Nigerian Outpatients Research Articles

A Comparative Assessment of Disability Levels among Nigerian Outpatients with Schizophrenia and Type 2 Diabetes Mellitus

Background: Chronic illnesses are often associated with functional disability, thus compromising the ability to carry out everyday activities of daily living. The degree of disability depends on the severity and the type of illness experienced. Studies that compare the level of disability between people with chronic medical conditions and mental illnesses in North-Central Nigeria are scarce. This study aims to compare the disability levels between people with schizophrenia and Type 2 Diabetes Mellitus (T2DM) attending outpatient clinics at the Jos University Teaching Hospital, north-central Nigeria, and evaluate the factors associated with these conditions. Methods: It was a cross-sectional study with a total of 600 patients who were diagnosed with schizophrenia and T2DM, attending the Psychiatric and medical outpatient clinics of the Jos University Teaching Hospital, north-central Nigeria, between June 2017 and November 2017. The study assessed Psychotic and non-psychotic symptoms by applying the Brief Psychiatric Rating Scale (BPRS) among those with schizophrenia. We evaluated the level of disability by using World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.00). Results: Disability was significantly higher among respondents with schizophrenia than those with T2DM. This difference occurred across all the domains except domain 2 (moving around). Marital status, living situation, occupation, and treatment adherence were significant common factors associated with disability in these conditions. In contrast, age, educational status, income level, and duration of illness were significantly associated with disability among respondents with T2DM only. Conclusion: Disability and its associated factors among people with chronic diseases, if identified early and proper interventions instituted, disability can be avoided or minimized among people with chronic illnesses.

Self-stigma and decision about medication use among a sample of Nigerian outpatients with schizophrenia.

Self-stigma is a common barrier to maintenance therapy and recovery in schizophrenia. We investigated the prevalence of the decision not to use medication as prescribed and describe the multidimensional relationship of self-stigma with such a decision in 370 adults with schizophrenia. A multivariate binary logistic regression model was used to examine the relationship between specific aspects of self-stigma (alienation, perceived discrimination, stigma resistance, stereotype endorsement and social withdrawal) and the decision not to take medication, while controlling for other clinical variables. Of the total study participants, 16.5% reported high self-stigma while 39.2% decided not to use their medications. The decision not to use medication was associated with a high self-stigma global score, alienation, perceived discrimination and stigma resistance. Stereotype endorsement and social withdrawal did not demonstrate a relationship with nonuse of medication. Following regression analysis, the decision not to use medication was associated with self-stigma, especially high alienation and perceived discrimination, and other factors including medication side effects, worse psychopathology, not living alone, poor 24-hr medication use recall, and absence of medical comorbidity. Medication nonuse and self-stigma are prevalent and interrelated in patients on maintenance therapy for schizophrenia. Obtaining routine information during follow-up appointments about medication use including side effects, the symptom profile, and conducting a focused stigma screening can inform clinical discussions regarding medication use in a shared decision-making process. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The relationship between obsessive compulsive symptoms and quality of life in Nigerian patients with schizophrenia.

Obsessive compulsive symptoms (OCS) are relatively common in schizophrenia. Their presence and severity can affect the quality of life (QoL) of schizophrenia patients. This study aimed to determine the effect of OCS on the subjective QoL of the Nigerian outpatients with schizophrenia. It also determines the sociodemographic and clinical factors associated with OCS. A cross-sectional study involving 232 patients with schizophrenia completed socio-demographic and clinical characteristics questionnaire. OCS was examined with Obsessive Compulsive Inventory (OCI) and QoL was assessed using the brief version of the World Health Organisation Quality of Life questionnaire. Most of the schizophrenia patients with OCS were unmarried, unemployed, had an earlier onset, longer duration of illness, and were on higher doses of antipsychotics. They reported lower QoL and more severity of symptoms of schizophrenia when compared to those without OCS. The OCI total and it's subscales had negative weak to moderate relationship with all the domains of the WHOQoL Bref. Being unemployed, dosage of antipsychotic medication, negative symptoms and OCI total were the predictors of the total quality of life among Nigerian schizophrenia patients. OCS are very common and reduce QoL of schizophrenia patients. Hence, there is a need to routinely screen patients with schizophrenia for OCS and manage them appropriately.

Adaptation of the Beck Hopelessness Scale as a suicide risk screening tool among Nigerian patients with schizophrenia

Objectives: We examined the adaptation of the Beck Hopelessness Scale (BHS) as a subjective suicide risk assessment tool in detecting Nigerian patients with schizophrenia who are at a high risk of suicide.Methods: Schizophrenia patients (211) completed the BHS in addition to a sociodemographic questionnaire. They were objectively interviewed with the suicidality module of the Mini International Neuropsychiatric Interview (MINI) as the ‘gold standard’, against which the criterion validity of the BHS was examined.Results: The receiver operating characteristics (ROC) curve of the 20-item BHS scale at a total cut-off score of 9 (sensitivity 0.889, specificity 0.916) against the patients’ MINI Suicidality Module risk categorisation had an Area Under the Curve (AUC) of 0.96 (95% CI: 0.928–0.987), while, the four-item BHS scale demonstrated a ROC curve with an AUC of 0.92 (95% CI: 0.868–0.966) at a cut-off score of 1 (sensitivity 1.000, specificity 0.832).Conclusions: The BHS has proven to be valid in terms of its sensitivity and specificity in the identification of the high suicidal risk Nigerian schizophrenia outpatients.

Disability assessment as an outcome measure: a comparative study of Nigerian outpatients with schizophrenia and healthy control.

Background and objectiveSchizophrenia is a chronic mental disorder that leads to disability in several aspects of the individual’s personal, social, and occupational functioning. This study assesses and compares the level of disability among Nigerian outpatients with schizophrenia and healthy controls (HC).MethodsA comparative cross-sectional study among 100 schizophrenia outpatients with an ICD-10 diagnosis and 100 HC was conducted over a 4-month period. They completed a questionnaire containing the Zung’s Self-Rating Depression Scale (SDS), the World Health Organization Disability Assessment Schedule-Second Version (WHODAS-II). Symptoms of schizophrenia were assessed with the Positive and Negative Syndrome Scale (PANSS). Student’s t tests and Chi-square were used to compare patient with schizophrenia and healthy control. Pearson correlation and multiple linear regression analyses were used to assess the relationships of socio-demographic and clinical variable with disability.ResultsThe patients with schizophrenia reported greater disability than the HC on most of the disability domains of WHODAS-II. They also reported significantly higher mean Zung’s SDS scores than the HC. Depressive symptoms, negative symptoms, and PANSS total were significantly related to all the WHODAS-II domains. The disability summary score was significantly predicted by depressive symptoms, negative and positive symptoms of schizophrenia, number of active symptoms (relapse) of schizophrenia, and marital status [F (5, 94) = 23.90, p < 0.001].ConclusionSchizophrenia is a disabling disorder that affects different aspects of a patient’s life. Treatment strategies that target these different aspects may help in reducing disability.

Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania.

BackgroundWe have previously described the development of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen for use in populations with low levels of formal education. The IDEA cognitive screen was developed and field-tested in an elderly, community-based population in rural Tanzania with a relatively high prevalence of cognitive impairment. The aim of this study was to validate the IDEA cognitive screen as an assessment of major cognitive impairment in hospital settings in Nigeria and Tanzania.MethodsIn Nigeria, 121 consecutive elderly medical clinic outpatients reviewed at the University College Hospital, Ibadan were screened using the IDEA cognitive screen. In Tanzania, 97 consecutive inpatients admitted to Mawenzi Regional Hospital (MRH), Moshi, and 108 consecutive medical clinic outpatients attending the geriatric medicine clinic at MRH were screened. Inter-rater reliability was assessed in Tanzanian outpatients attending St Joseph’s Hospital in Moshi using three raters. A diagnosis of dementia or delirium (DSM-IV criteria) was classified as major cognitive impairment and was provided independently by a physician blinded to the results of the screening assessment.ResultsThe area under the receiver operating characteristic (AUROC) curve in Nigerian outpatients, Tanzanian outpatients and Tanzanian inpatients was 0.990, 0.919 and 0.917 respectively. Inter-rater reliability was good (intra-class correlation coefficient 0.742 to 0.791). In regression models, the cognitive screen did not appear to be educationally biased.ConclusionsThe IDEA cognitive screen performed well in these populations and should prove useful in screening for dementia and delirium in other areas of sub-Saharan Africa.

Trust in Physician Scale: Factor structure, reliability, validity and correlates of trust in a sample of Nigerian psychiatric outpatients

BackgroundTrust is essential in the patient–physician relationship and has not been explored among Nigerian psychiatric outpatients. ObjectivesThe purpose of this study was to evaluate the psychometric characteristics of the Trust in Physician Scale among a cross-sectional sample of stable Nigerian outpatients receiving treatment for psychiatric disorders. MethodsA consecutive sample of outpatients attending a Nigerian university teaching hospital psychiatric clinic in South-western Nigeria completed the scale (N=223). Factorial analysis, internal consistency, validity and correlates of the scale were evaluated. ResultsThe structure of the Trust in Physician Scale was best explained by a 2 factor construct. Cronbach's alpha was 0.68, indicating a rather modest degree of internal consistency. The 2 factors extracted also had modest internal consistencies (Cronbach's alpha 0.66 and 0.76). A fair degree of construct validity was indicated by weak positive correlation of trust with medication adherence and the numbers of previous admissions. The mean trust score was relatively high. Significant positive correlations were observed between trust scores and adherence score, number of previous admissions and the number of schizophrenic relapses. ConclusionThe results suggest that despite the comparatively weak psychometric properties of the Trust in Physician Scale, it is still useful in the evaluation of trust among Nigerian psychiatric outpatients. More studies are needed to further explore and compare the properties of this scale across a wider range of patient groups in Nigeria, and to identify other factors that could interact with trust among the different patient populations in our environment.

Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia

To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital. This was a cross-sectional descriptive study of 313 consecutive outpatients with diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis (SCID). Data was collected on sociodemographics, clinic attendance, perceived social support, perceived satisfaction with hospital care and illness severity (assessed using the Brief Psychiatric Rating Scale, BPRS). Logistic regression analysis was used to identify factors associated with outpatient clinic default. Overall, 20.4% respondents were defaulters, with a median duration of clinic non-attendance of 8 weeks. Outpatient clinic defaulters had significantly higher BPRS scores and had missed more outpatient clinic appointments compared with non-defaulters. A significantly higher proportion of defaulters resided more than 20 km away from the hospital and reported "not satisfied" with their outpatient care. Being financially constrained was the commonest reason given by defaulters for missing their clinic appointments. The significant predictors of outpatient clinic default included residing more than 20 km from the hospital, missing previous appointments and dissatisfaction with outpatient care. Outpatient clinic non-attendance is common among patients with schizophrenia, and is significantly associated with demographic, clinical and service related factors. Interventions targeted at addressing the risk factors for defaulting peculiar to developing country settings similar to the location of this study, could significantly improve treatment outcome.

Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital

IntroductionPolypharmacy and inappropriate prescriptions are prominent prescribing issues with elderly patients. Beers criteria and other guidelines have been developed to assist in the reduction of potentially inappropriate medications prescribed to elderly patients. The objectives of this study were to assess the prescribing pattern for elderly Nigerian outpatients and estimate the prevalence of potentially inappropriate medications among them using the Beers criteria.MethodologyThis was a prospective cross-sectional study of elderly patients (65 years and above) who were attending the general outpatients clinic of a rural Nigerian hospital. For the drug utilization aspect of the study, drug-use indicators were assessed using established World Health Organization guidelines, while the Beers criteria was used to screen for potentially inappropriate medications.ResultThe medical records of 220 patients aged 65 years and above were utilized for the study. A total of 837 drugs were prescribed for the patients, giving an average of 3.8 ± 1.3 drugs per person. Antihypertensive drugs accounted for 30.6% of the prescriptions, followed by multivitamins/food supplements (11.5%) and analgesics (10.8%). A review of the prescribed medications using the 2012 Updated Beers Criteria by the American Geriatric Society identified 56 patients with at least one potentially inappropriate medication prescribed giving a rate of 25.5%. The drug groups identified were nonsteroidal anti-inflammatory drugs, antihistamines, and amitriptyline.ConclusionPolypharmacy and prescription of potentially inappropriate medications are major therapeutic issues in Nigeria. There is a need for prescriber training and retraining with emphasis on the geriatric population.

Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia

This study aimed to measure the subjective quality of life (QOL) of Nigerian outpatients with schizophrenia and to examine its socio-demographic as well as clinical determinants. A total of 313 outpatients with schizophrenia participated in the study. Data were collected on socio-demographics, outpatient clinic attendance, perceived social support, perceived satisfaction with hospital care, medication adherence, illness severity and QOL. Multiple linear regression analysis was used to determine the amount of variance in the QOL domain scores explained by socio-demographic and clinical variables. Employment status, perceived social support, satisfaction with outpatient care, antipsychotic medication dose, Brief Psychiatric Rating Scale (BPRS) scores and medication adherence had significant relationships with all the QOL domains. Average monthly allowance and outpatient clinic default were significantly associated with all QOL domains except social relationship. Socio-demographic and clinical factors explained only a modest part (29.4%) of the variance in the QOL scores. It is likely that unmeasured ‘internalised’ determinants contribute in a much larger sense to the variation in subjective QOL.

Intervention for improving the appropriateness of physician orders for oral medications in geriatric VIP patients during the journey to JCI accreditation

Correspondence: Quan Zhou Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang 310009, China Tel +86 571 8778 4615 Fax +86 571-8702 2776 Email zhouquan142602@zju.edu.cn Dear editor We read with great interest the study by Fadare et al, who assessed the prescribing pattern for elderly Nigerian outpatients and concluded that polypharmacy and the prescription of potentially inappropriate medications are major therapeutic issues in Nigeria, and there is a need for prescriber training and retraining with emphasis on the geriatric population. We completely agree with Fadare et al’s point of view that a low proportion of patients with potentially inappropriate medications highlights the importance of information technology in medication management. We discuss and share our perspectives in the following paragraphs. Geriatric patients may suffer from multiple chronic diseases and receive more medications compared to younger patients. Medication therapy management (MTM) services provide essential reviews of drug regimens and are increasingly recognized as beneficial to patient safety, improved health outcomes, and cost savings. Undoubtedly, the elderly patients especially need MTM services. The Joint Commission International (JCI) accreditation standard has strict requirements for rational drug use. Irrational drug use includes inappropriateness of the drug, dose, frequency and route of administration, real or potential drug–drug interactions (DDIs), allergies, therapeutic duplications, and variation from organization criteria for use. The study of Fadare et al indicates that irrational drug use is still a major issue internationally. Our hospital successfully passed JCI accreditation on Feb 24, 2013 and became the first accredited academic medical center hospital, globally. Very recently, we randomly evaluated the physician orders for oral medications in geriatric very important person (VIP) wards of our hospital before and after JCI accreditation so as to illustrate the effectiveness of clinical interventions during the journey to JCI accreditation. Geriatric patient information and indicators of rational drug use are presented in Table 1. The results of our survey show that the proportion of drug-related problems (DRPs) decreased significantly from 13.0% (before JCI accreditation) to 3.5% (after JCI accreditation) (P , 0.01). Statistically significant changes (as decreasing) in five indicators demonstrated statistically significant changes (P , 0.01 or P , 0.05), ie, DDIs with potential adverse consequences, therapeutic duplication or combination use of two drugs within the same therapeutic or structurally similar class, and inappropriate dosing time, dosing frequency and dosing route. Seven DDIs with potential adverse consequences occurred before JCI accreditation whereas no adverse DDIs Dovepress

Risk factors of obstructive sleep apnea among nigerian outpatients

Obstructive sleep apnea (OSA) is a medical condition with adverse consequences. OSA is credited to be a sleep disorder that disproportionately affects blacks. The Berlin Questionnaire (BQ) is a screening questionnaire for OSA. ObjectiveTo describe the risk factors associated with OSA among adults attending an out-patient specialist clinic. Study design: Prospective, clinical study including adult outpatients attending a specialist clinic. MethodData was collected using a questionnaire incorporating the BQ and patients were divided into low and high risks of OSA. The risk factors associated with OSA in the univariate analyses were subjected to a multivariate binary logistic regression model. Adjusted odds ratios with 95% confidence intervals were calculated for these independent variables. ResultsOne hundred and ninety five patients participated in the study (Males 56.4%; Age 43.5 ± 15.6 years; Non-habitual snorers 81.5%; High risk OSA 17.4%; BMI 24.1 ± 4.6 kg/m2; Obese 12.9%). Six factors including marital status and blood pressure were significantly associated with OSA using bivariate analysis nevertheless age, hours at work, smoking status and BMI remained predictive of OSA on logistic regression analysis. ConclusionsOSA is common among Nigerian outpatients, may be under-recognized and is associated with risk factors that are amenable to preventive strategies.

Medication adherence and quality of life among Nigerian outpatients with schizophrenia

Objective The aim of this study was to examine medication adherence among outpatients with schizophrenia in relation to their subjective quality of life and other sociodemographic, clinical and service related factors. Methods Three hundred and thirteen consecutive outpatient clinic attendees with a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis were recruited for the study. Respondents were interviewed using a questionnaire evaluating sociodemographic, medication, illness and clinic attendance related variables. Medication adherence was assessed using the Morisky medication adherence questionnaire. Participants also completed the World Health Organization Quality of Life Scale-BREF questionnaire as a measure of their subjective quality of life, while severity of illness was measured using the Brief Psychiatric Rating Scale (BPRS). Results Overall, 40.3% of the respondents were medication nonadherent. Medication adherent respondents significantly reported their perceived social support as “good” ( P=.006), took significantly fewer number of medications ( P≤.001), had higher medication use recall scores ( P≤.001), had lower total BPRS scores ( P=.001) and were “very satisfied” with their outpatient care ( P=.002). Independent predictors of medication nonadherence were BPRS score [odds ratio (OR)=1.08, 95% confidence interval (95% CI)=1.03–1.13], outpatient clinic default (OR= 4.97, 95% CI=2.59–9.53) and moderate satisfaction with outpatient care (OR=2.78, 95% CI=1.47–5.24). Medication nonadherence was significantly associated with lower scores on all domains and facets of quality of life. Conclusions Medication nonadherence is common among outpatients with schizophrenia and is associated with poor quality of life. Clinicians’ awareness of the risk factors for medication nonadherence early in patients’ management may significantly improve treatment outcomes, including patients’ quality of life.

Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates

Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one's particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. Out-patients with Schizophrenia (n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. Overall, 21 patients (21.2%) were categorised as having 'good' and 36 (36.4%) as having 'poor' subjective QOL. 'Poor' subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93-11.48), comorbid medical problems (OR 4.75, 95% CI 1.43-16.33), unemployment (OR 3.75, 95% CI 1.25-11.72) and poor social support (OR 4.60, 95% CI 1.49-14.28). Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment.

Flexibility and Variability in Lexicon Usage among Yoruba-Speaking Nigerian Outpatients with Schizophrenia

Background: The studies on language dysfunction in schizophrenia are few, inconclusive and have all been done in the western culture. There may be cross-cultural and cross-lingual differences in problems with speeches of patients with schizophrenia. This study aims to examine the flexibility or variability in the use of words among a group of Nigerian patients with schizophrenia compared with healthy controls. Sampling and Methods: The spoken samples of 48 outpatients with schizophrenia and 48 matched controls were assessed using the mean segmental type-token ratio (MSTTR). The sociodemographic and clinical variables of the patients with schizophrenia were also compared with their MSTTR scores. Results: The MSTTR score for the patients with schizophrenia was significantly lower compared with that of healthy controls (p < 0.001). The factors independently associated with a lower MSTTR in patients with schizophrenia include younger age at onset of illness, presence of negative formal thought disorder and simple or hebephrenic subtype of schizophrenia. Conclusions: The problem with flexibility and variability in lexicon usage among patients with schizophrenia is a cross-cultural phenomenon. The MSTTR may have value in predicting clinical judgements of thought disorder or in identifying deviant language. These may have broad potentials for application in longitudinal and pathogenetic studies of schizophrenia.

363 – Flexibility and variability in lexicon usage among yoruba speaking nigerian outpatients with schizophrenia: A controlled study

363 – Flexibility and variability in lexicon usage among yoruba speaking nigerian outpatients with schizophrenia: A controlled study

Relationship between depression and quality of life in Nigerian outpatients with heart failure

Objective Our objective was to evaluate the relationship between depression and health-related quality of life (QoL) in Nigerian outpatients with heart failure (HF). Methods We used a cross-sectional study in which outpatients with HF ( n=100) completed the WHO Quality of Life Scale—Brief Version to assess their subjective QoL. The patients were also assessed for the diagnosis of major depressive disorder (MDD) in accordance with the Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition. Results The factors independently associated with poor QoL include disability due to illness, presence of MDD, younger age, and longer duration of illness. Patients with MDD had worse QoL than patients without MDD on dimensions of physical health, psychological health, and environment. Conclusion Depression adversely affects the QoL of patients with HF. Programs designed to improve the QoL of patients with HF need to incorporate the early identification and treatment of depression. Future studies are warranted to investigate the impact of improved depression management on QoL in patients with HF.

Prevalence and Correlates of Major Depressive Disorder in Nigerian Outpatients With Heart Failure

This study aims to estimate the prevalence and correlates of major depressive disorder (MDD) in Nigerian outpatients with heart failure. Authors assessed patients with heart failure (N = 102) for DSM-IV diagnosis of MDD and obtained sociodemographic and clinical data. MDD was found in 28 (27.5%) of the patients. The significant correlates predicting MDD included unemployment and disability due to the illness, more severe illness (NYHA class), age younger than 60 years, and not being married. These factors should be considered in planning further studies and in screening and intervention programs for patients with heart failure.

Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index

Abstract Background: When limited resources are available for orthodontic treatment, it is important that those with the greatest need receive treatment. Aims: The aims of this study were to determine the orthodontic treatment needs of Nigerian children and young adults attending a University Hospital as outpatients, and to determine if a relationship exists between social class and orthodontic treatment need. Methods: Of 148 consecutive patients attending a hospital department for orthodontic treatment, 136 were children and young adults (67 males, 69 females) between 6 and 18 years of age. These subjects were assessed with the Dental Aesthetic Index (DAI), and classified into two social classes with the Standard Occupational Classification. Results: Almost 30 per cent of the children and young adults presenting for treatment had “no/little” need of orthodontic treatment, 20 per cent had DAI scores between 26 and 30 indicating that treatment was “elective”, 15 per cent had a “desirable” need for treatment, and 35 per cent had a “mandatory” need for treatment. There was a significant association (p &lt; 0.05) between treatment need and social class: more subjects from the lower social classes (semi-skilled and unskilled occupations) needed orthodontic treatment than subjects from the higher social classes (professional, managerial, and skilled occupations). Conclusion: The study has shown that not all outpatients presenting/referred for orthodontic treatment “need” treatment. Patients from the semi-skilled and unskilled occupations were more likely to need orthodontic treatment than patients from the professional, managerial and skilled occupations.

Financial cost of treating out-patients with schizophrenia in Nigeria

An assessment of the monetary costs of treating a group of Nigerian out-patients with schizophrenia, in comparison with insulin-dependent diabetics, was made. Fifty out-patients with schizophrenia (mean age 42.9) and 40 with diabetes (mean age 41.9), attending government hospitals in Lagos, were assessed at six-monthly intervals, for direct and indirect costs (US$ = 82 naira; minimum monthly wage = 500 naira). Twenty (40%) of those with schizophrenia and eight (20%) of the diabetics had no income at all. The mean total cost of schizophrenia in six months (2941.4 naira) or US$ 35.9) was significantly less than that of diabetes (11,791 naira or US $143). The cost of antipsychotic drugs accounts for 52.8% of the cost of schizophrenia; insulin injections accounted for 92.8% of the total cost of diabetes. Patients with schizophrenia and their relatives suffered significantly more loss of working days. Cost of illness was not significantly correlated with age and duration of illness. Because of drastic currency devaluation, and lack of disability benefits and nursing homes, the findings contrast with Western reports where cost of drugs constitutes 2-5%, and indirect costs constitute over 50% of the total cost of schizophrenia.