Pattern of impairments and late diagnosis of autism spectrum disorder among a sub-Saharan African clinical population of children in Nigeria.

BACKGROUND: Autism spectrum disorder (ASD) is a complex group of neurodevelopmental disorders. Studies conducted among Africans living outside the continent indicate that African children are more likely than Caucasian children to have a late diagnosis of ASD. There is a dearth of information on this topic among children with ASD living in Africa. METHODS: To determine the pattern of impairments and age at diagnosis in ASD, sixty Nigerian children with a diagnosis of ASD were recruited from a neurodevelopmental clinic. DSM-V criteria were used to make a diagnosis of ASD, while a symptom checklist for ASD was used to determine the pattern of impairments in ASD. RESULTS: Ages of the children ranged from 2 to 17 years with a mean age of 9.45 ± 4.33 years with the majority of them (75%) being 12 years or younger. All the children (100%) with ASD exhibited poor eye contact, difficulty in mixing with other children and inability to consistently respond to his/her name. More than a half of them (55%) lack verbal communication. Impairments that were uncommon are in the areas of object attachment (20.0%), odd postures (26.7%) and inappropriate facial expression (30.0%). Mean age at the observation of ASD features was 17.0 ± 6.7 months. Mean age at diagnosis of ASD was 9.00 ± 4.30 years. The mean time lag from a parental concern of ASD features to seeking specialist care was 85 months and to diagnosis was 91 months. CONCLUSIONS: Core symptoms/impairments of ASD are present in Nigerian children but a late diagnosis is common.

Effects of first-line anti-retroviral therapy on blood coagulation parameters of HIV-infected patients attending a tertiary hospital at Abuja, Nigeria.

BACKGROUND: Blood coagulation abnormalities are common in persons infected with the human immunodeficiency virus (HIV). However, few studies showed the association of these abnormalities with anti-retroviral therapy (ART). OBJECTIVE: This cross-sectional study investigated the effects of ART on blood coagulation parameters of patients infected with HIV attending HIV special clinics of the University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria. MATERIAL AND METHODS: A total of 191 patients comprising 128 HIV subjects on ART (test subjects) and 63 other HIV patients not on ART (control subjects) were included in the study. CD4+ lymphocyte counts, platelet counts, prothrombin time (PT) and partial thromboplastin time with kaolin (PTTK) of subjects were determined using flow cytometry, automated hematology analyser and Quick one-stage methods respectively. RESULTS: Of the total test subjects, 21 (16.4%) were CD4 lymphopaenic, and the mean CD4+ cell count for the test subjects was statistically higher than that of the control subjects (578 versus 322 cells/ mm(3)) (p = 0.014). Eight (6.3%) of test subjects had prolong PTTK, and the mean values of PT and PTTK were statistically not significant between test subjects and control subjects (p = 0.358 and p= 0.141 respectively). Eight (6.3%) of test subjects had thrombocytopaenia, the mean platelet count was significantly lower than that of the control subjects (238 versus 278.6 x 10(9)/L, p = 0.001), and also varied significantly with the duration of ART (p = 0.0086). CONCLUSION: Findings from this study revealed ART decreased platelet counts of HIV-infected individuals, but did not affect the PT and PTTK results.

Recognition of Autism Spectrum Disorder (ASD) symptoms and knowledge about some other aspects of ASD among final year medical students in Nigeria, Sub-Saharan Africa.

BACKGROUND: Earlier studies suggest that knowledge about Autism Spectrum Disorder (ASD) among healthcare workers in Nigeria is low. This present study assessed the knowledge of Nigerian final year medical students about symptoms of ASD and some other aspects of ASD. This is a cross sectional descriptive study that drew a total of seven hundred and fifty-seven (757) final year medical students from ten (10) randomly selected fully accredited medical schools out of a total of twenty-seven (27) fully accredited medical schools in Nigeria. Sociodemographic and Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaires were used to assess knowledge of final year medical students about ASD and obtain demographic information. RESULTS: Only few, 218 (28.8 %) of the 757 final year medical students had seen and participated in evaluation and management of at least a child with ASD during their clinical postings in pediatrics and psychiatry. Knowledge and recognition of symptoms of ASD is observed to be better among this group of final year medical students as shown by higher mean scores in the four domains of KCAHW questionnaire. Knowledge about ASD varies across gender and regions. Misconceptions about ASD were also observed among the final year medical students. CONCLUSIONS: More focus needs to be given to ASD in the curriculum of Nigerian undergraduate medical students, especially during their psychiatry and pediatric clinical postings.

Factors associated with depression and suicide among patients with diabetes mellitus and essential hypertension in a Nigerian teaching hospital.

BACKGROUND: Diabetes mellitus (DM) and essential hypertension are chronic medical conditions that place a lot of burden on patients. The presence of depression and suicidal behaviour may worsen the prognosis. OBJECTIVE: To assess the prevalence of depression and suicidal behaviour in subjects with diabetes mellitus and essential hypertension and also determine the socio-demographic correlates. METHODS: Major depressive episode and suicidality modules of Mini-International Neuropsychiatric Interview were used to assess depression and suicidal behaviour respectively. RESULTS: The prevalence of depression for the subjects with DM was 27.8% and 26.7% for essential hypertension. The subjects with DM had prevalence of 6.3% for suicidal behaviour while essential hypertension had 7.8%. Depression was higher in subjects with DM if they were not married or had no education while the subjects with essential hypertension were more likely to have depression if they were not married, had no education or not employed. Suicidal behaviour was higher in subjects with DM if they had no education while in essential hypertension suicidal behaviour was higher in females, those not married and those not educated. CONCLUSION: Depression and suicidal behaviour occur with DM and essential hypertension.

Pathway to care: first points of contact and sources of referral among children and adolescent patients seen at neuropsychiatric hospital in South-Eastern Nigeria.

OBJECTIVE: Child and adolescents mental health services are at infancy stage of development in most Sub-Saharan African region. Little is known about help seeking behaviour for childhood neuropsychiatric disorders in Sub-Saharan Africa. This study was aimed at assessing first points of contact during help seeking and eventual sources of referral for a group of patients seen in a neuropsychiatric facility in south-eastern Nigeria. METHODS: At the point of presentation, information were obtained on where help was first sought before presenting at the hospital with the major aim of identifying other competing services. Other information obtained in addition to socio-demographic variables included information on source of referral or the source that initiated help seeking from Federal Neuropsychiatric Hospital, Enugu, South-eastern Nigeria. RESULTS: Neuropsychiatric hospital, prayer houses/faith healing centres, other hospitals, traditional healers, patent medicine stores, roadside medical laboratories and specialized school were various first points of contact noted. Relatives, family and friends, other hospitals, prayer houses and specialized school constituted sources of referral. CONCLUSIONS: The need to incorporate all these sources with the aim of improving accessibility of neuropsychiatric services for children and adolescents in this environment is paramount.

Attention deficit hyperactivity symptoms and disorder (ADHD) among African children: a review of epidemiology and co-morbidities.

OBJECTIVE: To review literature from Africa on the epidemiology of ADHD as well attention deficit hyperactivity symptoms and associated co-morbid conditions among African children. METHOD: A literature search was done through Pubmed/MEDLINE and Google Scholar using then following terms, "attention deficit", "hyperactivity disorders", "epidemiology", "co-morbid conditions", "Africa". Nine studies met the inclusion criteria with four studies coming from South Africa, two each from Democratic Republic of Congo and Nigeria respectively and one from Ethiopia. RESULTS: The prevalence of ADHD varied with rates of between 5.4% and 8.7%, amongst school children, 1.5% amongst children from the general population between 45.5% to 100.0% amongst special populations of children with possible organic brain pathology. Common associated co-morbid conditions were oppositional defiant disorder, conduct disorder as well as anxiety/depressive symptoms. CONCLUSION: Published data from Africa is limited. For effective healthcare policy further studies are needed to define the magnitude and burden of ADHD and other childhood neurodevelopmental disorders in Africa.

Functional status and its associated factors in Nigerian adolescents with bipolar disorder.

OBJECTIVE: This study assessed general functioning in Nigerian adolescents with bipolar disorder. It also determined the factors associated with functioning in these adolescents. METHOD: Adolescents with bipolar disorder diagnosed over one year or more attending the outpatient unit of Federal Neuro-Psychiatric Hospital, Enugu (FNHE), Nigeria for follow-up visits were interviewed with a socio-demographic questionnaire and their functioning was rated with the Children Global Assessment Scale (C-GAS) based on the clinical information obtained from the children and their care givers during a one year follow-up period. Further information such as history of sexual risk behavior, pre-morbid peer relationship, relationship with siblings, level of religion activities among others were also obtained through clinical interview. RESULTS: A total of 46 adolescents with bipolar disorder were followed up. Minimal to moderate impairment in functioning in the past year was found in these adolescents. The mean score on C-GAS was 68.41 ± 16.63. Factors including co-morbidity, pre-morbid peer relationship, relationship with siblings, level of religion activities and history of sexual risk behavior were significantly associated with functioning (p = 0.000), while marital status of the parents showed a weak association with functioning in these adolescents (p = 0.068). Negative correlation was also found between mean number of hospital admissions in the past year during follow up and mean score on C-GAS (r = - 0.908, p = 0.000). CONCLUSION: Functional impairments complicate bipolar disorder in Nigerian adolescents. To ensure good overall outcome in these adolescents, attention needs to be focused on promoting those factors that help good functioning. Future longitudinal follow up studies that would assess long-term outcome and its correlates in children and adolescents with bipolar disorder in this environment are desirable.

Autism spectrum disorders (ASD) in Africa: a perspective.

BACKGROUND: The universal occurrence of autism spectrum disorders (ASD) was queried about twenty-six years ago. It was thought to occur only in western industrialized countries with high technological development. Over the last decade, knowledge about ASD and its prevalence has been documented as being on the rise in different regions of the world, with most literature coming from the western world -- the situation in Africa on aspects of ASD remain unclear. METHODS: Literature cited in Pubmed over the last decade on aspects of epidemiology, diagnosis, aetiology and knowledge of ASD in the African context were assessed. KEYWORDS: autism, diagnosis, aetiology, knowledge and Africa were variously combined in the literature search. RESULTS: No study specifically addressed the epidemiology of ASD in Africa. One of the two studies that were relevant addressed epidemiology of ASD in Arab countries, though included two Northern African countries. A higher proportion of non-verbal cases of ASD compared to verbal cases was documented in literature coming from Africa. Associated co-morbid disorders included intellectual disability, epilepsy and oculo-cutaneous albinism. Aetiological factors postulated included post-encephalitic infection, genetic and auto-immune factors, and vitamin D deficiency. Knowledge about ASD in Africa was noted to be low. CONCLUSION: There is a need for epidemiological studies in Africa to define the magnitude of the problem of ASD and the characteristics of children affected by ASD in this region. This would help in planning and might be helpful in answering the question of aetiology of ASD. Policy making needs to be directed at issues of childhood developmental disorders in Africa.

Effect of Tamarindus indica. L on the bioavailability of ibuprofen in healthy human volunteers.

The influence of Tamarindus indica L fruit extract incorporated in a traditional meal on the bioavailability of Ibuprofen tablets 400 mg dose when given concurrently was studied in 6 healthy human volunteers. There was a statistically significant increase in the plasma levels of Ibuprofen and its metabolites hydroxy-ibuprofen and carboxy-ibuprofen respectively, when the meal containing Tamarindus indica fruit extract was administered with the ibuprofen tablets than when taken under fasting state or with the meal without the fruit extract. The C(max), AUC(0-6 hr) and Ka for ibuprofen increased from 38 +/- 0.70 microg/ml to 42 +/- 0.98 microg/ml (p > 0.05); and 28.03 +/- 2.40 microg/ml x hr to 56.51 +/- 0.16 microg/ml x hr (p < 0.05) and 1.048 +/- 0.02hr(-1) to 2.781 +/- 0.11 hr(-1) (p < 0.05) respectively. There was no change in the t(max) (120.00 +/- 0.43m) but there was a decrease in the k(el) from 0.63 +/- 0.20 hr(-1) to 0.46 +/- 0.11 hr(-1) (p<0.05). Similarly the C(max), AUC(0-6 h) and Ka for hydroxy-ibuprofen rose from 43 +/- 0.76 microg/ml to 45 +/- 0.16 microg/ml (p < 0.05); 39.04 +/- 2.30 microg/ml x hr to 59.49 +/- 2.39 microg/ml.hr in (p < 0.05) and 1.498 +/- 0.79hr(-1) to 3.442 +/- 0.23 hr(-1) (p < 0.05) respectively; while the C(max), AUC(0-6 h) and Ka for carboxy-ibuprofen rose from 48 +/- 0.7 microg/ml to 51 +/- 0.16 microg/ml (p < 0.05); 41.972 +/- 0.68 microg/ml x hr to 63.948 +/- 0.12 microg/ml x hr (p < 0.05) and 1.649 +/- 0.08 hr(-1) to 4.187 +/- 0.42 hr(-1) (p < 0.05) respectively. The study has indicated that Tamarindus indica L. fruit extract significantly increased the bioavailability of Ibuprofen.

Microbial densities and physicochemical quality of some crude oil flow stations' saver pit effluents in the Niger Delta areas of Nigeria.

Five crude oil flow stations saver-pit effluents were sampled during the months of October, November, December and January to determine some of their physicochemical qualities and microbiological densities before their discharge into the environment. Standard analytical techniques were employed in the investigation. A high microbial density in the range of 10(6) cfu/ml was observed in the samples. The high coliform count obtained poses a potential threat to the local inhabitants of the area. The physicochemical qualities of the effluents appear to fall within or near acceptable standards. Nevertheless, adequate treatment of the effluent is required especially during the month of January before its discharge into the environment.