMH to national development, there must be a continued search for ways of bringing the state of CAMH in Nigeria to the attention of policy-makers. OBJECTIVES: To use information from UNICEF's State of the World's Children as proxy data to speculate on the state of child mental health in Nigeria. METHODS: With a view to discussing its CAMH implications, social and health indicators in the Nigerian child were extracted from UNICEF's 2012 edition. RESULTS: Most of the social and health indicators assessed reflect significant mental health risks. Up to 65% of households live on less than US$1·25 per day, child malnutrition is evident in up to 40% of children, and the primary and secondary school net enrolment ratios are only 63% and 25%, respectively. In addition, the rate of attendance for antenatal care was 45%, and only 39% of deliveries were supervised by skilled birth attendants. Child labour and under-age marriage is very common. A literature review demonstrates that children living in these circumstances are at significant risk of mental health problems. CONCLUSION: Current data on the state of Nigerian children contain indices that can serve as proxy information for the state of CAMH in the country. Policy-makers need to invest more in pre-emptive child health initiatives as a way of preserving the physical and mental health of children.

Does the Strengths and Difficulties Questionnaire - self report yield invariant measurements across different nations? Data from the International Child Mental Health Study Group.

AIMS: This study evaluated the measurement invariance of the strengths and difficulties questionnaire (SDQ) self-report among adolescents from seven different nations. METHODS: Data for 2367 adolescents, aged 13-18 years, from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria and Croatia were available for a series of factor analyses. RESULTS: The five-factor model including original SDQ scales emotional symptoms, conduct problems, hyperactivity-inattention problems, peer problems and prosocial behaviour generated inadequate fit degree in all countries. A bifactor model with three factors (i.e., externalising, internalising and prosocial) and one general problem factor yielded adequate degree of fit in India, Nigeria, Turkey and Croatia. The prosocial behaviour, emotional symptoms and conduct problems factor were found to be common for all nations. However, originally proposed items loaded saliently on other factors besides the proposed ones or only some of them corresponded to proposed factors in all seven countries. CONCLUSIONS: Due to the lack of a common acceptable model across all countries, namely the same numbers of factors (i.e., dimensional invariance), it was not possible to perform the metric and scalar invariance test, what indicates that the SDQ self-report models tested lack appropriate measurement invariance across adolescents from these seven nations and it needs to be revised for cross-country comparisons.

Taking the first step towards entrenching mental health in the workplace: insights from a pilot study among HR personnel in Nigeria.

BACKGROUND: The continued relevance of optimal employee mental health to sustainable human capital development in the workplace underscores the need to start harnessing all resources that can be mobilized to promote the entrenchment of workplace mental health. The strategic place of workplace Human Resource (HR) units in formulating and implementing workplace welfare schemes makes them potential partners. To actualize this, it is important to initially assess the preparedness of HR personnel for, and the possible barriers to entrenching mental health in the workplace. To suggest the initial course of action and to serve as a template for a robust large-scale study, we conduct a pilot assessment of the experience with, attitudes towards, and level of prioritization of mental health in the workplace among a cohort of HR personnel in Nigeria. METHODS: Participants were recruited in the course of a seminar/workshop and questionnaires were developed by authors to assess variables of interest. Attitudes were examined using an adapted form of the Link's Discrimination-Devaluation (LD-D) scale. RESULTS: A total of 90 human-resource personnel completed the questionnaires. Only 16% of the participants reported having handled the case of an employee with a suspected mental health problem in the preceding 2 years. Attitudes toward employees and prospective employees with mental illness were largely poor. For instance, more than 70% were likely to consider for employment someone with a pre-existing physical disability than for someone with a history of mental illness. In terms of workplace health promotion priorities, physical health seminars took wide precedence over mental health seminars. CONCLUSION: The preliminary findings of this pilot study justify a need to conduct a large scale study. Significant challenges encountered in the course of this pilot study were highlighted while insights were drawn for the conduct of the main study/project.

Role of personal and family factors in alcohol and substance use among adolescents: an international study with focus on developing countries.

Most studies examining adolescent alcohol and substance use or abuse hardly include samples from developing countries. To bridge some gap, the prevalence and associated social correlates of alcohol and substance use and abuse was examined among a cohort of school-going adolescents sampled from seven developing countries. Alcohol and substance abuse was measured using the CRAFFT instrument, independent socio-demographic correlates were determined using regression models. A total of 2454 adolescents completed the study, among which 40.9% reported using either alcohol or at least one other substance during the previous 12 months. This was mostly alcohol (37.8%), followed by marijuana/hashish (8.6%) and other substances (8.1%). Among the adolescents who reported using at least one substance, 45% (18.3% of total sample) had CRAFFT scores indicative of problematic or hazardous substance use. Several personal and family factors were independently associated with use/abuse, and the modifiable nature of these factors calls for appropriate intervention strategies.

Neurological and intellectual disabilities among adolescents within a custodial institution in South-West Nigeria.

A total of 67 adolescents from a juvenile remand home were matched with 67 other adolescents by age and gender, with a view to determine the prevalence and spectrum of neurological and intellectual disabilities. Intelligence quotient (IQ) was estimated using an adapted version of the Slosson's Intelligence Test and a full neurological evaluation was carried out. The mean IQ score for the remand home participants was significantly lower than the controls (77 ± 11 vs. 99 ± 14; t = 1.6, P = 0.001). Almost half (46.7%) of the participants in the remand home had intellectual disability of varying degrees, including borderline intellectual functioning, compared with only two (3.3%) of the comparison group (P < 0.001). Epilepsy and neurological deficits were significantly more prevalent among the remand home group, particularly those admitted as victims of neglect, compared with the comparison group (P ≤ 0.02). These findings and recent literature were used to speculate the possible underlying factors. Policy implications for child social welfare in Nigeria were suggested.

Beyond prevalence and pattern: problematic extent of alcohol and substance use among adolescents in Ibadan South-west Nigeria.

BACKGROUND: Previous research on adolescent alcohol/substance use in Nigeria had focused on the pattern of use without consideration for the extent of use. Socio-demographic correlates have also not been well explored. Information about socio-demographic correlates can also inform target-points in preventive strategies. Knowledge of the prevalence of problematic pattern of alcohol/substance use can inform the inclusion of rehabilitation strategies in intervention policies. OBJECTIVES: To determine the prevalence, pattern and extent-as well as socio-demographic correlates-of alcohol/substance use among a cohort of adolescents in Nigeria. METHODS: Pattern and extent of alcohol/substance use was examined using the CRAFFT instrument. RESULTS: A total of 538 adolescents with a mean age of 15.1 ± 1.4 years returned completed questionnaires. 12-month prevalence of alcohol and other substance use was 21.4%. About 46% of those who reported use of alcohol or any other substance had a CRAFFT score of >2 which suggests problematic pattern of use. Older age, male gender, parental alcohol and substance and lower than average school performance were independently associated with 12-moNth use of alcohol or any other substance. CONCLUSIONS: Adolescent alcohol and substance use is common in Nigeria and a large proportion of users show a problematic pattern of use that warrants rehabilitative intervention.

Do patients on antipsychotics know the role of anti-cholinergic drugs in their treatment? Reports from an outpatient clinic in south-west Nigeria.

BACKGROUND: In a developing country like Nigeria where prohibitive cost and availability limits the use of atypical antipsychotics, a large number of patients on antipsychotics are expected to be on conventional antipsychotics. Studies have shown that more than half of patients on conventional antipsychotics are also prescribed anti-cholinergic drugs. There are reports that psychiatric patients may not know important aspects of their treatments. Such audits of psychiatric services are uncommon in Nigeria. METHODS: Socio-demographic data and views about the specific role of Benzhexol in treatment were obtained from all patients whose case records showed that they were concurrently prescribed Benzhexol alongside antipsychotics. RESULTS: 200 participants met inclusion criteria. A third (n = 60; 30%) reported not knowing the role of Benzhexol in their treatment as against 70% (n = 140) who claimed to know. Of those who claimed to know, 64% (n = 89) gave responses that reflected no understanding. Majority (n = 66; 74%) of such responses were adjudged to have potentially deleterious implications on their health and outcome. Only 18% (n = 36) reported having ever been educated about the role of Benzhexol in their treatment. CONCLUSION: The study provides some evidence that a large number of the patients may not be well informed about the specific role of BenzhexoI in their treatment and that that some of their assumptions may portend danger for their health and outcome. Health workers may also have neglected to educate them. There is a need to intensify patient education in our clinics.

Prevalence and correlates of psychiatric disorders among residents of a juvenile Remand Home in Nigeria: implications for mental health service planning.

BACKGROUND: Research has established that psychiatric disorders are common among children and adolescents within thejuvenile justice system. However, the bulk of these researches had been from the developed countries, with very limited data from sub-Sahara Africa. In a region like sub-Sahara Africa with acute shortage of mental healthcare resources, availability of data on mental health needs of children within the juvenile justice system is about the only way to ensure that they are not excluded from needed services. This study aims to determine the pattern, prevalence and correlates of psychiatric disorders among the residents of a juvenile justice facility in Nigeria and to speculate appropriate policy responses. METHODS: Using a cross-sectional comparative study design, 60 consecutive residents of the Ibadan juvenile Remand home and 60 randomly selected age- and gender-matched school going adolescents were evaluated for the presence of current and lifetime psychiatric disorders. The Kiddies Schedule for Affective Disorders and Schizophrenia was used to assess psychiatric disorders. Logistic regression was done to determine sociodemographic variables that were independently associated with the presence of lifetime psychiatric disorders. RESULTS: Thirty eight (63%) of the Remand Home participants had at least one lifetime psychiatric disorder compared with 14 (23%) among the comparison group (p < 0.001). Thirteen (22%) of the Remand Home participants had at least one current psychiatric disorder compared with 2 (3%) among the comparison group (p = 0.004). Disruptive behaviour disorders, posttraumatic stress disorder and substance use disorders were the most common psychiatric disorders among the Remand Home residents. Indices of family disruption and inconsistency in caregivers were the key predictors of psychiatric disorders. CONCLUSION: Study has established further that psychiatric disorders are common among children within the juvenile justice system and that there is a need for appropriate policy response. Some policy directions were highlighted.

Children within the juvenile justice system in Nigeria: psychopathology and psychosocial needs.

BACKGROUND: Many children in Nigeria face a life of poverty, family instability, inadequate educational opportunities and poor physical and mental health which hinder their ability to develop into healthy adults, live an improved quality of life or fulfil their life aspirations. These factors have also been associated with juvenile delinquency and need for institutional care. OBJECTIVES: As a step toward providing comprehensive services for incarcerated children in Nigeria, this study aimed to identify the psychosocial needs as well as types of psychopathology among a group of incarcerated children at the Ibadan remand home. METHODS: A cross-sectional survey of children and adolescents at the Ibadan remand home was carried out using a semi-structured questionnaire. RESULTS: A total of 59 children were assessed over a one year period. Majority (90%) were in need of care and protection. All (100%) had significant psychosocial needs presenting as difficulty with their primary support, economic, social environment, or educational systems. Majority (97%) also demonstrated significant psychopathology and anxiety, suicidal and depressive symptoms were the most commonly elicited. CONCLUSION: Incarcerated children in this study showed significant mental health needs which need to be addressed as a matter of urgency. This should be carried out through the collaborative efforts of mental health professionals with various stakeholders in child care.

Pattern of Psychiatric Inpatient Admission in Ibadan: Implications for Service Organisation and Planning

Introduction: Reports from different parts of the world has shown a seasonal pattern in psychiatric admission. Seasonal changes in climatic and social situations have been attributed. Such audit of psychiatric services is not a popular research venture in Nigeria. Objectives: The study aims to describe the pattern of old psychiatric admissions in a tertiary health facility and the socio-cultural and environmental factors that may influence the pattern. Methods: Data on monthly admissions over a 5-year period were extracted from the admission and discharge records kept by the nursing services unit. The data was processed using Microsoft excel and the pattern over the 5-year period was examined using graphical representations. Results: There were 2140 admissions during the review period; comprising 1138 ( 53.2) females and 1002 males. The mean new admission per month was 34.55 (M:16.7; F:18.96) with a standard deviation of 7.49 for all admissions. There was a seasonal pattern in admission. Some socio-cultural and environmental factors that may explain the pattern were examined. Conclusion: This study suggests a seasonal pattern of psychiatric admission in a tertiary health facility in Ibadan. Recommendations were made on how to make use of the knowledge of the seasonal pattern of admission to mitigate disruptions in workload that may be occasioned by the observed pattern