The Stigma of Epilepsy among Outpatients in a Tertiary Hospital in South-East Nigeria

Background: The stigma of epilepsy is pervasive in developing country contexts and negatively affects the psychological and social wellbeing of its sufferers. The experience of stigma varies across settings and probably relate to disease severity and social characteristics. This study sought to describe the extent and correlates of perceived and enacted stigma among outpatients with epilepsy. Methods: The participants were consecutively presenting epilepsy outpatients in a tertiary facility that attended clinic regularly and had no overt medical or psychiatric co-morbidities. The patients were interviewed with a semi-structured questionnaire. Results: There were 93 participants with a mean age of 30.2 ± 10.3 years and 57.0% were males. The experience of stigma was reported by 46.2% and 67.7% of the participants for perceived and enacted stigma, respectively. Over one-third of the patients had suffered burns or a similar injury in the past. The correlates of perceived stigma were rural residence, lower levels of education, and longer duration of illness. Gender, age and frequency of seizures were not statistically significant determinants. The correlates of enacted stigma were being single, older age, rural residence, and longer duration of epilepsy. A past history of burns and disclosure of epilepsy to individuals outside the family added to the likelihood of experiencing stigma. Conclusion: The burden of epilepsy related social stigma is high in Nigeria. Cultural stereotypes and misconception add to this. There is need for appropriate culture-congruent educational interventions to provide the right information about epilepsy and debunk the misconceptions and myths associated with the condition. This will need to be coupled with astute clinical management of cases and active case finding. Both qualitative and longitudinal quantitative studies would be required to deepen our understanding of the lived reality of grappling with stigma in our setting.

Factors Influencing Student Nurses’ Willingness to Care for Mentally Ill Patients with Highly Infectious Diseases in Nigeria: A Cross-Sectional Study

Background: Individuals experiencing mental illness and diagnosed with highly infectious diseases (HID) are doubly stigmatized. Identifying the factors influencing student’s willingness to care for this special population is essential not only to inform stigma reduction strategies but also to provide useful information towards building a critical mass of future compassionate caregivers with ultimate goal of improving the quality of nursing care for mentally ill persons. Methodology: A cross-sectional descriptive research design was utilized to examine 200 participants from a training institution in Ebonyi state. Data was collected using validated author constructed instrument. Descriptive and inferential statistics were utilized to analyze data. Result: Multiple logistic regression analysis revealed that the variables were statistically significant at χ2(4) = 23.133, p < 0.001. This demonstrates that all factors (gender, marital status, incentives, and family type) influence student nurses’ willingness to work with mentally ill patients who have highly infectious diseases. Conclusion: The findings of this study suggest that appropriate institutional policies, additional training, and incentives should be adopted to boost student motivation.

Health Workers’ Preparedness towards Integrating Mental Healthcare into Primary Health Settings: Evidence from Nigeria

Background: The global drive to scale up mental health services and eliminate the treatment gap requires incorporating mental health services into primary health care (PHC). Primary health care provides comprehensive, continuous, and coordinated care and if need be provides referrals to higher levels of care. However, for these services to meet the basic objective of PHC, it is necessary to determine healthcare workers’ preparedness for caring for the mentally ill. Therefore, this study aimed to examine health workers’ preparedness for integrating mental healthcare into primary settings in a rural community in Nigeria. Methodology: A descriptive research design was used to conduct the study among all 215 primary healthcare workers within Nkanu West Local Government Area (LGA). The instrument for data collection was a structured questionnaire constructed by the author. A pilot study was conducted on 10% of the sample population. Cronbach’s Alpha formula was used to estimate the reliability coefficient (0.85). The collected data were analysed with descriptive statistical frequencies and percentages. Results: Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Findings show that healthcare workers’ preparedness to care for the mentally ill at the primary healthcare centre is quite low. It was also found that mental illness is still shredded by stigma as a result of poor awareness. Consequently, there is still a persistent pervasive belief system that Mental illness is a form of retribution from the gods for one’s wrong deed in the study area. Conclusion: It was concluded that few of the respondents were prepared for the care of the mentally ill which might be a result of poor awareness about mental health and the negative stereotype given about mental health. From the analysis, it can be deduced that health workers exhibit some degree of positive attitude towards care of the mentally ill, though, mental illness is associated with stigmatization due to a lack of public understanding of mental disorders. There was strong support for integrating mental health into primary health care by health care providers. Therefore there is a need for community education and building of the capacity of healthcare workers for integration of the care of the mentally ill to be feasible in PHC centres.

Community Action Plan for Adolescent Substance Use Prevention: The First Step to Creating a Community Participatory Action

Background: The study was designed to explore and catalyze the development of action plan for adolescent substance use prevention in a rural community in Ebonyi State, Nigeria. Methodology: This study adopted a two-phase multi-method design. The first phase was a quantitative assessment that determined the real-life situation of adolescents’ substance use in the community using 417 respondents. Contemporaneously, the second qualitative phase focused on the development of an action plan by community stakeholders for adolescent substance use prevention using thirty (30) participants selected through purposive sampling. The reliability of the instrument for quantitative data was established using a test re-test method and computed using Pearson moment correlation. A coefficient of 0.8 was obtained. Validity was established for both quantitative and qualitative instruments. The generated data were subjected to descriptive statistics whereas the qualitative data from respondents’ narratives were analysed thematically. Result: The data revealed that participants who have ever used substances consisted of 128 (59.5%) males and 87 (40.5%) females. The findings on the opinion of 30 participants interviewed about the consequences of substance use brought out majorly four consequences of substance use. The result of catalysing the involvement of community residents towards developing community action for adolescent substance use showed that the challenges associated with adolescents’ substance use as identified by the participants were discussed under one theme—living with the cause and three elements. Conclusion: Substance use prevention policies and plans in the local community have strong potential for stimulating local adolescent substance use prevention actions.

Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

The optimum control of seizures requires adequate dosing of appropriately selected anti-epileptic medications. The availability of AEDs in Nigeria is limited and this constrains the prescription latitude of clinicians. This study was conducted to describe the prescribing pattern of anti-epileptic drugs in the outpatient service of a psychiatric facility in southeast Nigeria. The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma. The information extracted include age, sex, marital status, residence, type of seizure and anti-seizure medications prescribed, frequency of administration and dosage among other variables. Of the 178 patients whose prescriptions and case records were assessed, males constituted 62.9% and females 37.1%. Most of the patients were single (78.1%) and the group had a mean age of 25.6 ± 10.9 years. Generalized tonic-clonic seizures predominated (61.2%) among the seizure types, whilst complex partial seizure type was identified in 35.4% of the patients. Patient diagnosis relied heavily on the use of clinical description alone. About 92.7% of the patients were treated with monotherapy, whereas 7.3% received two anti-epileptic drug combinations. Carbamazepine was the most frequently prescribed drug, and was utilized in the treatment of 87.9% of patients receiving monotherapy and 92.3% of individuals receiving two drug combinations. Adjunctive medications like benzodiazepines were rarely utilised to improve the effect of the AEDs. The patients that received polytherapy could only be distinguished from those that received monotherapy by higher frequency of epileptic auras and higher mean dose of AEDs per day. The predominant use of monotherapy is in accordance with the treatment recommendations and needs to be encouraged. The greater use of carbamazepine is probably related to its perceived benefits in the control of behavioural symptoms.