Pattern and predictors of internet addiction among secondary school adolescents in Enugu, Nigeria.

Background: Internet addiction has negative effects on adolescents. These range from psychological and social impediments to school absenteeism. Aim: To ascertain the pattern of Internet addiction and the factors that predict Internet addiction among secondary school adolescents in southeast Nigeria. Subjects and Methods: This was a cross-sectional study that involved 796 secondary school adolescents drawn from six secondary schools in Enugu, Nigeria. The data were analyzed using IBM Statistical Package for Social Sciences (SPSS) software. Results: The highest proportion of the respondents (36.3%) had a moderate level of Internet addiction, while the least proportion (2.1%) had severe dependence on the Internet. Adolescents who were less than 15 years of age have 1.1 odds of having Internet addiction when compared to those who were 20 years and above (AOR = 1.1; 95% CI: 0.4-2.8). The respondents who were of the low socioeconomic class were 1.2 times more likely to have Internet addiction when compared with those in the high socioeconomic class (AOR = 1.2; 95% CI: 0.9-1.7). About 20.1% of adolescents were always depressed when they are not using the Internet, while 16.3% of adolescents who were addicted to the Internet developed insomnia. Conclusion: There is a rising prevalence of Internet addiction among secondary school adolescents. Younger adolescents tend to be more addicted to the Internet than their older counterparts. A small number of them had severe Internet addiction. A subpopulation of adolescents who were addicted to the Internet presents with depression and sleep disorders.

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.

Religion, coping and outcome in out-patients with depression or diabetes mellitus.

OBJECTIVE: The study assesses the association between religiosity and coping style with the outcome of depression and diabetes. METHOD: Using a simple random sampling, we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using Religious Orientation Scale (revised) (ROS-R), coping styles with Brief Religious Coping (Brief RCOPE) scale and Mental Adjustment to Cancer (MAC) scale (adapted). Primary and secondary outcomes were evaluated using Sheehan's Disability Scale (SDS) and Becks Depression Inventory-II (BDI-II) respectively. RESULTS: Among participants with diabetes, BDI-II total scores correlated negatively with ROS-R Extrinsic Social (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.3, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.3, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). SDS global scores correlated positively with Helplessness/Hopelessness (r = 0.3, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). Among participants with depression, BDI-II total scores correlated negatively with Intrinsic religiosity (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.4, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.6, P < 0.05) and Brief RCOPE Negative (r = 0.7, P < 0.05). SDS global scores correlated negatively with Intrinsic religiosity (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.3, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.5, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). CONCLUSION: High intrinsic and extrinsic religiosities are likely to be associated with positive coping skills and better treatment outcome in patients with depression or diabetes.

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

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.

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.