Prevalence and correlates of medical student mistreatment in Nigeria: A narrative review

Mistreatment in medical education encompasses various forms of abusive behavior, often indicating a disregard for students' dignity and interfering with the learning process. This review paper aims to investigate the prevalence, patterns, and correlates of medical student mistreatment in Nigerian medical education and shed light on its impact on students' well-being. A literature search was conducted in August 2023 using Medline, Google Scholar, and Web of Science databases to identify relevant studies on the mistreatment of Nigerian medical students. Inclusion criteria encompassed all studies written in English, regardless of study design, while editorials, reviews, and opinion articles were excluded. Six studies with a total sample size of 1432 were included in the review. The review revealed high mistreatment rates, ranging from 46% to 91%, with verbal abuse being the most common form. Male students were more likely to experience mistreatment, while females had higher rates of sexual abuse. Perpetrators included male and female healthcare professionals, with consultants and resident doctors as common perpetrators. Age and study level were associated with mistreatment experiences. Consequences of mistreatment included emotional distress, depression, loss of self-confidence, academic disillusionment, substance abuse, and suicidal thoughts. Reporting rates were low due to a lack of awareness, fear of reprisal, and perceived futility. The findings underscore the need for institutions to create a supportive environment, raise awareness of available support systems, and implement policies to prevent mistreatment. Future research should focus on larger-scale studies with diverse samples and longitudinal designs to address limitations in the current literature.

Workforce migration and brain drain - A nationwide cross-sectional survey of early career psychiatrists in Nigeria

Background

Nigeria's shortage of psychiatrists is exacerbated due to health worker migration.

Aim

This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria.

Methods

We conducted a cross-sectional survey covering Nigeria's six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29.

Results

Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had 'ever' considered migration, 69.2% were planning to leave 'now', and 52.9% had taken 'practical migration steps'. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05-4.88) predicted planning to leave 'now', while being in a relationship (OR = 3.46, 95%CI = 1.06-11.30) predicted taking 'practical migration steps'. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested.

Conclusions

Systemic changes to address psychiatrists' migration from Nigeria are needed.

Psychosocial challenges of persons with sickle cell anemia: A narrative review

Sickle cell anemia (SCA) is a severe form of sickle cell disease that primarily affects black populations and individuals in tropical countries. This condition causes significant morbidity and mortality and leads to a range of psychosocial challenges. A preliminary search was conducted on Ovid Medline and public databases with a combination of Medical Subject Headings keywords, resulting in 368 articles. The articles were screened based on the selection criteria in a nonsystematic method by 3 researchers, and a narrative synthesis was done to analyze extracted data from selected peer-reviewed article. Mental disorders, sleep disturbances, interpersonal relationship challenges, stigmatization, and workplace discrimination were identified as significant contributors to the psychosocial distress experienced by individuals with SCA and their families. Depression and anxiety were prevalent among individuals with SCA, leading to poor treatment adherence, increased pain, and disruptions in various aspects of life. Sleep disturbances, including sleep-disordered breathing and sleepwalking, were also identified as significant contributors to poor sleep quality in SCA patients. Families of individuals with SCA also face challenges, including psychological stress, financial strain, and social disruption. Stigmatization is common, leading to misconceptions and discrimination. Workplace discrimination is prevalent, with a high unemployment rate among adult SCA patients. Comprehensive care is crucial to address these psychosocial issues. Early identification and intervention, comprehensive support programs, patient and family education, enhanced pain management strategies, and integration of mental health into clinical care are recommended. School-based support, research and advocacy, and community support groups are also important. By addressing these challenges through comprehensive care and support, healthcare professionals, policymakers, and society can reduce psychosocial distress and improve the lives of individuals with SCA.

Psychometric Properties of the Modified Family Affluence Scale (FAS II) among Adolescents in Nigeria: A Preliminary Report

OBJECTIVE

Social inequalities have serious health consequences for the developing child. Measuring these disparities is challenging, and the Family Affluence Scale (version II), a proxy indicator based on material wealth, was developed as a solution. However, it has not been validated for use in Sub-Saharan Africa and may not be applicable in developing countries. This preliminary study aimed to determine the convergent validity and reliability of a culturally adapted version of the FAS II.

METHODS

A cross-sectional study was carried out among 422 senior secondary school students in Calabar, Nigeria. Modified versions of the Family Affluence Scale Version II (FAS II) were tested for their psychometric properties as proxy measures of socioeconomic status among Nigerian adolescents. Cronbach's alpha was computed as a measure of internal consistency, while Spearman's rank correlation and regression analysis were done to assess convergent validity.

RESULTS

The mean sample age was 14.95 (±1.53) years, with an approximately equal gender distribution. Internal consistency was 0.68 for the 4-item version of the modified scale and increased to 0.75 when the item about travelling abroad was deleted. The modified FAS II scores (4 items) had a significant positive correlation with tuition cost (r=0.48, p<0.001), paternal educational attainment (r=0.27, p<0.001), and maternal educational attainment (r=0.30, p<0.001). Similarly, the 3-item version had a significant positive correlation with tuition cost (r=0.52, p<0.001), paternal educational attainment (r=0.24, p<0.001), and maternal educational attainment (r=0.30, p<0.001). Moderate (aOR: 4.25; 95%CI 2.45-7.39) and high affluence (aOR: 11.43; 95%CI 6.36-20.55) predicted attending more expensive schools. Moderate affluence (aOR: 2.15; 95%CI 1.28-3.62) and high affluence (aOR: 5.21; 95%CI 2.76-9.84) predicted a higher paternal education. Also, moderate affluence (aOR: 2.18; 95%CI 1.31-3.63) and high affluence (aOR: 7.42; 95%CI 3.76-14.66) predicted higher maternal education. The 3-item version performed similarly in terms of its predictive ability.

CONCLUSION

The modified version of the FAS II appears to have sufficient validity and reliability for measuring the socio-economic status of adolescents in Nigeria.

Depression and Suicidality in a COVID-19 Patient: A Case Report from Calabar, Nigeria

BACKGROUND

The coronavirus pandemic is associated with significant morbidity and mortality. While physical recovery has been made a priority, the psychological wellbeing of recovered patients is not receiving the attention it deserves.

CASE PRESENTATION

We present the case of a 27-year-old male who developed severe depression associated with anxiety and suicidal ideations two weeks after full recovery from COVID- 19 infection. Significant somatization was also present at the onset which he misattributed to a recurrence of the infection. He was admitted for in-patient psychiatric care and fully recovered after six weeks of medication and psychotherapy.

CONCLUSION

Infection with the virus is a psychologically distressing experience that can trigger mental disorders in vulnerable individuals. Our report highlights the mental health needs of all COVID-19 patients and the need for psychological evaluation in the post-recovery period.

Drugs of Abuse among In-Patients Receiving Treatment for Substance Use Disorders in a Tertiary Health Care Center in South-South Nigeria: An Exploratory Qualitative Study

INTRODUCTION

Recently, there has been an increase in the abuse of relatively newer substances sometimes in unusual combinations. Some of these drugs and their street names are unfamiliar to researchers and clinicians, hindering their identification. Our objective was to investigate current trends in drug abuse, focusing on eliciting drugs of use and their street names in Calabar, Nigeria.

METHODS

Using a qualitative design, we conducted focus group discussions among 15 male in-patients of the drug treatment ward of the Federal Neuropsychiatric Hospital, Calabar. Data was collected as audio recordings and handwritten notes and was analyzed using the Nvivo software.

RESULTS

Prescription drugs like flunitrazepam (street name Blueboy, Sweetnol), trihexyphenidyl, codeine and tramadol were commonly abused. Illicit substances included cannabis of various potencies (each having unique street names), vulcanizing gum (street name Solution), cocaine and heroin (street name Thailand). Some unusual substances such as soakaway fumes, formaldehyde or gammalin (lindane) mixed with cannabis were described. Few supposedly nonpsychoactive substances were reportedly potent when consumed alone (e.g., leaves of the papaya plant) or in mixtures, such as menthol candy dissolved in soft drinks. Other prescription drugs such as Benadol or D4, unfamiliar to the researchers, were volunteered.

CONCLUSION

Newer substances of abuse in their various combinations are abused by Nigerian youth. More studies are needed to elucidate further the chemical composition of these drugs/mixtures and their mechanism of action.

Pattern and predictors of Brain Fag syndrome among senior secondary school students in Calabar, Nigeria

CONTEXT

Brain Fag syndrome (BFS) is a culture-bound disorder that is quite common among Nigerian students. It is known to be associated with study difficulty, and in severe cases, discontinuation of education. Little is known about its pattern and predictors among secondary school (SS) students in Calabar.

AIMS

This study aims to determine the pattern and sociodemographic predictors of BFS among SS students in Calabar.

PARTICIPANTS AND METHODS

Stratified sampling was used in this cross-sectional study to recruit 1091 students from ten SSs in Calabar metropolis. The students completed the Brain Fag Syndrome Scale and a sociodemographic questionnaire which were used in the survey. Data was analysed using SPSS software version 21.

RESULTS

The prevalence of BFS was 20.4%. Female gender, school type and local government of location, residence type, parental marital status and maternal educational status were found to have statistically significant relationships with the disorder (P ≤ 0.05). Significant predictors of BFS were female gender (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.14-2.09) and having parents who were 'not married' (OR = 1.8, 95% CI = 1.24-2.85).

CONCLUSIONS

We conclude that BFS is highly prevalent amongst SS students in Calabar metropolis albeit at a relatively lower level compared to similar studies and is significantly predicted by female gender and having parents who are unmarried. We recommend that more research should be performed on this much-neglected psychopathology to elucidate it further, with consequent development of appropriate treatment modalities.

Depression and posttraumatic stress disorder among road traffic accident victims managed in a Tertiary hospital in Southern Nigeria

BACKGROUND

Psychological responses to traumatic events vary widely across different cultures but studies in the developing countries are scant. The objective of this study is to determine prevalence of depression and posttraumatic stress disorder (PTSD) among patients involved in road traffic accident (RTA) compared with that of the general population using a matched control group.

MATERIALS AND METHODS

The study design was case control and employed the convenient sampling technique. All consecutive attendees of the trauma clinic of a Tertiary Hospital who had been involved in RTA in the previous year and met inclusion criteria were recruited to participate in the study. Controls were drawn from patient relatives attending other clinics in the same hospital. The final sample comprised of 46 cases and controls, totaling 92 participants. A Sociodemographic questionnaire, the PTSD, and depression modules of the Mini International neuropsychiatric interview were administered to both groups by trained research assistants. The data were analyzed using IBM SPSS version 22. Statistical significance was set at 0.05.

RESULTS

The prevalence of PTSD among cases was 41.3% compared with 13% among controls, whereas the prevalence of depression among cases was 63% compared with 30.4% among the controls. Both of these findings were statistically significant (P < 0.002). Sociodemographic variables such as age, sex, marital status, religion, level of education, and occupation did not have statistically significant relationship with neither PTSD nor depression.

CONCLUSION

Mental disorders such as PTSD and depression are common in victims of RTA. They would benefit from comanagement with mental health specialists.