A comparison of two screening instruments in detecting psychiatric morbidity in a Nigerian pediatric primary care service: assessing clinical suitability and applicability.

BACKGROUND: To improve poor attendance and underutilization of the child and adolescent psychiatric service in the University of Ilorin Teaching Hospital, Ilorin, Nigeria, we compared a child behavior questionnaire (CBQ) with reporting questionnaire for children (RQC) for use in our primary care unit where the bulk of referrals come from to determine which is more applicable. METHODS: This was a cross-sectional two-stage study on the prevalence and pattern of psychiatric disorders in children attending the primary care unit of University of Ilorin Teaching Hospital, over a 6-month period. CBQ and RQC were completed by the mothers of 350 children aged 7-14 years in the first stage; in the second, a stratified subsample of 157 children based on scores on CBQ were interviewed using the children's version of the schedule for affective disorders and schizophrenia (Kiddie-SADS-PL). The receiver operating characteristics (ROC) analysis was carried out to determine the screening properties of CBQ and RQC. RESULTS: The optimal cutoff score for CBQ and RQC were 7 and 1, respectively. Sensitivity, specificity, and misclassification rates at the cutoff for CBQ was 0.8 (80%); 0 96 (96%); 0.083 (8.3%), and RQC was 0.90 (90%); 0.78 (78%); 0.19 (19%). The discriminating ability of CBQ indicated by the area under the curve (AUC) in the ROC was 0.93 while RQC was 0.88. CONCLUSION: Even with the evident marginal superior discriminating ability of CBQ in our study in primary care, RQC has the advantage of brevity and ease of application for workers at this level. In the child and adolescent clinic CBQ may still be preferred.

Psychiatric morbidity in paediatric primary care clinic in Ilorin, Nigeria.

BACKGROUND: We observed poor attendance at the recently established child and adolescent psychiatric clinic in our hospital, despite our sensitization efforts prior and after the establishment of the unit. The study was conducted at the paediatric clinics of the Family medicine/General out-patient department (GOPD) of university of Ilorin teaching hospital (UITH), Ilorin. OBJECTIVE: The study was aimed at finding out the prevalence, types and associated factors of psychiatric disorders among children attending the primary care unit of University of Ilorin Teaching Hospital (UITH). METHOD: A cross-sectional two stage study in which 350 children aged 7-14 years were screened with the parents' version of Child Behaviour Questionnaire or Rutter Scale A2. Of these, a stratified sub-sample of 157 (consisting of all high scorers and ~30% of low scorers, randomly selected) were interviewed jointly with their mothers using the children's version of the schedule for affective disorders and schizophrenia (Kiddie-SADS-PL or K-SADS-PL). RESULTS: An overall prevalence of 11.4% (40 of 350) for the presence of one or more DSM IV disorders was obtained. Enuresis with significant distress was present in 6.0%, behavioural disorders of Conduct and ADHD in 3.1%, emotional disorders of depression and anxiety in 1.7% and mental retardation in 0.6%. The presence of chronic medical illness and frequent hospital visits were factors associated with risk of having psychiatric disorders. CONCLUSION: The study supports earlier ones in Nigeria that child psychiatric disorders are common in hospital patients, although differences may exist in pattern and types. It emphasizes the need to screen hospital patients for morbidity to ensure early detection and treatment of psychiatric disorders in childhood. This is to limit the period of illness and avoid its adverse effects on growth and development of the children and to reduce the risk of carrying over remediable problems in childhood into adulthood.