Factors associated with depression and anxiety among glaucoma patients in a tertiary hospital South-East Nigeria.

OBJECTIVE: To explore the factors associated with depression and anxiety among glaucoma patients. SUBJECTS AND METHODS: This was a cross-sectional study involving adult glaucoma patients, who attended the eye clinic of Enugu State University Teaching Hospital, Parklane, Enugu, from April to September 2018. In total, 182 glaucoma patients with no other significant ophthalmic or medical conditions were recruited. Information on their socio-demographic and clinical characteristics was obtained using a close-ended, interviewer-administered questionnaire. Detailed ophthalmic evaluation to characterize the glaucoma was done. Depression and anxiety were assessed using the hospital anxiety and depression scale. Data were analyzed using SPSS version 21. Bivariate analysis was done to identify factors associated with depression and anxiety. The level of significance was at P < 0.05. RESULTS: The participants were mainly females, 108 (59.3%), married, civil servants with tertiary education and mean age of 59.7 ± 13.3 SD years. Majority of them had advanced stage of primary open angle glaucoma. Eighty (44%) of the participants had anxiety, while 76 (41.8%) had depression. Severe/blind stage of glaucoma and reduced visual acuity were significantly associated with anxiety and depression; occupation (trading) and intraocular pressure of <21 mmHg also significantly associated with depression. CONCLUSION: The prevalence of anxiety and depression among glaucoma patients in Enugu was high. Severe/blind stage of glaucoma and reduced visual acuity were the most important factors that associated with both anxiety and depression. Incorporating a psychological health approach to glaucoma care especially in patients with severe glaucoma and reduced visual acuity may promote effective communication between clinicians and patients and treatment adherence.

ADHD Among Rural Southeastern Nigerian Primary School Children: Prevalence and Psychosocial Factors.

OBJECTIVE: To determine the prevalence of ADHD among primary school pupils in a rural community in Southeastern Nigeria and to determine the psychosocial factors associated with the condition. METHOD: One hundred eighty-one randomly selected participants had their teachers complete the school version of ADHD Rating Scale-IV. Their parents also completed a sociodemographic questionnaire, the clinical interview form for the child and adolescent ADHD patients, and home version of the ADHD Rating Scale-IV. RESULTS: Twelve (6.6%) of the children met the criteria for diagnosis. A history of prolonged labor (odds ratio [OR] = 14.1; 95% confidence interval [CI] = [2.13, 93.1]), and parents' negative assessment of their marriages (OR = 0.1; CI = [0.017, 0.567]) were the most predominant factors which independently associated with the ADHD in the children. CONCLUSION: There is, therefore, a need for the care of rural dwelling African children, who otherwise would have difficulties accessing health care that is concentrated in the cities.

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among Rural Primary School Children in Southeastern Nigeria: Comparison of School and Home Settings

Background: Diagnosis of ADHD depends on manifestation of symptoms in at least two different settings. This therefore emphasizes the importance of multiple informants; parents and teachers. However perception could differ because of differences and inconsistencies across different settings. This is particularly important in rural settings in Africa where the educational attainment and outlook of teachers are very different from those of the parents. The study is aimed at comparing the presentations of children with ADHD in the rural area; across two different settings: home and school. Methods: The teachers of 181 rural primary school children in Ogberuru in Imo state; south eastern; Nigeria completed the school version of ADHD rating scale-IV; and their parents completed a Socio demographic questionnaire and the home versions of the ADHD rating scale IV. Results: Of the 18 symptoms of the condition; there were significant differences in the rate of identification in eight symptoms. These symptoms include 'being easily distracted' (p=0.0427); 'difficulty following through on instruction' (p=0.0026); 'fails to give close attention to details (p=0.0001); 'avoids tasks necessary for tasks' (p=0.0013); 'difficulty playing quietly (p=0.0059 ) ; 'talks excessively' (p=0.0023); 'intrudes on others' (p=0.0004); and 'seems not to listen when spoken to directly' (p=0.0002). They were all consistently more manifest in school settings than in their homes. Conclusion: Teachers identified ADHD symptoms more commonly than parents. They could therefore play critical roles in programs aimed at improving early identification and management of children with ADHD especially in rural Africa where healthcare facilities are scarce

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among Rural Primary School Children in Southeastern Nigeria: Comparison of School and Home Settings

Background: Diagnosis of ADHD depends on manifestation of symptoms in at least two different settings. This therefore emphasizes the importance of multiple informants; parents and teachers. However perception could differ because of differences and inconsistencies across different settings. This is particularly important in rural settings in Africa where the educational attainment and outlook of teachers are very different from those of the parents. The study is aimed at comparing the presentations of children with ADHD in the rural area; across two different settings: home and school.Methods: The teachers of 181 rural primary school children in Ogberuru in Imo state; south eastern; Nigeria completed the school version of ADHD rating scale-IV; and their parents completed a Socio demographic questionnaire and the home versions of the ADHD rating scale IV. Results: Of the 18 symptoms of the condition; there were significant differences in the rate of identification in eight symptoms. These symptoms include 'being easily distracted' (p=0.0427); 'difficulty following through on instruction' (p=0.0026); 'fails to give close attention to details (p=0.0001); 'avoids tasks necessary for tasks' (p=0.0013); 'difficulty playing quietly (p=0.0059 ) ; 'talks excessively' (p=0.0023); 'intrudes on others' (p=0.0004); and 'seems not to listen when spoken to directly' (p=0.0002). They were all consistently more manifest in school settings than in their homes. Conclusion: Teachers identified ADHD symptoms more commonly than parents. They could therefore play critical roles in programs aimed at improving early identification and management of children with ADHD especially in rural Africa where healthcare facilities are scarce

Clinical and Socio-Demographic Profile of Women with Post-Partum Psychiatric Conditions at a Federal Neuropsychiatric Hospital in Southeast Nigeria between 2009 and 2011.

BACKGROUND: Pregnancy and labor in areas with high maternal morbidities as in Nigeria could be sufficiently stressful to precipitate mental disorders in women after delivery, which may be a new or a relapse of previously existing one, or an exacerbation of an attenuated mental illness in the nursing mother. Mental illness in a nursing mother, if not treated may result in impaired mother-infant relationship. AIM: To determine the clinical and socio-demographic characteristics of women diagnosed with postpartum psychiatric conditions in a tertiary mental health facility of a developing country. SUBJECTS AND METHODS: A retrospective case note reviews of 76 women diagnosed with postpartum psychiatric conditions for the first time in the Federal Neuropsychiatric Hospital Enugu between January 2009 and December 2011. RESULTS: The mean age of the women was 27.76 years, with 63% (48/76) of them coming from the rural areas. 93% (71/76) of them had at least a secondary education and 78% (59/76) of the women had a family history of psychiatric disorders. Schizophrenia was commonest, 48.7% (37/76) followed by depression, 22% (17/76) and mania, 15% (11/76). Those presenting with schizophrenia were younger when compared with other diagnostic groups, had a lower level of education and presented earlier for treatment. The husbands were the primary caregivers in 48% of them. CONCLUSION: With 63% (48/76) of them being rural dwellers, policy changes become imperative that would encourage establishment of psychiatric services in rural areas to ensure early detection and prompt treatment of postpartum women with a need for psychiatric services.

Knowledge of conversion disorder in children by pediatricians in a developing country.

INTRODUCTION: Conversion disorder (CD) in children presents the clinician with a diagnostic and treatment dilemma. Mistaking a physical condition for CD carries serious consequences for the child while continued investigation in line with physical disease in a child with CD also may expose the child to serious harm. MATERIALS AND METHODS: One hundred and seventy-four consenting doctors who attended a national conference of pediatricians were administered a 10 item questionnaire developed by the researchers. RESULTS: Only 5 (2.9%) of participants had good knowledge (scored above the mean plus one standard deviation of the score obtained by the psychiatry residents. Gender, rank, years of experience, availability of psychiatric service in center and duration of the psychiatry posting as the medical student could not differentiate those with good/fair knowledge from those without. However, those who have referred children for psychiatric assessment (P=0.015), those who believe that children can have CD (P=0.000) and those who are fairly confident that they could diagnose CD in children (P=0.000) had better knowledge of CD. CONCLUSION: Pediatricians have poor knowledge of CDs in children. Those that know that children could have the condition have confidence that they can identify children with the condition and have referred with mental health problems to psychiatrists have better knowledge than those who did not.