Browsing by Author "Esan, O.B."

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A survey of traditional and faith healers providing mental health care in three sub-Saharan African countries
(Springer Science + Business Media, 2019) Esan, O.B.; Appiah-Poku, J.; Othieno, C.; Kola, L.; Harris, B.; Nortje, G.; Makanjuola, V.; Oladeji, B.; Price, L.; Seedat, S.; Gureje, O.
Background: Traditional and faith healers constitute an important group of complementary and alternative mental health service providers (CAPs) in sub-Sahara Africa. Governments in the region commonly express a desire to integrate them into the public health system. The aim of the study was to describe the profile, practices and distribution of traditional and faith healers in three sub-Saharan African countries in great need for major improvements in their mental health systems namely Ghana, Kenya and Nigeria. Materials and methods: A mapping exercise of CAPs who provide mental health care was conducted in selected catchment areas in the three countries through a combination of desk review of existing registers, engagement activities with community leaders and a snowballing technique. Information was collected on the type of practice, the methods of diagnosis and the forms of treatment using a specially designed proforma. Results: We identified 205 CAPs in Ghana, 406 in Kenya and 82 in Nigeria. Most (> 70%) of the CAPs treat both physical and mental illnesses. CAPs receive training through long years of apprenticeship. They use a combination of herbs, various forms of divination and rituals in the treatment of mental disorders. The use of physical restraints by CAPs to manage patients was relatively uncommon in Kenya (4%) compared to Nigeria (63.4%) and Ghana (21%). CAPs often have between 2- to 10-fold capacity for patient admission compared to conventional mental health facilities. The profile of CAPs in Kenya stands out from those of Ghana and Nigeria in many respects. Conclusion: CAPs are an important group of providers of mental health care in sub-Saharan Africa, but attempts to integrate them into the public health system must address the common use of harmful treatment practices.
Acute and transient psychotic disorder (ATPD) in a developing country
(SAGE Publications, 2014) Esan, O.B.; Fawole, O.I.
Background: Acute and transient psychotic disorders (ATPDs) are relatively under-researched. There is therefore a dearth of information on the disorders especially in developing countries, where they have been shown to be relatively common. Aim: To describe the socio-demographic and clinical characteristics of patients with ATPD, as well as to examine the factors that are associated with early recovery in patients with ATPD in a developing country. Methods: A review of 124 cases of untreated first episode of ATPD that presented at the University College Hospital, Ibadan, Nigeria over a five-year period. Results: Of the new cases that presented at the psychiatry department of the hospital, 10.1% were ATPDs. There was no significant difference between the proportions of males and females presenting at the hospital (50.8% vs 49.2%). Mean age at presentation was 29.5 (SD = 9.6) years, while the mean duration of illness before presentation was 7.3 (SD = 6.1) days. Female gender was significantly associated with earlier recovery (p= .047). Conclusion: ATPDs are common in developing countries. The epidemiology in developing countries is probably different from that of the developed countries.
Bipolar I disorder in remission vs. schizophrenia in remission: Is there a difference in burden?
(Elsevier, 2017) Esan, O.B.; Osunbote, C.; Oladele, O.; Fakunle, S.; Ehindero, C.; Fountoulakis, K.N.
Introduction: Bipolar disorder (BD) is considered to have a better outcome in comparison to schizophrenia. However, recent data dispute this notion. The current study aimed to compare the burden of patients with BD type I (BD-I) in remission with similar patients with schizophrenia (SZ) in remission. Material and Methods: Patients with schizophrenia (n=75) and BD-I (n=54) aged 18-64 years were included in the study. The diagnosis was made with the SCID-I/P. Patients were assessed for sociodemographic variables, stigma, quality of life, disability, suicidality and current symptomatology. The statistical analysis included Analysis of Covariance (ANCOVA) and chi-square test. Results: ANCOVA with age at onset as a covariate and marital status and diagnosis as grouping variables returned no significant difference. Discussion: The results of the current study suggest that when in remission, BD-I patients do not differ from patients with schizophrenia with regards to stigma, quality of life, disability level and suicidality. Also, when in remission, they do not differ regarding the severity of their psychopathology.
Chronic pain conditions and depression in the Ibadan Study of Ageing
(Elsevier Inc, 2011) Oladeji, B.D.; Makanjuola, V.A.; Esan, O.B.; Gureje, O.
"Background—Chronic pain is quite common in the elderly and is often associated with co morbid depression, limitation of functioning and reduced quality of life. The aim of this study was to ascertain whether there is a differential risk of depression among persons with pain in different anatomical sites and to determine which pain conditions are independent risk factors for depression. Methods—Data is from the Ibadan Study of Ageing (ISA), a community based longitudinal survey of persons aged 65 years and older from eight contiguous Yoruba Speaking states in Nigeria (n = 2152). Data was collected in face-to-face interviews; depression was assessed using the World Mental Health initiative version of the Composite International Diagnostic Interview (CIDI) while chronic pain was assessed by self-report (response rate = 74%). Results—Estimates of persistent pain (lasting more than 6 months), in different anatomical sites range from 1.3% to 12.8%, with the commonest being joint pains (12.8%), neck or back (spinal) pain (7.6%) and chest pain (3.0%). Significantly more pain conditions were reported by females and by respondents who were aged over 80 years. The risk for depression was higher in respondents with spinal, joint and chest pain. However, only chest pain was independently associated with depression after adjustments were made for pains at other sites and for functional disability. Conclusion—Our data suggests that, among elderly persons, there is a differential association of depression with chronic pain that is related to the anatomical site of the pain."
Collaboration Between Biomedical and Complementary and Alternative Care Providers: Barriers and Pathways
(SAGE Publishing, 2017) "Van der Watt, A.S.J.; Nortje, G.; Kola, L.; Appiah-Poku, J.; Othieno, C.; Harris, B.; Oladeji, B.D.; Esan, O.B.; Makanjuola, V.; Price, L.N.; Seedat, S.; Gureje, O.
We examined the scope of collaborative care for persons with mental illness as implemented by traditional healers, faith healers, and biomedical care providers. We conducted semistructured focus group discussions in Ghana, Kenya, and Nigeria with traditional healers, faith healers, biomedical care providers, patients, and their caregivers. Transcribed data were thematically analyzed. A barrier to collaboration was distrust, influenced by factionalism, charlatanism, perceptions of superiority, limited roles, and responsibilities. Pathways to better collaboration were education, formal policy recognition and regulation, and acceptance of mutual responsibility. This study provides a novel cross-national insight into the perspectives of collaboration from four stakeholder groups. Collaboration was viewed as a means to reach their own goals, rooted in a deep sense of distrust and superiority. In the absence of openness, understanding, and respect for each other, efficient collaboration remains remote. The strongest foundation for mutual collaboration is a shared sense of responsibility for patient well-being.
Collaborative shared care to improve psychosis outcome (COSIMPO): study protocol for a randomized controlled trial
(BioMed Central, 2017) Gureje, O.; Makanjuola, V.; Kola, L.; Yusuf, B.; Price, L.; Esan, O.B.; Oladeji, B.D.; Appiah-Poku, J.; Haris, B.; Othieno, C.; Seedat, S.
Keywords Background: Psychotic disorders are a group of severe mental disorders that cause considerable disability to sufferers and a high level of burden to families. In many low- and middle-income countries (LMIC), traditional and faith healers are the main providers of care to affected persons. Even though frequently canvassed as desirable for improved care delivery, collaboration between these complementary alternative health providers (CAPs) and conventional health providers has yet to be rigorously tested for feasibility and effectiveness on patient outcomes. Methods/design: COSIMPO is a single-blind, cluster randomized controlled trial (RCT) being conducted in Nigeria and Ghana to compare the effectiveness of a collaborative shared care (CSC) intervention program implemented by CAPs and primary health care providers (PHCPs) with care as usual (CAU) at improving the outcome of patients with psychosis. The study is designed to test the hypotheses that patients receiving CSC will have a better clinical outcome and experience fewer harmful treatment practices from the CAPs than patients receiving CAU at 6 months after study entry. An estimated sample of 296 participants will be recruited from across 51 clusters, with a cluster consisting of a primary care clinic and its neighboring CAP facilities. CSC is a manualized intervention package consisting of regular and scheduled visits of PHCPs to CAP facilities to assist with the management of trial participants. Assistance includes the administration of antipsychotic medications, management of comorbid physical condition, assisting the CAP to avoid harmful treatment practices, and engaging with CAPs, caregivers and participants in planning discharge and rehabilitation. The primary outcome, assessed at 6 months following trial entry, is improvement on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes, assessed at 3 and 6 months, consist of levels of disability, experience of harmful treatment practices and of victimization, and levels of perceived stigma and of caregivers’ burden. Discussion: Information about whether collaboration between orthodox and complementary health providers is feasible and can lead to improved outcome for patients is important to formulating policies designed to formally engage the services of traditional and faith healers within the public health system.
Combining depot antipsychotic with an assertive monitoring programme for treating first-episode schizophrenia in a resource- constrained setting
(John Wiley & Sons Australia, Ltd, 2016) Chiliza, B.; Ojagbemi, A.; Esan, O.B.; Asmal, L.; Oosthuizen, P.; Kidd, M.; Gureje, O.; Emsley, R.
Aim: To assess the feasibility and effectiveness of depot antipsychotic (flupentixol decanoate) combined with an assertive monitoring programme (AMP) in first-episode schizophrenia. Methods: This was a prospective, non-comparative, longitudinal study conducted over 12 months assessing patient acceptance, adherence, outcome in domains of psychopathology, functionality and quality of life, and tolerability. Results: Of 207 participants, 149 (72%) completed 12 months of treatment. Acceptance of and adherence to depot was good. Treatment response was achieved by 170 (82%) participants and remission by 124 (60%). Thirty-three (19%) responders relapsed and10(5%) participants met a priori criteria for treatment resistance. Treatment was generally well tolerated. Conclusions: Combination of depot antipsychotic with an AMP maybe an effective and safe intervention linearly phase of schizophrenia, and may be particularly suitable for resource constrained settings.
Comparison of the profile of patients with acute and transient psychotic disorder and schizophrenia in a Nigerian teaching hospital
(American Psychiatric Assicaition Publishing, 2013) Esan, O.B.; Fawole, O.I.
Acute and transient psychotic disorders (ATPD) are different from schizophrenia; however, very little research has been done on this disorder in low-income countries, where the incidence is as high as 10 times the incidence in the more developed countries. The authors sought to identify/ characterize the sociodemographic and clinical differences between the two disorders by performing a retrospective review of the records of patients with untreated first episode of ATPD and schizophrenia seen at the University College Hospital, Ibadan, between January 1, 2006 and December 31, 2010, extracting sociodemographic and clinical data. A group of 243 patients with schizophrenia and 124 subjects with ATPD met the inclusion criteria. Patients with ATPD were more likely to present below the age of 25 years. Excitement was more common in ATPD than in schizophrenia; suspiciousness was more common in subjects with schizophrenia than ATPD. Also, anxiety and uncooperativeness were significantly more likely to occur in ATPD. Poor orientation, disturbance of volition, and preoccupation were more common in schizophrenia. The mean age at onset was similar between patients with schizophrenia and ATPD. In keeping with findings in Europe and North America, there are clinical and sociodemographic differences between ATPD and schizophrenia; however, a different set of features differentiate between the two conditions in Nigerians.
Concepts of madness in diverse settings: a qualitative study from the INTREPID project.
(BioMed Central, 2016) Cohen, A.; Padmavati, R.; Hibben, M.; Oyewusi, S.; John, S.; Esan, O.B.; Patel, V.; Weiss, H.; Murray, R.; Hutchinson, G.; Gureje, O.; Thara, R.; Morgan, C.
Background: In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings. Methods: We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted. Results: Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years. Conclusions: The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
Depression and anxiety disorders amongst a cohort of infertile women attending an in-vitro fertilization clinic in south-western Nigeria.
(Zambia Medical Association, 2019) Obajimi, G.O.; Esan, O.B.; Ogunkinle, B. N.
Background: Psychological consequences of infertility have been documented in both developed and less developed countries. Depression and anxiety disorders have been identified as important causative factors. The prevalence of psychiatric morbidity amongst infertile women has been shown to be quite high with values as high as 46.4%. A high premium is placed on childbirth in Nigeria and failure to conceive is associated with disastrous consequences. Failed In-Vitro Fertilization (IVF) cycles have been implicated in psychological distress. Objective: This study aimed to determine the prevalence of anxiety and depression amongst infertile women undergoing IVF and to examine the psychosocial stressors associated with the development of these morbidities. Materials and Methods: A descriptive cross sectional study of fifty-one infertile women attending an In-Vitro Fertilization clinic in Lagos, South Western, Nigeria. Participants were recruited consecutively at their first consultation visit and a self-administered questionnaire consisting of sociodemographic information along with the Hospital Anxiety and Depression Scale (HADS) was completed by the participants. Data obtained from the respondents was analyzed using the Statistical Package for Social Sciences (IBM SPSS, New York) version 21. The Chi-Square statistic was used in testing for associations between categorical variables. Results: The mean age of the respondents was 38.96 ± 5.91 years with a range of 23-49 years. 76.5% (39/51) of the women had infertility greater than 5 years, while 49 % (25/51) of the women were aged 40 years and above with 96% (24/25) of this group experiencing infertility greater than 5 years. Anxiety was recorded in 24 respondents (47.1%) while Eighteen respondents (35.3%) had evidence of depression. Marital disharmony was found to be associated with the development of anxiety (P<0.05) Conclusion: The impact of infertility on the Nigerian couple can be devastating. Lack of support coupled with the overbearing and intrusive nature of family members predisposes to the development of psychosocial distress. We therefore recommend that Physicians pay attention to the psychosocial stressors experienced by infertile women prior to In Vitro Fertilization with the aim of ensuring appropriate referral for psychiatric assessment and treatment.
Depression in adult Nigerians: results from the Nigerian Survey of Mental Health and Well-being
(Cambridge University Press & Assessment, 2010) Gureje, O.; Uwakwe, R.; Oladeji, B.; Makanjuola, V.O.; Esan, O.B.
Background: Community-based studies of the rates and profile of depression among Africans are still sparse. Methods: As part of the World Mental Health Surveys initiative, a clustered multi-stage sampling of households in 21 of Nigeria's 36 states (representing 57% of the national population) was implemented to select adults aged 18 years and over(N=6752)for face-to-face interviews using the Composite International Diagnostic Interview (CIDI 3.0). Diagnosis of major depressive episode (MDE) was based on the criteria of the Diagnostic and Statistical Manual, 4th edition. Results: Lifetime and 12 monthestimatesofMDEwere3.1%(standarderror0.3) and1.1% (s.e.0.1), receptively. Increasing age was associated with higher estimates of positive responses to stem (screen)questions for depression and of lifetime disorders among stem-positive respondents. The mean age of onset was about 29.2 years. The median (inter quantile range, IQR) duration of an episode among lifetime cases was 1.0 (2.0–2.4) year and the median (IQR) number of lifetime episodes was 1.5 (2.0–2.8). MDE was highly comorbid with anxiety disorders, musculoskeletal conditions, chronic pain and ulcer. The odds ratio of lifetime suicide attempt among persons with lifetime MDEwas11.6(95%confidenceinterval,3.9–34.9).Over25%of12-monthcaseswererated as severely disabled in the performance of usual roles. Only 16.9%(i.e. 5.0) of 12-monthcases had received any treatment. Limitations: All data were based on self-reports. Conclusion: MDE, defined according to DSM-IV, is a risk factor for mental and physical comorbidity as well as disability in Nigerians. Age-related telescoping or denial may partly explain the low rates in this young population
Determinants of transition across the spectrum of alcohol use and misuse in Nigeria
(Elsevier Inc, 2013) Esan, O.B.; Makanjuola, V.; Oladeji, B.; Gureje, O.
Many studies have examined the risk factors associated with alcohol use disorders. No information is available from developing countries about the factors that may determine the transitions across different levels of use and misuse. Alcohol use and its misuse were assessed in a cohort of 2143 Nigerians using Version 3.0 of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI). This generated six levels of alcohol use and related disorders. Using age of onset variables created for the purpose, analysis was done to determine rates of and risk factor for transition between the levels. Lifetime prevalence estimates were 57.8% for alcohol use, 27.6% for regular use, 2.9% for abuse, and 0.3% for dependence. Whereas 47.8% transited to regular use from lifetime ever use, only 10.5% transited to abuse from regular use and 9.5% from abuse to dependence. Male sex, age 18e49 years and being never married predicted onset of alcohol use. Transition to regular use was predicted only by male sex while transition to abuse was predicted by male sex and age 35e49 years. Factors associated with recovery from abuse were female sex and a student status. Higher rates of transition occurred in the stages preceding the onset of alcohol use disorders. Sex and age were the main determinants of transition, with male gender and middle age being risk factors for transition to problematic use of alcohol.
DSM-5 schizoaffective disorder: will clinical utility be enhanced?
(Springer Science + Business Media, 2015) Esan, O.B.
Recently, the latest edition of the Diagnostic and Statistical Manual (DSM), the DSM-5, was published following extensive scrutiny and elaborate revision of the DSM-IV. According to the American Psychiatric Association (APA), the main concerns in modifying DSM-IV included opti mizing clinical utility, upholding continuity with previous editions, and that recommendations should be directed by research evidence [1]. Therefore, the result expected was to be a text that is more useful for medical practitioners, patients and policy makers, and which should reveal not only scientific advances in our understanding of the causes and consequences of psychiatric disorders, but also com mon usage.
Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO): a cluster randomised controlled trial
(Elsevier Ltd, 2020) Gureje, O.; Appiah-Poku, J.; Bello, T.; Kola, L.; Araya, R.; Chisholm, D.; Esan, O.B.; Harris, B.; Makanjuola, V.; Othieno, C.; Price, L.
Background: Traditional and faith healers (TFH) provide care to a large number of people with psychosis in many sub Saharan African countries but they practise outside the formal mental health system. We aimed to assess the effectiveness and cost-effectiveness of a collaborative shared care model for psychosis delivered by TFH and primary health-care providers (PHCW). Methods: In this cluster-randomised trial in Kumasi, Ghana and Ibadan, Nigeria, we randomly allocated clusters (a primary care clinic and neighbouring TFH facilities) 1:1, stratified by size and country, to an intervention group or enhanced care as usual. The intervention included a manualised collaborative shared care delivered by trained TFH and PHCW. Eligible participants were adults (aged ≥18 years) newly admitted to TFH facilities with active psychotic symptoms (positive and negative syndrome scale [PANSS] score ≥60). The primary outcome, by masked assessments at 6 months, was the difference in psychotic symptom improvement as measured with the PANSS in patients in follow-up at 3 and 6 months. Patients exposure to harmful treatment practices, such as shackling, were also assessed at 3 and 6 months. Care costs were assessed at baseline, 3-month and 6-month follow-up, and for the entire 6 months of follow-up. This trial was registered with the National Institutes of Health Clinical Trial registry, NCT02895269. Findings: Between Sept 1, 2016, and May 3, 2017, 51 clusters were randomly allocated (26 intervention, 25 control) with 307 patients enrolled (166 [54%] in the intervention group and 141 [46%] in the control group). 190 (62%) of participants were men. Baseline mean PANSS score was 107∙3 (SD 17∙5) for the intervention group and 108∙9 (18∙3) for the control group. 286 (93%) completed the 6-month follow-up at which the mean total PANSS score for intervention group was 53∙4 (19∙9) compared with 67∙6 (23∙3) for the control group (adjusted mean difference –15∙01 (95% CI –21∙17 to –8∙84; 0·0001). Harmful practices decreased from 94 (57%) of 166 patients at baseline to 13 (9%) of 152 at 6 months in the intervention group (–0∙48 [–0∙60 to –0∙37] (p<0.001) and from 59 (42%) of 141 patients to 13 (10%) of 134 in the control group (–0·33 [–0∙45 to –0∙21] (p<0.001) with no significant difference between the two groups. Greater reductions in overall care costs were seen in the intervention group than in the control group. At the 6-month assessment, greater reductions in total health service and time costs were seen in the intervention group; however, cumulative costs over this period were higher (US $627 per patient vs $526 in the control group). Five patients in the intervention group had mild extrapyramidal side effects. Interpretation: A collaborative shared care delivered by TFH and conventional health-care providers for people with psychosis was effective and cost-effective. The model of care offers the prospect of scaling up improved care to this vulnerable population in settings with low resources
Epidemiology and burden of bipolar disorder in Africa: a systematic review of data from Africa
(Springer Science + Business Media, 2016) Esan, O.B.; Esan, A.
Background Bipolar disorder impacts negatively on the patient, the family, as well as the society. It taxes the health care services due to a combination of the illness with associated medical and psychiatric comorbidities. In Africa, unfortunately, knowledge of the epidemiology and burden of bipolar disorder is based mainly on studies from the USA and Europe. In this systematic review of literature from Africa, we highlight the epidemiology and burden of bipolar disorder. Methods A systematic review of publications from Africa relating to the epidemiology and burden of bipolar disorder was conducted. Result Data from community surveys conducted in Nigeria and Ethiopia indicated a lifetime prevalence estimate of 0.1 % to 1.83 for bipolar disorder. Missed diagnosis rate of bipolar disorder was up to 36.2 %. In one study, 8.1 % of the males and 5.4 % of the females reported a previous suicide attempt. A study showed that up to 60 % of patients with bipolar disorder had at least one comorbidity. There were no reports on all-cause mortality and cost of illness. Conclusion Bipolar disorder is a major mental health problem in Africa. Scientific findings on bipolar disorder from Africa are consistent with the existing literature from other parts of the world. There still exists a dearth of high-quality studies addressing the epidemiological, clinical, social, and economic burden of the disorder.
Epidemiology of schizophrenia-- an update with a focus on developing countries
(Taylor & Francis, 2012) Esan, O.B.; Ojagbemi, A.; Gureje, O.
Developments over the past few decades in analytical epidemiological research in schizophrenia have challenged some long-held views about the disorder. For example, the conventional view that schizophrenia may have a favourable outcome in developing countries is currently being challenged by emerging empirical data. However, quality research from develop ing countries is still relatively scarce. In this article we review some major epidemiological fi ndings of schizophrenia with a focus on data from the developing world and within the context of the methodological issues and challenges associ ated with such studies.
Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities
(Springer Science + Business Media, 2016) Makanjuola, V.; Esan, O.B.; Oladeji, B.; Kola, L.; Appiah-Poku, J.; Harris, B.; Othieno, C.; Price, L.; Seedat, S.; Gureje, O.
Mental disorders are cross-culturally ubiquitous [1]. Psychosis is, by far, the more easily recognisable form of mental disorder by the lay public and traditional healers [2]. While the experience of psychosis is universal, interpretation of the experience, notions of causation, treatment, preferred source of care, and the consequences and perceptions of associated stigma vary from one culture to another. We used a mixed-methods approach consisting of in-depth interviews with key informants to explore respondents’ explanatory models of the causation of psychosis as well as questionnaire assessment of the level of internalized (or self) stigma. The conduct of the interviews was guided by the specifications of the McGill Illness Narrative Interview (MINI) [32], a semi-structured interview guide which, among other things, elicits lay illness narratives. A purposively selected sample of patients who were receiving treatment from traditional healers was interviewed. The transcribed interviews were read several times by the first author and subjected to thematic analysis. Supernatural and biopsychosocial explanatory models of the causation of psychosis were both endorsed by our respondents. Despite this, the majority of the respondents with severe forms of self-stigma held supernatural attributions. However, we also found that some respondents with low self-stigma embraced a supernatural model while some respondents with high self-stigma proffered a biopsychosocial explanation. Our findings suggest that individualising interventions to minimize self-stigma may be a better approach than programs that generically promote biopsychosocial models or discourage supernatural models.
Features of residency training and psychological distress among residents in a Nigerian teaching hospital
(AOSIS (Pty) Ltd, 2014) Esan, O.B.; Adeoye, A.; Onakoya, P.; Opeodu, O.; Owonikoko, K.; Olulana, D.; Bello, M.; Adeyemo, A.; Onigbogi, L.; Idowu, O.; Akute, T.
Background. Resident doctors at University College Hospital (UCH), Ibadan, Nigeria, made a series of complaints about inadequate consultant supervision, lack of structure in the training programme and excessive workload. These complaints led to an evaluation of residency training. Objective. To investigate perceptions of the residency training programme and levels of psychological distress among residents. Methods. All 250 resident doctors at UCH were invited to complete questionnaires about their residency training and general health as part of a cross-sectional study. Data were analysed using SPSS 16. Results. A total of 128 residents (51.2%) responded to the questionnaire. Of the respondents, 72% rated their consultant supervision as good and 82.6% rated support from nurses as good; 61.8% had <5 hours of research or private study per week. There was evidence of psychological distress in 48.4% of the respondents, and there was a significant association between psychological distress and the intensity of work (p<0.01) Conclusion. The residency training programme at UCH appears to prioritise service provision over research and education activities. Residents who report high workloads also have high levels of psychological distress. Tackling these issues could improve overall satisfaction with residency training and reduce complaints.
Gender and rural-urban differences in the nutritional status of in-school adolescents in south-western Nigeria
(Cambridge University Press, 2010) Omigbodun, O.O.; Adediran, K.I.; Akinyemi, J.O.; Omigbodun, A.O.; Adedokun, B.O.; Esan, O.B.
This study assessed gender and rural/urban differences in height and weight, and the prevalence of stunting, underweight and overweight of school-going adolescents in south-west Nigeria, using 2007 WHO reference values for comparison. The influence of sexual maturity and the socio demographic correlates of growth performance were also examined. In this cross-sectional study, 924 male (51.4%) and 875 female (48.6%) students (1799 in total) aged 10–19 years from eighteen schools in Ibadan (five rural, nine urban public and four urban private) were interviewed and examined. Although males were significantly taller than females (p<0.05) stunting was more pronounced for males, who were 7.5 cm shorter than the 2007 WHO reference, compared with females who were 3.5 cm shorter. Body mass index (BMI) for girls was also greater than for boys (p<0.05) Rural adolescents had lower heights and BMIs compared with those in urban areas. The mean height of male adolescents in rural schools fell below 2 SDs of the 2007 WHO reference between 14 and 17 years, while heights of males and females in private schools were similar to the median 2007 WHO standard. Low height-for-age was observed in 282 adolescents (15.7%), which, after multivariate analysis, was significantly associated with school type, gender, number of mother’s children and puberty onset. Adolescents in rural schools were much more likely to be stunted than those in urban private schools (AOR 13.1; 95% CI 5.2–33.2) and males were three times more likely to be stunted compared with females (AOR 3.3; 95% CI 2.4–1.4). Low BMI-for-age was observed in 240 adolescents (18.9%), with correlates similar to stunting. Adolescents at the pre-puberty stage were twice as likely to have low BMI-for-age (OR 2.0; 95% CI 1.6–2.5) than those with signs of puberty. There were 2.3% overweight adolescents, who were significantly more likely to be female, in private school and post-pubertal. Innovative interventions for Nigerian adolescents, especially rural inhabitants and males, are needed to reduce the prevalence of stunting and underweight
Mental health care in Anglophone West Africa
(American Psychiatric Association Publishing, 2014) Esan, O.B.; Abdumalik, J.O.; Eaton, J.; Kola, L.; Fadahunsi, W.; Gureje, O.
This column describes the current state of resources and practice in mental health care in the Anglophone countries of West Africa: the Gambia, Sierra Leone, Ghana, Nigeria, and Liberia. Information was systematically gathered from the five countries by using a standard framework for country situation analysis. Mental health services, which are in various stages of development, are characterized by inadequate human resources and long policy neglect. Despite the low numbers of specialists, the region has made important contributions to community service development and global mental health research. Challenges include man power development, policy and legislation updates, and increased attention to policy and budget. Although mental health service is still grossly inadequate in the con text of human and material constraints, there are slowly evolving signs of positive modernization and service development.